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Barboza-Solis C, Barahona-Cubillo J, Fantin R. Health inequalities in the geographic distribution of dental practitioners in Costa Rica: An ecological study. Community Dent Oral Epidemiol 2024; 52:39-46. [PMID: 37515401 DOI: 10.1111/cdoe.12899] [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: 02/27/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE The uneven distribution of dental health services in a territory can cause an imbalance in accessibility, increasing health inequalities. This study aimed to describe the geographical distribution of dental health practitioners according to urbanicity and area-level socio-economic status in Costa Rica. METHODS A National Dentist Survey was developed to identify employment status, number of working hours, address and list of the working clinics. Data was completed using information from the national College of Surgeons, including all Costa Rican dentists. The Minimal Geographic Units (MGU) allowed for aggregating the population's individual level socio-economic position. Local Potential Accessibility (LPA) calculated the density of full-time hour's equivalents around each MGU using floating sectors. Clinics were geocoded using Geographic Information Systems, creating 2853 clinical points. Distance between each MGU and the nearest accessible clinics considering full-time working hours equivalents was estimated. MGU were divided into six categories: 'No accessibility', 'Very low accessibility', 'Low accessibility', 'Good accessibility' 'High accessibility' and 'Very high accessibility'. RESULTS Mean national LPA was 6.5 full-time equivalents per 10 000 inhabitants, 3.4% of the Costa Rican population had no access to dentist; 12.9% had very low accessibility, 22.7% had low accessibility, 35.0% had good accessibility, 16.2% had high accessibility, and 9.8% had very high accessibility. Overall, 39% of the population has a rather low accessibility. LPA was higher in urban districts compared to rural districts and in wealthiest districts compared to most disadvantaged districts. Within districts, after adjustment for district's characteristics, LPA was higher in urban MGU compared to rural MGU and in wealthiest MGU compared to most disadvantaged MGU. CONCLUSIONS This study found that despite having a high number of dentists, their numbers are small in many areas, increasing inequalities in access to health care. The dentist's free establishment, where they can decide to provide private services within a community, creates zones with very high densities, in particular in the wealthiest urban areas, and others with very low densities, in particular the poorest rural areas. The lack of territorial planning has been one of the reasons that has encouraged an imbalance in the availability of dental human resources. To achieve effective universal health coverage, public institutions should focus their efforts on improving access to dental services in underserved areas.
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Affiliation(s)
| | | | - Romain Fantin
- Centro Centroamericano de Población, Universidad de Costa Rica, San José, Costa Rica
- Facultad de Medicina, Universidad de Costa Rica, San José, Costa Rica
- Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA, San José, Costa Rica
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Noochpoung R, Hung P, Hair NL, Putthasri W, Chen B. Can a High-Powered Financial Incentive Program Reduce Resignation Rates among Healthcare Providers in Rural Areas? Evidence from Thailand's 2008 Hardship Allowance Program. Health Policy Plan 2022; 37:624-633. [PMID: 35233635 DOI: 10.1093/heapol/czac018] [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: 08/28/2021] [Revised: 02/22/2022] [Accepted: 03/01/2022] [Indexed: 11/14/2022] Open
Abstract
Geographic disparities in the availability of healthcare providers remain a global health challenge. Financial incentives have been widely implemented to attract rural healthcare workers with limited scientific evidence in developing economies. In this study, we investigate the relationship between financial incentives and rural resignations in a middle-income country using Thailand's Hardship Allowance program that first doubled or tripled but later decreased direct payments to rural providers. This retrospective observational study used data on dentists' work status from the Human Resource Management Department at the Ministry of Public Health in Thailand. Segmented regression and difference-in-differences approaches were used to analyze the effect of changes to the Hardship Allowance on rural dentists' resignation and relocation patterns. We found that the dramatic increase in the Hardship Allowance in 2008 was associated with a decrease in resignation rates among dentists in rural areas. However, after Thailand recategorized certain rural districts into urban areas in 2016, dentists were more likely to relocate from the newly urbanized areas to established urban centers, likely due in part to reductions in the Hardship Allowance that accompanied recategorization. However, we did not find that resignations increased in these affected areas. Finally, in a subgroup analysis, we found that older dentists were less likely than younger dentists to relocate from areas affected by the 2016 rural-to-urban recategorization. Overall, our study found that a dramatic increase in financial incentives reduced resignation rates in rural Thailand, but a reversal of the incentives as a result of rural-to-urban reclassification resulted in relocations from the affected areas to established urban centers. When considering their strategic goals of equitable healthcare workforce distribution, policy makers should be aware that both direct and indirect changes to payment incentives may affect dentists' resignation and practice location decisions, and that these decisions may be influenced by provider demographics.
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Affiliation(s)
| | - Peiyin Hung
- Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, USA
| | - Nicole L Hair
- Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, USA
| | | | - Brian Chen
- Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, USA
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Chung PC, Chan TC. Association between local spatial accessibility of dental care services and dental care quality. BMC Oral Health 2021; 21:582. [PMID: 34789214 PMCID: PMC8600821 DOI: 10.1186/s12903-021-01943-z] [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: 09/13/2020] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of our study was to evaluate the allocation of dental resources and explore access to dental care in Taiwan. In addition, we tried to understand the spatiotemporal characteristics of dental care quality and analyze the relationship between dental care quality and areas with deficiencies in dental resources. METHODS The study used a two-step floating catchment area to calculate the dental resources accessibility and explore the spatiotemporal distributions of dental care quality. The association between dental care quality and spatial accessibility was analyzed using a spatial error model. RESULTS Most areas with deficient dental resources and lower dental care quality were remote townships, agricultural towns, or aging towns with spatial clustering. The quality of children's preventive dental care had increased over time. Most highly urbanized areas had higher dental care quality. The quality of some dental care types such as children's preventive care and full-mouth calculous removal was associated with higher accessibility. CONCLUSIONS Understanding the spatiotemporal distribution of both dental care accessibility and quality can assist in allocation of dental care resources. Adequate dental resources may elevate dental care quality. Suggestions include policies to balance dental resources and routinely monitor improvement in areas with deficient dental care.
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Affiliation(s)
- Ping-Chen Chung
- Department of Dentistry, Puzi Hospital, Ministry of Health and Welfare, Chiayi, Taiwan
| | - Ta-Chien Chan
- Research Center for Humanities and Social Sciences, Academia Sinica, 128 Academia Road, Section 2, Taipei, Taiwan. .,Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Putri LP, Russell DJ, O'Sullivan BG, Kippen R. Factors Associated With Working in Remote Indonesia: A National Cross-Sectional Study of Early-Career Doctors. Front Med (Lausanne) 2021; 8:594695. [PMID: 34055819 PMCID: PMC8155628 DOI: 10.3389/fmed.2021.594695] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 03/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Doctor shortages in remote areas of Indonesia are amongst challenges to provide equitable healthcare access. Understanding factors associated with doctors' work location is essential to overcome geographic maldistribution. Focused analyses of doctors' early-career years can provide evidence to strengthen home-grown remote workforce development. Method: This is a cross-sectional study of early-career (post-internship years 1–5) Indonesian doctors, involving an online self-administered survey on demographic characteristics, and; locations of upbringing, medical clerkship (placement during medical school), internship, and current work. Multivariate logistic regression was used to test factors associated with current work in remote districts. Results: Of 3,176 doctors actively working as clinicians, 8.9% were practicing in remote districts. Compared with their non-remote counterparts, doctors working in remote districts were more likely to be male (OR 1.5,CI 1.1–2.1) or unmarried (OR 1.9,CI 1.3–3.0), have spent more than half of their childhood in a remote district (OR 19.9,CI 12.3–32.3), have completed a remote clerkship (OR 2.2,CI 1.1–4.4) or internship (OR 2.0,CI 1.3–3.0), currently participate in rural incentive programs (OR 18.6,CI 12.8–26.8) or have previously participated in these (OR 2.0,CI 1.3–3.0), be a government employee (OR 3.2,CI 2.1–4.9), or have worked rurally or remotely post-internship but prior to current position (OR 1.9,CI 1.2–3.0). Conclusion: Our results indicate that building the Indonesian medical workforce in remote regions could be facilitated by investing in strategies to select medical students with a remote background, delivering more remote clerkships during the medical course, deploying more doctors in remote internships and providing financial incentives. Additional considerations include expanding government employment opportunities in rural areas to achieve a more equitable geographic distribution of doctors in Indonesia.
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Affiliation(s)
- Likke Prawidya Putri
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,School of Rural Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Bendigo, VIC, Australia
| | - Deborah Jane Russell
- School of Rural Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Bendigo, VIC, Australia.,Menzies School of Health Research, Alice Springs, NT, Australia
| | - Belinda Gabrielle O'Sullivan
- School of Rural Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Bendigo, VIC, Australia.,Rural Clinical School, University of Queensland, Toowoomba, QLD, Australia
| | - Rebecca Kippen
- School of Rural Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Bendigo, VIC, Australia
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Huang Y, Danovaro-Holliday MC. Characterization of immunization secondary analyses using demographic and health surveys (DHS) and multiple indicator cluster surveys (MICS), 2006-2018. BMC Public Health 2021; 21:351. [PMID: 33581740 PMCID: PMC7880859 DOI: 10.1186/s12889-021-10364-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 01/31/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Infant immunization coverage worldwide has plateaued at about 85%. Using existing survey data to conduct analyses beyond estimating coverage may help immunization programmes better tailor strategies to reach un- and under-immunized children. The Demographic and Health Survey (DHS) and the Multiple Indicators Cluster Survey (MICS), routinely conducted in low and middle-income countries (LMICs), collect immunization data, yet vaccination coverage is often the only indicator reported and used. We conducted a review of published immunization-related analyses to characterize and quantify immunization secondary analyses done using DHS and MICS databases. METHODS We conducted a systematic search of the literature, of immunization-related secondary analyses from DHS or MICS published between 2006 and August 2018. We searched 15 electronic databases without language restrictions. For the articles included, relevant information was extracted and analyzed to summarize the characteristics of immunization-related secondary analyses. Results are presented following the PRISMA guidelines. RESULTS Among 1411 papers identified, 115 met our eligibility criteria; additionally, one article was supplemented by the Pan American Health Organization. The majority were published since 2012 (77.6%), and most (68.9%) had a first or corresponding author affiliated with institutions in high-income countries (as opposed to LMICs where these surveys are conducted). The median delay between survey implementation and publication of the secondary analysis was 5.4 years, with papers with authors affiliated to institutions in LMIC having a longer median publication delay (p < 0.001). Over 80% of the published analyses looked at factors associated with a specific vaccine or with full immunization. Quality proxies, such as reporting percent of immunization data from cards vs recall; occurrence and handling of missing data; whether survey analyses were weighted; and listing of potential biases or limitations of the original survey or analyses, were infrequently mentioned. CONCLUSION Our review suggests that more needs to be done to increase the increase the utilization of existing DHS and MICS datasets and improve the quality of the analyses to inform immunization programmes. This would include increasing the proportion of analyses done in LMICs, reducing the time lag between survey implementation and publication of additional analyses, and including more qualitative information about the survey in the publications to better interpret the results.
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Affiliation(s)
- Yue Huang
- Department of Immunization, Immunization, Analytics and Insights (IAI), Vaccines and Biologicals (IVB), World Health Organization (WHO), 1211, Geneva, Switzerland
- Present affiliation: State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, 361102, China
| | - M Carolina Danovaro-Holliday
- Department of Immunization, Immunization, Analytics and Insights (IAI), Vaccines and Biologicals (IVB), World Health Organization (WHO), 1211, Geneva, Switzerland.
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Wu TT, Liu WW, Zou M, Lei X, Yang Q, Sharma M, Zhao Y, Shi ZM. Changes in preventive care utilisation and its influencing factors among Chinese adults before and after the healthcare reform: cross-sectional evidence from the China Health and Nutrition Survey in 2004-2015. BMJ Open 2020; 10:e038763. [PMID: 33004399 PMCID: PMC7534708 DOI: 10.1136/bmjopen-2020-038763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE China launched its health reform in 2009. This study aimed to assess changes in preventive care utilisation (PCU) and its relationship with the healthcare reform. DESIGN A cross-sectional study using demographic characteristics, socioeconomic status, environmental factors, and lifestyle and health status data of adults from five waves (2004-2015) of the China Health and Nutrition Survey (CHNS) was conducted. Multilevel mixed-effects logistic regression models were used. SETTING Data were derived from urban and rural communities of nine provinces in China. PARTICIPANTS Data were obtained from five waves of the CHNS, with 9960 participants in 2004, 9888 in 2006, 10 286 in 2009, 9709 in 2011, and 10 628 in 2015. OUTCOME The primary outcome was PCU. RESULTS PCU in 2004-2015 among adults was 3.29%, 3.13%, 3.77%, 4.95% and 2.73%, respectively. Whether before or after the health reform, having a history of disease and female gender were positive influencing factors of PCU. Before 2009, PCU was significantly associated with gender, income, medical insurance status and region. Age, medical insurance status, history of drinking and education level significantly affected PCU in 2009-2011. Having medical insurance was no longer a positive influencing factor of PCU, while high income had a negative effect on PCU, in 2011-2015. CONCLUSIONS PCU from 2004 to 2015 was low and the health reform in China may lack sustainable effect on PCU. Further studies on how to ensure sustainability of PCU are necessary, and further reforms on preventive care services should be aimed at different ages, rural areas and participants without history of disease.
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Affiliation(s)
- Ting Ting Wu
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Centerfor Medicine and Social Development, Chongqing Medical University, Chongqing, China
- Collaborative Innovation Centerof Social Risks Governance in Health, Chongqing Medical University, Chongqing, China
| | - Wei Wei Liu
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Centerfor Medicine and Social Development, Chongqing Medical University, Chongqing, China
- Collaborative Innovation Centerof Social Risks Governance in Health, Chongqing Medical University, Chongqing, China
| | - Mao Zou
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Centerfor Medicine and Social Development, Chongqing Medical University, Chongqing, China
- Collaborative Innovation Centerof Social Risks Governance in Health, Chongqing Medical University, Chongqing, China
| | - Xun Lei
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Centerfor Medicine and Social Development, Chongqing Medical University, Chongqing, China
- Collaborative Innovation Centerof Social Risks Governance in Health, Chongqing Medical University, Chongqing, China
| | - Qiang Yang
- The Hospital on Integration of Chinese and Western Medical Science in Shapingba District, Chongqing, China
| | - Manoj Sharma
- Department of Behavioral and Environmental Health, Jackson State University, Jackson, Mississippi, USA
| | - Yong Zhao
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Centerfor Medicine and Social Development, Chongqing Medical University, Chongqing, China
- Collaborative Innovation Centerof Social Risks Governance in Health, Chongqing Medical University, Chongqing, China
| | - Zu Min Shi
- Human Nutrition Department, QU Health, Qatar University, Doha, Ad Dawhah, Qatar
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Urban-Rural Disparity in Geographical and Temporal Availability of Pediatric Clinics: A Nationwide Survey in Taiwan. Pediatr Neonatol 2017; 58:344-349. [PMID: 28126449 DOI: 10.1016/j.pedneo.2016.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/14/2016] [Accepted: 07/28/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The shortage and maldistribution of pediatricians affected after-hours pediatric services, especially in rural areas. Our study aimed to examine the urban-rural disparity in geographical and temporal availability of the pediatrician workforce in Taiwan by analyzing opening time schedules of all pediatric clinics throughout the country. METHODS The opening time schedules of nonhospital pediatric clinics were downloaded from the website of the National Health Insurance Administration in Taiwan for analysis. The geographical and temporal availability of pediatric clinics was calculated and stratified by urbanization level and opening time, which was divided into daytime and evening sessions over 1 week. Each of 368 towns in Taiwan was also regarded as a unit of measurement to estimate the local availability of at least one pediatric clinic open in after-hours sessions. RESULTS Among 1483 nonhospital pediatric clinics in Taiwan, the overwhelming majority were situated in urban (65.8%) and suburban (30.6%) areas. On average, a pediatric clinic provided 16.3 (standard deviation=3.04) sessions of services per week. One-third (34.7%, n=50) of 144 suburban towns and over three-fourths (77.4%, n=120) of 155 rural towns had no pediatric clinic. Most pediatric clinics remained open on weekday evenings (91.1%) and during Saturday daytime (91.8%). The percentage of open clinics gradually decreased over the weekend: Saturday evening (58.1%), Sunday daytime (33.4%), and Sunday evening (19.4%). Rural pediatric clinics remained closed mostly on weekends. On Sunday evenings, pediatric clinics were open only in 5.2% of rural towns, with a decline of 77.1%, whereas they were open in 78.3% of urban towns, with a decline of 18.2%. CONCLUSION Pediatric clinics in Taiwan were unevenly distributed between urban and rural areas. The disparity of pediatric services became more obvious at weekends. The consequences of undersupplied rural pediatric care deserve further investigation.
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Jäger R, van den Berg N, Schwendicke F. Interventions for enhancing the distribution of dental professionals: a concise systematic review. Int Dent J 2017. [PMID: 28643435 DOI: 10.1111/idj.12316] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND A spatially unequal distribution of dentists or dental care professionals (D/DCPs), such as therapists or hygienists, could reduce the quality of health services and increase health inequities. This review describes the interventions available to enhance this spatial distribution and systematically assesses their effectiveness. METHODS Electronic databases (Cochrane CENTRAL, Medline, Embase, CINAHL) were searched and cross-referencing was performed using a standardised searching algorithm. Randomised and non-randomised controlled trials, controlled before-and-after studies and interrupted time series were included. Studies investigating a minimum of one of four interventions (educational, financial, regulatory and supportive) were included. The primary outcome was the spatial distribution of D/DCPs. Secondary outcomes were access, quality of services and equity or adverse effects. This review was registered (CRD42015026265). RESULTS Of 4,885 articles identified, the full text of 201 was assessed and three (all investigating national policy interventions originally not aiming to change the distribution of D/DCPs) were included. In one Japanese study spanning 1980 to 2000, the unequal spatial distribution of dentists decreased alongside a general increase in the number of dentists. It remained unclear if these findings were associated. In a second Japanese study, an increase in the number of dentists was found in combination with a postgraduate training programme implemented in 2006, and this occurred alongside an increasingly unequal distribution of dentists, again without proof of cause and consequence. A third study from Taiwan found the introduction of a national universal-coverage health insurance to equalise the distribution of dentists, with statistical association between this equalisation and the introduction of the insurance. CONCLUSIONS The effectiveness of interventions to enhance the spatial distribution of D/DCPs remains unclear.
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Affiliation(s)
- Ralf Jäger
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Neeltje van den Berg
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Weng SW, Chen TL, Yeh CC, Liao CC, Lane HL, Lin JG, Shih CC. An investigation of the use of acupuncture in stroke patients in Taiwan: a national cohort study. Altern Ther Health Med 2016; 16:321. [PMID: 27566677 PMCID: PMC5002127 DOI: 10.1186/s12906-016-1272-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 08/09/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Acupuncture is considered a complementary and alternative medicine in many countries. The purpose of this study was to report the pattern of acupuncture use and associated factors in patients with stroke. METHODS We used claims data from Taiwan's National Health Insurance Research Database and identified 285001 new-onset stroke patients in 2000-2008 from 23 million people allover Taiwan. The use of acupuncture treatment after stroke within one year was identified. We compared sociodemographics, coexisting medical conditions, and stroke characteristics between stroke patients who did and did not receive acupuncture treatment. RESULTS The use of acupuncture in stroke patients increased from 2000 to 2008. Female gender, younger age, white-collar employee status, higher income, and residence in areas with more traditional Chinese medicine (TCM) physicians were factors associated with acupuncture use in stroke patients. Ischemic stroke (odds ratio [OR] 1.21, 95 % confidence interval [CI] 1.15-1.28), having no renal dialysis (OR 2.76, 95 % CI 2.45-3.13), receiving rehabilitation (OR 3.20, 95 % CI 3.13-3.27) and longer hospitalization (OR 1.23, 95 % CI 1.19-1.27) were also associated with acupuncture use. Stroke patients using rehabilitation services were more likely to have more acupuncture visits and a higher expenditure on acupuncture compared with stroke patients who did not receive rehabilitation services. CONCLUSIONS The application of acupuncture in stroke patients is well accepted and increasing in Taiwan. The use of acupuncture in stroke patients is associated with sociodemographic factors and clinical characteristics.
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Li X, Cai H, Wang C, Guo C, He Z, Ke Y. Economic burden of gastrointestinal cancer under the protection of the New Rural Cooperative Medical Scheme in a region of rural China with high incidence of oesophageal cancer: cross-sectional survey. Trop Med Int Health 2016; 21:907-16. [PMID: 27125226 DOI: 10.1111/tmi.12715] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Xiang Li
- Key Laboratory of Carcinogenesis and Translational Research; Peking University Cancer Hospital & Institute; Beijing China
| | - Hong Cai
- Key Laboratory of Carcinogenesis and Translational Research; Peking University Cancer Hospital & Institute; Beijing China
| | | | - Chuanhai Guo
- Key Laboratory of Carcinogenesis and Translational Research; Peking University Cancer Hospital & Institute; Beijing China
| | - Zhonghu He
- Key Laboratory of Carcinogenesis and Translational Research; Peking University Cancer Hospital & Institute; Beijing China
| | - Yang Ke
- Key Laboratory of Carcinogenesis and Translational Research; Peking University Cancer Hospital & Institute; Beijing China
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Fang WH, Yen CF, Hu J, Lin JD, Loh CH. The utilization and barriers of Pap smear among women with visual impairment. Int J Equity Health 2016; 15:65. [PMID: 27068132 PMCID: PMC4828796 DOI: 10.1186/s12939-016-0354-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 04/04/2016] [Indexed: 01/08/2023] Open
Abstract
Background Many evidences illustrate that the Pap smear screening successfully reduces if the cervical cancer could be detected and treated sufficiently early. People with disability were higher comorbidity prevalence, and less likely to use preventive health care and health promotion activities. There were also to demonstrate that people with visual impairment has less access to appropriate healthcare services and is less likely to receive screening examinations. In Taiwan, there was no study to explore utilization of Pap smear, associated factors and use barriers about Pap smear screening test among women with visual impairment. The purpose is to explore the utilization and barriers of using Pap smear for women with visual impairment in Taiwan. To identify the barriers of women with visual from process of receiving Pap smear screening test. Methods The cross-sectional study was conducted and the totally 316 participators were selected by stratified proportional and random sampling from 15 to 64 year old women with visual impairment who lived in Taipei County during December 2009 to January 2010. The data was been collected by phone interview and the interviewers were well trained before interview. Results The mean age was 47.1 years old and the highest percentage of disabled severity was mile (40.2 %). Totally, 66.5 % of participators were ever using Pap smear and 38.9 % used it during pass 1 year. Their first time to accept Pap smear was 38.8 year old. There was near 50 % of them not to be explained by professionals before accepting the Pap smear. For non-using cases, the top two percentage of barriers were “feel still younger” (22.3 %), the second was “there’s no sexual experience” (21.4 %). We found the gynecology experiences was key factor for women with visual impairment to use Pap smear, especially the experiences was during 1 year (OR = 4). Conclusions Associated factors and barriers to receive Pap smear screening test for women with visual impairment can be addressed through interventions aimed at improving on cognitions and attitudes for cervical cancer risk factors. Our study would be as a reference resource for erasing the barriers and inequality among the visually disabled women.
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Affiliation(s)
- Wen-Hui Fang
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Feng Yen
- Department of Public Health, Tzu-Chi University, Hualien, Taiwan.
| | - Jung Hu
- Medical Quality Department, E-DA Hospital, Kaohsiung, Taiwan
| | - Jin-Ding Lin
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Ching-Hui Loh
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Grobler L, Marais BJ, Mabunda S. Interventions for increasing the proportion of health professionals practising in rural and other underserved areas. Cochrane Database Syst Rev 2015; 2015:CD005314. [PMID: 26123126 PMCID: PMC6791300 DOI: 10.1002/14651858.cd005314.pub3] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The inequitable distribution of health professionals, within countries, poses an important obstacle to the optimal functioning of health services. OBJECTIVES To assess the effectiveness of interventions aimed at increasing the proportion of health professionals working in rural and other underserved areas. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, including specialised register of the Cochrane Effective Practice and Organisation of Care Group; March 2014), MEDLINE (1966 to March 2014), EMBASE (1988 to March 2014), CINAHL (1982 to March 2014), LILACS (February 2014), Science Citation Index and Social Sciences Citation Index (up to April 2014), Global Health (March 2014) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (June 2013). We also searched reference lists of all papers and relevant reviews identified, and contacted authors of relevant papers regarding any further published or unpublished work. SELECTION CRITERIA Randomised trials, non-randomised trials, controlled before-and-after studies and interrupted time series studies evaluating the effects of various interventions (e.g. educational, financial, regulatory or support strategies) on the recruitment or retention, or both, of health professionals in underserved areas. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts and assessed full texts of potentially relevant studies for eligibility. Two review authors independently extracted data from eligible studies. MAIN RESULTS For this first update of the original review, we screened 8945 records for eligibility. We retrieved and assessed the full text of 125 studies. Only one study met the inclusion criteria of the review. This interrupted time series study, conducted in Taiwan, found that the implementation of a National Health Insurance scheme in 1995 was associated with improved equity in the geographic distribution of physicians and dentists. We judged the certainty of the evidence provided by this one study very low. AUTHORS' CONCLUSIONS There is currently limited reliable evidence regarding the effects of interventions aimed at addressing the inequitable distribution of health professionals. Well-designed studies are needed to confirm or refute findings of observational studies of educational, financial, regulatory and supportive interventions that might influence healthcare professionals' decisions to practice in underserved areas. Governments and medical schools should ensure that when interventions are implemented, their impacts are evaluated using scientifically rigorous methods to establish the true effects of these measures on healthcare professional recruitment and retention in rural and other underserved settings.
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Affiliation(s)
- Liesl Grobler
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesPO Box 241TygerbergCape TownWestern CapeSouth Africa8000
| | - Ben J Marais
- University of SydneyMarie Bashir Institute for Infectious Diseases and BiosecuritySydneyAustralia
- University of SydneyChildren’s Hospital at WestmeadSydneyAustralia
| | - Sikhumbuzo Mabunda
- University of Cape Town/Western Cape Department of HealthP.O. Box 768RondeboschSouth Africa7701
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Chen CH, Huang KY, Wang JY, Huang HB, Chou P, Lee CC. Combined effect of individual and neighbourhood socioeconomic status on mortality of rheumatoid arthritis patients under universal health care coverage system. Fam Pract 2015; 32:41-8. [PMID: 25304308 DOI: 10.1093/fampra/cmu059] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The National Health Insurance program in Taiwan is a public insurance system for the entire population of Taiwan initiated since March 1995. However, the association of socioeconomic status (SES) and prognosis of rheumatoid arthritis (RA) patients under this program has not been identified. OBJECTIVES Using the National Health Insurance Research Database in Taiwan, we aimed to examine the combined effect of individual and neighbourhood SES on the mortality rates of RA patients under a universal health care coverage system. MEASURES A study population included patients with RA from 2004 to 2008. The primary end point was the 5-year overall mortality rate. Individual SES was categorized into low, moderate and high levels based on the income-related insurance payment amount. Neighbourhood SES was defined by household income and neighbourhoods were grouped as an 'advantaged' area or a 'disadvantaged' area. The Cox proportional hazards regression model was used to compare outcomes between different SES categories. A two-sided P value < 0.05 was considered statistically significant. RESULTS Medical data of 23900 RA patients from 2004 to 2008 were reviewed. Analysis of the combined effect of individual SES and neighbourhood SES revealed that 5-year mortality rates were worse among RA patients with a low individual SES compared to those with a high SES (P < 0.001). In the Cox proportional hazards regression model, RA patients with low individual SES in disadvantaged neighbourhoods incurred the highest risk of mortality (Hazard ratio = 1.64; 95% confidence interval, 1.26-2.13, P < 0.001). CONCLUSIONS RA patients with a low SES have a higher overall mortality rate than those with a higher SES, even with a universal health care system. It is crucial that more public policy and health care efforts be put into alleviating the health disadvantages, besides providing treatment payment coverage.
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Affiliation(s)
- Cheng-Hsin Chen
- Department of Internal Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City
| | - Kuang-Yung Huang
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, School of Medicine, Tzu Chi University, Hualian, Department of Life Science and Institute of Molecular Biology, National Chung Cheung University, Chiayi
| | - Jen-Yu Wang
- Department of Internal Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City
| | - Hsien-Bin Huang
- Department of Life Science and Institute of Molecular Biology, National Chung Cheung University, Chiayi
| | - Pesus Chou
- Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei
| | - Ching-Chih Lee
- School of Medicine, Tzu Chi University, Hualian, Department of Life Science and Institute of Molecular Biology, National Chung Cheung University, Chiayi, Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Department of Otolaryngology, Department of Education and Center for Clinical Epidemiology and Biostatistics, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan, Republic of China.
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Improvements in dental care using a new mobile app with cloud services. J Formos Med Assoc 2014; 113:742-9. [PMID: 24796822 DOI: 10.1016/j.jfma.2014.02.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 02/12/2014] [Accepted: 02/23/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND/PURPOSE Traditional dental care, which includes long-term oral hygiene maintenance and scheduled dental appointments, requires effective communication between dentists and patients. In this study, a new system was designed to provide a platform for direct communication between dentists and patients. METHODS A new mobile app, Dental Calendar, combined with cloud services specific for dental care was created by a team constituted by dentists, computer scientists, and service scientists. This new system would remind patients about every scheduled appointment, and help them take pictures of their own oral cavity parts that require dental treatment and send them to dentists along with a symptom description. Dentists, by contrast, could confirm or change appointments easily and provide professional advice to their patients immediately. In this study, 26 dentists and 32 patients were evaluated by a questionnaire containing eight dental-service items before and after using this system. Paired sample t test was used for statistical analysis. RESULTS After using the Dental Calendar combined with cloud services, dentists were able to improve appointment arrangements significantly, taking care of the patients with sudden worse prosthesis (p < 0.05). Patients also achieved significant improvement in appointment reminder systems, rearrangement of appointments in case of sudden worse prosthesis, and establishment of a direct relationship with dentists (p < 0.05). CONCLUSION Our new mobile app, Dental Calendar, in combination with cloud services, provides efficient service to both dentists and patients, and helps establish a better relationship between them. It also helps dentists to arrange appointments for patients with sudden worsening of prosthesis function.
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Hsu YH, Tsai WC, Kung PT. Health examination utilization in the visually disabled population in Taiwan: a nationwide population-based study. BMC Health Serv Res 2013; 13:509. [PMID: 24313981 PMCID: PMC3880214 DOI: 10.1186/1472-6963-13-509] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 11/29/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with visual disabilities have increased health needs but face worse inequity to preventive health examinations. To date, only a few nationwide studies have analyzed the utilization of preventive adult health examinations by the visually disabled population. The aim of this study was to investigate the utilization of health examinations by the visually disabled population, and analyze the factors associated with the utilization. METHODS Visual disability was certified by ophthalmologists and authenticated by the Ministry of the Interior (MOI), Taiwan. We linked data from three different nationwide datasets (from the MOI, Bureau of Health Promotion, and National Health Research Institutes) between 2006 and 2008 as the data sources. Independent variables included demographic characteristics, income status, health status, and severity of disability; health examination utilization status was the dependent variable. The chi-square test was used to check statistical differences between variables, and a multivariate logistic regression model was used to examine the associated factors with health examination utilization. RESULTS In total, 47,812 visually disabled subjects aged 40 years and over were included in this study, only 16.6% of whom received a health examination. Lower utilization was more likely in male subjects, in those aged 65 years and above, insured dependents and those with a top-ranked premium-based salary, catastrophic illness/injury, chronic diseases of the genitourinary system, and severe or very severe disabilities. CONCLUSION The overall health examination utilization in the visually disabled population was very low. Lower utilization occurred mainly in males, the elderly, and those with severe disabilities.
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Affiliation(s)
| | | | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, No, 500 Lioufeng Road, Wufeng, Taichung 41354, R,O,C, Taiwan.
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