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Garg S, Bebarta KK, Tripathi N, Keshri VR. Impact of Government-Funded Health Insurance on Out-of-Pocket Expenditure and Quality of Hospital-Based Care in Indian States of Madhya Pradesh and Maharashtra. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024:10.1007/s40258-024-00911-2. [PMID: 39183223 DOI: 10.1007/s40258-024-00911-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/08/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND With its clear focus on financial protection, government-funded health insurance (GFHI) stands out among the strategies for universal health coverage (UHC) implemented by low-to-middle income countries globally. Since 2018, India has implemented a GFHI programme called the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), which covers 500 million individuals. The current study aims to evaluate the performance of GFHI in meeting its key objectives of improving access, quality and financial protection for hospital-based care in two large central Indian states: Madhya Pradesh and Maharashtra. METHODS The study measures access in terms of utilisation of inpatient care. Financial protection was measured in terms of catastrophic health expenditure which was defined as the incidence of out-of-pocket expenditure (OOPE) above thresholds of 10% and 25% of annual household expenditure. Patient-satisfaction with care was taken as an indicator of quality. A household survey was conducted in 2023, covering a multi-stage sample of 11,569 and 12,384 individuals in Madhya Pradesh and Maharashtra, respectively. Multi-variate analyses were conducted to find the effect of GFHI-enrolment on the desired outcomes. The instrumental variable method was applied to address potential endogeneity in insurance enrolment. Additionally, propensity score matching was done to ensure robustness. RESULTS Around 71% and 63% of surveyed individuals were enrolled under GFHI in Madhya Pradesh and Maharashtra, respectively. The hospitalisation rate did not differ much between the GFHI-enrolled and non-enrolled population. The average OOPE on hospitalisation was similar for the GFHI-enrolled and non-enrolled patients. The OOPE and catastrophic health expenditure in private hospitals remained very high, irrespective of GFHI enrolment. The pattern was similar in both states. Multi-variate adjusted models showed that GFHI had no significant effect on utilisation, quality, OOPE and catastrophic health expenditure. The above results were confirmed by propensity score matching. CONCLUSIONS Coverage by GFHI enrolment was ineffective in improving access, quality or financial protection for inpatient hospital care despite 5 years of implementation of the programme. Long-standing supply-side gaps and poor regulation of private providers continue to hamper the effectiveness of GFHI in India.
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Affiliation(s)
- Samir Garg
- State Health Resource Centre, Chhattisgarh, Raipur, India
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Yulistiani Y, Abdissalam E, Rahem A, Hamidi NF, Utomo FN. Cost burden of chemotherapy for Indonesian healthcare insurance and social security/Jaminan Kesehatan Nasional (JKN) patients with non-Hodgkin lymphoma. J Oncol Pharm Pract 2024:10781552241261250. [PMID: 38860280 DOI: 10.1177/10781552241261250] [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: 06/12/2024]
Abstract
BACKGROUND Cancer is among the leading causes of death globally, posing a significant economic burden on the healthcare sector. Among other types of cancer in Indonesia, non-Hodgkin lymphoma (NHL) ranks fifth in terms of prevalence. Chemotherapy for NHL patients is funded by a national health insurance scheme through the National Healthcare Insurance and Social Security/Jaminan Kesehatan Nasional (JKN). OBJECTIVE This study aimed to analyze cost burden of chemotherapy for JKN patients with NHL. DATA SOURCE A retrospective cross-sectional observational study was conducted among NHL patients receiving chemotherapy at a hospital in East Java, Indonesia in 2021. Data were collected from medical record documents and a total of 44 patient visits were recorded in this study. DATA SUMMARY The result showed that patient visits were dominated by females (55%), a significant proportion were aged 31 to 40 years (32%), and the majority were JKN participants in the Contribution Assistance Recipients/Penerima Bantuan Iuran (PBI) category (64%). The most chemotherapy regimen given was R-CHOP (68%) and the mean total cost for NHL patients was Indonesian Rupiah (IDR) 5,178,146. The highest mean cost burden was on chemotherapy drugs with a value of IDR 6,333,315. Based on the regimen, the highest cost burden was R-CHOP-Bleo with a mean cost of IDR 8,764,091. CONCLUSION Based on the results, the highest cost burden for chemotherapy among JKN patients with NHL in Indonesia was attributed to R-CHOP-Bleo regimen with a mean of IDR 8,764,091.
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Affiliation(s)
- Yulistiani Yulistiani
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia
- Department of Pharmacy, Universitas Airlangga Hospital, Surabaya, Indonesia
| | | | - Abdul Rahem
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia
| | - Nur Fauzi Hamidi
- Department of Pharmacy, Universitas Airlangga Hospital, Surabaya, Indonesia
- Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia
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Nugroho AW. The start-up of a neurosurgical service in an East Indonesian archipelagic province: The first 2-year experience of North Maluku Database in Neurosurgery (NOMADEN). Surg Neurol Int 2024; 15:53. [PMID: 38468665 PMCID: PMC10927227 DOI: 10.25259/sni_1026_2023] [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: 12/27/2023] [Accepted: 01/31/2024] [Indexed: 03/13/2024] Open
Abstract
Background Despite encouraging developments after its initial founding in Indonesia more than seven decades ago, inequity in access and availability of neurosurgical services throughout the country continues to pose a challenge. We aimed to elaborate on the start-up of a previously inactive neurosurgical service in North Maluku, an archipelagic province in East Indonesia, and describe cases managed within the first two years of service. Methods In the North Maluku Database in the Neurosurgery register, demographic and clinical information of neurosurgical patients admitted to Chasan Boesoirie General Hospital, Ternate, from January 2021 to December 2022, were analyzed. Surgically managed patients were rendered visually according to their decades of life and districts of events. Results There were 998 new patients (mean age ± standard deviation [SD]: 34.7 ± 19.6 years, 60.3% male) managed and 216 neurosurgical procedures (mean age ± SD: 33 ± 20.4 years, 67.1% male) performed. The majority of patients operated were within the 1st decade of life (18.5%), presented to the emergency room (56.5%), covered by national health insurance (69.4%), from outside Ternate (62.5%), diagnosed with neurotrauma (40.7%), and discharged alive (80.1%). Ternate was the only district where all seven types of neurological diseases were encountered. No surgeries were performed for patients from Taliabu, the farthest district from Ternate. Conclusion A large portion of neurosurgical patients in North Maluku were those young and at productive age who were transported from outside Ternate with acute neurological disease (particularly neurotrauma). Distance and geographical circumstances may have a profound effect on access to neurosurgical services.
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Ahmed A, Sayeed A, Tanwi TS, Saha N, Hanson M, Protyai DA, Hossain AT, Ahmed A, Rahman F, Akter E, Nusrat N, Badsha MS, Rahman A, Islam MK, Alam MS, Nahar Q, Arifeen SE, Rahman AE, Tahsina T. Trends and inequity in improved sanitation facility utilisation in Bangladesh: Evidence from Bangladesh Demographic and Health Surveys. BMC Res Notes 2023; 16:303. [PMID: 37908017 PMCID: PMC10619219 DOI: 10.1186/s13104-023-06555-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 10/05/2023] [Indexed: 11/02/2023] Open
Abstract
Improved sanitation is indispensable to human health. However, lack of access to improved sanitation remains one of the most daunting public health challenges of the twenty-first century in Bangladesh. The aim of the study was to describe the trends in access to improved sanitation facilities following the inequity gap among households in different socioeconomic groups in Bangladesh. Data from the Bangladesh Demographic and Health Survey (BDHS) 2007, 2011, 2014, and 2017-18 were extracted for this study. Inequity in access to improved sanitation was calculated using rich-poor ratio and concentration index to determine the changes in inequity across the time period. In Bangladesh, the proportion of households with access to improved sanitation increased steadily from 25.4% to 45.4% between 2007 and 2014, but slightly decreased to 44.0% in 2017-18. Age, educational status, marital status of household head, household wealth index, household size, place of residence, division, and survey year were significantly associated with the utilisation of improved sanitation. There is a pro-rich situation, which means that utilisation of improved sanitation was more concentrated among the rich across all survey years (Concentration Index ranges: 0.40 to 0.27). The government and other relevant stakeholders should take initiatives considering inequity among different socioeconomic groups to ensure the use of improved sanitation facilities for all, hence achieving universal health coverage.
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Affiliation(s)
- Anisuddin Ahmed
- Department of Women's and Children's Health, Uppsala University, 75205, Uppsala, Sweden.
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh.
| | - Abu Sayeed
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Tania Sultana Tanwi
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Nondo Saha
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Molly Hanson
- Department of Women's and Children's Health, Uppsala University, 75205, Uppsala, Sweden
| | | | - Aniqa Tasnim Hossain
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Ali Ahmed
- Western Sydney University, Penrith Campus, Sydney, Australia
| | - Fariya Rahman
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Ema Akter
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Nowrin Nusrat
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Md Shawon Badsha
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
| | - Afruna Rahman
- Infectious Disease Division (IDD), International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | | | - Md Shah Alam
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Quamrun Nahar
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Shams El Arifeen
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Tazeen Tahsina
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
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Fattah RA, Cheng Q, Thabrany H, Susilo D, Satrya A, Haemmerli M, Kosen S, Novitasari D, Puteri GC, Adawiyah E, Hayen A, Gilson L, Mills A, Tangcharoensathien V, Jan S, Asante A, Wiseman V. Incidence of catastrophic health spending in Indonesia: insights from a Household Panel Study 2018-2019. Int J Equity Health 2023; 22:185. [PMID: 37674199 PMCID: PMC10483778 DOI: 10.1186/s12939-023-01980-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 08/08/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Indonesia implemented one of the world's largest single-payer national health insurance schemes (the Jaminan Kesehatan Nasional or JKN) in 2014. This study aims to assess the incidence of catastrophic health spending (CHS) and its determinants and trends between 2018 and 2019 by which time JKN enrolment coverage exceeded 80%. METHODS This study analysed data collected from a two-round cross-sectional household survey conducted in ten provinces of Indonesia in February-April 2018 and August-October 2019. The incidence of CHS was defined as the proportion of households with out-of-pocket (OOP) health spending exceeding 10% of household consumption expenditure. Chi-squared tests were used to compare the incidences of CHS across subgroups for each household characteristic. Logistic regression models were used to investigate factors associated with incurring CHS and the trend over time. Sensitivity analyses assessing the incidence of CHS based on a higher threshold of 25% of total household expenditure were conducted. RESULTS The overall incidence of CHS at the 10% threshold fell from 7.9% to 2018 to 4.4% in 2019. The logistic regression models showed that households with JKN membership experienced significantly lower incidence of CHS compared to households without insurance coverage in both years. The poorest households were more likely to incur CHS compared to households in other wealth quintiles. Other predictors of incurring CHS included living in rural areas and visiting private health facilities. CONCLUSIONS This study demonstrated that the overall incidence of CHS decreased in Indonesia between 2018 and 2019. OOP payments for health care and the risk of CHS still loom high among JKN members and among the lowest income households. More needs to be done to further contain OOP payments and further research is needed to investigate whether CHS pushes households below the poverty line.
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Affiliation(s)
- Rifqi Abdul Fattah
- Centre for Social Security Studies, University of Indonesia, Jakarta, Indonesia
| | - Qinglu Cheng
- Kirby Institute, University of New South Wales, Sydney, Australia.
- Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, High Street, 2052, Kensington, NSW, Australia.
| | | | - Dwidjo Susilo
- Faculty of Medicine and Health, University of Muhammadiyah, Jakarta, Indonesia
| | - Aryana Satrya
- Centre for Social Security Studies, University of Indonesia, Jakarta, Indonesia
- Department of Management, Faculty of Economics, University of Indonesia, Depok, Indonesia
| | - Manon Haemmerli
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Danty Novitasari
- Centre for Social Security Studies, University of Indonesia, Jakarta, Indonesia
| | - Gemala Chairunnisa Puteri
- Centre for Social Security Studies, University of Indonesia, Jakarta, Indonesia
- Centre for Health Economics and Policy Studies, Faculty of Public Health, University of Indonesia, Jakarta, Indonesia
| | - Eviati Adawiyah
- Biostatistics and Demography Department, Faculty of Public Health, University of Indonesia, Jakarta, Indonesia
| | - Andrew Hayen
- School of Public Health, University of Technology Sydney, Sydney, Australia
| | - Lucy Gilson
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- Health Policy and Systems Division, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Anne Mills
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, Australia
| | - Augustine Asante
- School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia
| | - Virginia Wiseman
- Kirby Institute, University of New South Wales, Sydney, Australia
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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Pham MD, Sawyer SM, Agius PA, Kennedy EC, Ansariadi A, Kaligis F, Wiguna T, Wulan NR, Devaera Y, Medise BE, Riyanti A, Wiweko B, Cini KI, Tran T, Fisher J, Luchters S, Azzopardi PS. Foregone health care in adolescents from school and community settings in Indonesia: a cross-sectional study. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 13:100187. [PMID: 37383556 PMCID: PMC10305962 DOI: 10.1016/j.lansea.2023.100187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/21/2022] [Accepted: 03/22/2023] [Indexed: 06/30/2023]
Abstract
Background Adolescence is a development period marked by the onset of a new set of health needs. The present study sought to quantify the prevalence of foregone care (not seeking medical care when needed) and identify which adolescents are at greater risk of having unmet healthcare needs. Methods A multi-stage random sampling strategy was used to recruit school participants (grade 10-12) in two provinces in Indonesia. Respondent driven sampling was used to recruit out-of-school adolescents in the community. All participants completed a self-reported questionnaire which measured healthcare seeking behaviours, psychosocial wellbeing, use of healthcare services, and perceived barriers to accessing healthcare. Multivariable regression analysis was performed to examine factors associated with foregone care. Findings A total of 2161 adolescents participated in the present study and nearly one in four adolescents reported foregone care in the past year. Experiences of poly-victimisation and seeking care for mental health needs increased the risk of foregone care. In-school adolescents who reported psychological distress [adjusted risk ratio (aRR) = 1.88, 95%CI = 1.48-2.38] or had high body mass index (aRR = 1.25, 95%CI = 1.00-1.57) were at greater risk of foregone care. The leading reason for foregone care was lack of knowledge of available services. In-school adolescents predominantly reported non-access barriers to care (e.g., perception of the health concern or anxiety about accessing care) whereas most out-of-school adolescents reported access barriers (e.g., did not know where to get care or could not pay). Interpretation Foregone care is common among Indonesian adolescents, especially in adolescents with mental and physical health risks. Differences between in-school and out-of-school adolescents suggest that interventions to promote appropriate healthcare use will need tailoring. Further research is needed to determine causal relationships around barriers in access to healthcare. Funding Australia-Indonesia Centre.
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Affiliation(s)
- Minh D. Pham
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Susan M. Sawyer
- Murdoch Children's Research Institute, Parkville, Melbourne, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Paul A. Agius
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
- Faculty of Health, Deakin University, Melbourne, Australia
| | - Elissa C. Kennedy
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
- Murdoch Children's Research Institute, Parkville, Melbourne, Australia
| | - Ansariadi Ansariadi
- Centre for Epidemiology and Population Health Studies, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
| | - Fransiska Kaligis
- Department of Psychiatry, Universitas Indonesia, Jakarta, Indonesia
- Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Tjhin Wiguna
- Department of Psychiatry, Universitas Indonesia, Jakarta, Indonesia
- Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | | | - Yoga Devaera
- Department of Child Health, Universitas Indonesia, Jakarta, Indonesia
| | - Bernie E. Medise
- Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Department of Child Health, Universitas Indonesia, Jakarta, Indonesia
| | - Aida Riyanti
- Department of Obstetrics and Gynaecology, Universitas Indonesia, Jakarta, Indonesia
| | - Budi Wiweko
- Research and Social Services, Universitas Indonesia, Jakarta, Indonesia
| | - Karly I. Cini
- Burnet Institute, Melbourne, Australia
- Murdoch Children's Research Institute, Parkville, Melbourne, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Thach Tran
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Jane Fisher
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Stanley Luchters
- Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
- Centre for Sexual Health and HIV & AIDS Research (CeSHHAR), Harare, Zimbabwe
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Belgium
| | - Peter S. Azzopardi
- Burnet Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
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Pratiwi AB, Padmawati RS, Mulyanto J, Willems DL. Patients values regarding primary health care: a systematic review of qualitative and quantitative evidence. BMC Health Serv Res 2023; 23:400. [PMID: 37098522 PMCID: PMC10131468 DOI: 10.1186/s12913-023-09394-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 09/15/2022] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Accessible and high-quality primary health care (PHC) is fundamental to countries moving towards universal health coverage. In order to improve the quality of patient-centered care provided in PHC, a comprehensive understanding of patients' values is crucial to address any gaps in the health care system. This systematic review aimed to identify patients' values relevant to PHC. METHODS We searched primary qualitative and quantitative studies about patients' values related to primary care in PubMed and EMBASE (Ovid) from 2009 to 2020. The studies' quality was assessed using Joanna Briggs Institute (JBI) Critical Appraisal Checklist for both quantitative and qualitative studies and Consolidated Criteria for Reporting Qualitative Studies (COREQ) for qualitative studies. A thematic approach was used in the data synthesis. OUTCOME The database search resulted in 1,817 articles. A total of 68 articles were full-text screened. Data were extracted from nine quantitative and nine qualitative studies that met the inclusion criteria. The participants of the studies were mainly the general population in high-income countries. Four themes emerged from the analysis: patients' values related to privacy and autonomy; values associated with the general practitioners including virtuous characteristics, knowledge and competence; values involving patient-doctor interactions such as shared decision-making and empowerment; and core values related to the primary care system such as continuity, referral, and accessibility. CONCLUSIONS This review reveals that the doctor's personal characteristics and their interactions with the patients are critical considerations concerning the primary care services from the patients' point of view. The inclusion of these values is essential to improve the quality of primary care.
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Affiliation(s)
- Agnes Bhakti Pratiwi
- Department of Ethics, Law, and Humanities, Faculty of Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.
- Department of Medical Education and Bioethics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Retna Siwi Padmawati
- Department of Health Behavior, Environment, and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Center for Bioethics and Medical Humanities, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Joko Mulyanto
- Department of Public Health and Community Medicine, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia
- Department of Public and Occupational Health, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Dick L Willems
- Department of Ethics, Law, and Humanities, Faculty of Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
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Endaryanto A, Dewi A, Kusbaryanto, Nugraha RA. Trend in the admissions of patients with non-COVID-19 respiratory symptoms during COVID-19 pandemic and its impact on hospital finances in surabaya, Indonesia. Heliyon 2023; 9:e15122. [PMID: 37035376 PMCID: PMC10065813 DOI: 10.1016/j.heliyon.2023.e15122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 03/11/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Background COVID-19 cases surge, it has a crucial impact on healthcare systems, with rapidly increasing demand for healthcare resources in hospitals and intensive care units (ICUs) in Indonesia and worldwide. It is necessary to quantify the extent to which the effects of the COVID-19 pandemic on the hospital admissions, and clinical and financial outcomes of patients with non-COVID-19 respiratory symptoms. Objective To determine whether the COVID-19 pandemic changed the hospitalisation of child and adult patients with non-COVID-19 respiratory conditions and whether these changes affected the patient's disease condition, clinical outcomes, and hospital finances. Methods A retrospective cohort study was conducted from May 1, 2018 (before the COVID-19 pandemic) until December 31, 2021. Total sampling was done to compare hospital admission of patients with non-COVID-19 respiratory symptoms before versus during the COVID-19 pandemic. The results were analyzed using SPSS 26.0 and SmartPLS.v.3.2.9. Results There was a reduction in hospitalisations for respiratory disorders unrelated to COVID-19 during the pandemic by 55.3% in children and 47.8% in adult patients. During the pandemic, the average hospital revenue per patient of child and adult patients increased significantly, but the profit per patient decreased. Pathway analysis showed that in children, the COVID-19 Pandemic changed disease severity and complexity (β = 0.132, P < 0.001), as well as clinical outcomes (β = 0.029, P < 0.05). In adults, the COVID-19 pandemic improves disease severity and complexity (β = -0.020, P < 0.001), as well as clinical outcomes (β = -0.013, P < 0.001). COVID-19 pandemic increases care charges (in children with β = 0.135, P < 0.001; and in the adult patients with β = 0.110, P < 0.001), worsens hospital financial outcomes relating to child (β = -0.093, P < 0.001) and adult patient (β = -0.073, P < 0.001). In adult patients, seasonal variations moderate the impact of the COVID-19 pandemic on improving disease conditions (β = -0.032, P=<0.001). The child structural model effectively predicted clinical outcomes (Q2 = 0.215) and financial outcomes (Q2 = 0.462). The adult structural model effectively predicted clinical outcomes (Q2 = 0.06) and financial outcomes (Q2 = 0.472). Conclusion The conclusions are that the number of non-COVID respiratory patients decreased during the COVID-19 pandemic (47.8% in adult patients, 55.3% in child patients). Disease severity and complexity increased in child patients but decreased in adult patient. Costs of care and insurance payments increased. Since the insurance payments did not increase as much as the cost of care, hospital profit decreased.
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Pratiwi AB, Padmawati RS, Willems DL. Behind open doors: Patient privacy and the impact of design in primary health care, a qualitative study in Indonesia. Front Med (Lausanne) 2022; 9:915237. [PMID: 36341251 PMCID: PMC9626974 DOI: 10.3389/fmed.2022.915237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/29/2022] [Indexed: 11/14/2023] Open
Abstract
Background The importance and attention to patient privacy in recent decades have been directed mostly toward medical data protection in electronic means. Hence, other aspects of patients' privacy were overlooked, particularly in the primary health care (PHC) level. In the attempt of many countries, including Indonesia, to strive toward universal healthcare provision, a strong and accessible PHC is essential. This situation may create a tension in privacy provision where patients who need to disclose secrets may opt for other facilities, such as hospitals. This study aimed to describe and discuss patients' and doctors' perspectives and experiences about privacy in PHC in Indonesia, particularly since the universal coverage started. Design and methods We used in-depth interviews and observations to gather information. Inductive and thematic data analyses were conducted. We interviewed PHC users (n = 17), doctors (n = 16), other PHC staff (n = 7), and non-PHC users (n = 5) and observed the PHC activities. Results We found that privacy is imperative for both patients and doctors. Design and conditions in PHC, including consultation room doors open, separate rooms for treatment, and patients' symptoms asked by other staff were aspects that undermine privacy in PHC. Inadequate physical and informational privacy protection during a patient's visit has affected the quality of care negatively in ways that impede proper anamneses and physical examination. Conclusion Ensuring patients' and doctors' physical and informational privacy is essential to creating PHC as the primary source of care that responds to the privacy values of its users, but it has been overlooked. The PHC building designs and care provision guidelines should incorporate the privacy needs of patients and doctors.
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Affiliation(s)
- Agnes Bhakti Pratiwi
- Department of Ethics, Law, and Humanities, Amsterdam University Medical Center, Faculty of Medicine, University of Amsterdam, Amsterdam, Netherlands
- Department of Medical Education and Bioethics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Retna Siwi Padmawati
- Department of Health Behavior, Environment, and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Center for Bioethics and Medical Humanities, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Dick L. Willems
- Department of Ethics, Law, and Humanities, Amsterdam University Medical Center, Faculty of Medicine, University of Amsterdam, Amsterdam, Netherlands
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Sidipratomo P, Pandelaki J, Matondang SB, Ramandika H, Sitorus RS, Karismaputri KS, Anindyagari. Intra-arterial chemotherapy for retinoblastoma: Our first experience in Indonesia. Radiol Case Rep 2022; 17:4713-4716. [PMID: 36199445 PMCID: PMC9527629 DOI: 10.1016/j.radcr.2022.09.004] [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: 08/08/2022] [Revised: 08/30/2022] [Accepted: 09/04/2022] [Indexed: 11/07/2022] Open
Abstract
Intra-arterial chemotherapy (IAC) has become the mainstay therapy for retinoblastoma group D and E for the past few decades. However, IAC had never been done in Indonesia before. In this report, we present a case of a 2-year-old girl with recurrent Group D retinoblastoma of the left eye that improved significantly after one session of IAC, the first IAC in Indonesia.
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Affiliation(s)
- Prijo Sidipratomo
- Department of Radiology, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jl. Pangeran Diponegoro No. 71, Central Jakarta 10430, Indonesia,Corresponding author.
| | - Jacub Pandelaki
- Department of Radiology, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jl. Pangeran Diponegoro No. 71, Central Jakarta 10430, Indonesia
| | - Sahat B.R.E. Matondang
- Department of Radiology, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jl. Pangeran Diponegoro No. 71, Central Jakarta 10430, Indonesia
| | - Heltara Ramandika
- Department of Radiology, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jl. Pangeran Diponegoro No. 71, Central Jakarta 10430, Indonesia
| | - Rita Sita Sitorus
- Department of Ophthalmology, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jl. Pangeran Diponegoro No. 71, Central Jakarta 10430, Indonesia
| | - Komang S. Karismaputri
- Department of Radiology, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jl. Pangeran Diponegoro No. 71, Central Jakarta 10430, Indonesia
| | - Anindyagari
- Department of Radiology, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jl. Pangeran Diponegoro No. 71, Central Jakarta 10430, Indonesia
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11
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Laksono AD, Nugraheni WP, Rohmah N, Wulandari RD. Health insurance ownership among female workers in Indonesia: does socioeconomic status matter? BMC Public Health 2022; 22:1798. [PMID: 36138387 PMCID: PMC9494853 DOI: 10.1186/s12889-022-14189-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Female workers are vulnerable groups in the Indonesian context, and female workers must be responsible for domestic problems and earn a living. The study aimed to analyze the role of socioeconomic on health insurance ownership among female workers in Indonesia. METHODS The study population was all female workers in Indonesia. This cross-sectional study involved 7,943 respondents. The study analyzed health insurance ownership as an outcome variable and socioeconomic status as an exposure variable. The study also involved five control variables: residence, age, marital, education, and occupation. The research used multinomial logistic regression in the final step. RESULTS The results show the poorest female workers have a possibility of 0.735 times more than the richest to have NHI (AOR 0.733; 95% CI 0.733-0.737). The poorer female workers have 0.939 times less likely than the richest to have NHI (AOR 0.939; 95% CI 0.937-0.942). Female workers with middle socioeconomic status are possibly 0.833 times less than the richest to have NHI (AOR 0.833; 95% 0.831-0.835). Moreover, the richer female workers have 1.028 times more likely than the richest to have NHI (AOR 1.028; 95% CI 1.025-1.030). Moreover, all socioeconomic statuses have a lower possibility than the richest of having other health insurance. CONCLUSIONS The study concluded that socioeconomic has a role in health insurance ownership among female workers in Indonesia.
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Affiliation(s)
- Agung Dwi Laksono
- National Research and Innovation Agency Republic of Indonesia, Jakarta, Indonesia
| | | | - Nikmatur Rohmah
- Faculty of Health Science, Muhammadiyah University of Jember, East Java, Indonesia
| | - Ratna Dwi Wulandari
- Department of Administration and Health Policy, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia.
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12
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Rahman AN, Herman H, Kriswanto E, Faried A, Nasser MK. Combine Approach of Proximal Fibula Osteotomy (PFO) Followed by Intra-Articular Dextrose Prolotherapy in Severe Medial Knee Osteoarthritis. J Pain Res 2022; 15:1983-1993. [PMID: 35873953 PMCID: PMC9296878 DOI: 10.2147/jpr.s357284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 07/04/2022] [Indexed: 12/19/2022] Open
Abstract
Background Knee osteoarthritis (OA) is a chronic and progressive degenerative disease. It resulted from mechanical and chemical disorders that damage the joint and the underlying bone. The management of knee OA is challenging due to poor self-regeneration of connective tissues. Surgical treatment with prolotherapy approaches was conducted to treat medial compartment knee OA. Aim To know the injection frequency to reach a 50% improvement in VAS score and WOMAC index. Methods Six patients who suffered from late-stage medial compartment knee OA underwent PFO followed by twelve sessions of intra-articular dextrose prolotherapy. The subjective pain score, visual analog scale (VAS), was assessed based on the patient subjectiveness before and after treatment. Patients marked the score from 0 to 10 cm to describe the current pain state. The functional index, the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index used to evaluate the Patient's clinical symptoms. It ranges from 0 to 96 points consisting of three main sections: pain (total 20 points), stiffness (total: eight points), and physical function disability (total 68 points). Higher scores indicate severe symptoms and function. Results Four patients showed pain relief and functional improvement with more than 50% scores of VAS and WOMAC after the treatment. Two patients received more than twelve doses of intra-articular dextrose prolotherapy due to a lack of progress. Conclusion This study provides clinical evidence for a new treatment strategy for advanced knee OA. This combined therapy improves the patient's daily activity function and postpones the need for total knee arthroplasty (TKA).
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Affiliation(s)
- Alif Noeriyanto Rahman
- Musculoskeletal Pain Intervention and Regeneration, Faculty of Medicine Universitas Padjadjaran, Orthopaedic and Pain Intervention Center of Sentra Medika Hospital, Depok, Indonesia.,Pain Intervention and Regeneration, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Herry Herman
- Pain Intervention and Regeneration, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia.,Department of Orthopaedic and Traumatology Hasan Sadikin General Hospital Faculty of Medicine Padjadjaran University, Bandung, West Java, Indonesia
| | - Eri Kriswanto
- Pain Intervention and Regeneration, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia.,Department of Orthopaedic and Traumatology Baptist Hospital, Kediri, Indonesia
| | - Ahmad Faried
- Pain Intervention and Regeneration, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia.,Department of Neurosurgery, Hasan Sadikin General Hospital Faculty of Medicine Padjadjaran University, Bandung, West Java, Indonesia
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13
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Prabandari YS, Hartanti W, Syafriani, Widiastuti M, Witaningrum R, Hutajulu SH, Allsop MJ. "Alas … my sickness becomes my family's burden": A nested qualitative study on the experience of advanced breast cancer patients across the disease trajectory in Indonesia. Breast 2022; 63:168-176. [PMID: 35413611 PMCID: PMC9010781 DOI: 10.1016/j.breast.2022.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/17/2022] [Accepted: 04/01/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Limited research exists exploring the experience of living with advanced breast cancer in Indonesia. We sought to explore the narratives of women with breast cancer across the illness trajectory to understand their experiences from diagnosis to accessing and undergoing cancer treatments to inform the development of cancer care. Methods A nested, exploratory study adopting a qualitative approach. We conducted in-depth face-to-face interviews with women living with advanced breast cancer in Yogyakarta, Indonesia. We purposively sampled participants by age, education and marital status. All interviews were transcribed verbatim with thematic analysis used to identify, analyse and report patterns and themes within the data. Findings Four main themes were derived: 1) Early experiences, prior to accessing health care; 2) Navigating the system to access treatment; 3) Enduring chemotherapy and advancing disease, with crucial family support; 4) Seeking normalcy and belief in treatment. From initial symptoms through to undergoing treatments, the experience of participants was punctuated by barriers and challenges. Discussion Presentation delays were driven by dismissing initial symptoms, seeking alternative medicines, and fear of surgery. Access to healthcare required participants to contend with long-distance travel to facilities, tiered and convoluted referral processes, and adverse effects and financial impact of treatments. Individual determination, belief in God, and the role of families were critical throughout the disease trajectory. Adopting a focus across the disease trajectory facilitated the identification of enduring and persistent challenges to care delivery that can inform targeted development and optimisation of care delivery for women with breast cancer. This is the first exploration of breast cancer patients' experiences across the disease trajectory in Indonesia. Patients endure convoluted referral processes, long distance travel, and commonly experience financial burden and severe side effects. Family play a critical role in providing physical, psychological and financial support during treatment. Healing is understood as resuming normalcy in daily activity, mobility and independence rather than cure. Focusing across the disease trajectory facilitated the identification of enduring and persistent challenges to care delivery that can inform targeted development of care delivery.
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Affiliation(s)
- Yayi Suryo Prabandari
- Department of Health Behavior, Environment and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia; Center of Bioethics and Medical Humanities, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia.
| | - Wika Hartanti
- Center of Bioethics and Medical Humanities, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia.
| | - Syafriani
- Center of Health Behavior and Promotion, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia.
| | - Mentari Widiastuti
- Center of Health Behavior and Promotion, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia.
| | - Riani Witaningrum
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Dr. Sardjito General Hospital, Yogyakarta, Indonesia.
| | - Susanna Hilda Hutajulu
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia.
| | - Matthew John Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, UK.
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14
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Garg S, Bebarta KK, Tripathi N. Household expenditure on non-Covid hospitalisation care during the Covid-19 pandemic and the role of financial protection policies in India. Arch Public Health 2022; 80:108. [PMID: 35366948 PMCID: PMC8976164 DOI: 10.1186/s13690-022-00857-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 03/17/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Despite global guidance for maintaining essential non-Covid health services during the pandemic, there is a concern that existing services faced a major disruption. The access as well as affordability of healthcare could have suffered during the pandemic, especially in developing countries including India. There are no population based studies available in India on changes in access and financial risk for non-Covid hospitalisation during the pandemic. India has a policy of Publicly Funded Health Insurance (PFHI) to ensure access and financial protection for hospital care but no information is available on its performance during the pandemic. The current study was aimed to find out the change in access and financial protection for non-Covid hospitalisations during the Covid-19 pandemic and to examine the performance of PFHI in this context. METHODS Panel data was analyzed, from two rounds of annual household surveys conducted in Chhattisgarh state for year 2019 and 2020. The survey followed a two-stage population based sample of around 3000 households, representative for the state. Two kinds of measures of catastrophic health expenditure were used - based on annual household consumption expenditure and on non-food consumption expenditure. Multivariate analysis was carried out to find determinants of utilisation and spending. In addition, Propensity Score Matching method was applied to find effect of PFHI schemes. RESULTS Utilisation of hospital care per 1000 population reduced from 58.2 in 2019 to 36.6 during the pandemic i.e. in 2020. The share of public hospitals in utilisation increased from 60.1% in 2019 to 67.0% in 2020. Incidence of catastrophic expenditure was significantly greater during the pandemic. The median Out of Pocket Expenditure (OOPE) in private hospitals doubled from 2019 to 2020. The size of OOPE and occurrence of catastrophic expenditure were significantly associated with utilisation in private hospitals. Enrolment under PFHI schemes including the Ayushman Bharat-Pradhan Mantri Jan Arogaya Yojana (PMJAY) was not effective in reducing OOPE or catastrophic expenditure. CONCLUSION While the utilisation of hospital care dropped during the pandemic, the private hospitals became further unaffordable. The government policy for financial protection through health insurance remained ineffective during the pandemic.
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Affiliation(s)
- Samir Garg
- State Health Resource Centre, Chhattisgarh, Raipur India
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Kusumo Rahardjo A. Case series: Treatment outcome of late presentation of acute appendicitis. Int J Surg Case Rep 2022; 92:106881. [PMID: 35231734 PMCID: PMC8885464 DOI: 10.1016/j.ijscr.2022.106881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/13/2022] [Accepted: 02/22/2022] [Indexed: 10/29/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Late presentation of Acute Appendicitis (AA) is associated with a high risk of perforation-related complications and morbidity. Even though AA is a well-known disease, late presented AA is not uncommon. This study aims to report the treatment outcome of several cases of late presented AA, treated at a government public hospital at Mojokerto, a small town in East Java, Indonesia, where no previous report were known. CASE PRESENTATION Eleven patients experienced surgical removal of the appendix during one year period (January 2021 until December 2021). Those patients are treated by one surgeon at Dr. Wahidin Sudiro Husodo Kota Mojokerto Hospital. Furthermore, they were divided into 3 groups, (A: presented within 2 days after onset of abdominal pain; B: presented within 2-5 days after onset of abdominal pain; C: presented more than 5 days after onset of abdominal pain). The morbidities for all patients were studied, which they all followed up until the surgery wound healed completely. CLINICAL DISCUSSION The perforation of the appendix occurred in 7 patients consisting of 2 in Group A, 2 in Group B, and 3 in Group C. Furthermore, the two patients who experienced extension of surgical resection were all from Group C and this group has 10.67 days of highest Length of Stay (LOS). The two patients with perforated AA, 1 from group A and 1 from group C, developed surgical site infection. The main reason for the late presentation of AA was non-operative treatment due to equivocal clinical findings. CONCLUSION The late presentation of AA causes perforation-associated morbidities, including a possible extension of surgical resection, long hospitalization period, and surgical site infection. Some late presented AA does not develop into perforation since perforated and non-perforated AA may represents two different entities.
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Affiliation(s)
- Arif Kusumo Rahardjo
- Department of Surgery, Dr Wahidin Sudiro Husodo Kota Mojokerto Hospital, Mojokerto, East Java, Indonesia.
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