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Doubova SV, Leslie HH, Pérez-Cuevas R, Kruk ME, Arsenault C. Users' perception of quality as a driver of private healthcare use in Mexico: Insights from the People's Voice Survey. PLoS One 2024; 19:e0306179. [PMID: 38917130 PMCID: PMC11198766 DOI: 10.1371/journal.pone.0306179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 06/11/2024] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVE The Mexican government has pursued multiple initiatives to improve healthcare coverage and financial protection. Yet, out-of-pocket health spending and use of private sector providers in Mexico remains high. In this paper, we sought to describe the characteristics of public and private healthcare users, describe recent visit quality across provider types, and to assess whether perceiving the public healthcare sector as poor quality is associated with private health sector use. METHODS AND FINDINGS We analyzed the cross-sectional People's Voice Survey conducted from December 2022 to January 2023. We used Chi-square tests to compare contextual, individual, and need-for-care factors and ratings of most recent visits between users of public (social security and other public providers) and private sector providers (stand-alone private providers and providers adjacent to pharmacies). We used a multivariable Poisson regression model to assess associations between low ratings of public healthcare sources and the use of private care. Among the 811 respondents with a healthcare visit in the past year, 31.2% used private sources. Private healthcare users were more educated and had higher incomes than public healthcare users. Quality of most recent visit was rated more highly in private providers (70.2% rating the visit as excellent or very good for stand-alone private providers and 54.3% for pharmacy-adjacent doctors) compared to social security (41.6%) and other public providers (46.6%). Those who perceived public health institutions as low quality had a higher probability of seeking private healthcare. CONCLUSION Users rated public care visits poorly relative to private care; at the population level, perceptions of poor quality care may drive private care use and hence out-of-pocket costs. Improving public healthcare quality is necessary to ensure universal health coverage.
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Affiliation(s)
- Svetlana V. Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Hannah H. Leslie
- Division of Prevention Science, University of California San Francisco, San Francisco, California, United States of America
| | - Ricardo Pérez-Cuevas
- Division of Social Protection and Health, Interamerican Development Bank, Washington, DC, United States of America
| | - Margaret E. Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Catherine Arsenault
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States of America
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Lin C, Tu P, Parker T, Mella-Velazquez A, Bier B, Braund WE. The Influences of SES on Patient Choice of Doctor: A Systematic Review. Am J Prev Med 2024:S0749-3797(24)00210-1. [PMID: 38906427 DOI: 10.1016/j.amepre.2024.06.012] [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: 02/22/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/23/2024]
Abstract
INTRODUCTION As patients become increasingly involved in healthcare decision-making, it is important to examine the drivers behind patient choice of doctor (PCOD); the initial decision can have lasting impacts on patients' trust in providers and outcomes. However, limited studies have explored PCOD relative to socioeconomic status (SES) or health disparity. This review identified similar preferences and varied decision criteria in PCOD across SES groups. METHODS PubMed, PsycINFO, Web of Science, and relevant cross-references were searched for articles published between January 2007-September 2022. Papers were screened using Covidence. Included studies examined PCOD by income and/or educational levels. Analysis was performed in 2022-2023. RESULTS From 4,449 search results, 29 articles were selected (16 countries, 14 medical specialties, total of 32,651 participants). Higher-SES individuals ranked physician characteristics (e.g., qualifications, empathy) or performance more important than cost or convenience. Lower-SES individuals often had to prioritize logistical factors (e.g., insurance coverage, distance) due to resource constraints and gaps in knowledge or awareness about options. Despite differing healthcare systems, such divergence in PCOD were relatively consistent across countries. Some patients, especially females and disadvantaged groups, favored gender-concordant physicians for intimate medical matters (e.g., gynecologist); this partiality was not limited to conservative cultures. Few researchers investigated the outcomes of PCOD and indicated that lower-SES populations inadvertently chose, experienced, or perceived lower quality care. DISCUSSION Patients' decision criteria varied by SES, even under national systems intended for universal access, indicating the impacts of social determinants and structural inequities. Health education supporting patient decision-making and research on how SES affects PCOD and outcomes could help reduce health disparity.
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Affiliation(s)
- Cheryl Lin
- Policy and Organizational Management Program, Duke University, Durham, North Carolina
| | - Pikuei Tu
- Policy and Organizational Management Program, Duke University, Durham, North Carolina.
| | - Taylor Parker
- Policy and Organizational Management Program, Duke University, Durham, North Carolina
| | | | - Brooke Bier
- Policy and Organizational Management Program, Duke University, Durham, North Carolina
| | - Wendy E Braund
- Pennsylvania Department of Health, Harrisburg, Pennsylvania
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Rzadki K, Baqri W, Yermakhanova O, Habbous S, Das S. Choreographed expansion of services results in decreased patient burden without compromise of outcomes: An assessment of the Ontario experience. Neurooncol Pract 2024; 11:178-187. [PMID: 38496909 PMCID: PMC10940827 DOI: 10.1093/nop/npad076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Abstract
Background Neuro-oncology care in Ontario, Canada has been historically centralized, at times requiring significant travel on the part of patients. Toward observing the goal of patient-centered care and reducing patient burden, 2 additional regional cancer centres (RCC) capable of neuro-oncology care delivery were introduced in 2016. This study evaluates the impact of increased regionalization of neuro-oncology services, from 11 to 13 oncology centers, on healthcare utilization and travel burden for glioblastoma (GBM) patients in Ontario. Methods We present a cohort of GBM patients diagnosed between 2010 and 2019. Incidence of GBM and treatment modalities were identified using provincial health administrative databases. A geographic information system and spatial analysis were used to estimate travel time from patient residences to neuro-oncology RCCs. Results Among the 5242 GBM patients, 79% received radiation as part of treatment. Median travel time to the closest RCC was higher for patients who did not receive radiation as part of treatment than for patients who did (P = .03). After 2016, the volume of patients receiving radiation at their local RCC increased from 62% to 69% and the median travel time to treatment RCCs decreased (P = .0072). The 2 new RCCs treated 35% and 41% of patients within their respective catchment areas. Receipt of standard of care, surgery, and chemoradiation (CRT), increased by 11%. Conclusions Regionalization resulted in changes in the healthcare utilization patterns in Ontario consistent with decreased patient travel burden for patients with GBM. Focused regionalization did not come at the cost of decreased quality of care, as determined by the delivery of a standard of care.
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Affiliation(s)
- Kathryn Rzadki
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Wafa Baqri
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Steven Habbous
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Sunit Das
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
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Duncanson E, Davies CE, Muthuramalingam S, Johns E, McColm K, Hempstalk M, Tasevski Z, Gray NA, McDonald SP. Patient Perspectives of Center-Specific Reporting in Kidney Failure Care: An Australian Qualitative Study. Kidney Int Rep 2024; 9:843-852. [PMID: 38765598 PMCID: PMC11101730 DOI: 10.1016/j.ekir.2024.01.001] [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: 08/30/2023] [Revised: 12/13/2023] [Accepted: 01/02/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Public reporting of quality of care indicators in healthcare is intended to inform consumer decision-making; however, people may be unaware that such information exists, or it may not capture their priorities. The aim of this study was to understand the views of people with kidney disease about public reporting of dialysis and transplant center outcomes. Methods This qualitative study involved 27 patients with lived experience of kidney disease in Australia who participated in 11 online focus groups between August and December 2022. Transcripts were analyzed thematically. Results Patients from all Australian states and territories participated, with 22 (81%) having a functioning kidney transplant and 22 (81%) having current or previous experience of dialysis. Five themes were identified as follows: (i) surrendering to the health system, (ii) the complexity of quality, (iii) benefits for patient care and experience, (iv) concerned about risks and unintended consequences, and (v) optimizing the impact of data. Conclusion Patients desire choice among kidney services but perceive this as rarely possible in the Australian context. Health professionals are trusted to make decisions about appropriate centers. Public reporting of center outcomes may induce fear and a loss of balanced perspective; however, it was supported by all participants and represents an opportunity for self-advocacy and informed decision-making. Strategies to mitigate potential risks include availability of trusted clinicians and community members to aid in data interpretation, providing context about centers and patients, and framing statistics to promote positivity and hope.
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Affiliation(s)
- Emily Duncanson
- Australia and New Zealand Dialysis and Transplant Registry, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Christopher E. Davies
- Australia and New Zealand Dialysis and Transplant Registry, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Shyamsundar Muthuramalingam
- Australia and New Zealand Dialysis and Transplant Registry, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Effie Johns
- Australia and New Zealand Dialysis and Transplant Registry, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Kate McColm
- Australia and New Zealand Dialysis and Transplant Registry, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Matty Hempstalk
- Australia and New Zealand Dialysis and Transplant Registry, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
- Transplant Australia, Sydney, New South Wales, Australia
| | - Zoran Tasevski
- Australia and New Zealand Dialysis and Transplant Registry, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Nicholas A. Gray
- Australia and New Zealand Dialysis and Transplant Registry, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
- Renal Unit, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
- School of Health, University of Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Stephen P. McDonald
- Australia and New Zealand Dialysis and Transplant Registry, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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Mousavi S. Global Ethical Principles in Healthcare Networks, Including Debates on Euthanasia and Abortion. Cureus 2024; 16:e59116. [PMID: 38803720 PMCID: PMC11128767 DOI: 10.7759/cureus.59116] [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] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
In today's ever-evolving healthcare landscape, the focus is shifting towards integrated care, inter-organizational cooperation, and healthcare networks (HCNs) as alternatives to traditional healthcare institutions. This transformation is driven by factors such as an aging population and increasing healthcare costs, necessitating a reevaluation of ethical considerations to ensure the well-being of patients remains central. This review provides a narrative overview of ethics within HCNs, with a focus on patient-centered medical ethics. It elaborates on the four fundamental ethical principles, namely justice, beneficence, nonmaleficence, and autonomy. The principle of justice underscores HCNs' ethical obligation to provide equitable and transparent access to all patients, ensuring fairness in resource allocation. The principle of nonmaleficence underscores the responsibility to prioritize patient safety, while beneficence obliges HCNs to ensure continuity of care across all dimensions. Furthermore, the principle of autonomy is redefined as a commitment to actively promote and respect patient choices. HCNs that do not adhere to these ethical principles raise concerns and lack ethical justification. Additionally, the review delves into the legal aspects of euthanasia and abortion, both of which present complex ethical challenges in healthcare systems globally. A comparative analysis is provided, examining their legal status in Islamic countries, European nations, and the United States. This study sheds light on the evolving ethical landscape in HCNs and the diverse global perspectives on contentious issues. Therefore, harmonizing legislation and defining appropriate boundaries are crucial steps toward upholding ethical standards in healthcare practices on a global scale.
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Affiliation(s)
- Safa Mousavi
- Public Health, California State University, Fresno, USA
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Kadom N, Lasiecka ZM, Nemeth AJ, Rykken JB, Lui YW, Seidenwurm D. Patient Engagement in Neuroradiology: A Narrative Review and Case Studies. AJNR Am J Neuroradiol 2024; 45:250-255. [PMID: 38216301 DOI: 10.3174/ajnr.a8077] [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: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 01/14/2024]
Abstract
The field of patient engagement in radiology is evolving and offers ample opportunities for neuroradiologists to become involved. The patient journey can serve as a model that inspires patient engagement initiatives. The patient journey in radiology may be viewed in 5 stages: 1) awareness that an imaging test is needed, 2) considering having a specific imaging test, 3) access to imaging, 4) imaging service delivery, and 5) ongoing care. Here, we describe patient engagement opportunities based on literature review and paired with case studies by practicing neuroradiologists.
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Affiliation(s)
- Nadja Kadom
- From the Emory University School of Medicine (N.K.), Children's Healthcare of Atlanta, Atlanta, Georgia
| | | | - Alexander J Nemeth
- Northwestern University, Feinberg School of Medicine, Northwestern Memorial Hospital (A.J.N.), Chicago, Illinois
| | | | - Yvonne W Lui
- New York University, Grossman School of Medicine (Y.W.L.), New York, New York
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Wang CC, Bharadwa S, Domenech I, Barber EL. In the patient's shoes: The impact of hospital proximity and volume on stage I endometrial cancer care patterns and outcomes. Gynecol Oncol 2024; 182:91-98. [PMID: 38262244 DOI: 10.1016/j.ygyno.2024.01.003] [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: 11/07/2023] [Revised: 12/13/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To compare the impact of travel burden and hospital volume on care patterns and outcomes in stage I endometrial cancer. METHODS This retrospective cohort study identified patients from the National Cancer Database with stage I epithelial endometrial carcinoma who underwent hysterectomy between 2012 and 2020. Patients were categorized into: lowest quartiles of travel distance and hospital surgical volume for endometrial cancer (Local) and highest quartiles of distance and volume (Travel). Primary outcome was overall survival. Secondary outcomes were surgery route, lymph node (LN) assessment method, length of stay (LOS), 30-day readmission, and 30- and 90-day mortality. Results were stratified by tumor recurrence risk. Outcomes were compared using propensity-score matching. Propensity-adjusted survival was evaluated using Kaplan-Meier curves and compared using log-rank tests. Cox models estimated hazard ratios for death. Sensitivity analysis using modified Poisson regressions was performed. RESULTS Among 36,514 patients, 51.4% were Local and 48.6% Travel. The two cohorts differed significantly in demographics and clinicopathologic characteristics. Upon propensity-score matching (p < 0.05 for all), more Travel patients underwent minimally invasive surgery (88.1%vs79.1%) with fewer conversions to laparotomy (2.0%vs2.6%), more sentinel (20.5%vs11.3%) and fewer traditional LN assessments (58.1vs61.7%) versus Local. Travel patients had longer intervals to surgery (≥30 days:56.7%vs50.1%) but shorter LOS (<2 days:76.9%vs59.8%), fewer readmissions (1.9%vs2.7%%), and comparable 30- and 90-day mortality. OS and HR for death remained comparable between the matched groups. CONCLUSIONS Compared to surgery in nearby low-volume hospitals, patients with stage I epithelial endometrial cancer who travelled longer distances to high-volume centers experienced more favorable short-term outcomes and care patterns with comparable long-term survival.
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Affiliation(s)
- Connor C Wang
- Northwestern University Feinberg School of Medicine, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chicago, IL, USA.
| | - Sonya Bharadwa
- Northwestern University Feinberg School of Medicine, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chicago, IL, USA
| | - Issac Domenech
- Northwestern University Feinberg School of Medicine, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chicago, IL, USA
| | - Emma L Barber
- Northwestern University Feinberg School of Medicine, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chicago, IL, USA
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Fauziyyah AN, Shibanuma A, Ong KIC, Jimba M. What are the factors affecting primary care choice when the access under health insurance scheme is limited?: a cross-sectional study in Bandung, Indonesia. BMC PRIMARY CARE 2024; 25:64. [PMID: 38383314 PMCID: PMC10882734 DOI: 10.1186/s12875-024-02296-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 02/05/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Ensuring equal access to primary care services is crucial, as the gateway to a higher level of care. Indonesia has been trying to increase financial access to medical care by administering national health insurance known as BPJS-Health (Badan Penyelenggara Jaminan Sosial Kesehatan) since 2014. However, BPJS-Health beneficiaries can only use their benefits at a limited number of registered primary care providers (BPJS-Health partners). This study investigated the geographical coverage of BPJS-Health and BPJS-Health beneficiaries' primary care choices, based on their characteristics and healthcare preferences in the target areas of Bandung, Indonesia. METHODS The setting of this cross-sectional study was the areas with low physical access to BPJS-Health partners but high physical access to non-BPJS-Health partners. Physical access was determined by spatial network analysis, resulting in a geographical coverage map. A total of 216 adults were recruited and they completed the questionnaire about their primary care choice. All participants had been registered with the BPJS-Health system and living in the study areas. Their participation in non-BPJS-Health was also evaluated. Participants' choice of care was assessed in three different scenarios, when the individual was experiencing mild, chronic, and serious illnesses. RESULTS BPJS-Health partners' geographical coverage was unequally distributed in Bandung. Being registered with non-BPJS-Health company was negatively associated with the more frequent choice of using BPJS-Health partners' services (AOR = 0.18; 95% CI, 0.06-0.58, P = 0.004) among BPJS-Health beneficiaries. For serious illnesses, having a high income was associated with choosing non-BPJS-Health partners and hospitals (AOR = 4.90; 95% CI, 1.16-20.77, P = 0.031). When dealing with mild and chronic illnesses, participants were concerned about the quality of treatment they would receive as a major factor in choosing a primary care provider. However, receiving better treatment quality was negatively associated with choosing BPJS-Health partners in all cases of illness severities. CONCLUSIONS Sociodemographic characteristics, healthcare preference factors, and health insurance status were associated with participants' primary care choices in the target areas of Bandung, Indonesia. BPJS-Health partners' coverage map and the preference factors are potentially important for policymakers, especially for the development of future BPJS-Health partnerships.
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Affiliation(s)
- Afina Nur Fauziyyah
- Department of Community and Global Health, The University of Tokyo, Tokyo, Japan
- Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom
| | - Akira Shibanuma
- Department of Community and Global Health, The University of Tokyo, Tokyo, Japan
| | - Ken Ing Cherng Ong
- Department of Community and Global Health, The University of Tokyo, Tokyo, Japan.
| | - Masamine Jimba
- Department of Community and Global Health, The University of Tokyo, Tokyo, Japan
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Lognos B, Oude Engberink A, Gonzalez L, Leandri J, Charlot Pisoni C, Rachedi N, Clary B, Bourrel G, Bayen S, Million E. Meeting the needs of pregnant women in socially vulnerable situations: A phenomenological qualitative study. Heliyon 2024; 10:e24881. [PMID: 38318039 PMCID: PMC10840009 DOI: 10.1016/j.heliyon.2024.e24881] [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: 04/03/2022] [Revised: 12/28/2023] [Accepted: 01/16/2024] [Indexed: 02/07/2024] Open
Abstract
Objective Vulnerability relates to fragile physical, psychological, and socio-environmental circumstances. Pregnant women's social vulnerability can lead to disruptions in their medical follow-ups, prematurity, and increased infant mortality rates, such that their special needs must be considered. Yet, despite different governments' 'perinatality' plans, international literature suggests their care can be improved. Although quantitative studies regularly evaluate these plans, few studies have assessed vulnerable pregnant women's views. This study explores the needs and expectations of vulnerable women regarding their follow-ups during pregnancy and identified strategies to improve their circumstances. Methods The study was a phenomenological qualitative study involving semi-structured interviews with women who gave birth in the past six months (December 2017 to June 2018) and who fulfilled at least one vulnerability criterion. The women were recruited by French midwives and general practitioners (GPs). Findings Concerning these vulnerable pregnant women, three phenomenological categories emerged: 1) they need to be monitored by a single trusted contact; 2) they seek medical and social support adapted to their situations that addresses their needs; and 3) they expect kind and person-centred communication skills from professionals who provide them appropriate information. Conclusion We identified various international recommendations to screen and care for vulnerable pregnant women, but still these women often experience numerous challenges. Finally, the implementation of recommendations for healthcare professionals based on women's real-life experiences could help optimise the identification of vulnerable pregnant women as well as their follow-up care.
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Affiliation(s)
- Béatrice Lognos
- University of Montpellier, UMR UA11 INSERM – UM IDESP Institut Desbrest d’Épidémiologie et de Santé Publique Campus Santé, IURC, 641 avenue du doyen Gaston Giraud, 34 093, France
- Department of General Practice, Montpellier University of Montpellier, 34000 Montpellier, France
- Maison de santé pluriprofessionnelle universitaire Pauline Lautaud (ST Georges d’Orques, Castries, Prades le Lez, Vendargues), France
| | - Agnès Oude Engberink
- University of Montpellier, UMR UA11 INSERM – UM IDESP Institut Desbrest d’Épidémiologie et de Santé Publique Campus Santé, IURC, 641 avenue du doyen Gaston Giraud, 34 093, France
- Department of General Practice, Montpellier University of Montpellier, 34000 Montpellier, France
- Maison de santé pluri professionnelle universitaire Avicenne, 2 rue IBN Sinaï dit Avicenne 66 330 Cabestany, France
| | - Lorène Gonzalez
- Centre médical, Rue de la Brèche, 34630 Saint-Thibéry, France
| | - Julia Leandri
- Maison de santé pluriprofessionnelle universitaire Pauline Lautaud (ST Georges d’Orques, Castries, Prades le Lez, Vendargues), France
| | - Carla Charlot Pisoni
- Maison de santé pluriprofessionnelle universitaire Pauline Lautaud (ST Georges d’Orques, Castries, Prades le Lez, Vendargues), France
| | - Nadia Rachedi
- Département de L’Hérault, Hôtel du Département mas d’Alco, 1977 avenue du mas de Moulin 34087 Montpellier, France
| | - Bernard Clary
- University of Montpellier, UMR UA11 INSERM – UM IDESP Institut Desbrest d’Épidémiologie et de Santé Publique Campus Santé, IURC, 641 avenue du doyen Gaston Giraud, 34 093, France
- Department of General Practice, Montpellier University of Montpellier, 34000 Montpellier, France
- Maison de Santé Professionnelle 20 route Minervois, 11800 Trèbes, France
| | - Gérard Bourrel
- University of Montpellier, UMR UA11 INSERM – UM IDESP Institut Desbrest d’Épidémiologie et de Santé Publique Campus Santé, IURC, 641 avenue du doyen Gaston Giraud, 34 093, France
- Department of General Practice, Montpellier University of Montpellier, 34000 Montpellier, France
| | - Sabine Bayen
- Department of General Practice, Pôle formation Faculté médecine H. Warembourg 59045 Lille CEDEX 1, University of Lille, 1, place de Verdun, 59045, France
| | - Elodie Million
- University of Montpellier, UMR UA11 INSERM – UM IDESP Institut Desbrest d’Épidémiologie et de Santé Publique Campus Santé, IURC, 641 avenue du doyen Gaston Giraud, 34 093, France
- Department of General Practice, Montpellier University of Montpellier, 34000 Montpellier, France
- Maison de santé pluriprofessionnelle universitaire Pauline Lautaud (ST Georges d’Orques, Castries, Prades le Lez, Vendargues), France
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Bhaumik D, Schlesinger MJ. How exposure to patient narratives affects stereotyped choices of primary care clinicians. PLoS One 2023; 18:e0295243. [PMID: 38060553 PMCID: PMC10703228 DOI: 10.1371/journal.pone.0295243] [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: 04/10/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023] Open
Abstract
In this paper, we examine whether patient narratives alter the impact of stereotyping on choice of primary care clinicians: in this case, the common presumption that female doctors will be more attentive to empathic relationships with patients. 1052 individuals were selected from a nationally representative Internet panel to participate in a survey experiment. Participants were given performance data about 12 fictitious primary care physicians, including a randomized set of narrative feedback from patients. We compared the choice of clinician made by participants who value bedside manner and were exposed to narratives in the experiment, compared to those valuing bedside manner who had not had this exposure. We estimated multivariate logistic regressions to assess whether exposure to patient comments that "disrupt" stereotypes influenced choice of physicians. Participants who saw patient comments and had previously reported caring about bedside manner had a 67% higher odds of choosing a female physician than those participants that did not see a patient comments, controlling for the content of the narratives themselves. When participants were exposed to patient comments that disrupt gendered stereotypes, they had a 40% lower odds of choosing a female physician. Simple exposure to patient narratives that do not clearly disrupt gendered stereotypes increased the likelihood of choosing a female clinician by priming attention to relational aspects of care. However, when the content of a sufficient proportion of patient comments runs counter stereotypes, even a minority of narratives is sufficient to disrupt gendered-expectations and alter choices.
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Affiliation(s)
- Deepon Bhaumik
- Department of Health Policy and Management, Yale University, New Haven, Connecticut, United States of America
| | - Mark J. Schlesinger
- Department of Health Policy and Management, Yale University, New Haven, Connecticut, United States of America
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Listorti E, Pastore E, Alfieri A. How to direct patients to high-volume hospitals: exploring the influencing drivers. BMC Health Serv Res 2023; 23:1269. [PMID: 37974191 PMCID: PMC10655263 DOI: 10.1186/s12913-023-10229-9] [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: 11/30/2022] [Accepted: 10/26/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND During the last decade, planning concentration policies have been applied in healthcare systems. Among them, attention has been given to guiding patients towards high-volume hospitals that perform better, acccording to the volume-outcome association. This paper analyses which factors drive patients to choose big or small hospitals (with respect to the international standards of volumes of activity). METHODS We examined colon cancer surgeries performed in Piedmont (Italy) between 2004 and 2018. We categorised the patient choice of the hospital as big/small, and we used this outcome as main dependent variable of descriptive statistics, tests and logistic regression models. As independent variables, we included (i) patient characteristics, (ii) characteristics of the closest big hospital (which should be perceived as the most immediate to be chosen), and (iii) territorial characteristics (i.e., characteristics of the set of hospitals among which the patient can choose). We also considered interactions among variables to examine which factors influence all or a subset of patients. RESULTS Our results confirm that patient personal characteristics (such as age) and hospital characteristics (such as distance) play a primary role in the patient decision process. The findings seem to support the importance of closing small hospitals when they are close to big hospitals, although differences emerge between rural and urban areas. Other interesting insights are provided by examining the interactions between factors, e.g., patients affected by comorbidities are more responsive to hospital quality even though they are distant. CONCLUSIONS Reorganising healthcare services to concentrate them in high-volume hospitals emerged as a crucial issue more than forty years ago. Evidence suggests that concentration strategies guarantee better clinical performance. However, in healthcare systems in which patients are free to choose where to be treated, understanding patients' behaviour and what drives them towards the most effective choice is of paramount importance. Our study builds on previous research that has already analysed factors influencing patients' choices, and takes a step further to enlighten which factors drive patients to choose between a small or a big hospital (in terms of volume). The results could be used by decision makers to design the best concentration strategy.
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Affiliation(s)
- Elisabetta Listorti
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management - Bocconi University, Milan, Italy.
| | - Erica Pastore
- Department of Management and Production Engineering, Politecnico di Torino, Turin, Italy
| | - Arianna Alfieri
- Department of Management and Production Engineering, Politecnico di Torino, Turin, Italy
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Boerkoel A, Tischler L, Kaul K, Krause H, Stentzel U, Schumann S, van den Berg N, de Laffolie J. Healthcare service use in paediatric inflammatory bowel disease: a questionnaire on patient and parent care experiences in Germany. BMC Gastroenterol 2023; 23:378. [PMID: 37932708 PMCID: PMC10626645 DOI: 10.1186/s12876-023-03021-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/30/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Paediatric inflammatory bowel disease (PIBD) patients require chronic care over the lifespan. Care for these patients is complex, as it is adapted for childrens' life stages and changing disease activity. Guideline based care for this patient group recommends a multidisciplinary approach, which includes in addition to paediatric gastroenterologists, nutritional and psychological care services. For PIBD patients, a discrepancy between available guideline-based multidisciplinary care and actual care has been found from the provider side, but to what extent patients experience this is unclear. OBJECTIVES To identify which healthcare services were used and whether socio-demographic, geographic or disease related factors have an influence on health service utilisation. METHODS A standardised questionnaire (CEDNA) was distributed amongst parents of children aged 0-17 diagnosed with PIBD and adolescents (aged 12-17) with a PIBD. Items related to health service use were analysed, these included specialist care, additional care services, reachability of services and satisfaction with care. Logistic regression models on additional service use were calculated. Service availability and reachability maps were made. RESULTS Data was analysed for 583 parent and 359 adolescent questionnaires. Over half of the respondents had Crohn's Disease (CD, patients n = 186 parents n = 297). Most patients and parents reported their paediatric gastroenterologist as their main care contact (patients 90.5%; parents 93%). Frequently reported additional services were nutritional counselling (patients 48.6%; parents 42.2%) and psychological support (patients 28.1%; parents 25.1%). Nutritional counselling was more frequently reported by CD patients in both the patient (OR 2.86; 95%CI 1.73-4.70) and parent (OR 3.1; 95%CI 1.42-6.71) sample. Of the patients, 32% reported not using any additional services, which was more likely for patients with an illness duration of less than one year (OR 3.42; 95%CI 1.26-9.24). This was also observed for the parent population (OR 2.23; 95%CI 1.13-4.4). The population-based density of specialised paediatric gastroenterologists was not proportionate to the spatial distribution of patients in Germany, which may have an influence on access. CONCLUSIONS Parents and children reported highly specialised medical care. Multidisciplinary care offers do not reach the entire patient population. Access to multidisciplinary services needs to be ensured for all affected children.
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Affiliation(s)
- Aletta Boerkoel
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
| | - Luisa Tischler
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Kalina Kaul
- General Pediatrics & Pediatric Gastroenterology, Justus-Liebig-University, Giessen, Germany
| | - Heiko Krause
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Ulrike Stentzel
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Stefan Schumann
- General Pediatrics & Pediatric Gastroenterology, Justus-Liebig-University, Giessen, Germany
| | - Neeltje van den Berg
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Jan de Laffolie
- General Pediatrics & Pediatric Gastroenterology, Justus-Liebig-University, Giessen, Germany
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Schoffer O, Schriefer D, Werblow A, Gottschalk A, Peschel P, Liang LA, Karmann A, Klug SJ. Modelling the effect of demographic change and healthcare infrastructure on the patient structure in German hospitals - a longitudinal national study based on official hospital statistics. BMC Health Serv Res 2023; 23:1081. [PMID: 37821860 PMCID: PMC10566170 DOI: 10.1186/s12913-023-10056-y] [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: 01/27/2023] [Accepted: 09/24/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Effects of demographic change, such as declining birth rates and increasing individual life expectancy, require health system adjustments offering age- and needs-based care. In addition, healthcare factors can also influence health services demand. METHODS The official German hospital statistics database with odd-numbered years between 1995 and 2011 was analysed. This is a national comprehensive database of all general hospital inpatient services delivered. Official data from hospital statistics were linked at the district level with demographic and socio-economic data as well as population figures from the official regional statistics. Panel data regression, modelling case numbers per hospital, was performed for 13 diagnosis groups that characterised the patient structure. Socio-demographic variables included age, sex, household income, and healthcare factors included bed capacity, personnel and hospital characteristics. RESULTS The median number of annual treatments per hospital increased from 6 015 (5th and 95th percentile [670; 24 812]) in 1995 to 7 817 in 2011 (5th and 95th percentile [301; 33 651]). We developed models characterising the patient structure of health care in Germany, considering both socio-demographic and hospital factors. Demographic factors influenced case numbers across all major diagnosis groups. For example, the age groups 65-74 and 75 + influenced cerebrovascular disease case numbers (p < 0.001). Other important factors included human and material resources of hospitals or the household income of patients. Distinct differences between the models for the individual diagnosis groups were observed. CONCLUSIONS Hospital planning should not only consider demographic change but also hospital infrastructure and socio-economic factors.
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Affiliation(s)
- Olaf Schoffer
- Center for Evidence-based Healthcare, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Fetscherstr. 74, Dresden, 01307, Germany.
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany.
| | - Dirk Schriefer
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
- Center of Clinical Neuroscience, Faculty of Medicine and University Hospital Carl Gustav Carus, Dresden, Germany
| | - Andreas Werblow
- Health Economics Centre and Faculty of Business and Economics, TU Dresden, Dresden, Germany
| | - Andrea Gottschalk
- Institute For Medical informatics and Biometry, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Peter Peschel
- Health Sciences and Public Health, TU Dresden, Dresden, Germany
| | - Linda A Liang
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Alexander Karmann
- Health Economics Centre and Faculty of Business and Economics, TU Dresden, Dresden, Germany
| | - Stefanie J Klug
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
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Raza A, Furtado KM, Mathur D. Credentials That Matter While Selecting a Surgeon for Major Surgical Treatment. Patient Prefer Adherence 2023; 17:2487-2494. [PMID: 37817891 PMCID: PMC10561753 DOI: 10.2147/ppa.s404570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/07/2023] [Indexed: 10/12/2023] Open
Abstract
Purpose The credentials of surgeons, which include elements such as medical degree and length of practice, are vital information that forms a perception of their expertise in the patients' minds. The specific credentials that matter to patients and how important they are have not been sufficiently studied. The objective of this study was to assess the relative importance that patients assign to the specific credentials of a surgeon while selecting one for surgical treatment. Methods This study was conducted using the constant-variable-value vignette (CVVV) method. Four credentials- medical degrees, duration of practice, medical college attended, and type of surgeries performed - were assessed for their relative importance to patients. The participants were provided with vignettes of medical situations that required major surgical intervention and profiles of surgeons who could perform the required surgery, each dominating the others in a specific credential. The participants allocated a total of 10 points across the four surgeons proportionate to their preferences. The response data were analyzed using descriptive statistics, ANOVA and t-tests. Results The highest mean score of 3.73 (SD 2.21) was observed for the surgeon with focused experience, followed by 2.55 (1.57) for the surgeon with the best medical degrees, 2.17 (1.65) for the surgeon with the longest practice experience, and 1.54 (1.47) for the surgeon from a higher-ranked medical college. The mean of the surgeon with focused experience was significantly higher than that of other surgeons, and the mean of the surgeon with the best medical degrees was significantly higher than that of surgeons with the longest practice experience and the surgeon from the topmost medical college (p < 0.05). Preference did not vary with respondents' age or gender. Conclusion Patients seem to prioritize the focused surgical experience and superior medical degrees in their selection of surgeons.
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Affiliation(s)
- Arif Raza
- Healthcare Management, Goa Institute of Management, Goa, India
| | | | - Devasheesh Mathur
- Strategy and General Management, International Management Institute, New Delhi, India
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15
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Söderlund R. Signalling waiting times to citizens on public oral healthcare providers' websites. Acta Odontol Scand 2023; 81:517-527. [PMID: 37155352 DOI: 10.1080/00016357.2023.2204934] [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: 06/16/2022] [Accepted: 04/17/2023] [Indexed: 05/10/2023]
Abstract
Objective: The study aimed to analyse the usefulness of signalling waiting times to citizens on the websites of public primary oral healthcare providers in Finland. Finnish laws require this signalling.Material and methods: We gathered data with two cross-sectional surveys in 2021. One electronic questionnaire was for Finnish-speaking citizens in Southwest Finland. The other was for public primary oral healthcare managers (n = 159). We also gathered data on 15 public primary oral healthcare providers' websites. For the theoretical framework, we combined the agency and signalling theories.Results: Of the citizen respondents (n = 411), 57% knew about the waiting time signalling on the websites. The respondents considered waiting time a high-priority criterion in choosing a dentist, but they rarely searched for information anywhere on the choice of a dentist, wanting to visit the dentist they had earlier visited. The quality of signalled waiting times was low. One out of five managers (response rate 62%) answered that signalled waiting times were based on speculation.Conclusions: Waiting times were signalled to comply with the legislation rather than to inform citizens and to reduce information asymmetry. Further research is needed to acquire information on rethinking waiting time signalling and its desired goals.
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Affiliation(s)
- Riitta Söderlund
- Unit of Information Systems Science, University of Turku, Turku, Finland
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16
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Deng S, Bennett K. On the geographic access to healthcare, beyond proximity. GEOSPATIAL HEALTH 2023; 18. [PMID: 37768173 DOI: 10.4081/gh.2023.1199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/10/2023] [Indexed: 09/29/2023]
Abstract
This study examined the incongruence of travel distance between the nearest provider and the provider that pregnant woman actually chose to visit. Using a dataset of South Carolina claims including rural and urban areas for the period 2014-2018 based on live births of 27,290 pregnant women, we compared the travel distance and travel time for two providers of health: the nearest facility and the main one for the area in question. The number of the former type was counted for every case. The mean travel distance/time to the nearest provider was 3.2 miles (5.2 km) and 5.0 minutes, while that to the main (predominant) provider was 23.0 miles (37.0 km) and 31.7 minutes. Only 21.6% of pregnant women chose one of the closest facilities as their provider. The mean travel distance and time to the nearest provider for women in rural areas were more than twice that for urban women but only 1.2 times for the main provider. Rural women had one third fewer providers situated closer than the main in comparison to number available for urban women. Thus, we conclude that proximity is not the only factor associated with access to healthcare. While evaluating geographic access, the number of available health providers within the mean travel distance or time would be a better indicator of proximate access.
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Affiliation(s)
- Songyuan Deng
- South Carolina Center for Rural and Primary Healthcare, University of South Carolina, Columbia, South Carolina.
| | - Kevin Bennett
- South Carolina Center for Rural and Primary Healthcare, University of South Carolina, Columbia, South Carolina.
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17
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Rama-Caamaño J, Iglesias Sousa O, Rama J. [What determines public-private choice in Spanish healthcare?]. J Healthc Qual Res 2023; 38:262-267. [PMID: 36863940 DOI: 10.1016/j.jhqr.2023.02.002] [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: 10/31/2022] [Revised: 01/04/2023] [Accepted: 02/01/2023] [Indexed: 03/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES The aim of the study was to analyze, which individual characteristics (sociodemographic, attitudinal and political factors) mediates in the choice in Spain in 2022, of a private versus public health care alternative for family doctor, doctor specialist, hospital admissions and emergencies. METHODS Using the health barometers of the Centro de Investigaciones Sociológicas (CIS), we carried out four logistic regressions (then, average marginal effects [AMEs]) whose dependent variables are the preference for a private choice of family doctor versus a public one, the preference for a private choice of doctor specialist versus a public one; the preference for a private choice of hospital admission versus a public one and the preference for a private choice of emergency admission versus a public one. The dependent variables are binary (1=private; 0=public). The sample consisted of more than 4,500 individuals older than 18years old distributed representatively throughout Spain. RESULTS The probability of choosing private rather than public is correlated with the age of the individual: those over 50years are less likely to opt for a private alternative (P<.01), as well as by ideology and satisfaction with the way that the national health system (NHS) works. Patients with a conservative ideology are more likely to choose private options (P<.01) and individuals with greater satisfaction with the NHS are less likely to choose private ones (P<.01). CONCLUSIONS Satisfaction with the NHS and patient ideology are the most relevant factors for private versus public choice.
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Affiliation(s)
| | - O Iglesias Sousa
- Complejo Hospitalario Universitario de A Coruña, A Coruña, España
| | - J Rama
- Departamento de Ciencia Política y Relaciones Internacionales, Facultad de Derecho, Universidad Autónoma de Madrid, Madrid, España.
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18
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Nguyen MP, Tariq A, Hinchcliff R, Dunne MP. Why do consumers choose private over public health services? Reflective accounts of health providers in Vietnam. BMC Health Serv Res 2023; 23:900. [PMID: 37612661 PMCID: PMC10464385 DOI: 10.1186/s12913-023-09892-9] [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: 02/15/2023] [Accepted: 08/09/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND In Vietnam and many developing countries, private healthcare is increasingly being leveraged by governments to complement public services and increase health service access and utilisation. Extensive understanding of patterns of utilisation of private over public health services, and the rationale for such consumer decisions, is important to ensure and promote safe, affordable and patient-centred care in the two sectors. Few studies within the Southeast Asian Region have explored how private and public providers interact (via social networks, marketing, and direct contact) with consumers to affect their service choices. This study investigates providers' views on social factors associated with the use of private over public health services in Vietnam. METHOD A thematic analysis was undertaken of 30 semi-structured interviews with experienced health system stakeholders from the Vietnam national assembly, government ministries, private health associations, health economic association, as well as public and private hospitals and clinics. RESULTS Multiple social factors were found to influence the choice of private over public services, including word-of-mouth, the patient-doctor relationship and relationships between healthcare providers, healthcare staff attitudes and behaviour, and marketing. While private providers maximise their use of these social factors, most public providers seem to ignore or show only limited interest in using marketing and other forms of social interaction to improve services to meet patients' needs, especially those needs beyond strictly medical intervention. However, private providers faced their own particular challenges related to over-advertisement, over-servicing, excessive focus on patients' demands rather than medical needs, as well as the significant technical requirements for quality and safety. CONCLUSIONS This study has important implications for policy and practice in Vietnam. First, public providers must embrace social interaction with consumers as an effective strategy to improve their service quality. Second, appropriate regulations of private providers are required to protect patients from unnecessary treatments, costs and potential harm. Finally, the insights from this study have direct relevance to many developing countries facing a similar challenge of appropriately managing the growth of the private health sector.
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Affiliation(s)
- Mai P Nguyen
- Department of Medical Services Administration, Ministry of Health, Hanoi, Vietnam.
- School of Public Health & Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Amina Tariq
- School of Public Health & Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Reece Hinchcliff
- School of Public Health & Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
- School of Applied Psychology, Griffith Health Group, Griffith University, Queensland, Australia
| | - Michael P Dunne
- Institute for Community Health Research, Hue University, Hue, Vietnam
- Australian Centre for Health Law Research, Queensland University of Technology, Queensland, Australia
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Forgione AF, Noto G. Exploring the determinants of private healthcare providers' market power: A performance-based perspective. Health Serv Manage Res 2023:9514848231194850. [PMID: 37578998 DOI: 10.1177/09514848231194850] [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: 08/16/2023]
Abstract
This research focuses on market power in the private healthcare sector. This topic has been poorly explored by the extant literature and the reasons mainly rely on the peculiarities of the sector and the specific market. In fact, health providers' market power is influenced by multiple factors and by the fact that prices are often regulated by national or regional public authorities. To fill this gap, the article explores the relationship between performance characteristics and health providers' market power, measured through the Lerner index. The research is based on the analysis of panel data for 437 Italian private healthcare providers over the period 2012-2020. To explore the determinants of health providers' market power, this research employs System-generalized method of moments (SYS-GMM) estimation models. The results highlight a significant and non-linear relationship between market power and process performance, as well as with gender diversity. Intangible assets are another input variable that has a significant and positive relationship with market power. The study contributes to the identification of the performance characteristics driving health providers' market power.
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Affiliation(s)
| | - Guido Noto
- Department of Economics, University of Messina, Messina¸ Italy
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Rezaei Z, Lotfi F, Bayati M, Kavosi Z. The effect of Covid-19 pandemic on healthcare utilization in public vs private centers in Iran: a multiple group interrupted time-series analysis. BMC Health Serv Res 2023; 23:822. [PMID: 37528374 PMCID: PMC10394764 DOI: 10.1186/s12913-023-09846-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 07/25/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND The outbreak of Coronavirus in late 2019 and its continuation in the following years has affected all human societies, government organizations, and health systems. Access to health services is an important issue during crises. The present study aimed to investigate the effect of the Covid-19 pandemic on the consumption of health services in the public sector compared to the private sector in Iran. METHODS The research population consisted of all insured individuals covered by Iran Health Insurance Organization in Fars province, which amounts to approximately 2,700,000 people. The required information including the utilization of laboratory, radiology, medicine, and hospitalization services was extracted on a monthly basis from February 2019 to February 2021. The Multiple Group Interrupted Time Series Analysis (MGITSA) was used for data analysis along with STATA.15 software. RESULTS According to the findings of MGITSA, in the short-term, the utilization of private laboratory, radiology, medication, and hospital admissions had decreased by approximately 18,066, 8210, 135,445, and 1086 times, respectively (P < 0.05). In the long-run, the use of laboratory and radiology services had increased by about 2312 and 514 times (P < 0.05), respectively. The comparison between the public and private sectors showed that in the short-term, the use of radiology services decreased by about 12,525, while the use of medication increased by about 91,471 times (P < 0.05). In the long-run, the use of laboratory services decreased by about 1514 times (P = 0.076) and no change was observed in the other services utilization (in public relative to private centers). CONCLUSIONS Utilization of health services in the public versus private centers, except for medication and hospitalization, significantly decreased in the short-term. However the utilization of most services returned to the usual trend in the long-term. The reduction in access to health services could impose a significant burden of various diseases, at least in the short-term, and increase health costs in the coming years.
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Affiliation(s)
- Zohreh Rezaei
- Student Research Committee, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farhad Lotfi
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Almas Building, Alley 29, Qasrodasht Ave, Shiraz, 71336-54361, Iran
| | - Mohsen Bayati
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Almas Building, Alley 29, Qasrodasht Ave, Shiraz, 71336-54361, Iran.
| | - Zahra Kavosi
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Almas Building, Alley 29, Qasrodasht Ave, Shiraz, 71336-54361, Iran
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21
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Heaney S, Galeotti M, Aventin Á. Pregnancy loss following miscarriage and termination of pregnancy for medical reasons during the COVID-19 pandemic: a thematic analysis of women's experiences of healthcare on the island of Ireland. BMC Pregnancy Childbirth 2023; 23:529. [PMID: 37480006 PMCID: PMC10360341 DOI: 10.1186/s12884-023-05839-4] [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: 04/17/2023] [Accepted: 07/09/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Losing a baby during pregnancy can be a devastating experience for expectant parents. Many report dedicated, compassionate healthcare provision as a facilitator of positive mental health outcomes, however, healthcare services have been severely impacted during the COVID-19 pandemic. AIM To explore women's experiences of healthcare service provision for miscarriage and termination of pregnancy for medical reasons (TFMR) on the island of Ireland during the COVID-19 pandemic. METHODS Findings combine data from elements of two separate studies. Study 1 used a mixed methods approach with women who experienced miscarriage and attended a hospital in Northern Ireland. Study 2 was qualitative and examined experiences of TFMR in Northern Ireland and Ireland. Data analysed for this paper includes open-ended responses from 145 women to one survey question from Study 1, and semi-structured interview data with 12 women from Study 2. Data were analysed separately using Thematic Analysis and combined for presentation in this paper. RESULTS Combined analysis of results indicated three themes, (1) Lonely and anxiety-provoking experiences; (2) Waiting for inadequate healthcare; and (3) The comfort of compassionate healthcare professionals. CONCLUSIONS Women's experiences of healthcare provision were negatively impacted by COVID-19, with the exclusion of their partner in hospital, and delayed services highlighted as particularly distressing. Limited in-person interactions with health professionals appeared to compound difficulties. The lived experience of service users will be helpful in developing policies, guidelines, and training that balance both the need to minimise the risk of infection spread, with the emotional, psychological, and physical needs and wishes of parents. Further research is needed to explore the long-term impact of pregnancy loss during a pandemic on both parents and health professionals delivering care.
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Affiliation(s)
- Suzanne Heaney
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Martina Galeotti
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.
| | - Áine Aventin
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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22
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Berger E, Reichebner C, Eriksen A, Hildebrandt M, Kuklinski D, Busse R. [Specialised treatment of colorectal cancer in certified cancer centres: Do patients really have to travel further?]. DAS GESUNDHEITSWESEN 2023; 85:657-666. [PMID: 37321253 PMCID: PMC10442894 DOI: 10.1055/a-2055-9599] [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] [Indexed: 06/17/2023]
Abstract
INTRODUCTION In Germany, many cancer patients are treated outside of cancer centres certified by the German Cancer Society (DKG) resulting in underuse of these facilities and inferior oncological treatment. One way to address this issue would be to restructure the healthcare landscape by following the Danish approach that limits cancer treatment to specialized hospitals. Such an approach would have an impact on the travelling times to treatment centers. The present study determines the impact on patient travel times using the example of colorectal cancer. METHODS For the present analysis, data from structured quality reports (sQB) and from patients insured with the AOK who underwent resection of the colon or rectum during 2018 were used. In addition, data from the DKG regarding an existing certification of a colorectal cance centre were used. Travel time was defined as the time patients spent in an average car with average traffic from the midpoint of the ZIP code of their residence to the coordinates of the hospital. The coordinates of the hospitals and the midpoints of the ZIP codes were obtained by querying the Google API. Travel times were calculated with a local Open Routing Machine server. The statistical programs R and Stata were used for analyses and cartographic representations. RESULTS In 2018, nearly half of all patients with colon cancer were treated at the hospital nearest to their place of residence, of whom approximately 40% were treated at a certified colorectal cancer centre. Overall, only about 47% of all treatments took place at a certified colorectal cancer centre. Travel time to the chosen treatment site averaged 20 minutes. It was minimally shorter (18 minutes) if no certified centre was chosen and minimally longer (21 minutes) for those whose treatment took place in a certified colorectal cancer centre. Modeling of redistributions of all patients to certified centres resulted on an average travel time of 29 minutes. CONCLUSION Even if treatment were limited to specialized hospitals, treatment close to home would still be guaranteed. Regardless of certification, parallel structures can be identified, especially in metropolitan areas, which indicate a potential for restructuring.
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Affiliation(s)
- Elke Berger
- Fachgebiet Management im Gesundheitswesen, Technische
Universität Berlin, Fakultät VII Wirtschaft und Management,
Berlin, Germany
| | - Christoph Reichebner
- Fachgebiet Management im Gesundheitswesen, Technische
Universität Berlin, Fakultät VII Wirtschaft und Management,
Berlin, Germany
| | - Astrid Eriksen
- Fachgebiet Management im Gesundheitswesen, Technische
Universität Berlin, Fakultät VII Wirtschaft und Management,
Berlin, Germany
| | - Meik Hildebrandt
- Fachgebiet Management im Gesundheitswesen, Technische
Universität Berlin, Fakultät VII Wirtschaft und Management,
Berlin, Germany
| | - David Kuklinski
- School of Medicine, Universität St Gallen School of Medicine,
St Gallen, Switzerland
| | - Reinhard Busse
- Fachgebiet Management im Gesundheitswesen, Technische
Universität Berlin, Fakultät VII Wirtschaft und Management,
Berlin, Germany
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23
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Aggarwal A, Han L, Sullivan R, Haire K, Sangar V, van der Meulen J. Managing the cancer backlog: a national population-based study of patient mobility, waiting times and 'spare capacity' for cancer surgery. THE LANCET REGIONAL HEALTH. EUROPE 2023; 30:100642. [PMID: 37465324 PMCID: PMC10350851 DOI: 10.1016/j.lanepe.2023.100642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 07/20/2023]
Abstract
Background Waiting times for cancer treatments continue to increase in many countries. In this study we estimated potential 'spare surgical capacity' in the English NHS and identified regions more likely to have spare capacity based on patterns of patient mobility (the extent to which patients receive surgery at hospitals other than their nearest). Methods We identified patients who had an elective breast or colorectal cancer surgical resection between January 2016 and December 2018. We estimated each hospital's 'maximum surgical capacity' as the maximum 6-month moving average of its surgical volume. 'Spare surgical capacity' was estimated as the difference between maximum surgical capacity and observed surgical volume. We assessed the association between spare surgical capacity and whether a hospital performed more or fewer procedures than expected due to patient mobility as well as the association between spare surgical capacity and whether or not waiting times targets for treatment were likely to be met. Findings 100,585 and 49,445 patients underwent breast and colorectal cancer surgery respectively. 67 of 166 hospitals (40.4%) providing breast cancer surgery and 82 of 163 hospitals (50.3%) providing colorectal cancer surgery used less than 80% of their maximum surgical capacity. Hospitals with a 'net loss' of patients to hospitals further away had more potential spare capacity than hospitals with a 'net gain' of patients (p < 0.001 for breast and p = 0.01 for colorectal cancer). At the national level, we projected an annual potential spare capacity of 8389 breast cancer and 4262 colorectal cancer surgical procedures, approximately 25% of the volumes actually performed. Interpretation Spare surgical capacity potentially exists in the present configuration of hospitals providing cancer surgery and requires regional allocation for efficient utilisation. Funding National Institute for Health Research.
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Affiliation(s)
- Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Institute of Cancer Policy, King's College London, London, UK
| | - Lu Han
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Vijay Sangar
- The Christie NHS Trust and Manchester University NHS Foundation Trust, Manchester, UK
- Manchester University, UK
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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24
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Miller T, Reihlen M. Assessing the impact of patient-involvement healthcare strategies on patients, providers, and the healthcare system: A systematic review. PATIENT EDUCATION AND COUNSELING 2023; 110:107652. [PMID: 36804578 DOI: 10.1016/j.pec.2023.107652] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Patient involvement has become an important and lively field of research, yet existing findings are fragmented and often contested. Without a synthesis of the research field, these findings are of limited use to scholars, healthcare providers, or policy-makers. OBJECTIVE Examine the body of knowledge on patient involvement to determine what is known, contested, and unknown about benefits, risks, and effective implementation strategies. PATIENT INVOLVEMENT Patients were not involved. METHODS Systematic literature review of 99 journal articles using a conceptual model integrating three levels: health systems, health providers, and patients. We extracted individual research findings and organized them into the structure of our model to provide a holistic picture of patient involvement. RESULTS The review highlights overlaps and conflicts between various patient involvement approaches. Our results show benefits for individual patients and the health system as a whole. At the provider level, however, we identified clear barriers to patient involvement. DISCUSSION Patient involvement requires collaboration among health systems, healthcare providers, and patients. We showed that increasing patient responsibility and health literacy requires policy-maker interventions. This includes incentives for patient education by providers, adapting medical education curricula, and building a database of reliable health information and decision support for patients. Furthermore, policies supporting a common infrastructure for digital health data and managed patient data exchange will foster provider collaboration. PRACTICAL VALUE Our review shows how an approach integrating health systems, healthcare providers, and patients can make patient involvement more effective than isolated interventions. Such systematic patient involvement is likely to improve population health literacy and healthcare quality.
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Affiliation(s)
- Thomas Miller
- Institute of Management and Organization, Leuphana University Lüneburg, Lüneburg, Germany.
| | - Markus Reihlen
- Institute of Management and Organization, Leuphana University Lüneburg, Lüneburg, Germany.
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25
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Driehuis F, Bakker-Jacobs A, Staal JB, de Bie RA, Nijhuis-van der Sanden MWG, Hoogeboom TJ. Parents' and healthcare professionals' perspectives on manual therapy in infants: A mixed-methods study. PLoS One 2023; 18:e0283646. [PMID: 37023071 PMCID: PMC10079100 DOI: 10.1371/journal.pone.0283646] [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: 11/30/2020] [Accepted: 03/14/2023] [Indexed: 04/07/2023] Open
Abstract
OBJECTIVES Manual therapy in infants is embedded in Dutch healthcare despite inconsistent evidence and ongoing debate about its safety and merits. This study examines decision-making in manual therapy in infants and explores parents' and healthcare professionals' perspectives on this treatment approach. METHODS This mixed-methods study consisted of an online survey among manual physiotherapists and paediatric physiotherapists exploring decision-making on manual therapy in infants and interprofessional collaboration. These data prompted further exploration and were combined with data collected with semi-structured interviews exploring parents' and healthcare professionals' perspectives. Interviews were analysed using an inductive content analysis approach. RESULTS 607 manual physiotherapists and 388 paediatric physiotherapists completed the online survey; 45% and 95% indicated they treat infants, respectively. Collaboration was reported by 46% of manual physiotherapists and 64% of paediatric physiotherapists for postural asymmetry, positional preference, upper cervical dysfunction, excessive crying, anxiety or restlessness. Reasons to not treat or collaborate were: limited professional competence, practice policy, not perceiving added value, lack of evidence and fear of complications. Analysis of interviews with 7 parents, 9 manual physiotherapists, 7 paediatric physiotherapists, 5 paediatricians and 2 maternity nurses revealed that knowledge and beliefs, professional norms, interpersonal relation, treatment experiences and emotions of parents influenced attitudes and decision-making towards choosing for manual therapy in infants. CONCLUSION Parents' and healthcare professionals' attitudes towards manual therapy in infants can be divided as 'in favour' or 'against'. Those who experienced a good interpersonal relation with a manual physiotherapist and positive treatment outcomes reported positive attitudes. Lack of evidence, treatment experience and related knowledge, safety issues due to publications on adverse events and professional norms led to negative attitudes. Despite lacking evidence, positive treatment experiences, good interpersonal relation and parents feeling frustrated and despaired can overrule negative attitudes and directly influence the decision-making process and choosing for manual therapy treatment.
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Affiliation(s)
- Femke Driehuis
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Annick Bakker-Jacobs
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J. Bart Staal
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Rob A. de Bie
- Caphri Research School, Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | | | - Thomas J. Hoogeboom
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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26
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Yang S, Liu L, Wang C, Lo K, Wang D. Elderly people's preferences for healthcare facilities in Shanghai: gender features and influencing factor analysis. BMC Public Health 2023; 23:356. [PMID: 36800949 PMCID: PMC9936711 DOI: 10.1186/s12889-023-15279-6] [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: 08/17/2022] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND China has one of the fastest paces of the growing aging population, High-level policymakers have recently recognized the aging population presents significant challenges to the Chinese healthcare system. In this context, the healthcare-seeking behaviors of the elderly population have become an essential field of study. It is necessary to understand their access to health services and to improve their quality of life, as well as to help policymakers to formulate healthcare policy. The study empirically investigates the factors influencing the elderly population's healthcare-seeking behaviors in Shanghai, China, especially in choosing the quality of healthcare facilities to visit. METHODS We designed a cross-sectional study. The data of this study were derived from the "Shanghai elderly medical demand characteristics questionnaire" in the middle of November to early December 2017. A total of 625 individuals were included in the final sample. Logistic regression was adopted to investigate the differences in healthcare-seeking behaviors between elderly people when suffer from mild illness, severe illness and follow-up treatment. Next, the differences in gender were also discussed. RESULTS Factors affecting the healthcare-seeking behaviors of the elderly differ in mild illness and severe illness situations. For mild illness, demographic factors (gender and age) and socioeconomic factors (income and employment) play an important role in elderly healthcare choices. Female and older elderlies are more likely to choose local, lower-quality facilities, whereas those with high income and private employment are more likely to choose higher-quality facilities. For severe illness, socioeconomic factors (income and employment) are important. Furthermore, individuals with basic medical insurance are more likely to choose lower-quality facilities. CONCLUSION This study has shown that the affordability of public health services should be addressed. Medical policy support may be an important way to reduce the gap in access to medical services. We should pay attention to the gender differences in the elderly's choice of medical treatment behavior, consider the differences in the needs of male and female elderly. our findings are only for elderly Chinese participants in the greater Shanghai area.
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Affiliation(s)
- Shangguang Yang
- grid.28056.390000 0001 2163 4895Economic Development Institute, East China University of Science and Technology, 200237 Shanghai, China
| | - Luxue Liu
- grid.22069.3f0000 0004 0369 6365Student Affairs Office, East China Normal University, 200062 Shanghai, China
| | - Chunlan Wang
- grid.22069.3f0000 0004 0369 6365Population Research Institute, East China Normal University, 200062 Shanghai, China
| | - Kevin Lo
- grid.221309.b0000 0004 1764 5980Department of Geography, Hong Kong Baptist University, 999077 Hong Kong, China
| | - Danyang Wang
- Economic Development Institute, East China University of Science and Technology, 200237, Shanghai, China.
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de Cruppé W, Kummer MC, Geraedts M. [How do Surgical Patients Choose their Hospital? A Cross-sectional Study]. Zentralbl Chir 2023; 148:24-32. [PMID: 34587643 DOI: 10.1055/a-1555-3907] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Free hospital choice is promoted in health policy through public quality reporting. Previous studies on hospital choice mostly survey patients for specific elective procedures. This study examines all full inpatient surgical patients and compares them to those in other specialties. Research questions are: How many patients make their own decisions about the hospital? How much time do they have before admission? Where do they obtain information and what are their important decision criteria? MATERIALS AND METHODS This study evaluates cross-sectional primary data on hospital choice collected by questionnaire from 1925 consecutively hospitalised patients from 11 medical specialties and 3 levels of care, including 438 surgical patients from 6 general surgery departments. RESULTS Three quarters of surgical patients decide on the hospital themselves. Their own previous experience with the hospital is an important source of information and decision-making criterion for a good half of the patients, along with relatives and outpatient treatment providers as well as the hospital reputation. CONCLUSION Many surgical patients decide in favour of a hospital because of the trust they have built up through previous treatment in the hospital, which they experience as satisfactory. The professional quality of treatment is thus the greatest impact factor on patients, their relatives and outpatient treatment providers. It is important to actively and specifically address and clarify possible dissatisfaction on the part of the patient before discharge.
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Affiliation(s)
- Werner de Cruppé
- Institut für Versorgungsforschung und Klinische Epidemiologie, Philipps-Universitat Marburg Fachbereich Medizin, Marburg, Germany
| | | | - Max Geraedts
- Medizin, Philipps-Universität Marburg Fachbereich Medizin, Marburg, Germany
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Prior SJ, Mather CA, Campbell SJ. Redesigning Rural Acute Stroke Care: A Person-Centered Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1581. [PMID: 36674336 PMCID: PMC9864304 DOI: 10.3390/ijerph20021581] [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: 11/28/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
Stroke service delivery in rural areas in Australia lacks evidence-based, best practice care protocols as a result of limited resources and opportunity. Healthcare redesign is an approach to improving health services by understanding barriers and enablers to service provision and work with users to develop solutions for improvement. This research aimed to qualitatively evaluate stroke care in rural Tasmania using a person-centered approach, as part of a larger healthcare redesign initiative to improve acute stroke care. Semi-structured interviews, aimed at gaining insight into experiences of healthcare staff and users, were conducted. Thematic analysis revealed three global themes (communication, holistic care, and resourcing) that demonstrated some consistency between healthcare staff and user experience, highlighting that some needs and expectations were not being met. Results of this experiential study provide important perspectives for delivering needs-based improvements in service provision for acute stroke care. Overall, this study showed that systems of stroke care in rural areas could be improved by utilizing a redesign approach including healthcare staff and users in the development of solutions for health service improvement.
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Affiliation(s)
- Sarah J. Prior
- Tasmanian School of Medicine, Rural Clinical School, University of Tasmania, Burnie, TS 7320, Australia
| | - Carey A. Mather
- Australian Institute of Health Service Management, University of Tasmania, Launceston, TS 7250, Australia
| | - Steven J. Campbell
- School of Nursing, University of Tasmania, Launceston, TS 7250, Australia
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Affiliation(s)
- Chizimuzo Zim Okoli
- Chizimuzo (Zim) Okoli, PhD, MPH, MSN, PMHNP-BC, FAAN, American Psychiatric Nurses Association, Falls Church, VA, USA
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30
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Yılmaz NG, Timmermans DR, Van Weert JC, Damman OC. Breast cancer patients' visual attention to information in hospital report cards: An eye-tracking study on differences between younger and older female patients. Health Informatics J 2023; 29:14604582231155279. [PMID: 36840473 DOI: 10.1177/14604582231155279] [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: 02/26/2023]
Abstract
To (1) explore how women visually attend to a hospital report card (HRC), (2) explore whether visual attention of younger and older women (patients and non-patients) differs. Eye-tracking study with a short survey. Participants (N = 37) were provided with a hypothetical realistic HRC. Total dwell times and fixation counts were measured while participants viewed the information. Overall, no differences existed between younger and older women. Visual attention to the hospital of choice (vs not of choice) and to indicators perceived as most important (vs least important) did not differ. However, women with higher health literacy looked longer at the HRC than women with lower health literacy. Also, per fixation, older patients (vs younger patients) looked longer at the hospital of choice and at indicators perceived most important. Pre-existing conceptions of what information is relevant might result in more in-depth information processing among older patients than younger patients. In general, differences in level of health literacy, rather than (chronological) age, seem to be relevant to take into account when designing and/or updating HRCs.
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Affiliation(s)
- Nida Gizem Yılmaz
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, 1209Vrije Universiteit Amsterdam, The Netherlands; Department of Communication Science, Amsterdam School of Communication Research/ASCoR, 118065University of Amsterdam, Netherlands
| | - Danielle Rm Timmermans
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, 1209Vrije Universiteit Amsterdam, The Netherlands
| | - Julia Cm Van Weert
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, 118065University of Amsterdam, Netherlands
| | - Olga C Damman
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, 1209Vrije Universiteit Amsterdam, The Netherlands
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Hekmat SN, Haghdoost AA, Zamaninasab Z, Rahimisadegh R, Dehnavieh F, Emadi S. Factors associated with patients' mobility rates within the provinces of Iran. BMC Health Serv Res 2022; 22:1556. [PMID: 36539751 PMCID: PMC9764717 DOI: 10.1186/s12913-022-08972-6] [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: 03/24/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The absence of a referral system and patients' freedom to choose among service providers in Iran have led to increased patient mobility, which continues to concern health policymakers in the country. This study aimed to determine factors associated with patient mobility rates within the provinces of Iran. METHODS This cross-sectional study was conducted in Iran. Data on the place of residence of patients admitted to Iranian public hospitals were collected during August 2017 to determine the status of patient mobility within each province. The sample size were 537,786 patients were hospitalized in public hospitals in Iran during August 2017. The patient mobility ratio was calculated for each of Iran's provinces by producing a patient mobility matrix. Then, a model of factors affecting patient mobility was identified by regression analysis. All the analyses were performed using STATA14 software. RESULTS In the study period, 585,681 patients were admitted to public hospitals in Iran, of which 69,692 patients were referred to the hospital from another city and 51,789 of them were admitted to public hospitals in the capital of the province. The highest levels of intra-provincial patient mobility were attributed to southern and eastern provinces, and the lowest levels were observed in the north and west of Iran. Implementation of negative binomial regression indicated that, among the examined parameters, the distribution of specialist physicians and the human development index had the highest impact on intra-provincial patient mobility. CONCLUSION The distribution of specialists throughout different country areas plays a determining role in patient mobility. In many cases, redistributing hospital beds is impossible, but adopting different human resource policies could prevent unnecessary patient mobility through equitable redistribution of specialists among different cities.
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Affiliation(s)
- Somayeh Noori Hekmat
- grid.412105.30000 0001 2092 9755Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Akbar Haghdoost
- grid.412105.30000 0001 2092 9755Health Modeling Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Zamaninasab
- grid.412105.30000 0001 2092 9755Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Rohaneh Rahimisadegh
- grid.412105.30000 0001 2092 9755Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Dehnavieh
- grid.412105.30000 0001 2092 9755Health Foresight and Innovation Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Samira Emadi
- grid.412105.30000 0001 2092 9755Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Dubas-Jakóbczyk K, Kocot E, Tambor M, Szetela P, Kostrzewska O, Siegrist Jr RB, Quentin W. The Association Between Hospital Financial Performance and the Quality of Care - A Scoping Literature Review. Int J Health Policy Manag 2022; 11:2816-2828. [PMID: 35988029 PMCID: PMC10105205 DOI: 10.34172/ijhpm.2022.6957] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 07/20/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Improving the quality of hospital care is an important policy objective. Hospitals operate under pressure to contain costs and might face challenges related to financial deficits. The objective of this paper was to identify and map the available evidence on the association between hospital financial performance (FP) and quality of care (Q). METHODS A scoping review was performed. Searches were conducted in 7 databases: Medline via PubMed, EMBASE, Web of Science, Scopus, EconLit, ABI/INFORM, and Business Source Complete. The search strategy combined multiple terms from 3 topics: hospital AND FP AND Q. The collected data were analysed using both quantitative and qualitative methods. RESULTS 10 503 records were screened and 151 full text papers analysed. A total of 69 papers were included (60 empirical, 2 theoretical, 5 literature reviews, and 2 dissertations). The majority of identified studies were published within the last decade (2010-2021). Most empirical studies had been conducted in the United States (55/60), used cross-sectional approaches (32/60) and applied diverse regression models with FP measures as dependent variables, thus measuring the impact of Q on hospitals FP (34/60). The comparability of the studies' results is limited due to differences in applied methods and settings. Yet, the general overview shows that in almost half of the cases the association between hospital FP and Q was positive, while no study showed a clear negative association. CONCLUSION This scoping review provides an overview of the available literature on the association between hospital FP and Q. The results highlight numerous research gaps: (1) systematic reviews and meta-analyses of existing studies with similar measures of FP and Q are unavailable, (2) further methodological/conceptual work is needed on the metrics measuring hospital FP and Q, and (3) more empirical studies should analyse the association between FP and Q in non-US healthcare settings.
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Affiliation(s)
- Katarzyna Dubas-Jakóbczyk
- Health Economics and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Ewa Kocot
- Health Economics and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Marzena Tambor
- Health Economics and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Przemysław Szetela
- Health Economics and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Olga Kostrzewska
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | | | - Wilm Quentin
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
- European Observatory on Health Systems and Policies, WHO European Centre for Health Policy Eurostation (Office 07C020), Brussels, Belgium
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Wang W, Cao Y. How individual social capital affects residents' satisfaction with medical services: Based on the evidence from urban residents in China. Front Psychol 2022; 13:1077144. [PMID: 36571017 PMCID: PMC9780447 DOI: 10.3389/fpsyg.2022.1077144] [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: 10/22/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction Residents' satisfaction with medical services has commonly been treated as both a medical and psychosocial process. The influence of psychosocial factors on residents' satisfaction with medical treatment is generally considered as important as that of medical factors. However, the effect of individual social capital on residents' satisfaction after medical treatment-an important psychosocial variable that may influence health status and access to medical services-has not received sufficient attention. Methods This study used the questionnaire survey data of urban residents in eight Chinese cities in 2014 to investigate how individual social capital affects residents' satisfaction with medical services over the past year. Results The results revealed a negative impact of individual social capital on residents' overall satisfaction with medical services. In addition, the use of individual social capital significantly improved residents' satisfaction with medical resources and significantly reduced residents' satisfaction with the medical system. Moreover, the negative impact of individual social capital on residents' overall satisfaction with medical services was greater for individuals with a lower likelihood of using this capital, which may lead to unequal allocation of medical resources and long-term life satisfaction. Discussion The heterogeneous impact and mechanism of individual social capital on residents' satisfaction with medical services was confirmed under the premise of self-selection bias.
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Muacevic A, Adler JR, Aljuaid AM, Aljuaid AA, Althobaiti LT, Alosaimi FA, Abdelrahman TM. Analyzing Factors Influencing Patient Selection of a Surgeon for Elective Surgery in Saudi Arabia: A Questionnaire-Based Survey. Cureus 2022; 14:e32124. [PMID: 36601220 PMCID: PMC9806736 DOI: 10.7759/cureus.32124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Nowadays patients are encouraged to partake in healthcare decision making and patient preferences are given increasing weight. Patient's choice is important to reduce waiting time and to encourage competition between providers, as most patients look for high-quality care while minimizing costs, according to different studies this may not be as simple as the attributes and factors that patients value when selecting a hospital or surgeon. Overall, Saudi Arabia has minimal research on how patients select surgeons or surgical facilities. Therefore, the goal of the current study was to evaluate the criteria Saudi population patients used to select their surgeons. OBJECTIVE The objective is to determine the relative importance of the following aspects that patients may consider when selecting a surgeon: (a) physician-related considerations; (b) elements relating to healthcare service and access; (c) the perspectives of patients on various factors. METHODS This observational cross-sectional study attempts to investigate the criteria that people in Saudi Arabia considered most important while selecting their surgeons. This study was conducted between August and November 2022. The questionnaire is also given in English along with Arabic. RESULTS Six hundred nine completed the survey with a response rate of 91.6%. Concerning physician-related factors considered when choosing a surgeon attitudes of the physician were the factor most significantly contributed to physician selection rather than reputation or professional experience and physician social media: (84.7%) mentioned that paying attention to patient's needs and opinions is important; sparing enough time for patients is important as reported by 83.9% of the participants; Personal care and hygiene is important for 83.4% of the participants; Communication skills were considered to be important as stated by 82.6% of the participants. Regarding healthcare services/access-related factors considered by patients in physician selection; it was found that patients considered hospital hygiene-cleanliness (91.3 %) as the most significant healthcare service/access-related factor in physician selection and then it comes Ease of obtaining an appointment (89.7%), reasonable scheduling and wait for time (87.7%) and cost of surgery (82.1%). Physician selection was deemed crucial to the success of the therapy by 87.7% of patients, while 88.3% of patients thought it was crucial to research the doctor before contacting her or him for the current admission. CONCLUSION Patients consider a wide range of variables when selecting their surgeons and the location of their procedure. Depending on sociodemographic, cultural, and other aspects, the conditions surrounding patients' decisions may vary. Overall, the selection of a surgeon by surgery patients appears to be more influenced by the doctor's attitudes than by his or her reputation, professional experience, or social media presence. In order to elicit preferences across a wider range of surgical subspecialties and patient demographics, more study is necessary.
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Liu J, Ma Z, Su J, Ge B. Optimal information disclosure strategy in the primary healthcare service market: From the perspective of signaling theory. Front Public Health 2022; 10:959032. [PMID: 36388347 PMCID: PMC9650283 DOI: 10.3389/fpubh.2022.959032] [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: 06/01/2022] [Accepted: 10/06/2022] [Indexed: 01/24/2023] Open
Abstract
The promotion of general practitioner (GP) contract service is one of the key components of China's healthcare reform. We consider GPs providing primary health services with private competency information over two periods, where patients decide when to sign. Two types of GPs are considered: those with higher and lower competency. Under asymmetric information, to spur the patients' incentive to sign, the GPs can move to offer competency disclosure schemes to patients, for example, separating or pooling, through which true competency information is revealed, respectively. We investigate three scenarios, which are referred to as "separating-separating," "pooling-separating," and "pooling-pooling." The results of the three scenarios yield intriguing insights into the impact of the GP's competency disclosure decisions. Findings include that GPs prefer the "pooling-separating" strategy, but patients prefer "separating-separating." Besides, an extremely low cure rate may enable GPs to conceal some competency information. Furthermore, low-competency GPs may exaggerate their competency level for profit, but greater efforts in disclosing competency information may result in diminished benefits. Therefore, to promote the services of GPs, the core is always to improve GPs' competency.
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Abstract
Ajay Aggarwal and colleagues argue that relying on patient choice to cut waiting times is oversimplistic and likely to widen inequalities
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Affiliation(s)
- Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Guy's Cancer Centre, Guy's & St Thomas' NHS Trust, London, UK
- Institute of Cancer Policy, King's College London, London, UK
| | - Fiona M Walter
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Richard Sullivan
- Guy's Cancer Centre, Guy's & St Thomas' NHS Trust, London, UK
- Institute of Cancer Policy, King's College London, London, UK
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Wangai MW, Wangai FK, Njiri F, Wangai EN, Wangai P, Nyongesa C, Kinuthia J. Understanding and comparing the medical tourism cancer patient with the locally managed patient: A case control study. PLoS One 2022; 17:e0273162. [PMID: 36129938 PMCID: PMC9491543 DOI: 10.1371/journal.pone.0273162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/03/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
Medical tourism is characterized by people seeking treatment abroad for various medical conditions due to varied reasons, many of whom benefit from specialized care for non-communicable diseases. Conversely, there are associated negative effects such as medical complications and weakened health systems. Currently, there is paucity of scientific evidence on patient-related factors influencing seeking treatment benefits abroad. This study sought to compare patient-related factors associated with choice of cancer treatment center locally or abroad, to understand reasons for seeking treatment outside Kenya.
Materials and methods
As a case-control study, 254 cancer patients were randomly sampled to compare responses from those who chose to receive initial treatment abroad or in Kenya. The cases were recruited from Ministry of Health while the controls from Kenyatta National Hospital and Texas Cancer Center. Data was analyzed using SPSS Software Version 21. Descriptive statistics, bivariate and multiple logistic regression analysis was carried out. Level of significance was set at 5%.
Results
Out of 254 respondents, 174 (69.5%) were treated for cancer in Kenya and 80 (31.5%) in India. We found that cost effectiveness was a significant factor for over 73% of all respondents. The study revealed independent predictors for seeking treatment in India were: monthly income higher than US$ 250; every additional month from when disclosure to patients was done increased likelihood by 1.16 times; physician advice (Odds Ratio(OR) 66; 95% Confidence Interval(CI) 7.9–552.9); friends and family (OR 42; 95% CI 7.07–248.6); and perception of better quality of care (OR 22.5; 95% CI 2.2–230.6).
Conclusion
Reasons patients with cancer sought treatment in India are multifactorial. Several of these can be addressed to reverse out-ward bound medical tourism and contribute to improving the in-country cancer healthcare. It will require strengthening the health system accordingly and sensitizing the medical fraternity and general public on the same.
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Affiliation(s)
- Mary W. Wangai
- Department of International Health Relations, Ministry of Health, Nairobi, Kenya
- * E-mail:
| | - Frederick K. Wangai
- Department of Clinical Medicine and Therapeutics, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Francis Njiri
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya
| | - Enan N. Wangai
- School of Medicine, College of Health Sciences—University of Nairobi, Nairobi, Kenya
| | | | | | - John Kinuthia
- Research and Programs Department, Kenyatta National Hospital, Nairobi, Kenya
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Salampessy BH, Ikkersheim D, Portrait FRM, Koolman X. Do patients' preferences prevail in hospital selection?: a comparison between discrete choice experiments and revealed hospital choice. BMC Health Serv Res 2022; 22:1136. [PMID: 36076226 PMCID: PMC9461248 DOI: 10.1186/s12913-022-08403-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/27/2022] [Indexed: 11/29/2022] Open
Abstract
Background In patient choice, patients are expected to select the provider that best fits their preferences. In this study, we assess to what extent the hospital choice of patients in practice corresponds with their preferred choice. Methods Dutch patients with breast cancer (n = 631) and cataract (n = 1109) were recruited. We employed a discrete choice experiment (DCE) per condition to measure stated preferences and predict the distribution of patients across four hospitals. Each DCE included five attributes: patient experiences, a clinical outcome indicator, waiting time, travel distance and whether the hospital had been recommended (e.g., by the General Practitioner (GP)). Revealed choices were derived from claims data. Results Hospital quality was valued as most important in the DCE; the largest marginal rates of substitution (willingness to wait) were observed for the clinical outcome indicator (breast cancer: 38.6 days (95% confidence interval (95%CI): 32.9–44.2); cataract: 210.5 days (95%CI: 140.8–280.2)). In practice, it was of lesser importance. In revealed choices, travel distance became the most important attribute; it accounted for 85.5% (breast cancer) and 95.5% (cataract) of the log-likelihood. The predicted distribution of patients differed from that observed in practice in terms of absolute value and, for breast cancer, also in relative order. Similar results were observed in population weighted analyses. Discussion Study findings show that patients highly valued quality information in the choice for a hospital. However, in practice these preferences did not prevail. Our findings suggest that GPs played a major role and that patients mostly ended up selecting the nearest hospital. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08403-6.
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Affiliation(s)
- Benjamin H Salampessy
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.
| | - David Ikkersheim
- KPMG, Laan van Langerhuize 1, 1186 DS, Amstelveen, The Netherlands
| | - France R M Portrait
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
| | - Xander Koolman
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
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Arsyad DS, Hamsyah EF, Qalby N, Qanitha A, Westerink J, Cramer MJ, Visseren FLJ, Doevendans PA, Ansariadi A. The readiness of public primary health care (PUSKESMAS) for cardiovascular services in Makasar city, Indonesia. BMC Health Serv Res 2022; 22:1112. [PMID: 36050732 PMCID: PMC9436735 DOI: 10.1186/s12913-022-08499-w] [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: 04/26/2022] [Accepted: 08/24/2022] [Indexed: 11/25/2022] Open
Abstract
Backgrounds The increasing burden of cardiovascular disease (CVD) has become a major challenge globally, including in Indonesia. Understanding the readiness of primary health care facilities is necessary to confront the challenge of providing access to quality CVD health care services. Our study aimed to provide information regarding readiness to deliver CVD health services in public primary health care namely Puskesmas. Methods The study questionnaire was adapted from the World Health Organization (WHO) Service Availability and Readiness Assessment (SARA), modified based on the package of essentials for non-communicable disease (PEN) and the Indonesian Ministry of health regulation. Data were collected from all Puskesmas facilities (N = 47) located in Makassar city. We analysed relevant data following the WHO-SARA manual to assess the readiness of Puskesmas to deliver CVD services. Human resources, diagnostic capacity, supporting equipment, essential medication, infrastructure and guidelines, and ambulatory services domain were assessed based on the availability of each tracer item in a particular domain. The mean domain score was calculated based on the availability of tracer items within each domain. Furthermore, the means of all domains’ scores are expressed as an overall readiness index. Higher scores indicate greater readiness of Puskesmas to deliver CVD-related health care. Results Puskesmas delivers health promotion, disease prevention, and prompt diagnosis for cardiovascular-related diseases, including hypertension, diabetes, coronary heart disease (CHD), and stroke. Meanwhile, basic treatments were observed in the majority of the Puskesmas. Long-term care for hypertension and diabetes patients and rehabilitation for CHD and stroke were only observed in a few Puskesmas. The readiness score of Puskesmas to deliver CVD health care ranged from 60 to 86 for. Furthermore, there were 11 Puskesmas (23.4%) with a score below 75, indicating a sub-optimal readiness for delivering CVD health services. A shortage of essential medicines and a low capacity for diagnostic testing were the most noticeable shortcomings leading to suboptimal readiness for high-quality CVD health services. Conclusion Close cooperation with the government and other related stakeholders is required to tackle the identified shortcomings, especially the continuous monitoring of adequate supplies of medicines and diagnostic tools to achieve better CVD care for patients in Indonesia. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08499-w.
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Affiliation(s)
- Dian Sidik Arsyad
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, 3584, CT, Utrecht, The Netherlands. .,Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia.
| | - Esliana Fitrida Hamsyah
- Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
| | - Nurul Qalby
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, 3584, CT, Utrecht, The Netherlands.,Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | | | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maarten J Cramer
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, 3584, CT, Utrecht, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Ansariadi Ansariadi
- Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
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Strumann C, Geissler A, Busse R, Pross C. Can competition improve hospital quality of care? A difference-in-differences approach to evaluate the effect of increasing quality transparency on hospital quality. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:1229-1242. [PMID: 34997865 PMCID: PMC9395484 DOI: 10.1007/s10198-021-01423-9] [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: 02/12/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
Public reporting on the quality of care is intended to guide patients to the provider with the highest quality and to stimulate a fair competition on quality. We apply a difference-in-differences design to test whether hospital quality has improved more in markets that are more competitive after the first public release of performance data in Germany in 2008. Panel data from 947 hospitals from 2006 to 2010 are used. Due to the high complexity of the treatment of stroke patients, we approximate general hospital quality by the 30-day risk-adjusted mortality rate for stroke treatment. Market structure is measured (comparatively) by the Herfindahl-Hirschman index (HHI) and by the number of hospitals in the relevant market. Predicted market shares based on exogenous variables only are used to compute the HHI to allow a causal interpretation of the reform effect. A homogenous positive effect of competition on quality of care is found. This effect is mainly driven by the response of non-profit hospitals that have a narrow range of services and private for-profit hospitals with a medium range of services. The results highlight the relevance of outcome transparency to enhance hospital quality competition.
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Affiliation(s)
- Christoph Strumann
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
| | | | - Reinhard Busse
- Department of Health Care Management, Berlin University of Technology, Berlin, Germany
| | - Christoph Pross
- Department of Health Care Management, Berlin University of Technology, Berlin, Germany
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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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Weinhold I, Wende D, Schrey C, Militzer-Horstmann C, Schang L, Sundmacher L. Assessing patients’ acceptable and realised distances to determine accessibility standards for the size of catchment areas in outpatient care. Health Policy 2022; 126:1180-1186. [DOI: 10.1016/j.healthpol.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/18/2022] [Accepted: 08/22/2022] [Indexed: 11/04/2022]
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Patient satisfaction and its health provider-related determinants in primary health facilities in rural China. BMC Health Serv Res 2022; 22:946. [PMID: 35883080 PMCID: PMC9316702 DOI: 10.1186/s12913-022-08349-9] [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: 12/14/2021] [Accepted: 07/18/2022] [Indexed: 12/17/2022] Open
Abstract
Background Patient satisfaction is an important outcome measure of health service and is one of the main reasons for the gradual deterioration of doctor–patient relationships in China. This study used the standardized patient (SP) method to explore patient satisfaction and its health provider-related determinants among primary health facilities in rural China. Methods The dataset comprised 1138 clinic cases in 728 rural primary health facilities in 31 counties, spread across four provinces. Information regarding the consultation interaction between the unannounced SPs and primary physicians was recorded. Patient satisfaction was gathered from the feedback of SPs after the visit. Results The overall average score of SP satisfaction with rural primary health facilities was only 13.65 (SD = 3.22) out of 20. The SP scores were found to be consistent with those of real patients. After controlling variances in patient population via the SP method, the regression analysis demonstrated that health provider-related factors, such as physician-level characteristics, consultation process, affordability, and convenience, have a significant correlation with patient satisfaction among primary physicians. Among factors relating to physician-level characteristics, affordability, convenience and the consultation process of the visit, the quality of the consultation process (e.g., consultation time, proactively providing necessary instructions and other crucial information) were found to be the prominent determinants. Conclusions This study revealed the need to improve patient satisfaction in primary health facilities in rural China. To solve this issue, we recommend that policies to increase medical service quality be implemented in rural primary healthcare systems. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08349-9.
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Barnea R, Tur-Sinai A, Levtzion-Korach O, Weiss Y, Tal O. Patient preferences and choices as a reflection of trust-A cluster analysis comparing postsurgical perceptions in a private and a public hospital. Health Expect 2022; 25:2340-2354. [PMID: 35833265 PMCID: PMC9615048 DOI: 10.1111/hex.13487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 11/29/2022] Open
Abstract
Background Active participation of patients in managing their medical treatment is a major component of the patient empowerment process and may contribute to better clinical outcomes. Patient perceptions and preferences affect the patient–physician encounter in a variety of dimensions, such as patient autonomy, freedom of choice and trust in the healthcare system. The Israeli healthcare system is mostly publicly funded, with additional private healthcare services for surgery and other medical treatments. The aim of this study was to compare the perceptions and preferences of patients in the public and private hospitals in Israel. Methods A cross‐sectional study among 545 individuals who had surgical procedures at two hospitals in Israel (one public and one private). A structured questionnaire comprising 23 items was used to collect perceptions via personal telephone interviews. The responses were categorized into five clusters and compared by type of health services provider (public vs. private) and sociodemographic characteristics (gender, age and education level). Results A hierarchical cluster analysis methodology identified five conceptual groups: trust, concern towards medical errors, dialogue between medical staff and the patient/patient's family, confidentiality and staff bias towards more informed patients, or those with supportive families. Four main themes that highlight patients' preferences were found: physical conditions, personal empowerment and perceived autonomy, patient experience and patient–provider encounter communication. Significant differences between the private and the public healthcare systems were found in four clusters: trust and patient care, patient's concerns, the extent of explanation and medical staff's commitment. Differences secondary to sociodemographic parameters were noticed: patients treated at the private hospital scored significantly higher items of trust, medical staff caring and the importance of choosing their treating surgeon, while patients treated at the public hospital scored higher staff commitment to the patient than those treated at the private hospital. Conclusions The study revealed the perceptions underlying the decisions of patients to undergo surgical procedures in public or private hospitals. Mutual learning could pave the way to better patient–physician encounters. Patient or Public Contribution Patients from the two hospitals were involved in this study by responding to the questionnaire. The data presented is based on the patient's responses.
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Affiliation(s)
- Royi Barnea
- Assuta Health Services Research Institute, Assuta Medical Centers, Tel-Aviv, Israel.,School of Health Systems Management, Netanya Academic College, Netanya, Israel
| | - Aviad Tur-Sinai
- Department of Health Systems Management, The Max Stern Yezreel Valley College, Yezreel Valley, Israel.,School of Nursing, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Yossi Weiss
- Assuta Health Services Research Institute, Assuta Medical Centers, Tel-Aviv, Israel.,Ariel University, Ariel, Israel
| | - Orna Tal
- Shamir Medical Center (Assaf Harofeh), Zerifin, Israel.,Israeli Center for Emerging Technologies (ICET), Tel Aviv, Israel.,Department of Management, Bar Ilan University, Ramat Gan, Israel
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Keshavarzi MH, Safaie S, Faghihi SAA, Zare S. Barriers of physician-patient relationships in professionalism: A qualitative study. JOURNAL OF ADVANCES IN MEDICAL EDUCATION & PROFESSIONALISM 2022; 10:199-206. [PMID: 35910520 PMCID: PMC9309164 DOI: 10.30476/jamp.2022.94010.1563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/13/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Undoubtedly, there are several obstacles in the path of medical professionalism. This study examines these obstacles in the relationship between physician and patient. Therefore, this study was conducted to explore the barriers of physician-patient relationships in professionalism based on physician experiences. METHODS It was a qualitative study with a conventional content analysis approach. Our participants were 14 patients and 11 physicians. The sampling method was purposive, and data was collected through semi-structured interviews and field notes. Interviews continued until data saturation. RESULTS Findings of the study regarding barriers of patient-physician relationship were classified into five main categories: misperception of the physician's identity, unprofessional behavior of the physician, physician's sense of self-superiority, patients' cultural differences, and lack of supportive services in the health care system. CONCLUSION The results of this study showed that the communication challenges between physician and patient were not limited to the physicians' education. Part of these challenges depends on the patients and their culture. Another part of these challenges is directly related to the medical and management system structure.
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Affiliation(s)
- Mohammad Hasan Keshavarzi
- Clinical Education Research Center, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz Iran
| | | | - Seyed Ali Akbar Faghihi
- Clinical Education Research Center, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz Iran
| | - Soolmaz Zare
- Clinical Education Research Center, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz Iran
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Lassarén P, Tewarie IA, Gerstl JVE, Florman JE, Smith TR, Broekman MLD. Telemedicine and the right to health: A neurosurgical perspective. J Clin Neurosci 2022; 102:71-74. [PMID: 35738183 DOI: 10.1016/j.jocn.2022.06.011] [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: 05/19/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 11/24/2022]
Abstract
Neurosurgical task force is limited and unevenly distributed. Telemedicine has become increasingly popular, and could help neurosurgical centers meet patient right to care. This scoping review aims to evaluate the impact and feasibility of telemedicine on the right to neurosurgical care, using the AAAQ toolbox. The AAAQ toolbox consists of Availability, Accessibility, Acceptability and Quality. Neurosurgical availability is limited by the number of neurosurgeons, but by using task shifting and -sharing via telemedicine, the number of patients receiving neurosurgical care could increase without increasing the number of neurosurgeons. Telemedicine can improve geographic accessibility to neurosurgical care, but may also introduce technological literacy barriers. Acceptability of telemedicine is a double-edged sword; while a useful service, telemedicine also creates ethical concerns regarding privacy and confidentiality. Regulations and adaptations for vulnerable patient groups are key considerations for deploying telemedicine. Finally, there is emerging evidence that the quality of remote neurosurgical diagnostics and care can keep high standards. Overall, telemedicine has the potential of taking neurosurgery one step closer to meeting patient right to health, globally.
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Affiliation(s)
- Philipp Lassarén
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Computational Neurosciences Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
| | - Ishaan A Tewarie
- Computational Neurosciences Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands; Faculty of Medicine, Erasmus University Rotterdam/Erasmus Medical Center Rotterdam, The Netherlands
| | - Jakob V E Gerstl
- Computational Neurosciences Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Neurosurgery, Maine Medical Center, Portland, ME, United States
| | - Jeffrey E Florman
- Department of Neurosurgery, Maine Medical Center, Portland, ME, United States
| | - Timothy R Smith
- Computational Neurosciences Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, Boston, MA, United States
| | - Marike L D Broekman
- Computational Neurosciences Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands; Department of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Fredriksson M, Isaksson D. Fifteen years with patient choice and free establishment in Swedish primary healthcare: what do we know? Scand J Public Health 2022; 50:852-863. [PMID: 35596549 PMCID: PMC9578085 DOI: 10.1177/14034948221095365] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: In 2007, a reform of Swedish primary healthcare began when some regions implemented enhanced patient choice in combination with free establishment for private providers. Although heavily debated, in 2010 it became mandatory for all regions to implement this choice system. Aim: The aim of this article was to review all published research articles related to the primary healthcare choice reform in Sweden, to investigate what has been published about the reform and summarise its first 15 years. Methods: A scoping review was performed to cover the breadth of research on the reform. Searches were made in Scopus, Web of Science and PubMed for articles published between 2007 and 2021, resulting in 217 unique articles. In total, 52 articles were included. Results: The articles were summarised and presented in relation to six overarching themes: arguments about the primary healthcare choice reform; governance and financial reimbursements; choice of provider and use of information; effects on equity and access; effects on quality; and differences between private and public primary healthcare centres. Conclusions: The articles show that the reform has led to an increase in access to primary healthcare, but most studies indicate that the increase is inequitably distributed in terms of socioeconomy and geographical location. The effects on quality are unclear but several studies show that the mechanisms supposed to lead to quality improvements do not work as intended. Furthermore, from a population health perspective, it is time to discuss how such a responsibility can be reintegrated into primary healthcare and function with the choice system.
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Affiliation(s)
- Mio Fredriksson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - David Isaksson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Chapon MP, Ghabi A, Choufani C, Caubere A, Moynot JC, Versier G, Wein F, Barbier O. How do patients choose their surgeon? Example of anterior cruciate ligament reconstruction. Orthop Traumatol Surg Res 2022; 108:103037. [PMID: 34375771 DOI: 10.1016/j.otsr.2021.103037] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/15/2021] [Accepted: 03/04/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION In this age of social media, with an ever-higher profile for surgery and rankings for the general public, patients' criteria for choosing a surgeon or team are not precisely known, especially in France. We therefore conducted a prospective study concerning anterior cruciate ligament reconstruction: (1) to determine how patients came to know their surgeon; (2) to identify factors affecting final choice. HYPOTHESIS Patients' choice of surgeon is affected by scores found in social media and rankings found in the press. MATERIAL AND METHOD A prospective continuous study included all patients operated on, without standardization of technique, in 3 hospitals (public and private sector). An anonymous questionnaire on surgeon selection criteria, scored 0 to 10, was distributed on a voluntary basis on the day of surgery scheduling. RESULTS One hundred and five patients were included. They had come to know of their surgeon via family or friends or their personal physician in more than two-thirds of cases. The essential criterion of final choice was the clarity of the written and oral information provided in consultation (mean score, 8.09±1.83). Other factors included wait-time to surgery (7.39±2.25) and to first consultation (7.26±2.01) and the surgeon's reputation (7.42/10±2.43). CONCLUSION "Word of mouth" and the quality if information provided in consultation motivated final choice, more than any influence of social media or press hospital rankings. LEVEL OF EVIDENCE IV; prospective observational study without control group.
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Affiliation(s)
- Marie-Pauline Chapon
- Service de chirurgie orthopédique, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.
| | - Ammar Ghabi
- Service de chirurgie orthopédique, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - Camille Choufani
- Service de chirurgie orthopédique, HIA Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France
| | - Alexandre Caubere
- Service de chirurgie orthopédique, HIA Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France
| | - Jean-Clair Moynot
- Service de chirurgie orthopédique, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - Gilbert Versier
- Clinique de Tournan-en-Brie, 2, rue Jules-Lefebvre, 77200 Tournan-en-Brie, France
| | - Franck Wein
- Groupe de chirurgie orthopédique et traumatologique ARTIC-S, 24, boulevard 21(e) Régiment Aviation, 54000 Nancy, France
| | - Olivier Barbier
- Service de chirurgie orthopédique, HIA Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France
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Evaluation approaches, tools and aspects of implementation used in pharmacist interventions in residential aged care facilities: A scoping review. Res Social Adm Pharm 2022; 18:3714-3723. [DOI: 10.1016/j.sapharm.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 02/15/2022] [Accepted: 05/07/2022] [Indexed: 11/21/2022]
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Ossai C, Bedrick S, Orwoll B. Using Publicly Available Reddit Data to Understand How Parents Choose Pediatricians. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2022. [DOI: 10.1080/15398285.2022.2062659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Chionye Ossai
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA
- Department of Pediatric Hospital Medicine, Cleveland Clinic Children’s Hospital, Cleveland, Ohio, USA
| | - Steven Bedrick
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Benjamin Orwoll
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, USA
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