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Forbes SM, Schwartz N, Fu SH, Hobin E, Smith BT. The association between off- and on-premise alcohol outlet density and 100% alcohol-attributable emergency department visits by neighbourhood-level socioeconomic status in Ontario, Canada. Health Place 2024; 89:103284. [PMID: 38875963 DOI: 10.1016/j.healthplace.2024.103284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 05/17/2024] [Accepted: 05/31/2024] [Indexed: 06/16/2024]
Abstract
Alcohol availability is positively associated with alcohol use and harms, but the influence of socioeconomic status (SES) on these associations is not well established. This population-based cross-sectional study examined neighbourhood-level associations between physical alcohol availability (measured as off- and on-premise alcohol outlet density) and 100% alcohol-attributable emergency department (ED) visits by neighbourhood SES in Ontario, Canada from 2017 to 2019 (n = 19,740). A Bayesian spatial modelling approach was used to assess associations and account for spatial autocorrelation, which produced risk ratios (RRs) and 95% credible intervals (95% CrI). Each additional off-premise alcohol outlet in a neighbourhood was associated with a 3% increased risk of alcohol-attributable ED visits in both men (RR = 1.03, 95%CrI: 1.02-1.04) and women (RR = 1.03, 95% CrI: 1.02-1.04). Positive associations were also observed between on-premise alcohol outlet density and alcohol-attributable ED visits, although effect sizes were small. A disproportionately greater association with ED visits was observed with increasing alcohol outlet density in the lowest compared to higher SES neighbourhoods. Reducing physical alcohol availability may be an important policy lever for reducing alcohol harm and alcohol-attributable health inequities.
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Affiliation(s)
- Samantha M Forbes
- Public Health Ontario, 661 University Ave, Toronto, Ontario, Canada, M5G 1M1.
| | - Naomi Schwartz
- Public Health Ontario, 661 University Ave, Toronto, Ontario, Canada, M5G 1M1.
| | - Sze Hang Fu
- Public Health Ontario, 661 University Ave, Toronto, Ontario, Canada, M5G 1M1.
| | - Erin Hobin
- Public Health Ontario, 661 University Ave, Toronto, Ontario, Canada, M5G 1M1; Dalla Lana School of Public Health, University of Toronto, 1 55 College St, Toronto, Canada, M5T 3M7.
| | - Brendan T Smith
- Public Health Ontario, 661 University Ave, Toronto, Ontario, Canada, M5G 1M1; Dalla Lana School of Public Health, University of Toronto, 1 55 College St, Toronto, Canada, M5T 3M7.
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2
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Vyas N, Zaheer A, Wijeysundera HC. Untangling the Complex Multidimensionality of the Social Determinants of Cardiovascular Health: A Systematic Review. Can J Cardiol 2024; 40:1000-1006. [PMID: 38513932 DOI: 10.1016/j.cjca.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/21/2024] [Accepted: 03/09/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The cardiovascular literature is limited by the lack of consensus on what are the best metrics for reporting social determinants of health (SDH) or social deprivation, and if they should be reported as a single metric or separately by their domains. METHODS A systematic review of the literature on cardiovascular surgeries and procedures was conducted, identifying articles from January 1, 2010, to December 31, 2023, that studied the relationship between health outcomes after cardiovascular procedures or surgeries and SDH/social deprivation. The cardiovascular procedures/surgeries of interest were coronary and valve surgeries and procedures including coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), valve replacement or repair, and transcatheter aortic valve intervention. RESULTS After screening 638 articles, we identified 47 papers that met our inclusion and exclusion criteria. The most common procedure evaluated was CABG and PCI; 46 of the studies focused on these 2 procedures. Almost all of the articles reported a different metric for SDH/social deprivation (41 different metrics); despite this, all of the metrics showed a consistent relationship with worse outcomes associated with greater degrees of SDH/deprivation. Only 9 reported on the individual domains of SDH/social deprivation; 3 studies showed a discordant relationship. CONCLUSIONS Although our systematic review identified numerous articles evaluating the relationship between SDH/social deprivation in cardiovascular disease, there was substantial heterogeneity in which metric was used and how it was reported. This reinforces the need for standards as to the best metrics for SDH/social deprivation as well as best practices for reporting.
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Affiliation(s)
- Navya Vyas
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Aida Zaheer
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Harindra C Wijeysundera
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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3
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Kratzer TB, Bandi P, Freedman ND, Smith RA, Travis WD, Jemal A, Siegel RL. Lung cancer statistics, 2023. Cancer 2024; 130:1330-1348. [PMID: 38279776 DOI: 10.1002/cncr.35128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/19/2023] [Accepted: 10/27/2023] [Indexed: 01/28/2024]
Abstract
Despite decades of declining mortality rates, lung cancer remains the leading cause of cancer death in the United States. This article examines lung cancer incidence, stage at diagnosis, survival, and mortality using population-based data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries. Over the past 5 years, declines in lung cancer mortality became considerably greater than declines in incidence among men (5.0% vs. 2.6% annually) and women (4.3% vs. 1.1% annually), reflecting absolute gains in 2-year relative survival of 1.4% annually. Improved outcomes likely reflect advances in treatment, increased access to care through the Patient Protection and Affordable Care Act, and earlier stage diagnosis; for example, compared with a 4.6% annual decrease for distant-stage disease incidence during 2013-2019, the rate for localized-stage disease rose by 3.6% annually. Localized disease incidence increased more steeply in states with the highest lung cancer screening prevalence (by 3%-5% annually) than in those with the lowest (by 1%-2% annually). Despite progress, disparities remain. For example, Native Americans have the highest incidence and the slowest decline (less than 1% annually among men and stagnant rates among women) of any group. In addition, mortality rates in Mississippi and Kentucky are two to three times higher than in most western states, largely because of elevated historic smoking prevalence that remains. Racial and geographic inequalities highlight longstanding opportunities for more concerted tobacco-control efforts targeted at high-risk populations, including improved access to smoking-cessation treatments and lung cancer screening, as well as state-of-the-art treatment.
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Affiliation(s)
- Tyler B Kratzer
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Priti Bandi
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Neal D Freedman
- Tobacco Control Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
| | - Robert A Smith
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - William D Travis
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Rebecca L Siegel
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
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Currie J, Kurdyak P, Zhang J. Socioeconomic status and access to mental health care: The case of psychiatric medications for children in Ontario Canada. JOURNAL OF HEALTH ECONOMICS 2024; 93:102841. [PMID: 38113755 DOI: 10.1016/j.jhealeco.2023.102841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/27/2023] [Accepted: 11/18/2023] [Indexed: 12/21/2023]
Abstract
We examine differences in the prescribing of psychiatric medications to lower-income and higher-income children in the Canadian province of Ontario using rich administrative data that includes diagnosis codes and physician identifiers. Our most striking finding is that conditional on diagnosis and medical history, low-income children are more likely to be prescribed antipsychotics and benzodiazepines than higher-income children who see the same doctors. These are drugs with potentially dangerous side effects that ideally should be prescribed to children only under narrowly proscribed circumstances. Lower-income children are also less likely to be prescribed SSRIs, the first-line treatment for depression and anxiety conditional on diagnosis. Hence, socioeconomic differences in the prescribing of psychotropic medications to children persist even in the context of universal public health insurance and universal drug coverage.
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Affiliation(s)
- Janet Currie
- Princeton University and Center for Health and Wellbeing, United States of America.
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Ferrari A, Seghieri C, Giannini A, Mannella P, Simoncini T, Vainieri M. Driving time drives the hospital choice: choice models for pelvic organ prolapse surgery in Italy. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:1575-1586. [PMID: 36630004 PMCID: PMC9833017 DOI: 10.1007/s10198-022-01563-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The Italian healthcare jurisdiction promotes patient mobility, which is a major determinant of practice variation, thus being related to the equity of access to health services. We aimed to explore how travel times, waiting times, and other efficiency- and quality-related hospital attributes influenced the hospital choice of women needing pelvic organ prolapse (POP) surgery in Tuscany, Italy. METHODS We obtained the study population from Hospital Discharge Records. We duplicated individual observations (n = 2533) for the number of Tuscan hospitals that provided more than 30 POP interventions from 2017 to 2019 (n = 22) and merged them with the hospitals' list. We generated the dichotomous variable "hospital choice" assuming the value one when hospitals where patients underwent surgery coincided with one of the 22 hospitals. We performed mixed logit models to explore between-hospital patient choice, gradually adding the women's features as interactions. RESULTS Patient choice was influenced by travel more than waiting times. A general preference for hospitals delivering higher volumes of interventions emerged. Interaction analyses showed that poorly educated women were less likely to choose distant hospitals and hospitals providing greater volumes of interventions compared to their counterpart. Women with multiple comorbidities more frequently chose hospitals with shorter average length of stay. CONCLUSION Travel times were the main determinants of hospital choice. Other quality- and efficiency-related hospital attributes influenced hospital choice as well. However, the effect depended on the socioeconomic and clinical background of women. Managers and policymakers should consider these findings to understand how women behave in choosing providers and thus mitigate equity gaps.
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Affiliation(s)
- Amerigo Ferrari
- Institute of Management, MeS (Management and Health) Laboratory, Sant'Anna School of Advanced Studies, Via San Zeno 2, 56127, Pisa, Italy.
| | - Chiara Seghieri
- Institute of Management, MeS (Management and Health) Laboratory, Sant'Anna School of Advanced Studies, Via San Zeno 2, 56127, Pisa, Italy
| | - Andrea Giannini
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynaecology, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Paolo Mannella
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynaecology, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynaecology, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Milena Vainieri
- Institute of Management, MeS (Management and Health) Laboratory, Sant'Anna School of Advanced Studies, Via San Zeno 2, 56127, Pisa, Italy
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6
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Vazquez S, Dominguez JF, Jacoby M, Rahimi M, Grant C, DelBello D, Salik I. Poor socioeconomic status is associated with delayed femoral fracture fixation in adolescent patients. Injury 2023; 54:111128. [PMID: 37875032 DOI: 10.1016/j.injury.2023.111128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 10/06/2023] [Accepted: 10/13/2023] [Indexed: 10/26/2023]
Abstract
INTRODUCTION Healthcare disparities continue to exist in pediatric orthopedic care. Femur fractures are the most common diaphyseal fracture and the leading cause of pediatric orthopedic hospitalization. Prompt time to surgical fixation of femur fractures is associated with improved outcomes. OBJECTIVE The objective of this study was to evaluate associations between socioeconomic status and timing of femoral fixation in adolescents on a nationwide level. METHODS The 2016-2020 National Inpatient Sample (NIS) database was queried using International Classification of Disease, 10th edition (ICD-10) codes for repair of femur fractures. Patients between the ages of 10 and 19 years of age with a principal diagnosis of femur fracture were selected. Patients transferred from outside hospitals were excluded. Baseline demographics and characteristics were described. Patients were categorized as poor socioeconomic status (PSES) if they were classified in the Healthcare Cost and Utilization Project's (HCUP) lowest 50th percentile median income household categories and on Medicaid insurance. The primary outcome studied was timing to femur fixation. Delayed fixation was defined as fixation occurring after 24 h of admission. Secondary outcomes included length of stay (LOS) and discharge disposition. RESULTS From 2016-2020, 10,715 adolescent patients underwent femur fracture repair throughout the United States. Of those, 765 (7.1 %) underwent late fixation. PSES and non-white race were consistently associated with late fixation, even when controlling for injury severity. Late fixation was associated with decreased rate of routine discharge (p < 0.01), increased LOS (p < 0.01) and increased total charges (p < 0.01). CONCLUSION Patients of PSES or non-white race were more likely to experience delayed femoral fracture fixation. Delayed fixation led to worse outcomes and increased healthcare resource utilization. Research studying healthcare disparities may provide insight for improved provider education, implicit bias training, and comprehensive standardization of care.
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Affiliation(s)
- Sima Vazquez
- School of Medicine, New York Medical College, Valhalla, NY, USA.
| | - Jose F Dominguez
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
| | - Michael Jacoby
- Department of Anesthesiology, Maria Fareri Children's Hospital, Westchester Medical Center, Valhalla, NY, USA
| | - Michael Rahimi
- Department of Anesthesiology, Maria Fareri Children's Hospital, Westchester Medical Center, Valhalla, NY, USA
| | - Christa Grant
- Department of Pediatric Surgery, Maria Fareri Children's Hospital, Westchester Medical Center, Valhalla, NY, USA
| | - Damon DelBello
- Department of Orthopaedic Pediatric Surgery, Maria Fareri Children's Hospita, Westchester Medical Center, Valhalla, NY, USA
| | - Irim Salik
- Department of Anesthesiology, Maria Fareri Children's Hospital, Westchester Medical Center, Valhalla, NY, USA
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LoMartire R, Johansson P, Frumento P. Sickness Absence and Disability Pension Among Patients With Chronic Pain in Interdisciplinary Treatment or Unspecified Interventions. THE JOURNAL OF PAIN 2023; 24:2003-2013. [PMID: 37348775 DOI: 10.1016/j.jpain.2023.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/24/2023]
Abstract
Interdisciplinary treatment is a widely implemented strategy for the rehabilitation of patients with chronic pain. A primary treatment objective is to decrease the load on the social insurance system; however, it is questionable whether interdisciplinary treatment reduces sickness absence and disability pension (SA/DP). This register-based observational study compared SA and DP between patients in interdisciplinary treatment and unspecified interventions. With data from 7,752 Swedish specialist health care patients in their prime working age, we analyzed total net SA/DP days over 3 years from the first visit to a pain rehabilitation center. A zero-one-inflated beta model, adjusted for theoretically substantiated confounders, was used to estimate the mean differences in total days and the proportions of patients with both zero and maximum days. Compared with unspecified interventions, interdisciplinary treatment resulted in a mean (95% confidence interval) absolute increase of 50 (37, 62) total days, a 13.0% (11.3%, 14.6%) decrease in patients with zero days, and a 1.5% (.2%, 2.8%) decrease in patients with the maximum days. These findings support that interdisciplinary treatment increases SA/DP compared to less intensive interventions but reduces the risk of maximum days, implying that it is advantageous for patients with the highest absence. This highlights the need for improved patient selection procedures and the adaptation of interdisciplinary treatment programs to more adequately target SA/DP reduction. PERSPECTIVES: This study provides an accessible overview of SA/DP among working-age patients with chronic pain in Swedish specialist health care. It also shows that interdisciplinary treatment does not decrease SA/DP more than alternative treatments in most patients but is advantageous for the patients with the longest absence.
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Affiliation(s)
- Riccardo LoMartire
- Center for Clinical Research Dalarna, Uppsala University, Falun, Region Dalarna, Sweden
| | - Per Johansson
- Department of Statistics, Uppsala University, Uppsala, Region Uppsala, Sweden; Yau Mathematical Science Center, Tsinghua University, Beijing, China
| | - Paolo Frumento
- Department of Political Sciences, University of Pisa, Pisa, Administrative Region of Tuscany, Italy
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8
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Brindley C, Lomas J, Siciliani L. The effect of hospital spending on waiting times. HEALTH ECONOMICS 2023; 32:2427-2445. [PMID: 37424194 DOI: 10.1002/hec.4735] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 05/03/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023]
Abstract
Long waiting times have been a persistent policy issue in the United Kingdom that the COVID-19 pandemic has exacerbated. This study analyses the causal effect of hospital spending on waiting times in England using a first-differences panel approach and an instrumental variable strategy to deal with residual concerns for endogeneity. We use data from 2014 to 2019 on waiting times from general practitioner referral to treatment (RTT) measured at the level of local purchasers (known as Clinical Commissioning Groups). We find that increases in hospital spending by local purchasers of 1% reduce median RTT waiting time for patients whose pathway ends with a hospital admission (admitted pathway) by 0.6 days but the effect is not statistically significant at 5% level (only at the 10% level). We also find that higher hospital spending does not affect the RTT waiting time for patients whose pathway ends with a specialist consultation (non-admitted pathway). Nor does higher spending have a statistically significant effect on the volume of elective activity for either pathway. Our findings suggest that higher spending is no guarantee of higher volumes and lower waiting times, and that additional mechanisms need to be put in place to ensure that increased spending benefits elective patients.
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Affiliation(s)
- Callum Brindley
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - James Lomas
- Centre for Health Economics, University of York, York, UK
| | - Luigi Siciliani
- Department of Economics and Related Studies, University of York, York, UK
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9
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Hernæs Ø, Kverndokk S, Markussen S, Øien H. When health trumps money: Economic incentives and health equity in the public provision of nursing homes in Norway. Soc Sci Med 2023; 333:116116. [PMID: 37562246 DOI: 10.1016/j.socscimed.2023.116116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/29/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023]
Abstract
The allocation of public care services should be determined by individual needs, but can be influenced by economic factors. This paper examines the impact of economic incentives on the allocation of public nursing home care in the Norwegian long-term care system. In Norway, municipalities and city districts have economic incentives for choosing nursing home care for high-income individuals in need of care and home-based care in sheltered housing for low-income individuals. The study uses a theoretical model and empirical data from the municipality of Oslo to determine if nursing home spots are allocated based on income, which would be financially advantageous for the city districts. We do not find evidence that the economic incentives of the care provider play a role in the allocation of nursing homes. Thus, in this setting, needs seem to be the dominant factor for allocation of nursing home care, while economic incentives seem to play no significant role. The clear legal mandate to provide services based on needs only is likely an important factor in this.
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Affiliation(s)
- Øystein Hernæs
- Ragnar Frisch Centre for Economic Research, Gaustadalléen 21, 0349, Oslo, Norway.
| | - Snorre Kverndokk
- Ragnar Frisch Centre for Economic Research, Gaustadalléen 21, 0349, Oslo, Norway.
| | - Simen Markussen
- Ragnar Frisch Centre for Economic Research, Gaustadalléen 21, 0349, Oslo, Norway.
| | - Henning Øien
- Norwegian Institute of Public Health and Department of Health Management and Health Economics, University of Oslo, Postboks, 1089 Blindern, 0317, Oslo, Norway.
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10
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Meunier A, Longworth L, Gomes M, Ramagopalan S, Garrison LP, Popat S. Distributional Cost-Effectiveness Analysis of Treatments for Non-Small Cell Lung Cancer: An Illustration of an Aggregate Analysis and its Key Drivers. PHARMACOECONOMICS 2023:10.1007/s40273-023-01281-8. [PMID: 37296369 DOI: 10.1007/s40273-023-01281-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Distributional cost-effectiveness analysis (DCEA) facilitates quantitative assessments of how health effects and costs are distributed among population subgroups, and of potential trade-offs between health maximisation and equity. Implementation of DCEA is currently explored by the National Institute for Health and Care Excellence (NICE) in England. Recent research conducted an aggregate DCEA on a selection of NICE appraisals; however, significant questions remain regarding the impact of the characteristics of the patient population (size, distribution by the equity measure of interest) and methodologic choices on DCEA outcomes. Cancer is the indication most appraised by NICE, and the relationship between lung cancer incidence and socioeconomic status is well established. We aimed to conduct an aggregate DCEA of two non-small cell lung cancer (NSCLC) treatments recommended by NICE, and identify key drivers of the analysis. METHODS Subgroups were defined according to socioeconomic deprivation. Data on health benefits, costs, and target populations were extracted from two NICE appraisals (atezolizumab versus docetaxel [second-line treatment following chemotherapy to represent a broad NSCLC population] and alectinib versus crizotinib [targeted first-line treatment to represent a rarer mutation-positive NSCLC population]). Data on disease incidence were derived from national statistics. Distributions of population health and health opportunity costs were taken from the literature. A societal welfare analysis was conducted to assess potential trade-offs between health maximisation and equity. Sensitivity analyses were conducted, varying a range of parameters. RESULTS At an opportunity cost threshold of £30,000 per quality-adjusted life-year (QALY), alectinib improved both health and equity, thereby increasing societal welfare. Second-line atezolizumab involved a trade-off between improving health equity and maximising health; it improved societal welfare at an opportunity cost threshold of £50,000/QALY. Increasing the value of the opportunity cost threshold improved the equity impact. The equity impact and societal welfare impact were small, driven by the size of the patient population and per-patient net health benefit. Other key drivers were the inequality aversion parameters and the distribution of patients by socioeconomic group; skewing the distribution to the most (least) deprived quintile improved (reduced) equity gains. CONCLUSION Using two illustrative examples and varying model parameters to simulate alternative decision problems, this study suggests that key drivers of an aggregate DCEA are the opportunity cost threshold, the characteristics of the patient population, and the level of inequality aversion. These drivers raise important questions in terms of the implications for decision making. Further research is warranted to examine the value of the opportunity cost threshold, capture the public's views on unfair differences in health, and estimate robust distributional weights incorporating the public's preferences. Finally, guidance from health technology assessment organisations, such as NICE, is needed regarding methods for DCEA construction and how they would interpret and incorporate those results in their decision making.
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Affiliation(s)
| | | | - Manuel Gomes
- Department of Applied Health Research, University College London, London, UK
| | - Sreeram Ramagopalan
- Global Access, F. Hoffmann-La Roche Ltd, Grenzacherstrasse, Basel, Switzerland.
| | - Louis P Garrison
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA, USA
| | - Sanjay Popat
- The Royal Marsden Hospital, London, UK
- The Institute of Cancer Research, London, UK
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11
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Bosque-Mercader L, Carrilero N, García-Altés A, López-Casasnovas G, Siciliani L. Socioeconomic inequalities in waiting times for planned and cancer surgery: Evidence from Spain. HEALTH ECONOMICS 2023; 32:1181-1201. [PMID: 36772982 DOI: 10.1002/hec.4661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 12/20/2022] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
Waiting times act as a non-price rationing mechanism to bring together the demand for and the supply of public healthcare services and ensure equal access independently of ability to pay. This study tests for the presence of socioeconomic inequalities in waiting times for ten publicly-funded planned and cancer surgeries in Catalonia (Spain) in 2015-2019. Socioeconomic status (SES), measured by four categories (very low, low, middle, high), is based on co-payment levels for medicines which depend on patient's income. Using administrative data, we estimate the association between SES and waiting times controlling for patient characteristics and hospital fixed effects. Compared to patients with low SES, patients with middle SES wait 2-6 fewer days for hip replacement, cataract surgery, and hysterectomy, and less than a day for breast cancer surgery. These inequalities arise within hospitals and are not explained by patient nor hospital characteristics. For some surgeries, the results also show that patients with higher SES are more likely to voluntarily exit the waiting list and have a lower probability of having a surgery canceled for medical reasons and dying while waiting.
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Affiliation(s)
- Laia Bosque-Mercader
- Nuffield Department of Primary Care Health Sciences, Centre for Health Service Economics and Organisation, University of Oxford, Oxford, UK
- Department of Economics and Related Studies, University of York, York, UK
| | - Neus Carrilero
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain
| | - Anna García-Altés
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | | | - Luigi Siciliani
- Department of Economics and Related Studies, University of York, York, UK
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12
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Oña A, Athanasios K, Tederko P, Escorpizo R, Arora M, Sturm C, Yang S, Barzallo DP. Unmet healthcare needs and health inequalities in people with spinal cord injury: a direct regression inequality decomposition. Int J Equity Health 2023; 22:56. [PMID: 36998015 PMCID: PMC10060928 DOI: 10.1186/s12939-023-01848-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/18/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Inequality in health is a prevalent and growing concern among countries where people with disabilities are disproportionately affected. Unmet healthcare needs explain a large part of the observed inequalities between and within countries; however, there are other causes, many non-modifiable, that also play a role. AIM This article explores the difference in health across income levels in populations with spinal cord injury (SCI). SCI is of special interest in the study of health systems, as it is an irreversible, long-term health condition that combines a high level of impairment with subsequent comorbidities. METHODS We estimated the importance of modifiable and non-modifiable factors that explain health inequalities through a direct regression approach. We used two health outcomes: years living with the injury and a comorbidity index. Data come from the International Spinal Cord Injury Survey (InSCI), which has individual data on people with SCI in 22 countries around the world. Due to the heterogeneity of the data, the results were estimated country by country. RESULTS On average, the results exhibit a prevalence of pro-rich inequalities, i.e., better health outcomes are more likely observed among high-income groups. For the years living with the injury, the inequality is mostly explained by non-modifiable factors, like the age at the time of the injury. In contrast, for the comorbidity index, inequality is mostly explained by unmet healthcare needs and the cause of the injury, which are modifiable factors. CONCLUSIONS A significant portion of health inequalities is explained by modifiable factors like unmet healthcare needs or the type of accident. This result is prevalent in low, middle, and high-income countries, with pervasive effects for vulnerable populations like people with SCI, who, at the same time are highly dependent on the health system. To reduce inequity, it is important not only to address problems from public health but from inequalities of opportunities, risks, and income in the population. HIGHLIGHTS • Better health status is evident among high-income groups, which is reflected in pro-rich inequalities. • Age at the time of the injury is the most important factor to explain inequalities in years living with the injury. • Unmet health care needs are the most important factor to explain inequalities in comorbidities. • The inequality in health varies by country dependent upon socioeconomic factors.
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Affiliation(s)
- Ana Oña
- Swiss Paraplegic Research, Guido A. Zäch Institute, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Piotr Tederko
- Department of Rehabilitation, Medical University of Warsaw, Warsaw, Poland
| | | | - Mohit Arora
- John Walsh Centre for Rehabilitation Research, The Kolling Institute, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, Australia
- Faculty of Medicine and Health, Sydney Medical School - Northern, The University of Sydney, Sydney, Australia
| | - Christian Sturm
- Department of Rehabilitation Medicine, Hannover Medical School, Hanover, Germany
| | - Shujuan Yang
- China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- International Institute of Spatial Lifecourse Epidemiology (ISLE), Beijing, China
| | - Diana Pacheco Barzallo
- Swiss Paraplegic Research, Guido A. Zäch Institute, Nottwil, Switzerland.
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
- Center for Rehabilitation in Global Health Systems, WHO Collaborating Center, Lucerne, Switzerland.
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Nontarak J, Vichitkunakorn P, Waleewong O. Inequalities in access to new medication delivery services among non-communicable disease patients during the COVID-19 pandemic: findings from nationally representative surveys in Thailand. Int J Equity Health 2023; 22:38. [PMID: 36849923 PMCID: PMC9970126 DOI: 10.1186/s12939-023-01845-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/18/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND This study describes the inequalities in access to a medication delivery service (MDS) during the COVID-19 pandemic and identifies the social determinants of health-related inequalities among non-communicable disease (NCD) patients. METHODS Data were obtained from a study on the impact of health behaviours and modifications in health behaviours during the COVID-19 pandemic in the Thai population in 2021. The participants were recruited from Bangkok and all four regions of Thailand. The concentration index was used to examine the inequality among income quintiles, which were standardised by age, sex, living area, job type, health insurance scheme, and education level. Logistic regression was used to examine the associations between socio-demographics and access to regular services and new NCD MDSs, adjusted for age, sex, and other covariates. RESULTS Among 1,739 NCD patients, greater income inequalities in accessing regular NCD services and collecting medicines at registered pharmacies during the COVID-19 pandemic were observed, for which the concentration index indicated utilisation inequalities in favour of richer households. In contrast, receiving medicine at primary care centres, by postal delivery, and delivered by village health volunteers were the new NCD MDSs, which favoured less wealthy households. NCD patients living in rural areas were more likely to access new NCD MDSs, compared to those in urban areas (adjusted odds ratio = 2.30; 95% confidence interval [CI]: 1.22-4.34). Significant associations with receiving medicine at hospitals were also observed for the income quintiles. Individuals in the lowest and 2nd lowest income quintiles were more likely to access new MDSs than those in the richest quintiles. CONCLUSIONS This study highlighted a disproportionate concentration of access to new NCD MDSs during the COVID-19 pandemic in Thailand, which was more concentrated in lower-income groups. The government should further study and integrate MDSs with the highest cost benefits into nationwide regular systems, while addressing systematic barriers to access to these services, such as the lack of shared health data across health facilities and tele pharmacy equipment. This will promote access to public services among patients in the less advantaged groups and reduce the health inequality gap.
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Affiliation(s)
- Jiraluck Nontarak
- Department of Epidemiology, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Polathep Vichitkunakorn
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
| | - Orratai Waleewong
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
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Morgan A, Davies C, Olabi Y, Hope-Stone L, Cherry MG, Fisher P. Therapists' experiences of remote working during the COVID-19 pandemic. Front Psychol 2022; 13:966021. [PMID: 36591020 PMCID: PMC9802664 DOI: 10.3389/fpsyg.2022.966021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022] Open
Abstract
Objectives To explore the experiences of therapists who delivered remote psychological therapy during the COVID-19 pandemic. Design This was a qualitative, phenomenological study. Interpretative Phenomenological Analysis elicited themes from semi-structured interviews. Methods A purposive sample of eight therapists was recruited from breast cancer services in the United Kingdom. Results Analysis identified three superordinate themes. Participants spoke about how their experience of remote working changed over time from an initial crisis response to a new status quo. They adapted to the specific practical and personal challenges of remote working and struggled to connect with clients as the use of technology fundamentally changed the experience of therapy. Conclusion Consideration should be given to the impact of remote working on therapists and the quality of their practise. Adjustments to ways of working can help to maximize the advantages of remote working while minimizing potential issues.
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Affiliation(s)
- Andrew Morgan
- Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom,Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Cari Davies
- Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom,Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom,*Correspondence: Cari Davies,
| | - Yasmine Olabi
- Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom,Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Laura Hope-Stone
- Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom,Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Mary Gemma Cherry
- Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom,Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Peter Fisher
- Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom,Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
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FERNÁNDEZ-PÉREZ ÁNGEL, JIMÉNEZ-RUBIO DOLORES, ROBONE SILVANA. Freedom of choice and health services’ performance: Evidence from a National Health System. Health Policy 2022; 126:1283-1290. [DOI: 10.1016/j.healthpol.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 10/11/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022]
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Kirkwood G, Pollock AM. Socioeconomic inequality, waiting time initiatives and austerity in Scotland: an interrupted time series analysis of elective hip and knee replacements and arthroscopies. J R Soc Med 2022; 115:399-407. [PMID: 35413211 PMCID: PMC9720289 DOI: 10.1177/01410768221090672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES National Health Service (NHS) waiting times have long been a political priority in Scotland. In 2002, the Scottish government launched a programme of investment and reform to reduce waiting times. The effect on waiting time inequality is unknown as is the impact of subsequent austerity measures. DESIGN An interrupted time series analysis between the most and least socioeconomically deprived population quintiles since the introduction of waiting time initiative 1 July 2002 and austerity measures 1 April 2010. SETTING All NHS-funded elective primary hip replacement, primary knee replacement and arthroscopy patient data in Scotland from 1 April 1997 to 31 March 2019. PARTICIPANTS NHS Scotland funded patients treated in Scotland. MAIN OUTCOME MEASURES Trends and changes in mean waiting time. RESULTS There were 135,176, 122,883 and 173,976 NHS funded hip replacement, knee replacement and arthroscopy patients, respectively, in Scotland between 1 April 1997 and 31 March 2019. From 1 July 2002 to 31 March 2010, waiting time inequality between the most and least deprived patients fell and increased thereafter. For hip replacements before 1 July 2002, waiting time inequality increased 1.07 days per quarter; this changed at 1 July 2002 with significant slope change of -2.32 (-3.53, -1.12) days resulting in a decreasing rate of inequality of -1.26 days per quarter. On 1 April 2010 the slope changed significantly by 1.84 (0.90, 2.78) days restoring increasing inequality at 0.58 days per quarter. Knee replacements and arthroscopies had similar results. CONCLUSIONS The waiting time initiative in Scotland is associated with a reduction in waiting time inequality benefiting the most socioeconomically deprived patients. Austerity measures may be reversing these gains.
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Affiliation(s)
- Graham Kirkwood
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Allyson M Pollock
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
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Maheswaran R, Tong T, Michaels J, Brindley P, Walters S, Nawaz S. Socioeconomic disparities in abdominal aortic aneurysm repair rates and survival. Br J Surg 2022; 109:958-967. [PMID: 35950728 PMCID: PMC10364757 DOI: 10.1093/bjs/znac222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 05/23/2022] [Accepted: 05/29/2022] [Indexed: 08/02/2023]
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) is more prevalent in socioeconomically disadvantaged areas. This study investigated socioeconomic disparities in AAA repair rates and survival. METHODS The study used ecological and cohort study designs, from 31 672 census areas in England (April 2006 to March 2018), the Index of Multiple Deprivation 2010 as the area-level deprivation indicator, and Poisson, logistic and Cox regression. RESULTS Some 77 606 patients (83.4 per cent men) in four age categories (55-64, 65-74, 75-84, 85 or more years) were admitted with AAA from a population aged at least 55 years of 14.7 million. Elective open and endovascular repair rates were 41 (95 per cent c.i. 23 to 61) and 60 (36 to 89) per cent higher respectively among men aged 55-64 years in the most versus least deprived areas by quintile. This differences diminished and appeared to reverse with increasing age, with 26 (-1 to 45) and 25 (13 to 35) per cent lower rates respectively in men aged 85 years or more in the most deprived areas. Men admitted from more deprived areas were more likely to die in hospital without aneurysm repair. Among those who had aneurysm repair, this was more likely to be for a ruptured aneurysm than among men from less deprived areas. For intact aneurysm repair, they were relatively more likely to have this during an emergency admission. The mortality rate after repair was higher for men from more deprived areas, although the hazard diminished with age. Patterns were unclear for women. CONCLUSION There were clear socioeconomic disparities in operation rates, mode of presentation, and outcome for AAA surgery. Policies are needed to address these disparities.
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Affiliation(s)
- Ravi Maheswaran
- Correspondence to: Ravi Maheswaran, Public Health, School of Health and Related Research, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK (e-mail: )
| | - Thaison Tong
- School of Health and Related Research, University of Sheffield, UK
| | - Jonathan Michaels
- Clinical Decision Science, School of Health and Related Research, University of Sheffield, UK
| | - Paul Brindley
- Department of Landscape Architecture, University of Sheffield, Sheffield, UK
| | - Stephen Walters
- Medical Statistics and Clinical Trials, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Shah Nawaz
- Sheffield Vascular Institute, Sheffield Teaching Hospitals NHS Foundation Trust, UK
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Sacre A, Bambra C, Wildman JM, Thomson K, Sowden S, Todd A. Socioeconomic Inequalities and Vaccine Uptake: An Umbrella Review Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11172. [PMID: 36141450 PMCID: PMC9517548 DOI: 10.3390/ijerph191811172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/03/2022] [Accepted: 09/04/2022] [Indexed: 06/16/2023]
Abstract
The effectiveness of immunization is widely accepted: it can successfully improve health outcomes by reducing the morbidity and mortality associated with vaccine-preventable diseases. In the era of pandemics, there is a pressing need to identify and understand the factors associated with vaccine uptake amongst different socioeconomic groups. The knowledge generated from research in this area can be used to inform effective interventions aimed at increasing uptake. This umbrella systematic review aims to determine whether there is an association between socioeconomic inequalities and rate of vaccine uptake globally. Specifically, the study aims to determine whether an individual's socioeconomic status, level of education, occupation, (un)-employment, or place of residence affects the uptake rate of routine vaccines. The following databases will be searched from 2011 to the present day: Medline (Ovid), Embase (Ovid), CINAHL (EBSCO), Cochrane CENTRAL, Science Citation Index (Web of Science), DARE, SCOPUS (Elsevier), and ASSIA (ProQuest). Systematic reviews will be either included or excluded based on a priori established eligibility criteria. The relevant data will then be extracted, quality appraised, and narratively synthesised. The synthesis will be guided by the theoretical framework developed for this review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Equity extension (PRISMA-E) guidance will be followed. This protocol has been registered on PROSPERO, ID: CRD42022334223.
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Affiliation(s)
- Amber Sacre
- Population Health Sciences Institute, Newcastle University, Newcastle NE1 4LP, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC), Newcastle NE3 3XT, UK
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle NE1 4LP, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC), Newcastle NE3 3XT, UK
| | - Josephine M. Wildman
- Population Health Sciences Institute, Newcastle University, Newcastle NE1 4LP, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC), Newcastle NE3 3XT, UK
| | - Katie Thomson
- Population Health Sciences Institute, Newcastle University, Newcastle NE1 4LP, UK
| | - Sarah Sowden
- Population Health Sciences Institute, Newcastle University, Newcastle NE1 4LP, UK
| | - Adam Todd
- School of Pharmacy, Newcastle University, Newcastle NE1 7RU, UK
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19
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Yu M, Zhao G, Tang D. The relationship between internal and external factors about the outpatients’ choice of hospital: A cross‐sectional study from Jiaxing City, China. Health Sci Rep 2022; 5:e821. [PMID: 36110345 PMCID: PMC9464462 DOI: 10.1002/hsr2.821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Aims Exploring the mechanism influencing the choice of hospital among patients is important to render better care to them. The main purpose of this study is to evaluate the relationship between outpatients’ different internal factors (sociodemographic and psychological characteristics) and different external factors (provider characteristics) regarding their choice of hospital. Methods The data obtained via questionnaire was analyzed with a linear regression model to verify the relationship between outpatients’ internal and external factors. In addition, for external factors, we built a score reflecting a comprehensive hospital's “hard power” (diagnosis and treatment technology and expertise, i.e., to say, the curative capability) and “soft power” (whether the environment for seeing a doctor is convenient and cheap, etc.) factors which influence the choice of outpatients, and the factors were given different points and weighted according to the option's order of the questionnaire. Results We did not see evidence that internal factors such as gender, age, birthplace, and having or not having medical insurance had an effect on the comprehensive external factors of the hospital's choice (p > 0.05). However, statistically significant differences were found (p < 0.001) that outpatients who usually resided near Jiaxing valued hospitals’ “hard power” to a greater extent than did outpatients who lived in Jiaxing city, otherwise, “soft power” was prioritized. Similarly, outpatients who recognized themselves as having serious diseases valued hospitals’ “hard power” to a greater extent than those with moderate or minor diseases, otherwise, “soft power” was prioritized (p = 0.03). Conclusion By enhancing the hospital's “soft power,” the managers of small hospitals could attract different outpatients from large hospitals, such as outpatients with minor or moderate diseases. Moreover, the regional health service organizations should promote the building of first‐ and second‐level hospitals near cities to retain more outpatients and to achieve outpatients’ diversion from large tertiary hospitals.
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Affiliation(s)
- Mingming Yu
- Department of Economics and Management Shanghai Technical Institute of Electronics and Information Shanghai China
| | - Guoyang Zhao
- Department of Economics and Management Tongji Zhejiang College Jiaxing China
| | - Dan Tang
- Department of Economics and Management Tongji Zhejiang College Jiaxing China
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20
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Turner AJ, Francetic I, Watkinson R, Gillibrand S, Sutton M. Socioeconomic inequality in access to timely and appropriate care in emergency departments. JOURNAL OF HEALTH ECONOMICS 2022; 85:102668. [PMID: 35964420 DOI: 10.1016/j.jhealeco.2022.102668] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 07/25/2022] [Accepted: 08/02/2022] [Indexed: 06/15/2023]
Abstract
In publicly-funded healthcare systems, waiting times for care should be based on need rather than ability to pay. Studies have shown that individuals with lower socioeconomic status face longer waits for planned inpatient care, but there is little evidence on inequalities in waiting times for emergency care. We study waiting times in emergency departments (EDs) following arrival by ambulance, where health consequences of extended waits may be severe. Using data from all major EDs in England during the 2016/17 financial year, we find patients from more deprived areas face longer waits during some parts of the ED care pathway. Inequalities in waits are small, but more deprived individuals also receive less complex ED care, are less likely to be admitted for inpatient care, and are more likely to re-attend ED or die shortly after attendance. Patient-physician interactions and unconscious bias towards more deprived patients may be important sources of inequalities.
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Affiliation(s)
- Alex J Turner
- Health Organisation, Policy and Economics (HOPE) group, Centre for Primary Care & Health Services Research, The University of Manchester, Manchester, United Kingdom, M13 9PL; PHMR Ltd, London, NW1 8XY, England.
| | - Igor Francetic
- Health Organisation, Policy and Economics (HOPE) group, Centre for Primary Care & Health Services Research, The University of Manchester, Manchester, United Kingdom, M13 9PL
| | - Ruth Watkinson
- Health Organisation, Policy and Economics (HOPE) group, Centre for Primary Care & Health Services Research, The University of Manchester, Manchester, United Kingdom, M13 9PL
| | - Stephanie Gillibrand
- Health Organisation, Policy and Economics (HOPE) group, Centre for Primary Care & Health Services Research, The University of Manchester, Manchester, United Kingdom, M13 9PL
| | - Matt Sutton
- Health Organisation, Policy and Economics (HOPE) group, Centre for Primary Care & Health Services Research, The University of Manchester, Manchester, United Kingdom, M13 9PL
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21
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Makua SR, Khunou SH. Nurse managers' views regarding patients' long waiting time at community health centers in Gauteng Province, South Africa. BELITUNG NURSING JOURNAL 2022; 8:325-332. [PMID: 37546493 PMCID: PMC10401372 DOI: 10.33546/bnj.2096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/18/2022] [Accepted: 05/06/2022] [Indexed: 08/08/2023] Open
Abstract
Background Patients' long waiting time still exceeds the set target of 120 minutes. As a result, the volume of complaints remains a concern that points to systems inefficiencies. Minimal attention has been given to the experiences of nurse managers regarding patients' long waiting time. Objective To explore and describe the experiences of nurse managers regarding patients' long waiting time at Community Health Centers (CHCs) in Gauteng Province, South Africa. Methods The research applied qualitative exploratory descriptive and contextual design. Non-probability purposive sampling techniques were used to select eight nurse managers. Individual semi-structured interviews were conducted and captured with an audio tape. Tesch's 8-steps of data analysis were followed to analyze the data. Results Three themes and seven categories emerged from the study: (1) The adverse effects of patients' long waiting time (early birds to evade long queues, increased patients' complaints and compromised quality care), (2) Factors that contribute to patients' long waiting time (records and patient administration system deficiencies, poor time management, patients' lack of adherence to booking system), (3) Measures to mitigate patients' long waiting time (embracing decongestion systems to mitigate patients' overflow at CHC). Conclusion The study recommends the optimal implementation of an appointment system to avert long waiting times. Collaboration between CHCs' management and clinic committees is encouraged to provide the best solutions to the reduction of patients' long waiting times. In addition, time management is one area that needs to be improved. A digital record management system can assist in better-sought problems related to filling. Studies are encouraged on a model to enhance collaboration in reduction of patients' long waiting time.
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Affiliation(s)
- Solly Ratsietsi Makua
- Primary Health Care Services & Quality Assurance, Gauteng Department of Health, South Africa
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22
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An intelligent mind in a healthy body? Predicting health by cognitive ability in a large European sample. INTELLIGENCE 2022. [DOI: 10.1016/j.intell.2022.101666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Fowler Davis S, Humphreys H, Maden-Wilkinson T, Withers S, Lowe A, Copeland RJ. Understanding the Needs and Priorities of People Living with Persistent Pain and Long-Term Musculoskeletal Conditions during the COVID-19 Pandemic—A Public Involvement Project. Healthcare (Basel) 2022; 10:healthcare10061130. [PMID: 35742180 PMCID: PMC9222303 DOI: 10.3390/healthcare10061130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/05/2022] [Accepted: 06/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Critiques of public involvement (PI) are associated with failing to be inclusive of under-represented groups, and this leads to research that fails to include a diversity of perspectives. Aim: The aim of this PI project was to understand the experiences and priorities of people from three seldom-heard groups whose musculoskeletal pain may have been exacerbated or treatment delayed due to COVID-19. Engaging representatives to report diverse experiences was important, given the goal of developing further research into personalised and integrated care and addressing population health concerns about access and self-management for people with musculoskeletal pain. Methods: The project was approved via Sheffield Hallam University Ethics but was exempt from further HRA approval. A literature review was conducted, followed by informal individual and group discussions involving professionals and people with lived experience of (a) fibromyalgia pain, (b) those waiting for elective surgery and (c) experts associated with the care home sector. Findings from the literature review were combined with the insights from the public involvement. Resulting narratives were developed to highlight the challenges associated with persistent pain and informed the creation of consensus statements on the priorities for service improvement and future research. The consensus statements were shared and refined with input from an expert steering group. Results: The narratives describe pain as a uniformly difficult experience to share with professionals; it is described as exhausting, frustrating and socially limiting. Pain leads to exclusion from routine daily activities and often resigns people to feeling and being unwell. In all cases, there are concerns about accessing and improving services and critical issues associated with optimising physical activity, functional wellbeing and managing polypharmacy. Exercise and/or mobilisation are important and commonly used self-management strategies, but opportunity and advice about safe methods are variable. Services should focus on personalised care, including self-management support and medication management, so that people’s views and needs are heard and validated by health professionals. Conclusions: More research is needed to explore the most effective pain management strategies, and public involvement is important to shape the most relevant research questions. Health and care systems evaluation is also needed to address the scale of the population health need. The pandemic appears to have highlighted pre-existing shortcomings in holistic pain management.
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Affiliation(s)
- Sally Fowler Davis
- Organisation in Health and Care, Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (H.H.); (T.M.-W.); (A.L.); (R.J.C.)
- Correspondence:
| | - Helen Humphreys
- Organisation in Health and Care, Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (H.H.); (T.M.-W.); (A.L.); (R.J.C.)
| | - Tom Maden-Wilkinson
- Organisation in Health and Care, Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (H.H.); (T.M.-W.); (A.L.); (R.J.C.)
| | - Sarah Withers
- Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Broomhall, Sheffield S10 2JF, UK;
| | - Anna Lowe
- Organisation in Health and Care, Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (H.H.); (T.M.-W.); (A.L.); (R.J.C.)
| | - Robert J. Copeland
- Organisation in Health and Care, Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (H.H.); (T.M.-W.); (A.L.); (R.J.C.)
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Hernæs Ø, Kverndokk S, Markussen S, Øien H. Kun etter behov? Mottak av pleie- og omsorgstjenester og sammenheng med sosioøkonomisk status. TIDSSKRIFT FOR OMSORGSFORSKNING 2022. [DOI: 10.18261/tfo.8.1.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Tuczyńska M, Staszewski R, Matthews-Kozanecka M, Baum E. Impact of Socioeconomic Status on the Perception of Accessibility to and Quality of Healthcare Services during the COVID-19 Pandemic among Poles—Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095734. [PMID: 35565127 PMCID: PMC9104779 DOI: 10.3390/ijerph19095734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/01/2022] [Accepted: 05/06/2022] [Indexed: 12/07/2022]
Abstract
This pilot study was conducted on the reported hypothesis that the COVID-19 pandemic outbreak had an impact on the accessibility and quality of healthcare services and exacerbated socioeconomic inequalities. The aim was to determine whether economic status and education had an impact on the perception of access and quality to healthcare services during the COVID-19 pandemic and whether, according to patients, accessibility and quality had changed significantly compared to the pre-pandemic period in Poland. The study was based on the authors’ questionnaire and the results were statistically analyzed. Two hundred forty-seven feedback responses were received with a responsiveness rate of 93 percent. Statistically significant differences were found when comparing education level and utilization of healthcare services during the COVID-19 pandemic. A comparison of gender and economic situation, and average monthly income found no statistically significant differences. The outbreak of the COVID-19 pandemic has undoubtedly affected the provision of health services in many countries around the world. One result of the pandemic crisis has been widening socioeconomic inequalities among patients.
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Affiliation(s)
- Magdalena Tuczyńska
- SSC of Maxillofacial and Orthopaedics and Orthodontics, Poznan University of Medical Sciences, 61-701 Poznan, Poland
- Correspondence:
| | - Rafał Staszewski
- Department of Hypertension, Angiology and Internal Medicine, Poznan University of Medical Sciences, 61-701 Poznan, Poland;
| | - Maja Matthews-Kozanecka
- Department of Social Sciences and the Humanities, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (M.M.-K.); (E.B.)
| | - Ewa Baum
- Department of Social Sciences and the Humanities, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (M.M.-K.); (E.B.)
- Division of Philosophy of Medicine and Bioethics, Poznan University of Medical Sciences, 61-701 Poznan, Poland
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Fliegner M, Yaser JM, Stewart J, Nathan H, Likosky DS, Theurer PF, Clark MJ, Prager RL, Thompson MP. Area Deprivation and Medicare Spending for Coronary Artery Bypass Grafting: Insights from Michigan. Ann Thorac Surg 2022; 114:1291-1297. [PMID: 35300953 DOI: 10.1016/j.athoracsur.2022.02.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Prior work has established that high socioeconomic deprivation is associated with worse short- and long-term outcomes for coronary artery bypass graft (CABG) patients. The relationship between socioeconomic status and 90-day episode spending is poorly understood. In this observational cohort analysis, we evaluated whether socioeconomically disadvantaged patients were associated with higher expenditures during 90-day episodes of care following isolated CABG. METHODS We linked clinical registry data from 8,728 isolated CABG procedures from January 1st, 2012 to December 31st, 2018 to Medicare fee-for-service claims data. Our primary exposure variable was patients in the top decile of the Area Deprivation Index. Linear regression was used to compare risk-adjusted, price-standardized 90-day episode spending for deprived against non-deprived patients, as well as component spending categories: index hospitalization, professional services, post-acute care, and readmissions. RESULTS A total of 872 patients were categorized as being in the top decile. Mean 90-day episode spending for the 8,728 patients in the sample was $55,258 (standard deviation = $26,252). Socioeconomically deprived patients had higher overall 90-day spending compared to non-deprived patients ($61,579 vs. $54,557, difference = $3,003, p = 0.001). Spending was higher in socioeconomically deprived patients for index hospitalizations (difference = $1,284, p = 0.005), professional services (difference = $379, p = 0.002) and readmissions (difference = $1,188, p = 0.008). Inpatient rehabilitation was the only significant difference in post-acute care spending (difference = $469, p = 0.011). CONCLUSIONS Medicare spending was higher for socioeconomically deprived CABG in Michigan, indicating systemic disparities over and above patient demographic factors.
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Affiliation(s)
- Maximilian Fliegner
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Michigan; Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan
| | | | - James Stewart
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan; Department of Surgery, Michigan Medicine, Ann Arbor, Michigan Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Hari Nathan
- Michigan Value Collaborative, Ann Arbor, Michigan; Department of Surgery, Michigan Medicine, Ann Arbor, Michigan Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Donald S Likosky
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Michigan; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan; Michigan Value Collaborative, Ann Arbor, Michigan; Department of Surgery, Michigan Medicine, Ann Arbor, Michigan Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Patricia F Theurer
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan
| | - Melissa J Clark
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan
| | - Richard L Prager
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Michigan; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan
| | - Michael P Thompson
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Michigan; Michigan Value Collaborative, Ann Arbor, Michigan.
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Bernstein DN, Kurucan E, Fear K, Hammert WC. Evaluating the Impact of Patient Social Deprivation on the Level of Symptom Severity at Carpal Tunnel Syndrome Presentation. Hand (N Y) 2022; 17:339-345. [PMID: 32511021 PMCID: PMC8984716 DOI: 10.1177/1558944720928487] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: There is a paucity of research examining the impact of social deprivation on the level of symptom severity at presentation, including in common hand conditions like carpal tunnel syndrome. We aimed to determine whether patient deprivation is associated with worse Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE), Physical Function (PF), Pain Interference (PI), and Depression scores. Methods: Patients presenting to an academic hand clinic from December 2016 to December 2018 for a new patient visit for carpal tunnel syndrome completed PROMIS UE, PF, PI, and Depression Computer Adaptive Tests. Bivariate analyses were done to compare patient variables between the least and most deprived thirds, as measured by Area Deprivation Index (ADI), at the state (New York) and national levels. Multivariable linear regression was used to determine whether there was an association between social deprivation and PROMIS UE, PF, PI, and Depression scores. Results: All PROMIS domain scores were significantly worse in the most deprived cohort at the national level (P < .05) but not at the state level (P > .05). In multivariable regression at the national level, ADI values were associated with PROMIS UE (β = -0.06, P < .01) and PROMIS PI (β = .05, P < .01) but not PROMIS PF or PROMIS Depression. In multivariable regression at the state level, ADI values were associated with PROMIS UE (β = -0.79, P = .03) and PROMIS PI (β = 0.58, P < .05) but not PROMIS PF or PROMIS Depression. Conclusions: Higher levels of social deprivation are associated with worse PROMIS UE and PROMIS PI scores on both the state and national levels when initially seeking care for carpal tunnel syndrome.
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Affiliation(s)
| | | | | | - Warren C. Hammert
- University of Rochester Medical Center,
NY, USA,Warren C. Hammert, University of Rochester
Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642, USA.
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Cima J, Almeida Á. The impact of cancellations in waiting times analysis: evidence from scheduled surgeries in the Portuguese NHS. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:95-104. [PMID: 34304324 PMCID: PMC8310557 DOI: 10.1007/s10198-021-01354-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Equity in access to scheduled surgery has been a topic of attention of researchers and decision-makers on healthcare. Most studies analyse the number of days that patients wait before undergoing surgery, and ignore patients that have been on the waiting list but have not benefited from surgery. This study contributes to the existing literature on waiting lists by analysing cancellations along with surgery episodes. METHODS We use a database comprising all patients that entered the waiting list for scheduled surgeries in the Portuguese National Health Service from 2011 to 2015 (around 3 million observations) and estimate survival models to explain waiting times, where cancellations are introduced as censored data. RESULTS The cancellation rate is significant (around 14%), and has a considerable impact on results: ignoring cancellations biases estimates, in particular for gender differences (that are overestimated without cancelations), and for the age effect (that is underestimated). CONCLUSION Thus, our approach provides a more accurate understanding of the impact that several factors have on overall access to scheduled surgery.
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Affiliation(s)
- Joana Cima
- Faculdade de Economia, Universidade Do Porto, 4200-464 Porto, Portugal
| | - Álvaro Almeida
- CEF.UP and Faculdade de Economia, Universidade Do Porto, Porto, Portugal
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Jardine J, Gurol-Urganci I, Harris T, Hawdon J, Pasupathy D, van der Meulen J, Walker K. Risk of postpartum haemorrhage is associated with ethnicity: a cohort study of 981 801 births in England. BJOG 2021; 129:1269-1277. [PMID: 34889021 DOI: 10.1111/1471-0528.17051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/09/2021] [Accepted: 11/24/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the association between ethnic group and risk of postpartum haemorrhage in women giving birth. DESIGN Cohort study. SETTING Maternity units in England. POPULATION OR SAMPLE 981 801 records of births between 1st April 2015 and 31st March 2017 in a national clinical database. METHODS Multivariable logistic regression analyses with multiple imputation to account for missing data and robust standard errors to account for clustering within hospitals. MAIN OUTCOME MEASURES Postpartum haemorrhage of 1500ml or more (PPH). RESULTS 28 268 (2.9%) of births were complicated by PPH. Risks were higher in women from black (3.9%) and other (3.5%) ethnic backgrounds. Following adjustment for maternal and fetal characteristics, and care at birth, there was evidence of an increased risk of PPH in women from all ethnic minority groups, with the largest increase seen in black women (adjusted odds ratio 1.54 (1.45 to 1.63)). The increase in risk was robust to sensitivity analyses which included changing the outcome to PPH of 3000ml or more. CONCLUSIONS In England, women from ethnic minority backgrounds have an increased risk of PPH, when maternal, fetal and birth characteristics are taken into account. Factors contributing to this increased risk need further investigation. Perinatal care for women from ethnic minority backgrounds should focus on preventative measures to optimise maternal outcomes.
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Affiliation(s)
- Jennifer Jardine
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.,Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, 10-18 Union Street, London, SE1 1SZ, UK
| | - Ipek Gurol-Urganci
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.,Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, 10-18 Union Street, London, SE1 1SZ, UK
| | - Tina Harris
- Centre for Reproduction Research, Faculty of Health and Life Sciences, De Montfort University, The Gateway, Leicester, LE1 9BH, UK
| | - Jane Hawdon
- Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Dharmintra Pasupathy
- Department of Women and Children's Health, King's College London, 10th Floor, North Wing, St Thomas's Hospital London, SE1 7EH, UK.,Reproduction and Perinatal Centre, Faculty of Medicine and Health, University of Sydney NSW 2145, Australia
| | - Jan van der Meulen
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Kate Walker
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.,Clinical Effectiveness Unit, Royal College of Surgeons, 35-43 Lincoln's Inn Fields, Holborn, London, WC2A 3PE, UK
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30
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Muschol J, Gissel C. COVID-19 pandemic and waiting times in outpatient specialist care in Germany: an empirical analysis. BMC Health Serv Res 2021; 21:1076. [PMID: 34635091 PMCID: PMC8503703 DOI: 10.1186/s12913-021-07094-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/28/2021] [Indexed: 11/18/2022] Open
Abstract
Background International healthcare systems face the challenge that waiting times may create barriers to accessing medical care, and that those barriers are unequally distributed between different patient groups. The disruption of healthcare systems caused by the COVID-19 pandemic could exacerbate this already strained demand situation. Using the German healthcare system as an example, this study aims to analyze potential effects of the COVID-19 pandemic on waiting times for outpatient specialist care and to evaluate differences between individual patient groups based on their respective insurance status and the level of supply. Methods We conducted an experiment in which we requested appointments by telephone for different insurance statuses in regions with varying levels of supply from 908 outpatient specialist practices in Germany before and during the COVID-19 pandemic. Data from 589 collected appointments were analyzed using a linear mixed effect model. Results The data analysis revealed two main counteracting effects. First, the average waiting time has decreased for both patients with statutory (mandatory public health insurance) and private health insurance. Inequalities in access to healthcare, however, remained and were based on patients’ insurance status and the regional level of supply. Second, the probability of not receiving an appointment at all significantly increased during the pandemic. Conclusions Patient uncertainty due to the fear of a potential COVID-19 infection may have freed up capacities in physicians’ practices, resulting in a reduction of waiting times. At the same time, the exceptional situation caused by the pandemic may have led to uncertainty among physicians, who might thus have allocated appointments less frequently. To avoid worse health outcomes in the long term due to a lack of physician visits, policymakers and healthcare providers should focus more on regular care in the current COVID-19 pandemic.
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Affiliation(s)
- Jennifer Muschol
- Department of Health Economics, Justus Liebig University, Giessen, Germany
| | - Christian Gissel
- Department of Health Economics, Justus Liebig University, Giessen, Germany.
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31
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Salami B, Denga B, Taylor R, Ajayi N, Jackson M, Asefaw M, Salma J. Access to mental health for Black youths in Alberta. HEALTH PROMOTION AND CHRONIC DISEASE PREVENTION IN CANADA-RESEARCH POLICY AND PRACTICE 2021; 41:245-253. [PMID: 34549916 DOI: 10.24095/hpcdp.41.9.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The objective of this study was to examine the barriers that influence access to and use of mental health services by Black youths in Alberta. METHODS We used a youth-led participatory action research (PAR) methodology within a youth empowerment model situated within intersectionality theory to understand access to health care for both Canadian-born and immigrant Black youth in Alberta. The research project was co-led by an advisory committee consisting of 10 youths who provided advice and tangible support to the research. Seven members of the advisory committee also collected data, co-facilitated conversation cafés, analyzed data and helped in the dissemination activities. We conducted in-depth individual interviews and held four conversation café-style focus groups with a total of 129 youth. During the conversation cafés, the youths took the lead in identifying issues of concern and in explaining the impact of these issues on their lives. Through rigorous data coding and thematic analysis as well as reflexivity and member checking we ensured our empirical findings were trustworthy. RESULTS Our findings highlight key barriers that can limit access to and utilization of mental health services by Black youth, including a lack of cultural inclusion and safety, a lack of knowledge/information on mental health services, the cost of mental health services, geographical barriers, stigma and judgmentalism, and limits of resilience. CONCLUSION Findings confirm diverse/intersecting barriers that collectively perpetuate disproportional access to and uptake of mental health services by Black youths. The results of this study suggest health policy and practice stakeholders should consider the following recommendations to break down barriers: diversify the mental health service workforce; increase the availability and quality of mental health services in Black-dominated neighbourhoods; and embed anti-racist practices and intercultural competencies in mental health service delivery.
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Affiliation(s)
- Bukola Salami
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Benjamin Denga
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Robyn Taylor
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Nife Ajayi
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Margot Jackson
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Msgana Asefaw
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Jordana Salma
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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32
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Thompson MP, Yaser JM, Fliegner MA, Syrjamaki JD, Nathan H, Sukul D, Theurer PF, Clark MJ, Likosky DS, Prager RL. High Socioeconomic Deprivation and Coronary Artery Bypass Grafting Outcomes: Insights from Michigan. Ann Thorac Surg 2021; 113:1962-1970. [PMID: 34390700 DOI: 10.1016/j.athoracsur.2021.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cardiovascular outcomes are worse among individuals from areas with limited socioeconomic resources. This study evaluated the relationship between high socioeconomic deprivation and isolated coronary artery bypass grafting (CABG) outcomes. METHODS We linked statewide Society of Thoracic Surgeons Adult Cardiac Surgery Database data to Medicare fee-for-service records for 10,423 Michigan residents undergoing isolated CABG between 01/2012-12/2018. High socioeconomic deprivation was defined as residing in the highest decile of zip code-level area deprivation index (ADI). Multivariable logistic regression estimated the relationship between top ADI decile and major morbidity, in-hospital mortality, and operative mortality. Survival analyses evaluated long-term survival comparing patients in the top versus not in the top ADI decile. RESULTS A total of 1,036 patients were in the top decile of ADI (ADI>82.4), and were more likely to be female, black, and have a higher predicted risk of mortality. Patients in the top ADI decile had significantly higher rates of major morbidity (17.4% versus 11.4%, adjusted odds ratio =1.26, 95% CI: 1.04-1.54, p=0.021) and in-hospital mortality (3.2% versus 1.3%, adjusted odds ratio=1.84, 95% CI: 1.18-2.86, p=0.007), but not operative mortality. The adjusted hazard of mortality was 16% higher for patients residing in the top ADI decile (95% CI: 1.01-1.33, p=0.032). CONCLUSIONS Isolated CABG patients residing in the highest areas of socioeconomic deprivation differed with respect to demographic and clinical characteristics, and experienced worse short and long-term outcomes compared with those not in the top ADI decile.
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Affiliation(s)
- Michael P Thompson
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, MI, USA;; Michigan Value Collaborative, Ann Arbor, MI, USA.
| | | | | | | | - Hari Nathan
- Michigan Value Collaborative, Ann Arbor, MI, USA; Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Devraj Sukul
- Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Patricia F Theurer
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI, USA
| | - Melissa J Clark
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI, USA
| | - Donald S Likosky
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, MI, USA;; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI, USA
| | - Richard L Prager
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, MI, USA;; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI, USA
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LoMartire R, Björk M, Dahlström Ö, Constan L, Frumento P, Vixner L, Gerdle B, Äng BO. The value of interdisciplinary treatment for sickness absence in chronic pain: A nationwide register-based cohort study. Eur J Pain 2021; 25:2190-2201. [PMID: 34189810 DOI: 10.1002/ejp.1832] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Interdisciplinary treatment (IDT) is an internationally recommended intervention for chronic pain, despite inconclusive evidence of its effects on sickness absence. METHODS With data from 25,613 patients in Swedish specialist healthcare, we compared sickness absence, in the form of both sick leave and disability pensions, over a 5-year period between patients either allocated to an IDT programme or to other/no interventions (controls). To obtain population-average estimates, a Markov multistate model with theory-based inverse probability weights was used to compute both the proportion of patients on sickness absence and the total sickness absence duration. RESULTS IDT patients were more likely than controls to receive sickness absence benefits at any given time (baseline: 49% vs. 46%; 5-year follow-up: 36% vs. 35%), and thereby also had a higher total duration, with a mean (95% CI) of 67 (87, 48) more days than controls over the 5-year period. Intriguingly, sick leave was higher in IDT patients (563 [552, 573] vs. 478 [466, 490] days), whereas disability pension was higher in controls (152 [144, 160] vs. 169 [161, 178] days). CONCLUSION Although sickness absence decreased over the study period in both IDT patients and controls, we found no support for IDT decreasing sickness absence more than other/no interventions in chronic pain patients. SIGNIFICANCE In this large study of chronic pain patients in specialist healthcare, sickness absence is compared over a 5-year period between patients in an interdisciplinary treatment programme and other/no interventions. Sickness absence decreased over the study period in bothgroups; however, there was no support forthat it decreased more with interdisciplinary treatment than alternative interventions.
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Affiliation(s)
- Riccardo LoMartire
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Department of Research and Higher Education, Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, Falun, Sweden
| | - Mathilda Björk
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Örjan Dahlström
- Department of Behavioural, Sciences and Learning, Linköping University, Linköping, Sweden
| | - Lea Constan
- Department of Arts and Crafts, Konstfack: University of Arts, Crafts and Design, Stockholm, Sweden
| | - Paolo Frumento
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | - Linda Vixner
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Björn O Äng
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Department of Research and Higher Education, Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, Falun, Sweden.,School of Health and Welfare, Dalarna University, Falun, Sweden
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34
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McCoy JL, Dixit R, Lin RJ, Belsky MA, Shaffer AD, Chi D, Jabbour N. Impact of Patient Socioeconomic Disparities on Time to Tympanostomy Tube Placement. THE ANNALS OF OTOLOGY, RHINOLOGY, AND LARYNGOLOGY 2021:34894211015741. [PMID: 33978498 DOI: 10.1177/00034894211015741] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Extensive literature exists documenting disparities in access to healthcare for patients with lower socioeconomic status (SES). The objective of this study was to examine access disparities and differences in surgical wait times in children with the most common pediatric otolaryngologic surgery, tympanostomy tubes (TT). METHODS A retrospective cohort study was performed at a tertiary children's hospital. Children ages <18 years who received a first set of tympanostomy tubes during 2015 were studied. Patient demographics and markers of SES including zip code, health insurance type, and appointment no-shows were recorded. Clinical measures included risk factors, symptoms, and age at presentation and first TT. RESULTS A total of 969 patients were included. Average age at surgery was 2.11 years. Almost 90% were white and 67.5% had private insurance. Patients with public insurance, ≥1 no-show appointment, and who lived in zip codes with the median income below the United States median had a longer period from otologic consult and preoperative clinic to TT, but no differences were seen in race. Those with public insurance had their surgery at an older age than those with private insurance (P < .001) and were more likely to have chronic otitis media with effusion as their indication for surgery (OR: 1.8, 95% CI: 1.2-2.5, P = .003). CONCLUSIONS Lower SES is associated with chronic otitis media with effusion and a longer wait time from otologic consult and preoperative clinic to TT placement. By being transparent in socioeconomic disparities, we can begin to expose systemic problems and move forward with interventions. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Jennifer L McCoy
- UPMC Children's Hospital of Pittsburgh, Division of Pediatric Otolaryngology, Pittsburgh, PA, USA
| | - Ronak Dixit
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - R Jun Lin
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - Michael A Belsky
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Amber D Shaffer
- UPMC Children's Hospital of Pittsburgh, Division of Pediatric Otolaryngology, Pittsburgh, PA, USA
| | - David Chi
- UPMC Children's Hospital of Pittsburgh, Division of Pediatric Otolaryngology, Pittsburgh, PA, USA.,Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Noel Jabbour
- UPMC Children's Hospital of Pittsburgh, Division of Pediatric Otolaryngology, Pittsburgh, PA, USA.,Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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35
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Bernstein DN, Merchan N, Fear K, Rubery PT, Mesfin A. Greater Socioeconomic Disadvantage Is Associated with Worse Symptom Severity at Initial Presentation in Patients Seeking Care for Lumbar Disc Herniation. Spine (Phila Pa 1976) 2021; 46:464-471. [PMID: 33181773 DOI: 10.1097/brs.0000000000003811] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective, observational study. OBJECTIVE To determine the association of patient socioeconomic disadvantage, insurance type, and other characteristics on presenting symptom severity in patients with isolated lumbar disc herniation. SUMMARY OF BACKGROUND DATA Little is known of the impact of socioeconomic disadvantage and other patient characteristics on the level of self-reported symptom severity when patients first seek care for lumbar disc herniation. METHODS Between April 2015 and December 2018, 734 patients newly presenting for isolated lumbar disc herniation who completed the Patient-Reported Outcomes Measurement Information System Physical Function (PF), Pain Interference (PI), and Depression Computer Adaptive Tests (CATs) were identified. Socioeconomic disadvantage was determined using the Area Deprivation Index, a validated measure of socioeconomic disadvantage at the census block group level (0-100, 100 = highest socioeconomic disadvantage). Bivariate analyses were used. Multivariable linear regression was used to determine if there was an association between socioeconomic disadvantage, insurance type, and other patient factors and presenting patient-reported health status. RESULTS Significant differences in age, insurance type, self-reported race, marital status, and county of residence were appreciated when comparing patient characteristics by socioeconomic disadvantage levels (all comparisons, P < 0.01). In addition, significant differences in age, insurance type, marital status, and county of residence were appreciated when comparing patient characteristics by self-reported race (all comparisons, P < 0.01). Being in the most socioeconomically disadvantaged cohort was associated with worse presenting Patient-Reported Outcomes Measurement Information System scores (Physical Function: β = -3.27 (95% confidence interval [CI]: -4.89 to -1.45), P < 0.001; Pain Interference: β = 3.20 (95% CI: 1.58-4.83), P < 0.001; Depression: β = 3.31 (95% CI: 1.08-5.55), P = 0.004. CONCLUSION The most socioeconomically disadvantaged patients with symptomatic lumbar disc herniations present with worse functional limitations, pain levels, and depressive symptoms as compared to patients from the least socioeconomically disadvantaged cohort when accounting for other key patient factors.Level of Evidence: 3.
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Affiliation(s)
- David N Bernstein
- Department of Orthopedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY
| | - Nelson Merchan
- Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Kathleen Fear
- UR Health Lab, University of Rochester Medical Center, Rochester, NY
| | - Paul T Rubery
- Department of Orthopedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY
| | - Addisu Mesfin
- Department of Orthopedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY
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Brown RCH, Kelly D, Wilkinson D, Savulescu J. The scientific and ethical feasibility of immunity passports. THE LANCET. INFECTIOUS DISEASES 2021; 21:e58-e63. [PMID: 33075284 PMCID: PMC7567527 DOI: 10.1016/s1473-3099(20)30766-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/07/2020] [Accepted: 09/17/2020] [Indexed: 02/07/2023]
Abstract
There is much debate about the use of immunity passports in the response to the COVID-19 pandemic. Some have argued that immunity passports are unethical and impractical, pointing to uncertainties relating to COVID-19 immunity, issues with testing, perverse incentives, doubtful economic benefits, privacy concerns, and the risk of discriminatory effects. We first review the scientific feasibility of immunity passports. Considerable hurdles remain, but increasing understanding of the neutralising antibody response to COVID-19 might make identifying members of the community at low risk of contracting and transmitting COVID-19 possible. We respond to the ethical arguments against immunity passports and give the positive ethical arguments. First, a strong presumption should be in favour of preserving people's free movement if at all feasible. Second, failing to recognise the reduced infection threat immune individuals pose risks punishing people for low-risk behaviour. Finally, further individual and social benefits are likely to accrue from allowing people to engage in free movement. Challenges relating to the implementation of immunity passports ought to be met with targeted solutions so as to maximise their benefit.
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Affiliation(s)
- Rebecca C H Brown
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK.
| | - Dominic Kelly
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; Department of Paediatrics, Oxford University Hospitals National Health Service Foundation Trust, Oxford, UK; National Institute for Health Research Oxford Biomedical Research Centre, Oxford, UK
| | - Dominic Wilkinson
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK; Biomedical Ethics Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Melbourne Law School, Melbourne University, Melbourne, VIC, Australia
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Cima J, Guimarães P, Almeida Á. Explaining the Gender Gap in Waiting Times for Scheduled Surgery in the Portuguese National Health Service. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2021. [DOI: 10.1159/000514798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Objective:</i></b> This paper evaluates the gender gap in waiting times for scheduled surgery, using information on 2.6 million surgical episodes in Portuguese National Health Service hospitals covering the period from 2011 to 2015. <b><i>Methodology:</i></b> We estimated the gross gender gap, i.e., the differential between the waiting times of men and women, and then add several explanatory variables that can account for this difference to estimate an adjusted gender gap. The variables are added in a way that permits the most flexible parametric specification. Next, we used Gelbach’s decomposition to understand the contribution of each variable to the difference between the gross and the adjusted gender gaps. <b><i>Results:</i></b> The gross gender gap of 10% is reduced to a 3% adjusted gender gap after accounting for observable explanatory factors. Gelbach’s decomposition shows that patient priority and hospital-fixed effects are the variables that contribute the most to the explained component of the gap. The analysis suggests that men tend to be ranked with more severe priorities, and that there are hospital specificities that cause men to have shorter waiting times. <b><i>Conclusions:</i></b> Overall, we identified a gender bias against women in surgery waiting times, but the size of the bias is smaller than was previously suggested in the literature.
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Wirawan GBS, Januraga PP. Correlation of Demographics, Healthcare Availability, and COVID-19 Outcome: Indonesian Ecological Study. Front Public Health 2021; 9:605290. [PMID: 33598443 PMCID: PMC7882903 DOI: 10.3389/fpubh.2021.605290] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/05/2021] [Indexed: 01/19/2023] Open
Abstract
Objective: To analyze the correlation between demographic and healthcare availability indicators with COVID-19 outcome among Indonesian provinces. Methods: We employed an ecological study design to study the correlation between demographics, healthcare availability, and COVID-19 indicators. Demographic and healthcare indicators were obtained from the Indonesian Health Profile of 2019 by the Ministry of Health while COVID-19 indicators were obtained from the Indonesian COVID-19 website in August 31st 2020. Non-parametric correlation and multivariate regression analyses were conducted with IBM SPSS 23.0. Results: We found the number of confirmed cases and case growth to be significantly correlated with demographic indicators, especially with distribution of age groups. Confirmed cases and case growth was significantly correlated (p < 0.05) with population density (correlation coefficient of 0.461 and 0.491) and proportion of young people (-0.377; -0.394). Incidence and incidence growth were correlated with ratios of GPs (0.426; 0.534), hospitals (0.376; 0.431), primary care clinics (0.423; 0.424), and hospital beds (0.472; 0.599) per capita. For mortality, case fatality rate (CFR) was correlated with population density (0.390) whereas mortality rate was correlated with ratio of hospital beds (0.387). Multivariate analyses found confirmed case independently associated with population density (β of 0.638) and demographic structure (-0.289). Case growth was independently associated with density (0.763). Incidence growth was independently associated with hospital bed ratio (0.486). Conclusion: Pre-existing inequality of healthcare availability correlates with current reported incidence and mortality rate of COVID-19. Lack of healthcare availability in some provinces may have resulted in artificially low numbers of cases being diagnosed, lower demands for COVID-19 tests, and eventually lower case-findings.
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Affiliation(s)
| | - Pande Putu Januraga
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Bali, Indonesia
- Discipline of Public Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Simonsen NF, Oxholm AS, Kristensen SR, Siciliani L. What explains differences in waiting times for health care across socioeconomic status? HEALTH ECONOMICS 2020; 29:1764-1785. [PMID: 32996212 DOI: 10.1002/hec.4163] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 07/02/2020] [Accepted: 08/10/2020] [Indexed: 06/11/2023]
Abstract
In publicly funded health systems, waiting times act as a rationing mechanism that should be based on need rather than socioeconomic status. However, several studies suggest that individuals with higher socioeconomic status wait less. Using individual-level data from administrative registers, we estimate and explain socioeconomic inequalities in access to publicly funded care for seven planned hospital procedures in Denmark. For each procedure, we first estimate the association between patients' waiting time for health care and their socioeconomic status as measured by income and education, controlling for patient severity. Then, we investigate how much of the association remains after controlling for (i) other individual characteristics (patients' family status, labor market status, and country of origin) that may be correlated with income and education, (ii) possible selection due to patients' use of a waiting time guarantee, and (iii) hospital factors which allow us to disentangle whether inequalities in waiting times arise across hospitals or within the hospital. Only for a few procedures, we find inequalities in waiting times related to income and education. These inequalities can be explained mostly by geographical and institutional factors across hospitals. But we also find inequalities for some procedures in relation to non-Western immigrants within hospitals.
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Affiliation(s)
- Nicolai Fink Simonsen
- Department of Public Health, Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | - Anne Sophie Oxholm
- Department of Public Health, Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | - Søren Rud Kristensen
- Department of Public Health, Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Luigi Siciliani
- Department of Economics and Related Studies, University of York, York, UK
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Barman B, Roy A, Zaveri A, Saha J, Chouhan P. Determining factors of institutional delivery in India: A study from National Family Health Survey-4 (2015–16). CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2020.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Bonaccio M, Di Castelnuovo A, de Gaetano G, Iacoviello L. Socioeconomic gradient in health: mind the gap in 'invisible' disparities. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1200. [PMID: 33241049 PMCID: PMC7576022 DOI: 10.21037/atm.2020.04.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Marialaura Bonaccio
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli (IS), Italy
| | | | - Giovanni de Gaetano
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli (IS), Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli (IS), Italy.,Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese, Italy
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Martin S, Siciliani L, Smith P. Socioeconomic inequalities in waiting times for primary care across ten OECD countries. Soc Sci Med 2020; 263:113230. [PMID: 32823046 DOI: 10.1016/j.socscimed.2020.113230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/09/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
Waiting times for health care are a major policy concern across OECD countries. Waiting times are generally tolerated in publicly-funded health systems and perceived as equitable if access to care is not based on socioeconomic status. Although a growing literature has documented that socioeconomic status is negatively associated with waiting times for secondary care in several countries, less is known about waiting time inequalities in primary care, which is the focus of this study. We exploit the Commonwealth Fund's International Health Policy Survey of Adults in 2010, 2013 and 2016 and include ten OECD countries (Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom). Waiting time for primary care is measured by the time reported to get an appointment to see a doctor or a nurse. We employ interval regression models to investigate for each country whether socioeconomic status (household income and education) are associated with the waiting time for a primary care appointment. We control for age, gender, chronic conditions, and whether the individual holds private health insurance. We find a negative association between household income and waiting times in Canada, Germany, Norway and Sweden.
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Affiliation(s)
- Steve Martin
- Department of Economics and Related Studies, University of York, York, UK
| | - Luigi Siciliani
- Department of Economics and Related Studies, University of York, York, UK.
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Li AHT, Palmer KS, Taljaard M, Paterson JM, Brown A, Huang A, Marani H, Lapointe-Shaw L, Pincus D, Wettstein MS, Kulkarni GS, Wasserstein D, Ivers N. Effects of quality-based procedure hospital funding reform in Ontario, Canada: An interrupted time series study. PLoS One 2020; 15:e0236480. [PMID: 32813687 PMCID: PMC7437861 DOI: 10.1371/journal.pone.0236480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 07/07/2020] [Indexed: 11/19/2022] Open
Abstract
Background The Government of Ontario, Canada, announced hospital funding reforms in 2011, including Quality-based Procedures (QBPs) involving pre-set funds for managing patients with specific diagnoses/procedures. A key goal was to improve quality of care across the jurisdiction. Methods Interrupted time series evaluated the policy change, focusing on four QBPs (congestive heart failure, hip fracture surgery, pneumonia, prostate cancer surgery), on patients hospitalized 2010–2017. Outcomes included return to hospital or death within 30 days, acute length of stay (LOS), volume of admissions, and patient characteristics. Results At 2 years post-QBPs, the percentage of hip fracture patients who returned to hospital or died was 3.13% higher in absolute terms (95% CI: 0.37% to 5.89%) than if QBPs had not been introduced. There were no other statistically significant changes for return to hospital or death. For LOS, the only statistically significant change was an increase for prostate cancer surgery of 0.33 days (95% CI: 0.07 to 0.59). Volume increased for congestive heart failure admissions by 80 patients (95% CI: 2 to 159) and decreased for hip fracture surgery by 138 patients (95% CI: -183 to -93) but did not change for pneumonia or prostate cancer surgery. The percentage of patients who lived in the lowest neighborhood income quintile increased slightly for those diagnosed with congestive heart failure (1.89%; 95% CI: 0.51% to 3.27%) and decreased for those who underwent prostate cancer surgery (-2.08%; 95% CI: -3.74% to -0.43%). Interpretation This policy initiative involving a change to hospital funding for certain conditions was not associated with substantial, jurisdictional-level changes in access or quality.
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Affiliation(s)
- Alvin Ho-ting Li
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- * E-mail:
| | - Karen S. Palmer
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Monica Taljaard
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - J. Michael Paterson
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Adalsteinn Brown
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anjie Huang
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Husayn Marani
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Daniel Pincus
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Marian S. Wettstein
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Surgical Oncology (Urology), Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Girish S. Kulkarni
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Surgical Oncology (Urology), Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Division of Urology, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David Wasserstein
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Noah Ivers
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Myhr A, Anthun KS, Lillefjell M, Sund ER. Trends in Socioeconomic Inequalities in Norwegian Adolescents' Mental Health From 2014 to 2018: A Repeated Cross-Sectional Study. Front Psychol 2020; 11:1472. [PMID: 32733331 PMCID: PMC7358281 DOI: 10.3389/fpsyg.2020.01472] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/02/2020] [Indexed: 01/20/2023] Open
Abstract
Background Adolescents’ mental health, and its consistent relationship with their socioeconomic background, is a concern that should drive education, health, and employment policies. However, information about this relationship on a national scale is limited. We explore national overall trends and investigate possible socioeconomic disparities in adolescents’ mental health, including psychological distress and symptoms of depression, anxiety, and loneliness in Norway during the period 2014–2018. Methods The present study builds on data retrieved from five waves of the national cross-sectional Ungdata survey (2014–2018). In total 136,525 upper secondary school students (52% girls) completed the questionnaire during the study period. Trends in socioeconomic inequalities were assessed using the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII). Results The prevalence of students with moderate to high symptoms score and mean symptoms scores of psychological distress (in terms of symptoms of depression, anxiety, and loneliness) increased among girls and boys during 2014–2018, with girls showing higher rates. Our results suggest distinct, but stable, inequalities between socioeconomic groups, both in absolute and relative terms, among girls and boys during the study period. Conclusion Rising rates of adolescents’ psychological distress, particularly among girls, may have long-term consequences for individuals involved and the society as a whole. Future studies should investigate the causes of these results. We did not find evidence of any change in inequalities in adolescents’ mental health between socioeconomic groups, suggesting current strategies are not sufficiently addressing mental health inequalities in the adolescent population and therefore a significant need for research and public health efforts.
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Affiliation(s)
- Arnhild Myhr
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Trøndelag R&D Institute, Steinkjer, Norway
| | - Kirsti S Anthun
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Monica Lillefjell
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Erik R Sund
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Research Centre, Norwegian University of Science and Technology, Levanger, Norway.,Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway.,Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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Rural Population Aging and the Hospital Utilization in Cities: The Rise of Medical Tourism in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134790. [PMID: 32635241 PMCID: PMC7369718 DOI: 10.3390/ijerph17134790] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 11/17/2022]
Abstract
The disparity of rural and urban hospital utilization has aroused much concern. With the improvement of their living standards, patients in rural areas have an emerging need for traveling across borders for better medical treatment in China. This paper reveals the medical tourism of rural residents towards urban hospitals driven by hospital needs and points out that such disparities may be caused by medical tourism. The ratio of people aged 65 and above in total rural populations was used to identify the potential target customers for medical tourism. Based on rural and urban datasets ranging from 2007-2017 on the provincial level, this paper presents a mobile treatment model and market concentration model with an ecological foundation. The feasible generalized least squared approach was used in the estimation of the fixed-effect regressions. The study found that there was a positive and significant relationship between rural old-age ratios and urban inpatient visits from different income groups. On average, a one percent rise in rural old-age ratio would increase the inpatient visits of urban hospitals by 138 thousand persons. There was also a positive and significant relationship between the rural old-age ratio and the market concentration of urban inpatient visits. It was found that the rural old-age ratio significantly influenced the market concentration of urban inpatient visits in the middle-high income regions. The research showed that each income group from the rural aged population had participated in medical tourism, traveled to urbanized regions and made inpatient visits to urbanized medical facilities. It was also indicated that the rural aged population, especially from the middle-high income groups had a positive and significant influence on the market concentration of urban inpatient visits in the province.
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Wilf-Miron R, Novikov I, Ziv A, Mandelbaum A, Ritov Y, Luxenburg O. A novel methodology to measure waiting times for community-based specialist care in a public healthcare system. Health Policy 2020; 124:805-811. [PMID: 32595093 DOI: 10.1016/j.healthpol.2020.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 05/21/2020] [Accepted: 06/07/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Monitoring waiting time (WT) in healthcare systems is essential, since long WT are associated with adverse health outcomes, reduced patient satisfaction and increased private financing. OBJECTIVE To describe a methodology developed for routine national monitoring of WT for community-based non-urgent specialist appointments, in a public healthcare system. METHODS The methodology is based on data from computerized appointment scheduling systems of all Health Maintenance Organizations (HMOs) in Israel. Data included first 50 available appointments for community-based specialists and actual number of visits. Five most frequent specialties: orthopedics, ophthalmology, gynecology, dermatology and otolaryngology, were included. WT offered to HMO members for non-urgent care was calculated for two scenarios: "specific" physician and "any" physician in the region. Distribution of offered WT was calculated separately for each specialty and geographical region, combined to create the nationwide distribution. RESULTS The methodology was tested on data extracted between December 2018-June 2019. Estimated national median WT for "specific" physician, ranged from 9 days (ophthalmology/gynecology) to 20 days (dermatology), with large variation between geographic regions. WT were 26-56 % shorter for "any" than for "specific" physician. CONCLUSIONS This novel method offers a solution for ongoing national WT measurement, using computerized scheduling systems. It integrates two scenarios for appointment scheduling and allows identification of differences between specialties and regions, setting the ground for interventions to strengthen public healthcare systems.
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Affiliation(s)
- Rachel Wilf-Miron
- Health Technology Assessment Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 52621, Israel; Dept. of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ilya Novikov
- Biostatistics & Biomathematics Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 52621, Israel.
| | - Arnona Ziv
- Information & Computerization Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 52621, Israel.
| | - Avishai Mandelbaum
- Faculty of Industrial Engineering & Management, Technion, Haifa, Israel.
| | - Yaacov Ritov
- Department of Statistics, University of Michigan, USA.
| | - Osnat Luxenburg
- Medical Technology, Health Information and Research Directorate, Ministry of Health, Jerusalem, Israel.
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Spatial Interaction Model for Healthcare Accessibility: What Scale Has to Do with It. SUSTAINABILITY 2020. [DOI: 10.3390/su12104324] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This manuscript develops a theoretical spatial interaction model using the entropy approach to relax the assumption of the deterministic utility function. The spatial healthcare accessibility improves as the demand for healthcare increases or the opportunity cost of traveling to and from healthcare providers decreases. The empirical application used different spatial econometric techniques and multilevel modeling to evaluate the spatial distribution of existing hospitals in Texas and their social and economic correlates. To control for spatial autocorrelation, spatial autoregressive regression models were estimated, and geographically weighted regression models examined potential spatial non-stationarity. The multilevel modeling controlled for spatial autocorrelation and also allowed local variation and spatial non-stationarity. The empirical analysis showed that healthcare accessibility was not stationary in Texas in 2015, with areas of poor accessibility in rural and peripheral areas in Texas, when using hospitals’ location and county data. The model of spatial interaction applied to healthcare accessibility can be used to evaluate policies aiming at the provision of health services, such as closures of hospitals and capacity increases.
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Arman S, Amlani A, Doshi J. Glue ear management & deprivation-A retrospective study of 89 patients. Clin Otolaryngol 2020; 45:616-618. [PMID: 32248645 DOI: 10.1111/coa.13538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/08/2020] [Accepted: 03/22/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Sam Arman
- Birmingham Heartlands Hospital, Birmingham, UK
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Abstract
Socioeconomic inequality of access to healthcare is seen across the spectrum of healthcare, including diabetes. Health inequalities are defined as the 'preventable, unfair and unjust differences in health status between groups, populations or individuals that arise from the unequal distribution of social, environmental and economic conditions within societies, which determine the risk of people getting ill, their ability to prevent sickness or opportunities to take action and access treatment when ill health occurs' (NHS England; https://www.england.nhs.uk/about/equality/equality-hub/resources/). Access to diabetes technologies has improved glycaemic and quality-of-life outcomes for many users. Inability to access such devices, however, is evidenced in National Diabetes Audit data, with a reported tenfold variation in insulin pump use by people with type 1 diabetes across specialist centres. This variation suggests a lack of access to healthcare systems that should be investigated. This article highlights some of the key issues surrounding healthcare inequalities in the management of diabetes.
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Affiliation(s)
| | - Daniel Cherñavvsky
- Dexcom, Inc, San Diego, CA, USA
- University of Virginia, Charlottesville, VA, USA
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Chung GKK, Dong D, Wong SYS, Wong H, Chung RYN. Perceived poverty and health, and their roles in the poverty-health vicious cycle: a qualitative study of major stakeholders in the healthcare setting in Hong Kong. Int J Equity Health 2020; 19:13. [PMID: 31992307 PMCID: PMC6986077 DOI: 10.1186/s12939-020-1127-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 01/13/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Poverty and ill-health are closely inter-related. Existing studies on the poverty-health vicious cycle focus mainly on less developed countries, where the identified mechanisms linking between poverty and ill-health may not fit the situations in developed Asian regions. This study aims to qualitatively explore the perceived mechanisms and drivers of the poverty-health vicious cycle among major stakeholders in the healthcare setting in Hong Kong. METHODS Data were collected via focus group interviews with social workers (n = 8), chronically ill patients (n = 8), older adults (n = 6), primary care doctors (n = 7) and informal caregivers (n = 10). The transcribed data were then closely read to capture key themes using thematic analyses informed by social constructivism. RESULTS In this highly developed Asian setting with income inequality among the greatest in the world, the poverty-health vicious cycle operates. Material and social constraints, as a result of unequal power and opportunities, appear to play a pivotal role in creating uneven distribution of social determinants of health. The subsequent healthcare access also varies across the social ladder under the dual-track healthcare system in Hong Kong. As health deteriorates, financial hardship is often resulted in the absence of sufficient and coordinated healthcare, welfare and labour policy interventions. In addition to the mechanisms, policy drivers of the cycle were also discussed based on the respondents' perceived understanding of the nature of poverty and its operationalization in public policies, as well as of the digressive conceptions of disease among different stakeholders. CONCLUSIONS The poverty-health vicious cycle has remained a great challenge in Hong Kong despite its economic prosperity. To break the cycle, potential policy directions include the adoption of proportionate universalism, social integration and the strengthening of medical-social collaboration.
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Affiliation(s)
- Gary Ka-Ki Chung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Dong Dong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Samuel Yeung-Shan Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Hung Wong
- Department of Social Work, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Roger Yat-Nork Chung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territories, Hong Kong.
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