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Corvetto JF, Helou AY, Kriit HK, Federspiel A, Bunker A, Liyanage P, Costa LF, Müller T, Sauerborn R. Private vs. public emergency visits for mental health due to heat: An indirect socioeconomic assessment of heat vulnerability and healthcare access, in Curitiba, Brazil. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 934:173312. [PMID: 38761938 DOI: 10.1016/j.scitotenv.2024.173312] [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: 03/29/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 05/20/2024]
Abstract
Few studies have explored the influence of socioeconomic status (SES) on the heat vulnerability of mental health (MH) patients. As individual socioeconomic data was unavailable, we aimed to fill this gap by using the healthcare system type as a proxy for SES. Brazilian national statistics indicate that public patients have lower SES than private. Therefore, we compared the risk of emergency department visits (EDVs) for MH between patients from both healthcare types. EDVs for MH disorders from all nine public (101,452 visits) and one large private facility (154,954) in Curitiba were assessed (2017-2021). Daily mean temperature was gathered and weighed from 3 stations. Distributed-lag non-linear model with quasi-Poisson (maximum 10-lags) was used to assess the risk. We stratified by private and public, age, and gender under moderate and extreme heat. Additionally, we calculated the attributable fraction (AF), which translates individual risks into population-representative burdens - especially useful for public policies. Random-effects meta-regression pooled the risk estimates between healthcare systems. Public patients showed significant risks immediately as temperatures started to increase. Their cumulative relative risk (RR) of MH-EDV was 7.5 % higher than the private patients (Q-Test 26.2 %) under moderate heat, suggesting their particular heat vulnerability. Differently, private patients showed significant risks only under extreme heat, when their RR became 4.3 % higher than public (Q-Test 6.2 %). These findings suggest that private patients have a relatively greater adaptation capacity to heat. However, when faced with extreme heat, their current adaptation means were potentially insufficient, so they needed and could access healthcare freely, unlike their public counterparts. MH patients would benefit from measures to reduce heat vulnerability and access barriers, increasing equity between the healthcare systems in Brazil. AF of EDVs due to extreme heat was 0.33 % (95%CI 0.16;0.50) for the total sample (859 EDVs). This corroborates that such broad population-level policies are urgently needed as climate change progresses.
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Affiliation(s)
- Julia F Corvetto
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg University, Germany.
| | - Ammir Y Helou
- Laboratory of Chemical Neuroanatomy, Department of Anatomy, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Hedi K Kriit
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg University, Germany; Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Aditi Bunker
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg University, Germany
| | - Prasad Liyanage
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg University, Germany
| | | | - Thomas Müller
- Private Psychiatric Hospital Meiringen, 3860 Meiringen, Switzerland; Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000, Bern 60, Switzerland
| | - Rainer Sauerborn
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg University, Germany
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Mohammed Y, Tamir TT, Geberu DM, Destaw B, Kebede N. Adherence to Standard Precautions and Associated Factors Among Healthcare Workers at Public and Private Hospitals in Northeast Ethiopia. Risk Manag Healthc Policy 2024; 17:1599-1618. [PMID: 38894815 PMCID: PMC11184157 DOI: 10.2147/rmhp.s453735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 05/13/2024] [Indexed: 06/21/2024] Open
Abstract
Introduction Standard precautions are crucial for infection control in healthcare. Studies show public hospitals' adherence, but data on private hospitals are scarce. Understanding this disparity is vital for safety, policy, and better patient outcomes. Hence, this study aimed to assess precautions and associated factors among healthcare workers at public and private hospitals in Northeast Ethiopia. Methods A comparative cross-sectional study compared healthcare institutions. A total of 470 workers participated via stratified random sampling. Data collection used a pre-tested questionnaire and observation checklist. Epi data managed entry, while STATA analyzed. Binary logistic regression determined significance (P<0.05) for variables. Results The overall adherence to standard precautions was 51.6% (95% confidence interval (CI): 46.9-56.2). At public and private hospitals, it was 52.2% (95% CI: 45.6-58.6) and 60.4% (95% CI: 53.9-66.9), respectively. In public hospitals adherence was affected by female sex [adjusted odds ratio (AOR): 2.58; 95% CI: 1.32-5.02], availability of written guidelines [AOR: 3.10; 95% CI: 1.62-5.94], having good knowledge [AOR: 2.05; 95% CI: 1.03-4.11] and favorable attitude towards standard precautions [AOR: 2.21; 95% CI: 1.14-4.27]. In private hospitals, it was affected by the availability of running tape water [AOR: 2.36; 95% CI: 1.10-5.04], personal protective equipment (AOR: 2.22; 95% CI; 1.01-4.93), color-coded dust bins [AOR: 2.33; 95% CI: 1.04-5.21], having good knowledge [AOR: 2.10; 95% CI: 1.07-4.13] and favorable attitude [AOR: 2.63; 95% CI: 1.39-4.97]. Conclusion The adherence to standard precautions was higher among private than public hospital healthcare workers in Dessie City, Ethiopia. Thus, ensuring adequate availability of personal protective equipment, safety materials, and running tap water in working rooms, particularly in public hospitals is highly recommended. The initiatives aimed at promoting adherence to standard precautions should be designed and put into action for public hospitals.
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Affiliation(s)
- Yirgalem Mohammed
- Department of Health System and Policy, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Tadesse Tarik Tamir
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Demiss Mulatu Geberu
- Department of Health Systems and Policy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Bikes Destaw
- Department of Environmental Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Natnael Kebede
- Department of Health Promotion, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Asare AA, Otchi E, Manu A. Relevance of meeting general outpatients' information needs to their perceptions of healthcare quality in a hospital in Ghana: a Healthcare Quality Survey using modified SERVQUAL analysis. BMJ Open Qual 2024; 13:e002683. [PMID: 38858077 PMCID: PMC11168125 DOI: 10.1136/bmjoq-2023-002683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 05/28/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Patients determine quality of healthcare by their perception of the gap between the healthcare they experience/receive and that which they expect. This can be influenced by the ability of healthcare staff to adequately communicate information about the healthcare provided. This study assessed the level of relevance of meeting patients' information needs with respect to their assessment of healthcare quality in a private hospital's general outpatient department in Ghana. DESIGN Study design was cross-sectional using exit self-administered questionnaires among 390 outpatients. Healthcare quality was measured using a modified form of the Service Quality model gap analysis (gap between experience and expectations). A negative gap signifies unmet patient expectations. Microsoft Excel and Stata V.15.0 were used for analysis using t-test and multiple linear regression. A p value ≤0.05 denotes statistical significance. FINDINGS The mean percentage of patients' expectations of quality of healthcare was 87.6% (SE 0.031), while patient experience was 86.0% (SE 0.029), with a significant negative gap of -0.08 (p<0.002). Their highest expectation of the quality of healthcare was for their information needs to be met, with a mean score of 4.44 (SE 0.03). Two of the four items under the information needs dimension that showed no statistically significant gaps were 'saying all their problems' (gap=0.00; p<0.9) and 'explanation of treatment/medications' (gap=0.01; p<0.6). Those with statistically significant negative gaps were 'explanation of investigations and procedures' (gap=-0.18; p<0.0001) and 'explanation of the diagnoses' (gap=-0.11; p<0.02), signifying unmet expectations. CONCLUSIONS The outpatient's greatest need for quality healthcare in this study was for their information needs to be met. Providing information on patient diagnoses and investigations are the areas least likely to be adequately communicated to patients.
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Affiliation(s)
| | - Elom Otchi
- Quality Management Unit, Korle Bu Teaching Hospital, Accra, Ghana
- Quality and Patient Safety, Africa Institute of Healthcare Quality Safety & Accreditation, Accra, Ghana
| | - Adom Manu
- School of Public Health, University of Ghana, Legon, Ghana
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Florez MI, Botto E, Kim JY. Mapping Strategies for Reaching Socioeconomically Disadvantaged Populations in Clinical Trials. JAMA Netw Open 2024; 7:e2413962. [PMID: 38848069 PMCID: PMC11161842 DOI: 10.1001/jamanetworkopen.2024.13962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/14/2024] [Indexed: 06/10/2024] Open
Abstract
Importance Socioeconomically disadvantaged patients, such as persons with low income and those with low educational attainment, are less likely to participate in clinical trials than those with higher earnings and higher educational attainment, despite the former being more likely to have chronic medical conditions. Ways to improve the representation of socioeconomically disadvantaged patients in clinical trials deserve attention. Objective To examine whether current recruitment and enrollment strategies used by US clinical research sites appropriately include patients from socioeconomically disadvantaged backgrounds. Design, Setting, and Participants This survey study was conducted between April and July 2023. An online survey was distributed among US clinical research sites to explore their use of these strategies and the types of patient sociodemographic and socioeconomic data they collect. The survey was distributed by 13 pharmaceutical companies and 1 clinical research organization. Eight targeted strategies known to increase the recruitment and retention of socioeconomically disadvantaged participants as well as 6 general strategies to recruit and retain clinical trial participants were identified. Data analysis was performed between August and September 2023. Main Outcomes and Measures Proportions of for-profit vs nonprofit or governmental sites that use recruitment and retention strategies, proportions that have partnerships with community organizations that target socioeconomically disadvantaged groups, and the distribution of sociodemographic and socioeconomic data collected by sites about their patients. A χ2 test of independence was performed to assess the association between research site ownership type and levels of adoption of strategies. Results A total of 492 responses were collected from 381 clinical research sites in the US (219 for-profit sites [57.5%] and 162 nonprofit or governmental sites [42.5%]). Overall, compared with nonprofit or governmental sites, for-profit sites reported higher use of strategies shown to increase the recruitment and retention of socioeconomically disadvantaged populations, including always or often providing after-hours visits (84 of 173 for-profit sites [48.6%]; 22 of 123 nonprofit or governmental sites [17.9%]) and offering financial compensation (135 of 162 for-profit sites [83.3%]; 60 of 123 nonprofit or governmental sites [48.8%]). Additionally, there was an association between research site ownership type and levels of adoption of these strategies; for example, for-profit sites were more likely to provide after-hours visits (χ2 = 30.33; P < .001) and offer financial compensation (χ2 = 49.35; P < .001). Only 7.2% of for-profit sites (12 of 167) and 13.0% of nonprofit or governmental sites (16 of 123) collected information on the patient's annual income. Conclusions and Relevance In this survey study, we found an association between a clinical research site's ownership type (for-profit vs nonprofit or governmental) and how often it used strategies to engage socioeconomically diverse populations in clinical research. Regardless of ownership type, most clinical research sites did not collect socioeconomic information from patients. Adoption of strategies to engage socioeconomically diverse populations, particularly by nonprofit or governmental sites, may help minimize barriers to participation for socioeconomically disadvantaged patients.
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Affiliation(s)
- Maria I. Florez
- Tufts Center for the Study of Drug Development, Tufts University School of Medicine, Boston, Massachusetts
| | - Emily Botto
- Tufts Center for the Study of Drug Development, Tufts University School of Medicine, Boston, Massachusetts
| | - Jennifer Y. Kim
- Tufts Center for the Study of Drug Development, Tufts University School of Medicine, Boston, Massachusetts
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Kang HK, Bisht B, Kaur M, Alexis O, Worsley A, John D. Effectiveness of interpersonal psychotherapy in comparison to other psychological and pharmacological interventions for reducing depressive symptoms in women diagnosed with postpartum depression in low- and middle-income countries: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1399. [PMID: 38645302 PMCID: PMC11032640 DOI: 10.1002/cl2.1399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Background Postpartum depression (PPD) is a condition that can affect any woman regardless of ethnicity, age, party, marital status, income, and type of delivery. This condition is highly prevalent worldwide. PPD, if not treated timely, can affect the maternal-child bond and can have a detrimental impact on the future cognitive, emotional, and behavioral development of the child. Interpersonal psychotherapy (IPT) has been reported as an effective treatment of PPD in previous studies as this focuses on relationship and social support issues. Previous reviews conducted in developed nations have reported the superior efficacy of IPT in comparison to other treatment options. There is no systematic review conducted in low to middle-income countries on the efficacy of IPT on PPD. Therefore it was necessary to undertake a systematic review to assess the effectiveness of IPT in reducing the depression among postpartum women in low and middle-income countries (LMICs). Objectives The main aim of this systematic review was to assess the effectiveness of IPT alone or in conjunction with pharmacological therapy and/or other psychological and psychosocial interventions, in reducing depressive symptoms among women diagnosed with PPD residing in LMICs. Search Methods The systematic search encompassed several prominent databases and grey literature. Furthermore, experts specializing in the field of IPT were consulted to identify any relevant studies conducted in LMICs that fulfilled the predetermined eligibility criteria. The most recent search update was performed in July 2022. Selection Criteria The PICOS criteria were meticulously defined for this review as described. Participants: Postpartum women diagnosed with PPD in LMICs were included. Intervention: IPT either as a standalone treatment or in conjunction with pharmacological therapy was included. Comparison: any form of psychological therapy or pharmacological therapy, whether administered individually or in combination, was considered for comparison. Study designs: experimental and quasi-experimental, factorial designs, and quantitative components (experimental, quasi-experimental, factorial designs) of mixed methods designs were eligible to be included. Studies with single-group study designs and qualitative studies were excluded from the review. Data Collection and Analysis Two reviewers from our team conducted a rigorous screening process to determine the eligibility of articles for inclusion. This involved an initial evaluation of titles and abstracts, followed by a comprehensive assessment of the full text of selected articles. In instances where discrepancies arose between the two reviewers, resolution was achieved through discussion or consultation with a third author to establish a consensus. Following the screening process, two team members independently extracted pertinent information and data from the studies that met the inclusion criteria. The treatment effect of the intervention, in comparison to the control group, was subsequently analyzed utilizing the fixed effects model taking into account the small number of studies. Main Results A total of 17,588 studies were identified from various databases, and 6493 duplicate studies were removed. Subsequently, 9380 studies underwent independent title and abstract screening resulting in the exclusion of 9040 studies. 345 full texts were thoroughly assessed leading to the exclusion of 341 studies, finally including 4 studies for review. The four included trials were randomized trials and comprised a total sample size of 188 women diagnosed with PPD residing in LMICs. Among these studies, three compared IPT with usual treatment, while one study compared IPT with antidepressant medications (ADMs). In terms of the providers of IPT, in one study, IPT was administered by nurses, while psychologists delivered IPT in another study. In one study, community health workers were responsible for providing IPT. However, in one study, information regarding the specific providers of IPT was not available or reported. The primary outcome measure reported in all four studies was depression, assessed using the Edinburgh Postnatal Depression Scale (EPDS). The geographical distribution of the studies included; one conducted in Zambia, one in Kenya, one in Pakistan, and one in Iran. Out of the four studies, three were included in the meta-analysis, as missing data from one study could not be obtained. Based on the overall treatment effect, it was found that depression scores decreased significantly more in the IPT group compared to other interventions (usual treatment or ADMs) (standardized mean difference [SMD] -0.62, 95% confidence interval [CI] (-1.01, -0.23), Z = 3.13 (p = 0.002), χ 2 = 49.49; df = 2; p < 0.00001; I 2 = 96%; 3 studies, n = 136). Out of the three studies, two studies compared the effectiveness of IPT in reducing depression scores specifically when compared to the usual treatment, and in both studies, depression scores were reduced significantly in the IPT group as compared to the usual treatment group. Only one study directly compared the effectiveness of IPT with ADM, reporting that IPT was more effective than ADM in reducing depression scores among postpartum women. Regarding adverse outcomes, only one study reported suicidal ideation with one participant in the IPT group and two in the ADM group (RR 0.50, 95% CI (0.05, 5.30), p = 0.56, n = 78). The same study reported seven participants in the ADM group had adverse drug reactions as compared to none in the IPT group (RR 15.0, 95% CI (0.89, 254), p = 0.06, n = 78). Authors' Conclusions Our comprehensive search yielded a limited number of four studies conducted in such settings. Despite the scarcity of available evidence, the findings collectively suggest that IPT is indeed an effective treatment for reducing PPD when compared to usual treatment and pharmacological therapy. However given the low certainty of evidence, there is a need for further research in the form of well-designed randomized controlled trials with larger sample sizes and a reduced risk of bias. Such studies would greatly contribute to enhancing the strength and reliability of the evidence base regarding the effectiveness of IPT in the context of PPD in LMICs. The knowledge generated from future research endeavors would be highly valuable in guiding the development of more affordable and cost-effective treatment approaches for PPD in resource-limited settings.
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Affiliation(s)
| | - Bandana Bisht
- Department of PsychiatryGovernment Medical College & HospitalChandigarhIndia
| | - Manmeet Kaur
- Shaheed Kartar Singh Sarabha College of NursingSarabhaLudhianaIndia
| | | | | | - Denny John
- Faculty of Life and Allied Health SciencesM S Ramaiah University of Applied SciencesBangaloreKarnatakaIndia
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Silva N, Tavares AI, Koengkan M, Fuinhas JA. Analyzing the impact of fiscal conditions on private health expenditures in OECD countries: a quantile ARDL investigation. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2024:10.1007/s10754-024-09377-0. [PMID: 38777959 DOI: 10.1007/s10754-024-09377-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 05/12/2024] [Indexed: 05/25/2024]
Abstract
Organization for Economic Co-operation and Development (OECD) countries have embraced the aim of universal health coverage, as established in Sustainable Development Goal (SDG) 3.8. This goal guarantees access to quality healthcare services without financial hardship or poverty. Additionally, it requires correct and adequate financing sources. A country with weak protection for its population tends to spend less on healthcare and experiences a high share of out-of-pocket payments (OOPs), increasing the likelihood of people falling into poverty. This study aims to understand the relationship and causal effects between macroeconomic and public fiscal conditions and private health expenditure in OECD countries between 1995 and 2019. We retrieved OECD data for 26 OECD countries for the period 1995-2019. Panel AutoRegressive Distributed Lag (PARDL) and panel quantile AutoRegressive Distributed Lag (PQARDL) models were estimated to examine the relationship between private health expenditures and macroeconomic and public fiscal variables. Our results reveal a positive influence of government debt and economic freedom on private health expenditures. They also show a negative influence of the government budget balance, government health expenditures, and economic growth on private health expenditures. These results collectively suggest that public fiscal conditions will likely impact private health expenditures. The findings of this study raise concerns about the equity and financial protection objectives of universal health coverage in OECD countries.
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Affiliation(s)
- Nuno Silva
- Faculty of Economics, CeBER, University of Coimbra, Av Dias da Silva 165, 3004-512, Coimbra, Portugal.
| | - Aida Isabel Tavares
- CEISUC - Centre for Health Studies and Research, University of Coimbra, Coimbra, Portugal
- ISEG, UL - Lisbon School of Economics and Management, University of Lisbon, Lisbon, Portugal
| | - Matheus Koengkan
- University of Coimbra Institute for Legal Research (UCILeR), University of Coimbra, 3000-018, Coimbra, Portugal
| | - José Alberto Fuinhas
- Faculty of Economics, CeBER, University of Coimbra, Av Dias da Silva 165, 3004-512, Coimbra, Portugal
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Efthymiou A, Kalaitzaki A, Rovithis M. Validation of the Self-Efficacy Questionnaire (SE-12-Gr) Assessing the Healthcare Professionals' Self-Reported Communication Skills with Older Healthcare Users in Greece. HEALTH COMMUNICATION 2024:1-11. [PMID: 38711248 DOI: 10.1080/10410236.2024.2348841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Patients' satisfaction with their interaction with the healthcare providers has been found to correlate with adherence to therapeutic plans and better health outcomes. Healthcare providers are experiencing barriers when communicating with specific population subgroups, such as people with low health literacy, low education, and older age. Enhancing the communication skills of the healthcare providers working with older adults could facilitate their interaction with the patients. This study presents the validation of the Self-efficacy-12 (SE-12) in Greek. This is an instrument measuring healthcare providers' self-efficacy of communication skills used during their interaction with older patients. A sample of 230 healthcare providers working with older adults participated in the study. The scale showed good psychometric properties (S-CVI=.97, Cronbach a = .95, ICC = .81). A medium to high correlation was found with the generalized self-efficacy questionnaire. Exploratory Factor Analysis (EFA) yielded two factors ("Self-efficacy in communication skills and strategies" and "Self-efficacy of successful interaction") with good psychometric properties. The SE-12-GR is a brief, valid, and reliable tool for assessing self-efficacy of communication skills and it could be integrated as part of the health literacy tools for healthcare providers working with older people in Greece.
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Affiliation(s)
- Areti Efthymiou
- Quality of Life Lab, Social Work Department, Hellenic Mediterranean University
| | - Argyroula Kalaitzaki
- Quality of Life Lab, Social Work Department, Hellenic Mediterranean University
- Affiliated Researcher of the Research Centre 'Institute of Agri-Food and Life Sciences', Hellenic Mediterranean University
| | - Michael Rovithis
- Quality of Life Lab, Social Work Department, Hellenic Mediterranean University
- Department of Business Administration and Tourism, Hellenic Mediterranean University
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Ghammari F, Heidari K, Jalilian H. Financial protection and equity in the healthcare financing system in Iran: a cross-sectional study among slum dwellers with type 2 diabetes. BMJ Open 2024; 14:e081989. [PMID: 38702082 PMCID: PMC11086487 DOI: 10.1136/bmjopen-2023-081989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 04/19/2024] [Indexed: 05/06/2024] Open
Abstract
OBJECTIVES This study was conducted to assess financial protection and equity in the healthcare financing system among slum dwellers with type 2 diabetes (T2D) in Iran in 2022. DESIGN Cross-sectional study. SETTING Primary care centres in Iran were selected from slums. PARTICIPANTS Our study included 400 participants with T2D using a systematic random sampling method. Patients were included if they lived in slums for at least five consecutive years, were over 18 years old and did not have intellectual disabilities. PRIMARY AND SECONDARY MEASURES A self-report questionnaire was used to assess cost-coping strategies vis-à-vis T2D expenditures and factors influencing them, as well as forgone care among slum dwellers. RESULTS Of the 400 patients who participated, 53.8% were female. Among the participants, 27.8% were illiterate, but 30.3% could read and write. 75.8% had income below 40 million Rial. There was an association between age, education, income, basic insurance, supplemental insurance and cost-coping strategies (p<0.001). 88.2% of those with first university degree used health insurance and 34% of illiterate people used personal savings. 79.8% of people with income over 4 million Rial reported using insurance to cope with healthcare costs while 55% of those with income under 4 million Rial reported using personal savings and a combination of health insurance and personal savings to cope with healthcare costs. As a result of binary logistic regression, illiterate people (adjusted OR=16, 95% CI 3.65 to 70.17), individuals with low income (OR 5.024, 95% CI 2.42 to 10.41) and people without supplemental insurance (OR 1.885, 95% CI 0.03 to 0.37) are more likely to use other forms of cost-coping strategies than health insurance. CONCLUSIONS As a result of insufficient use of insurance, cost-coping strategies used by slum dwellers vis-à-vis T2D expenditures do not protect them from financial risks. Expanding universal health coverage and providing supplemental insurance for those with T2D living in slums are recommended. Iran Health Insurance should adequately cover the costs of T2D care for slum dwellers so that they do not need to use alternative strategies.
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Affiliation(s)
- Fawzieh Ghammari
- Department of Health Policy and Management School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of)
| | - Kousar Heidari
- Department of Education Development, Faculty Medical School, Ahvaz Jondishapour University of Medical Sciences, Ahvaz, Khuzestan, Iran (the Islamic Republic of)
| | - Habib Jalilian
- Department of Health Services Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran (the Islamic Republic of)
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Messersmith L, Kolhe C, Ladha A, Das P, Rao SR, Mohammady M, Conant E, Bose R, Ramanathan N, Patel A, Hibberd PL. Providing optimal care in the neonatal care units in India: How Covid-19 exacerbated existing barriers. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0000393. [PMID: 38696540 PMCID: PMC11065213 DOI: 10.1371/journal.pgph.0000393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/05/2024] [Indexed: 05/04/2024]
Abstract
Nearly one quarter (600,000) of all neonatal deaths worldwide per year occur in India. To reduce neonatal mortality, the Indian Ministry of Health and Family Welfare established neonatal care units, including neonatal intensive care units and specialized neonatal care units to provide immediate care at birth, resuscitation for asphyxiation, postnatal care, follow up for high-risk newborns, immunization, and referral for additional or complex healthcare services. Despite these efforts, neonatal mortality remains high, and measures taken to reduce mortality have been severely challenged by multiple problems caused by the Covid-19 pandemic. In this qualitative study, we conducted seven focus group discussions with newborn care unit nurses and pediatric residents and 35 key informant interviews with pediatricians, residents, nurses, annual equipment maintenance contractors, equipment manufacturers, and Ministry personnel in the Vidarbha region of Maharashtra between December 2019 and November 2020. The goal of the study was to understand barriers and facilitators to providing optimal care to neonates, including the challenges imposed by the Covid-19 pandemic. Covid-19 exacerbated existing barriers to providing optimal care to neonates in these newborn care units. As a result of Covid-19, we found the units were even more short-staffed than usual, with trained pediatric nurses and essential equipment diverted from newborn care to attend to patients with Covid-19. Regular training of neonatal nursing staff was also disrupted due to Covid-19, leaving many staff without the skills to provide optimate care to neonates. Infection control was also exacerbated by Covid-19. This study highlights the barriers to providing optimal care for neonates were made even more challenging during Covid-19 because of the diversion of critically important neonatal equipment and staff trained to use that equipment to Covid-19 wards. The barriers at the individual, facility, and systems levels will remain challenging as the Covid-19 pandemic continues.
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Affiliation(s)
- Lisa Messersmith
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | | | - Alyana Ladha
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Prabir Das
- Lata Medical Research Foundation, Nagpur, India
| | - Sowmya R. Rao
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Marym Mohammady
- Nexleaf Analytics, Los Angeles, California, United States of America
| | - Emily Conant
- Nexleaf Analytics, Los Angeles, California, United States of America
| | - Rejesh Bose
- Nexleaf Analytics, Los Angeles, California, United States of America
| | - Nithya Ramanathan
- Nexleaf Analytics, Los Angeles, California, United States of America
| | - Archana Patel
- Lata Medical Research Foundation, Nagpur, India
- Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Patricia L. Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
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Sax Dos Santos Gomes L, Efendi F, Putri NK, Bolivar-Vargas M, Saadeh R, Villarreal PA, Aye TT, De Allegri M, Lohmann J. The impact of international health worker migration and recruitment on health systems in source countries: Stakeholder perspectives from Colombia, Indonesia, and Jordan. Int J Health Plann Manage 2024; 39:653-670. [PMID: 38326291 DOI: 10.1002/hpm.3776] [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: 12/23/2023] [Accepted: 01/25/2024] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION To address domestic shortages, high-income countries are increasingly recruiting health workers from low- and middle-income countries. This practice is much debated. Proponents underline benefits of return migration and remittances. Critics point in particular to the risk of brain drain. Empirical evidence supporting either position is yet rare. This study contributes to filling this gap in knowledge by reporting high-level stakeholders' perspectives on health system impacts of international migration in general, and active recruitment of health workers in specific, in Colombia, Indonesia, and Jordan. METHOD We used a multiple case study methodology, based on qualitative methods integrated with information available in the published literature. RESULTS All respondents decried a lack of robust and detailed data as a serious challenge in ascertaining their perspectives on impacts of health worker migration. Stakeholders described current emigration levels as not substantially aggravating existing health workforce availability challenges. This is due to the fact that all three countries are faced with health worker unemployment grounded in unwillingness to work in rural areas and/or overproduction of certain cadres. Respondents, however, pleaded against targeting very experienced and specialised individuals. While observing little harm of health worker migration at present, stakeholders also noted few benefits such as brain gain, describing how various barriers to skill enhancement, return, and reintegration into the health system hamper in practice what may be possible in theory. CONCLUSION Improved availability of data on health worker migration, including their potential return and reintegration into their country of origin's health system, is urgently necessary to understand and continuously monitor costs and benefits in dynamic national and international health labour markets. Our results imply that potential benefits of migration do not come into being automatically, but need in-country supportive policy and programming, such as favourable reintegration policies or programs targeting engagement of the diaspora.
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Affiliation(s)
| | - Ferry Efendi
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | | | - Mery Bolivar-Vargas
- Faculty of Economic and Administrative Sciences, Universidad Jorge Tadeo Lozano, Bogotá, Colombia
| | - Rami Saadeh
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Pedro A Villarreal
- German Institute for International and Security Affairs, Berlin, Germany
- Max Planck Institute for Comparative Public Law and International Law, Heidelberg, Germany
| | - Thit Thit Aye
- Heidelberg Institute of Global Health, University Hospital and Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, University Hospital and Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Julia Lohmann
- Heidelberg Institute of Global Health, University Hospital and Medical Faculty, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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11
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Khairinisa S, Setiawati F, Darwita RR, Maharani DA. Perceived Barriers among Indonesian General Dentists in Providing Caries Preventive Care for Pediatric Patients. Eur J Dent 2024; 18:632-639. [PMID: 37591284 PMCID: PMC11132772 DOI: 10.1055/s-0043-1771336] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVE This study aimed to investigate Indonesian dentists' perceived barriers in providing caries prevention for pediatric patients. MATERIALS AND METHODS A total of 362 general dentists were included in this cross-sectional study. The participants were asked to complete a self-administered online questionnaire of dentist characteristics and perceived barriers in multiple domains (children, parents, dentists, and healthcare system-related barriers). The frequency of responses to items of the questionnaire was presented. The Mann-Whitney U test was used to compare perceived barriers by gender, Kruskal-Wallis by practice sector, and Spearman analysis was used to assess the correlation between perceived barrier with age, years of practice experience, weekly practice hours, percentage of pediatric patients, percentage of pediatric preventive care, and percentage of insured patients. A multivariate analysis was conducted through structural equation modeling. RESULTS The highest perceived barrier was found to be healthcare system-related, followed by parents, children, and dentists themselves. Most participants thought parents have poor knowledge of pediatric caries prevention (n = 290; 80%), and dental care for young children emphasizes curative treatment over prevention (n = 257; 70%). The multivariate analysis showed that dentists' practice sector and age affect perceived barriers and pediatric preventive care the most. CONCLUSION Factors and barriers identified in this study must be the main focus of oral health programs, and dentists, as service providers, need proper training to address these barriers to optimize caries prevention in Indonesia.
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Affiliation(s)
- Safira Khairinisa
- Department of Preventive and Public Health Dentistry, Faculty of Dentistry, Universitas Indonesia, Indonesia
| | - Febriana Setiawati
- Department of Preventive and Public Health Dentistry, Faculty of Dentistry, Universitas Indonesia, Indonesia
| | - Risqa Rina Darwita
- Department of Preventive and Public Health Dentistry, Faculty of Dentistry, Universitas Indonesia, Indonesia
| | - Diah Ayu Maharani
- Department of Preventive and Public Health Dentistry, Faculty of Dentistry, Universitas Indonesia, Indonesia
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Morris G, Maliqi B, Lattof SR, Strong J, Yaqub N. Private sector quality of care for maternal, new-born, and child health in low-and-middle-income countries: a secondary review. Front Glob Womens Health 2024; 5:1369792. [PMID: 38707636 PMCID: PMC11066217 DOI: 10.3389/fgwh.2024.1369792] [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: 01/12/2024] [Accepted: 03/21/2024] [Indexed: 05/07/2024] Open
Abstract
The private sector has emerged as a crucial source of maternal, newborn, and child health (MNCH) care in many low- and middle-income countries (LMICs). Quality within the MNCH private sector varies and has not been established systematically. This study systematically reviews findings on private-sector delivery of quality MNCH care in LMICs through the six domains of quality care (QoC) (i.e., efficiency, equity, effectiveness, people-centered care, safety, and timeliness). We registered the systematic review with PROSPERO international prospective register of systematic reviews (registration number CRD42019143383) and followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Statement for clear and transparent reporting of systematic reviews and meta-analyses. Searches were conducted in eight electronic databases and two websites. For inclusion, studies in LMICs must have examined at least one of the following outcomes using qualitative, quantitative, and/or mixed-methods: maternal morbidity, maternal mortality, newborn morbidity, newborn mortality, child morbidity, child mortality, service utilization, quality of care, and/or experience of care including respectful care. Outcome data was extracted for descriptive statistics and thematic analysis. Of the 139 included studies, 110 studies reported data on QoC. Most studies reporting on QoC occurred in India (19.3%), Uganda (12.3%), and Bangladesh (8.8%). Effectiveness was the most widely measured quality domain with 55 data points, followed by people-centered care (n = 52), safety (n = 47), timeliness (n = 31), equity (n = 24), and efficiency (n = 4). The review showed inconsistencies in care quality across private and public facilities, with quality varying across the six domains. Factors such as training, guidelines, and technical competence influenced the quality. There were also variations in how domains like "people-centered care" have been understood and measured over time. The review underscores the need for clearer definitions of "quality" and practical QoC measures, central to the success of Sustainable Development Goals (SDGs) and equitable health outcomes. This research addresses how quality MNCH care has been defined and operationalized to understand how quality is delivered across the private health sector and the larger health system. Numerous variables and metrics under each QoC domain highlight the difficulty in systematizing QoC. These findings have practical significance to both researchers and policymakers. Systematic Review Registration https://bmjopen.bmj.com/content/10/2/e033141.long, Identifier [CRD42019143383].
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Affiliation(s)
- Georgina Morris
- Department of International Development, London School of Economics and Political Science, London, United Kingdom
| | - Blerta Maliqi
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Samantha R. Lattof
- Department of International Development, London School of Economics and Political Science, London, United Kingdom
| | - Joe Strong
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Nuhu Yaqub
- Regional Office for Africa, World Health Organization, Brazzaville, Congo
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Wijewickrama E, Alam MR, Bajpai D, Divyaveer S, Iyengar A, Kumar V, Qayyum A, Yadav SP, Yadla M, Arruebo S, Bello AK, Caskey FJ, Damster S, Donner JA, Jha V, Johnson DW, Levin A, Malik C, Nangaku M, Okpechi IG, Tonelli M, Ye F, Singh Shah D, Prasad N. Capacity for the management of kidney failure in the International Society of Nephrology South Asia region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA). Kidney Int Suppl (2011) 2024; 13:123-135. [PMID: 38618495 PMCID: PMC11010620 DOI: 10.1016/j.kisu.2024.01.007] [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: 12/10/2023] [Accepted: 01/10/2024] [Indexed: 04/16/2024] Open
Abstract
The South Asia region is facing a high burden of chronic kidney disease (CKD) with limited health resources and low expenditure on health care. In addition to the burden of CKD and kidney failure from traditional risk factors, CKD of unknown etiologies from India and Sri Lanka compounds the challenges of optimal management of CKD in the region. From the third edition of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA), we present the status of CKD burden, infrastructure, funding, resources, and health care personnel using the World Health Organization's building blocks for health systems in the ISN South Asia region. The poor status of the public health care system and low health care expenditure resulted in high out-of-pocket expenditures for people with kidney disease, which further compounded the situation. There is insufficient country capacity across the region to provide kidney replacement therapies to cover the burden. The infrastructure was also not uniformly distributed among the countries in the region. There were no chronic hemodialysis centers in Afghanistan, and peritoneal dialysis services were only available in Bangladesh, India, Nepal, Pakistan, and Sri Lanka. Kidney transplantation was not available in Afghanistan, Bhutan, and Maldives. Conservative kidney management was reported as available in 63% (n = 5) of the countries, yet no country reported availability of the core CKM care components. There was a high hospitalization rate and early mortality because of inadequate kidney care. The lack of national registries and actual disease burden estimates reported in the region prevent policymakers' attention to CKD as an important cause of morbidity and mortality. Data from the 2023 ISN-GKHA, although with some limitations, may be used for advocacy and improving CKD care in the region.
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Affiliation(s)
- Eranga Wijewickrama
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- University Medical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
- National Institute of Nephrology, Dialysis and Transplantation, Colombo, Sri Lanka
| | - Muhammad Rafiqul Alam
- Department of Nephrology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Divya Bajpai
- Department of Nephrology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Smita Divyaveer
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arpana Iyengar
- Department of Paediatric Nephrology, St. John’s National Academy of Health Sciences, Bangalore, India
| | - Vivek Kumar
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ahad Qayyum
- Department of Nephrology and Transplantation, Bahria Town International Hospital, Lahore, Punjab, Pakistan
| | - Shankar Prasad Yadav
- Department of Pediatrics, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Manjusha Yadla
- Department of Nephrology, Gandhi Medical College, Hyderabad, India
| | - Silvia Arruebo
- The International Society of Nephrology, Brussels, Belgium
| | - Aminu K. Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Fergus J. Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Jo-Ann Donner
- The International Society of Nephrology, Brussels, Belgium
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Manipal Academy of Higher Education, Manipal, India
| | - David W. Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
- Australasian Kidney Trials Network at the University of Queensland, Queensland, Australia
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charu Malik
- The International Society of Nephrology, Brussels, Belgium
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ikechi G. Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Canada and Pan-American Health Organization/World Health Organization’s Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Dibya Singh Shah
- Department of Nephrology and Transplant Medicine, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, India
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Alayed TM, Alrumeh AS, Alkanhal IA, Alhuthil RT. Impact of Privatization on Healthcare System: A Systematic Review. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2024; 12:125-133. [PMID: 38764559 PMCID: PMC11098275 DOI: 10.4103/sjmms.sjmms_510_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/28/2024] [Accepted: 02/07/2024] [Indexed: 05/21/2024]
Abstract
Background A notable shift in healthcare policy is healthcare privatization, which refers to the transfer of ownership, management, or provision of healthcare services from the public sector to private entities. Objectives To provide a narrative examination of the impact of privatization on various dimensions of healthcare, including quality, equity, accessibility, and cost-effectiveness. Policymakers can utilize the findings of this study to make well-informed decisions regarding privatization strategies. Materials and Methods A systematic review was implemented using the following databases: PubMed, Scopus, and Google Scholar. Studies conducted from January 2000 to January 2023 in developing or developed countries that assessed the impact of healthcare privatization on population health within public sector institutions were included. Results Eleven studies were included. The findings revealed diverse perspectives on the impact of healthcare privatization, with four studies (36.4%) supporting privatization (two of these were conducted in Saudi Arabia), six studies (54.5%) opposing it (three of these were conducted in European countries), and one study (9.1%) taking a neutral stance. Two studies investigated the impact on healthcare quality, and both revealed that privatization negatively impacts uninsured patients and low-income populations. In addition, five studies investigated the healthcare access and equity dimensions following privatization: one was in favor, one was neutral, and three were opposing it. Four studies investigated the cost-effectiveness dimension, with three in favor and one study opposing it. Conclusion This review highlights different perspectives on healthcare privatization. While studies, as those from Saudi Arabia, suggest benefits in terms of efficiency and innovation, others, particularly from European countries, emphasize negative consequences such as inequity and reduced quality. This emphasizes the need for more investigations to understand privatization's impact on healthcare.
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Affiliation(s)
- Tareq M. Alayed
- Department of Critical Care Medicine, Pediatric Intensive Care Unit, Riyadh, Saudi Arabia
| | - Assem S. Alrumeh
- Department of Laboratory, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | | | - Raghad T. Alhuthil
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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15
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Naz L, Sriram S. Out-of-pocket expenditures associated with double disease burden in Pakistan: a quantile regression analysis. BMC Public Health 2024; 24:801. [PMID: 38486277 PMCID: PMC10938732 DOI: 10.1186/s12889-024-18320-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 03/10/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Pakistan is currently experiencing a double burden of disease. Families with members having both communicable and noncommunicable diseases are at a greater risk of impoverishment due to enormous out-of-pocket payments. This study examines the percentile distribution of the determinants of the out-of-pocket expenditure on the double disease burden. METHOD The study extracted a sample of 6,775 households with at least one member experiencing both communicable and noncommunicable diseases from the Household Integrated Economic Survey 2018-19. The dataset is cross-sectional and nationally representative. Quantile regression was used to analyze the association of various socioeconomic factors with the OOP expenditure associated with double disease burden. RESULTS Overall, 28.5% of households had double disease in 2018-19. The households with uneducated heads, male heads, outpatient healthcare, patients availing public sector healthcare services, and rural and older members showed a significant association with the prevalence of double disease. The out-of-pocket expenditure was higher for depression, liver and kidney disease, hepatitis, and pneumonia in the upper percentiles. The quantile regression results showed that an increased number of communicable and noncommunicable diseases was associated with higher monthly OOP expenditure in the lower percentiles (10th percentile, coefficient 312, 95% CI: 92-532), and OOP expenditure was less pronounced among the higher percentiles (75th percentile, coefficient 155, 95% CI: 30-270). The households with older members were associated with higher OOP expenditure at higher tails (50th and 75th percentiles) compared to lower (10th and 25th percentiles). Family size was associated with higher OOPE at lower percentiles than higher ones. CONCLUSION The coexistence of communicable and noncommunicable diseases is associated with excessive private healthcare costs in Pakistan. The results call for addressing the variations in financial costs associated with double diseases.
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Affiliation(s)
- Lubna Naz
- Department of Economics, School of Economics and Social Sciences, Institute of Business Administration, 75270, Karachi, Pakistan
| | - Shyamkumar Sriram
- Department of Social and Public Health, Ohio University, 45701, Athens, OH, USA.
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Akuffo KO, Osei Duah Junior I, Acquah EA, Abadua Mensah E, Andoh AKA, Kumah DB, Boateng BS, Boateng JA, Osei-Poku K, Eisenbarth W. Low Vision Practice and Service Provision Among Optometrists in Ghana: A Nationwide Survey. Ophthalmic Epidemiol 2024:1-8. [PMID: 38451021 DOI: 10.1080/09286586.2024.2317816] [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: 08/05/2023] [Accepted: 02/06/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE To characterize practice patterns of low vision services among Optometrists in Ghana. METHODS The nationwide cross-sectional survey identified entities through the Ghana Optometrists Association (GOA) registry and utilized a semi-structured questionnaire to consolidate survey information that comprises practitioners' demographics, available services, diagnostic equipment, barriers to service provision and utilization, and interventions. RESULTS 300 Optometrists were identified, with 213 surveyed (71% response rate). About fifty percent (52.6%) were in private practice, and more than two-thirds (77%) did not provide low vision services. Most (≥70%) reported lack of assistive devices, and basic eye care examination kits as the main barriers to low vision service provision. Similarly, practitioners reported unawareness of the presence of low vision centres (76.1%), and high cost of low vision aids (75.1%) as the prime perceived barriers for patients to utilize low vision services. Continuous professional development and public education (89-90%) were suggested as interventions to improve the uptake of low vision services. After statistical adjustment, private facility type (Adjusted odds ratio [AOR] = 0.35, p = 0.010) and lack of basic eye examination kits (AOR = 0.32, p = 0.002) were significantly associated with reduced odds of low vision service provision. Conversely, ≥15 years of work experience (AOR = 6.37, p = 0.011) was significantly associated with increased odds of low vision service provision. CONCLUSIONS Overall, the results indicate inadequate low vision coverage and service delivery. Government policies must be directed towards equipping practitioners with equipment and subsidize patient cost of treatment to optimize low vision care.
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Affiliation(s)
- Kwadwo Owusu Akuffo
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Isaiah Osei Duah Junior
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Biological Sciences, Purdue University, West-Lafayette, Indiana, USA
| | - Eldrick Adu Acquah
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Elna Abadua Mensah
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Albert Kwadjo Amoah Andoh
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - David Ben Kumah
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Josephine Ampomah Boateng
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kofi Osei-Poku
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Werner Eisenbarth
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Applied Science and Mechatronics, HM Hochschule München University of Applied Sciences, Munich, Germany
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Clarke D, Cocozza A, Appleford G, Thabet A, Ross S, Boggs M. Data-driven governance and the private sector in mixed health systems. BMJ Glob Health 2024; 8:e014705. [PMID: 38453254 PMCID: PMC10973688 DOI: 10.1136/bmjgh-2023-014705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/11/2024] [Indexed: 03/09/2024] Open
Affiliation(s)
- David Clarke
- Special Programme on Primary Health Care, World Health Organization, Geneva, Switzerland
| | - Anna Cocozza
- Special Programme on Primary Health Care, World Health Organization, Geneva, Switzerland
| | - Gabrielle Appleford
- Special Programme on Primary Health Care, World Health Organization, Geneva, Switzerland
| | - Aya Thabet
- Special Programme on Primary Health Care, World Health Organization, Geneva, Switzerland
| | - Susan Ross
- Maternal, Child Health and Nutrition, USAID, Washington, DC, USA
| | - Malia Boggs
- Public Health Institute, USAID, Washington, DC, USA
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Shrestha AB, Taha AM, Siddiq A, Shrestha S, Thakur P, Chapagain S, Sharma S, Halder A, Rajak K, Shah V. Virtual and augmented reality in cardiovascular care in low and middle income country. Curr Probl Cardiol 2024; 49:102380. [PMID: 38191103 DOI: 10.1016/j.cpcardiol.2024.102380] [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: 12/24/2023] [Accepted: 01/04/2024] [Indexed: 01/10/2024]
Abstract
The global health sector has witnessed an escalating integration of Virtual Reality (VR) and Augmented Reality (AR) technologies, particularly in high-income countries. The application of these cutting-edge technologies is gradually extending to Low- and Middle-Income Countries (LMICs), notably in the domain of cardiovascular care. AR and VR technologies are revolutionizing cardiovascular care by offering solutions for diagnosis, medical training, and surgical planning. AR and VR provide detailed and immersive visualizations of cardiac structures, aiding in diagnosis and intervention planning. In cardiovascular care, VR reduces patient-reported pain, eases anxiety, and accelerates post-procedural recovery. AR and VR are also valuable for life support training, creating immersive and controlled learning environments. AR and VR have the potential to significantly impact healthcare in low- and middle-income countries with enhanced accessibility and affordability. This review outlines the existing spectrum of VR and AR adoption and its burgeoning utility in the cardiovascular domain within LMICs.
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Affiliation(s)
- Abhigan Babu Shrestha
- Department of Internal medicine, M Abdur Rahim Medical College, Dinajpur, Bangladesh.
| | | | | | | | - Prince Thakur
- Nepalgunj Medical College and Research Institute, Nepalgunj, Nepal
| | | | | | - Anupam Halder
- Department of Internal Medicine, UPMC Harrisburg, PA, United States
| | - Kripa Rajak
- Department of Internal Medicine, UPMC Harrisburg, PA, United States
| | - Vaibhav Shah
- Department of Internal Medicine, Icahn School of Medicine, Mount Sinai- Elmhurst Hospital Centre, New York, United States
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Siddiky A, Mollick K, Aktarujjaman M, Islam F, Mamun MA, Roy N. Determinants of food safety knowledge and practices among food handlers in Bangladesh: An institution-based cross-sectional study. Heliyon 2024; 10:e25970. [PMID: 38384511 PMCID: PMC10878943 DOI: 10.1016/j.heliyon.2024.e25970] [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: 11/11/2023] [Revised: 12/23/2023] [Accepted: 02/06/2024] [Indexed: 02/23/2024] Open
Abstract
The engagement of a large number of people in big-scale cooking raises the danger of food contamination due to incorrect handling, whether deliberate or unintentional. Contamination during large-scale production poses a serious hazard to consumer health and has significant financial implications for a nation. This study aimed to investigate the food safety knowledge and practices of institutional food handlers in Bangladesh, considering the growing concern surrounding this issue and the lack of available information on foodborne illnesses related to institutions. In addition, the study aimed to determine the factors influencing both knowledge and practices. A cross-sectional study was conducted from June to September 2022, involving 408 institutional food handlers. The sample size was determined using Cochran's formula, and data was collected through purposive sampling. The participants were interviewed in person and completed a pilot-tested questionnaire. A multiple linear regression analysis was conducted to determine the factors related to food safety knowledge and practices. The majority of participants were female (71.3%) and aged between 26 and 35 (mean age 34.53 ± 9.06 years). They were most knowledgeable about hand hygiene and food separation but lacked knowledge about foodborne pathogens and food storage. Thawing food at room temperature was the most inappropriate practice (86%). The mean scores for knowledge and practice were found to be 16.11 ± 2.76 on a 26-point scale (61%), and 9.59 ± 2.07 on a 15-point scale (64%), respectively. Rural food handlers, those with higher education, working more than 10 h per day, and being familiar with HACCP, had higher knowledge. Food handlers aged 18 to 25, with higher income, working in private institutions, having food safety authority knowledge, actively engaging in food safety training, working more than 10 h per day, and having a positive health perception, had better food safety practices.The results of this study reinforce the notion that institutional food handlers would benefit from enhanced exposure to food safety interventions, active participation in training sessions, and strict adherence to food hygiene regulations in their food handling knowledge and practices.
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Affiliation(s)
- Aysha Siddiky
- Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, 8602, Bangladesh
| | - Kakali Mollick
- Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, 8602, Bangladesh
| | - Md. Aktarujjaman
- Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, 8602, Bangladesh
| | - Farhadul Islam
- Dept. of Biochemistry and Molecular Biology, University of Rajshahi, Bangladesh
| | - Mohammed A. Mamun
- CHINTA Research Bangladesh, Dhaka, Bangladesh
- Department of Public Health and Informatics, Jahangirnagar University, Dhaka, Bangladesh
| | - Nitai Roy
- Department of Biochemistry and Food Analysis, Patuakhali Science and Technology University, Patuakhali, 8602, Bangladesh
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20
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Lixandru CI, Maniu I, Cernușcă-Mițariu MM, Făgețan MI, Cernușcă-Mițariu IS, Domnariu HP, Lixandru M, Domnariu CD. Patient Satisfaction with the Quality of Oral Rehabilitation Dental Services: A Comparison between the Public and Private Health System. Dent J (Basel) 2024; 12:45. [PMID: 38534269 DOI: 10.3390/dj12030045] [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: 12/20/2023] [Revised: 02/03/2024] [Accepted: 02/19/2024] [Indexed: 03/28/2024] Open
Abstract
Measuring satisfaction can help us understand patients' expectations and adopt individualized treatment according to their expectations. In the current study, we applied the DPQ (Dental Practice Questionnaire) to analyze the degree of patient satisfaction regarding medical services in the public and private sector in a Romanian city from the central region. A group of 200 patients, 100 patients from the public sector and 100 patients from the private sector, participated in the survey. The results showed significant differences in response when patients were stratified by age, gender, visit frequency and length of time attending the same practice. Significant differences between public and private practices were encountered. Moreover, the degree of patient satisfaction was found to be related to appointment promptness/length of time and the confidentiality/ability to listen/knowledge/respect shown by the dentist, while patients' recommendations to others were influenced by dentists' explanations and warmth, followed by the appointment system and confidentiality. Patient satisfaction with oral rehabilitation dental services plays an essential role in maintaining patients' addressability, but there is a multitude of factors that can influence patients' opinions. Further analysis of the evolution of the influencing factors (causing satisfaction or dissatisfaction), in time, could provide deeper insights into the links between patient satisfaction and these factors.
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Affiliation(s)
| | - Ionela Maniu
- Mathematics and Informatics Department, Faculty of Sciences, Research Center in Informatics and Information Technology, "Lucian Blaga" University, 550024 Sibiu, Romania
- Research Team, Pediatric Clinical Hospital Sibiu, 550166 Sibiu, Romania
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21
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Wang N, Li Y, Wu S, Liu Y, Nie J, Wu J, Reheman Z, Ye J, Yang J. Effect of no eyeglasses sales on the quality of eye care: an experimental evidence from China. BMC Public Health 2024; 24:422. [PMID: 38336621 PMCID: PMC10858552 DOI: 10.1186/s12889-024-17882-7] [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: 08/23/2023] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Eye examinations and eyeglasses acquisition are typically integrated into a cohesive procedure in China. We conducted a randomized controlled trial using incognito standardized patient (SP) approach to evaluate the impact of separating eyeglasses sales on the accuracy of final prescription. METHODS 52 SPs were trained to provide standardized responses during eye examinations, and undergoing refraction by a senior ophthalmologist at a national-level clinical center. SPs subsequently received eye examinations at 226 private optical shops and public hospitals in Shaanxi, northwestern China. The visits were randomly assigned to either control group, where SPs would typically purchase eyeglasses after refraction, or treatment group, where SPs made an advance declaration not to purchase eyeglasses prior to refraction. The dioptric difference between the final prescriptions provided by local refractionists and expert in the better-seeing eye was determined using the Vector Diopteric Distance method, and the completeness of exams was assessed against national standards. Multiple regressions were conducted to estimate the impact of no eyeglasses sales on the accuracy of the final prescription of local refractionists, as well as the completeness of examinations. RESULTS Among 226 eye exams (73 in public hospitals, 153 in private optical shops), 133 (58.8%) were randomized to control group and 93 (41.2%) to no eyeglasses sales group. The inaccuracy rate of final prescriptions provided by local refractionists (≥ 1.0 D, experts' final prescription as the reference) was 25.6% in control group, while 36.6% in no-sale group (P = 0.077). The likelihood of providing inaccurate final prescriptions was significantly higher in no-sale group compared to control group (OR = 1.607; 95% CI: 1.030 to 2.508; P = 0.037). This was particularly evident in private optical shops (OR = 2.433; 95% CI: 1.386 to 4.309; P = 0.002). In terms of process quality, the no-sale group performed significantly less subjective refraction (OR = 0.488; 95% CI: 0.253 to 0.940; P = 0.032) and less testing SP's own eyeglasses (OR = 0.424; 95% CI: 0.201 to 0.897; P = 0.025). The duration of eye exams was 3.917 min shorter (95% CI: -6.798 to -1.036; P = 0.008) in no-sale group. CONCLUSIONS Separating eyeglasses sales from optical care could lead to worse quality of eye care. Policy makers should carefully consider the role of economic incentives in healthcare reform.
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Affiliation(s)
- Nan Wang
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, China
| | - Yangyuan Li
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, China
| | - Shichong Wu
- Department of Statistics, School of Economics, Xiamen University, Xiamen, China
| | - Yunjie Liu
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, China
| | - Jingchun Nie
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, China.
| | - Junhao Wu
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, China
| | - Zulihumaer Reheman
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, China
| | - Jinbiao Ye
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, China
| | - Jie Yang
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, China
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22
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Li Y, Roberts JA, Walker MM, Aslan AT, Harris PNA, Sime FB. The global epidemiology of ventilator-associated pneumonia caused by multi-drug resistant Pseudomonas aeruginosa: A systematic review and meta-analysis. Int J Infect Dis 2024; 139:78-85. [PMID: 38013153 DOI: 10.1016/j.ijid.2023.11.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/08/2023] [Accepted: 11/19/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVES The objective of this systematic review and meta-analysis was to estimate the global prevalence of multi-drug resistant (MDR) Pseudomonas aeruginosa causing ventilator-associated pneumonia (VAP). METHODS The systematic search was conducted in four databases. Original studies describing MDR P. aeruginosa VAP prevalence in adults from 2012- 2022 were included. A meta-analysis, using the random effects model, was conducted for overall, subgroups (country, published year, study duration, and study design), and European data, respectively. Univariate meta-regression based on pooled estimates was also conducted. Systematic review registered in International Prospective Register of Systematic Review (CRD42022384035). RESULTS In total of 31 studies, containing a total of 7951 cases from 16 countries, were included. The overall pooled prevalence of MDR among P. aeruginosa causing VAP was 33% (95% confidence interval [CI] 27.7-38.3%). The highest prevalence was for Iran at 87.5% (95% CI 69-95.7%), and the lowest was for the USA at 19.7% (95% CI 18.6-20.7%). The European prevalence was 29.9% (95% CI 23.2-36.7%). CONCLUSIONS This review indicates that the prevalence of MDR P. aeruginosa in patients with VAP is generally high and varies significantly between countries; however, data are insufficient for many countries. The data in this study can provide a reference for VAP management and drug customisation strategies.
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Affiliation(s)
- Yixuan Li
- UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, University of Queensland, Herston, Australia
| | - Jason A Roberts
- UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, University of Queensland, Herston, Australia; Departments of Phaemacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Australia; Pharmacy Department, Royal Brisbane and Women's Hospital, Herston, Australia; Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Mikaela M Walker
- UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, University of Queensland, Herston, Australia
| | - Abdullah Tarik Aslan
- UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, University of Queensland, Herston, Australia; Hacettepe University, Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Patrick N A Harris
- UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, University of Queensland, Herston, Australia; Pathology Queensland, Health Support Queensland, Herston, Australia
| | - Fekade B Sime
- UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, University of Queensland, Herston, Australia.
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23
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Brindley C, Wijemunige N, Dieteren C, Bom J, Meessen B, Bonfrer I. Health seeking behaviours and private sector delivery of care for non-communicable diseases in low- and middle-income countries: a systematic review. BMC Health Serv Res 2024; 24:127. [PMID: 38263128 PMCID: PMC10807218 DOI: 10.1186/s12913-023-10464-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 12/09/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Globally, non-communicable diseases (NCDs) are the leading cause of mortality and morbidity placing a huge burden on individuals, families and health systems, especially in low- and middle-income countries (LMICs). This rising disease burden calls for policy responses that engage the entire health care system. This study aims to synthesize evidence on how people with NCDs choose their healthcare providers in LMICs, and the outcomes of these choices, with a focus on private sector delivery. METHODS A systematic search for literature following PRISMA guidelines was conducted. We extracted and synthesised data on the determinants and outcomes of private health care utilisation for NCDs in LMICs. A quality and risk of bias assessment was performed using the Mixed Methods Appraisal Tool (MMAT). RESULTS We identified 115 studies for inclusion. Findings on determinants and outcomes were heterogenous, often based on a particular country context, disease, and provider. The most reported determinants of seeking private NCD care were patients having a higher socioeconomic status; greater availability of services, staff and medicines; convenience including proximity and opening hours; shorter waiting times and perceived quality. Transitioning between public and private facilities is common. Costs to patients were usually far higher in the private sector for both inpatient and outpatient settings. The quality of NCD care seems mixed depending on the disease, facility size and location, as well as the aspect of quality assessed. CONCLUSION Given the limited, mixed and context specific evidence currently available, adapting health service delivery models to respond to NCDs remains a challenge in LMICs. More robust research on health seeking behaviours and outcomes, especially through large multi-country surveys, is needed to inform the effective design of mixed health care systems that effectively engage both public and private providers. TRIAL REGISTRATION PROSPERO registration number CRD42022340059 .
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Affiliation(s)
- Callum Brindley
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands.
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands.
| | - Nilmini Wijemunige
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
- Institute for Health Policy, Colombo, Sri Lanka
| | - Charlotte Dieteren
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
| | - Judith Bom
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
| | | | - Igna Bonfrer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
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24
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Lewis TP, Kassa M, Kapoor NR, Arsenault C, Bazua-Lobato R, Dayalu R, Fink G, Getachew T, Jarhyan P, Lee HY, Mazzoni A, Medina-Ranilla J, Naidoo I, Tadele A, Kruk ME. User-reported quality of care: findings from the first round of the People's Voice Survey in 14 countries. Lancet Glob Health 2024; 12:e112-e122. [PMID: 38096883 PMCID: PMC10716624 DOI: 10.1016/s2214-109x(23)00495-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/12/2023] [Accepted: 10/16/2023] [Indexed: 12/17/2023]
Abstract
High-quality care is essential for improving health outcomes, although many health systems struggle to maintain good quality. We use data from the People's Voice Survey-a nationally representative survey conducted in 14 high-income, middle-income, and low-income countries-to describe user-reported quality of most recent health care in the past 12 months. We described ratings for 14 measures of care competence, system competence, and user experience and assessed the relationship between visit quality factors and user recommendation of the facility. We disaggregated the data by high-need and underserved groups. The proportion of respondents rating their most recent visit as high quality ranged from 25% in Laos to 74% in the USA. The mean facility recommendation score was 7·7 out of 10. Individuals with high needs or who are underserved reported lower-quality services on average across countries. Countries with high health expenditure per capita tended to have better care ratings than countries with low health expenditure. Visit quality factors explained a high proportion of variation in facility recommendations relative to facility or demographic factors. These results show that user-reported quality is low but increases with high national health expenditure. Elevating care quality will require monitoring and improvements on multiple dimensions of care quality, especially in public systems.
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Affiliation(s)
- Todd P Lewis
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | - Munir Kassa
- Minister's Office, Ministry of Health, Addis Ababa, Ethiopia
| | - Neena R Kapoor
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Catherine Arsenault
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Rodrigo Bazua-Lobato
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Rashmi Dayalu
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Theodros Getachew
- Health System & Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Hwa-Young Lee
- Graduate School of Public Health and Healthcare Management, The Catholic University of Korea, Seoul, South Korea
| | - Agustina Mazzoni
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | - Inbarani Naidoo
- Centre for Community Based Research, Public Health, Societies & Belonging, Human Sciences Research Council, Durban, South Africa
| | - Ashenif Tadele
- Health System & Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
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25
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Dixit P, Sundararaman T, Halli S. Is the quality of public health facilities always worse compared to private health facilities: Association between birthplace on neonatal deaths in the Indian states. PLoS One 2023; 18:e0296057. [PMID: 38150439 PMCID: PMC10752527 DOI: 10.1371/journal.pone.0296057] [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: 03/03/2023] [Accepted: 12/05/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND The role of place of delivery on the neonatal health outcomes are very crucial. Although the quality of care is being improved, there is no consensus about who is the better healthcare provider in low and middle-income countries (LMICs), public or private facilities. The aim of this study is to assess the differentials in neonatal mortality by the type of healthcare providers in India and its states. METHODS We used the data from the fourth wave of the National Family Health Survey 2015-16 (NFHS-4). Information on 259,627 live births to women within the five years preceding the survey was examined. Neonatal mortality rates for state and national levels were calculated using DHS methodology. Multi-variate logistics regression was performed to find the effect of birthplace on neonatal deaths. Propensity score matching (PSM) was used to evaluate the relationship between place of delivery and neonatal deaths to account for the bias attributable to observable covariates. RESULTS The rise in parity of the women and purchasing power influences the choice of healthcare providers. Increased neonatal mortality was found in private hospital delivery compared to public hospitals in Punjab, Rajasthan, Chhattisgarh, Madhya Pradesh, Bihar, Jharkhand, Odisha, Goa, Maharashtra, Andhra Pradesh and Karnataka states using propensity score matching analysis. However, analysis on the standard of pre-natal and post-natal care indicates that private hospitals generally outperformed public hospitals. CONCLUSIONS The study observed a significant variation in neonatal mortality among public and private health care systems in India. Findings of the study urges that more attention be paid to the improve care at the place of delivery to improve neonatal health. There is a need of strengthened national health policy and public-private partnerships in order to improve maternal and child health care in both private and public health facilities.
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Affiliation(s)
- Priyanka Dixit
- School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India
| | | | - Shiva Halli
- Department of Community Health Sciences Faculty of Medicine, University of Manitoba, Manitoba, Canada
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26
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Clarke D, Appleford G, Cocozza A, Thabet A, Bloom G. The governance behaviours: a proposed approach for the alignment of the public and private sectors for better health outcomes. BMJ Glob Health 2023; 8:e012528. [PMID: 38084487 PMCID: PMC10711895 DOI: 10.1136/bmjgh-2023-012528] [Citation(s) in RCA: 1] [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: 04/06/2023] [Accepted: 08/29/2023] [Indexed: 12/18/2023] Open
Abstract
Health systems are 'the ensemble of all public and private organisations, institutions and resources mandated to improve, maintain or restore health.' The private sector forms a major part of healthcare practice in many health systems providing a wide range of health goods and services, with significant growth across low-income and middle-income countries. WHO sees building stronger and more effective health systems through the participation and engagement of all health stakeholders as the pathway to further reducing the burden of disease and meeting health targets and the Sustainable Development Goals. However, there are governance and public policy gaps when it comes to interaction or engagement with the private sector, and therefore, some governments have lost contact with a major area of healthcare practice. As a result, market forces rather than public policy shape private sector activities with follow-on effects for system performance. While the problem is well described, proposed normative solutions are difficult to apply at country level to translate policy intentions into action. In 2020, WHO adopted a strategy report which argued for a major shift in approach to engage the private sector based on the performance of six governance behaviours. These are a practice-based approach to governance and draw on earlier work from Travis et al on health system stewardship subfunctions. This paper elaborates on the governance behaviours and explains their application as a practice approach for strengthening the capacity of governments to work with the private sector to achieve public policy goals.
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Affiliation(s)
- David Clarke
- Special Programme on Primary Health Care, World Health Organization, Geneve, Switzerland
| | - Gabrielle Appleford
- Special Programme on Primary Health Care, World Health Organization, Geneve, Switzerland
| | - Anna Cocozza
- Special Programme on Primary Health Care, World Health Organization, Geneve, Switzerland
| | - Aya Thabet
- Special Programme on Primary Health Care, World Health Organization, Geneve, Switzerland
- Health Systems, World Health Organisation Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Gerald Bloom
- Health and Nutrition Cluster, Institute of Development Study, Brighton, UK
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27
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Prendergast C, Flood M, Murry LT, Clyne B, Fahey T, Moriarty F. Prescribing differences among older adults with differing health cover and socioeconomic status: a cohort study. BMC Geriatr 2023; 23:755. [PMID: 37978448 PMCID: PMC10656928 DOI: 10.1186/s12877-023-04441-9] [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: 03/30/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION As health reforms move Ireland from a mixed public-private system toward universal healthcare, it is important to understand variations in prescribing practice for patients with differing health cover and socioeconomic status. This study aims to determine how prescribing patterns for patients aged ≥ 65 years in primary care in Ireland differ between patients with public and private health cover. METHODS This was an observational study using anonymised data collected as part of a larger study from 44 general practices in Ireland (2011-2018). Data were extracted from electronic records relating to demographics and prescribing for patients aged ≥ 65 years. The cohort was divided between those with public health cover (via the General Medical Services (GMS) scheme) and those without. Standardised rates of prescribing were calculated for pre-specified drug classes. We also analysed the number of medications, polypharmacy, and trends over time between groups, using multilevel linear regression adjusting for age and sex, and hospitalisations. RESULTS Overall, 42,456 individuals were included (56% female). Most were covered by the GMS scheme (62%, n = 26,490). The rate of prescribing in all drug classes was higher for GMS patients compared to non-GMS patients, with the greatest difference in benzodiazepine anxiolytics. The mean number of unique medications prescribed to GMS patients was 10.9 (SD 5.9), and 8.1 (SD 5.8) for non-GMS patients. The number of unique medications prescribed to both GMS and non-GMS cohorts increased over time. The increase was steeper in the GMS group where the mean number of medications prescribed increased by 0.67 medications/year. The rate of increase was 0.13 (95%CI 0.13, 0.14) medications/year lower for non-GMS patients, a statistically significant difference. CONCLUSION Our study found a significantly larger number of medications were prescribed to patients with public health cover, compared to those without. Increasing medication burden and polypharmacy among older adults may be accelerated for those of lower socioeconomic status. These findings may inform planning for moves towards universal health care, and this would provide an opportunity to evaluate the effect of expanding entitlement on prescribing and medications use.
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Affiliation(s)
- Ciaran Prendergast
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin, Ireland
| | - Michelle Flood
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin, Ireland
| | - Logan T Murry
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin, Ireland
| | - Barbara Clyne
- Department of General Practice, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - Tom Fahey
- Department of General Practice, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - Frank Moriarty
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin, Ireland.
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28
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Reid M, Agbassi YJP, Arinaminpathy N, Bercasio A, Bhargava A, Bhargava M, Bloom A, Cattamanchi A, Chaisson R, Chin D, Churchyard G, Cox H, Denkinger CM, Ditiu L, Dowdy D, Dybul M, Fauci A, Fedaku E, Gidado M, Harrington M, Hauser J, Heitkamp P, Herbert N, Herna Sari A, Hopewell P, Kendall E, Khan A, Kim A, Koek I, Kondratyuk S, Krishnan N, Ku CC, Lessem E, McConnell EV, Nahid P, Oliver M, Pai M, Raviglione M, Ryckman T, Schäferhoff M, Silva S, Small P, Stallworthy G, Temesgen Z, van Weezenbeek K, Vassall A, Velásquez GE, Venkatesan N, Yamey G, Zimmerman A, Jamison D, Swaminathan S, Goosby E. Scientific advances and the end of tuberculosis: a report from the Lancet Commission on Tuberculosis. Lancet 2023; 402:1473-1498. [PMID: 37716363 DOI: 10.1016/s0140-6736(23)01379-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/14/2023] [Accepted: 06/29/2023] [Indexed: 09/18/2023]
Affiliation(s)
- Michael Reid
- University of California San Francisco Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA; Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA.
| | - Yvan Jean Patrick Agbassi
- Global TB Community Advisory Board, Abidjan, Côte d'Ivoire, Yenepoya Medical College, Mangalore, India
| | | | - Alyssa Bercasio
- University of California San Francisco Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA; Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Anurag Bhargava
- Department of General Medicine, Yenepoya Medical College, Mangalore, India
| | - Madhavi Bhargava
- Department of Community Medicine, Yenepoya Medical College, Mangalore, India
| | - Amy Bloom
- Division of Tuberculosis, Bureau of Global Health, USAID, Washington, DC, USA
| | | | - Richard Chaisson
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel Chin
- Bill and Melinda Gates Foundation, Seattle, WA, USA
| | | | - Helen Cox
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Claudia M Denkinger
- Heidelberg University Hospital, German Center of Infection Research, Heidelberg, Germany
| | | | - David Dowdy
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Mark Dybul
- Department of Medicine, Center for Global Health Practice and Impact, Georgetown University, Washington, DC, USA
| | - Anthony Fauci
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | | | - Petra Heitkamp
- McGill International TB Centre, McGill University, Montreal, QC, Canada
| | - Nick Herbert
- Global TB Caucus, Houses of Parliament, London, UK
| | | | - Philip Hopewell
- University of California San Francisco Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | - Emily Kendall
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Aamir Khan
- Interactive Research & Development, Karachi, Pakistan
| | - Andrew Kim
- University of California San Francisco Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Nalini Krishnan
- Resource Group for Education and Advocacy for Community Health (REACH), Chennai, India
| | - Chu-Chang Ku
- School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Erica Lessem
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Payam Nahid
- University of California San Francisco Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | | | - Madhukar Pai
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada; McGill International TB Centre, McGill University, Montreal, QC, Canada
| | - Mario Raviglione
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Theresa Ryckman
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Sachin Silva
- Harvard TH Chan School of Public Health, Harvard University, Cambridge, MA, USA
| | | | | | | | | | - Anna Vassall
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Gustavo E Velásquez
- University of California San Francisco Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | | | - Gavin Yamey
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, USA
| | | | - Dean Jamison
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | | | - Eric Goosby
- University of California San Francisco Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA; Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
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Coveney L, Musoke D, Russo G. Do private health providers help achieve Universal Health Coverage? A scoping review of the evidence from low-income countries. Health Policy Plan 2023; 38:1050-1063. [PMID: 37632759 PMCID: PMC10566321 DOI: 10.1093/heapol/czad075] [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: 01/11/2023] [Revised: 08/07/2023] [Accepted: 08/15/2023] [Indexed: 08/28/2023] Open
Abstract
Universal Health Coverage (UHC) is the dominant paradigm in health systems research, positing that everyone should have access to a range of affordable health services. Although private providers are an integral part of world health systems, their contribution to achieving UHC is unclear, particularly in low-income countries (LICs). We scoped the literature to map out the evidence on private providers' contribution to UHC progress in LICs. Literature searches of PubMed, Scopus and Web of Science were conducted in 2022. A total of 1049 documents published between 2002 and 2022 were screened for eligibility using predefined inclusion criteria, focusing on formal as well as informal private health sectors in 27 LICs. Primary qualitative, quantitative and mixed-methods evidence was included, as well as original analysis of secondary data. The Joanna Briggs Institute's critical appraisal tool was used to assess the quality of the studies. Relevant evidence was extracted and analysed using an adapted UHC framework. We identified 34 papers documenting how most basic health care services are already provided through the private sector in countries such as Uganda, Afghanistan and Somalia. A substantial proportion of primary care, mother, child and malaria services are available through non-public providers across all 27 LICs. Evidence exists that while formal private providers mostly operate in well-served urban settings, informal and not-for-profit ones cater for underserved rural and urban areas. Nonetheless, there is evidence that the quality of the services by informal providers is suboptimal. A few studies suggested that the private sector fails to advance financial protection against ill-health, as costs are higher than in public facilities and services are paid out of pocket. We conclude that despite their shortcomings, working with informal private providers to increase quality and financing of their services may be key to realizing UHC in LICs.
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Affiliation(s)
- Laura Coveney
- The Wolfson Institute of Population Health, Queen Mary University of London, 58 Turner Street, London E1 2AB, United Kingdom
| | - David Musoke
- School of Public Health, Makerere University, New Mulago Hill Road, Mulango, Kampala, Uganda
| | - Giuliano Russo
- The Wolfson Institute of Population Health, Queen Mary University of London, 58 Turner Street, London E1 2AB, United Kingdom
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Shah S, Prakash V. Factors influencing physiotherapists implementation of high value care in the management of nonspecific low back pain in Indian healthcare settings: A qualitative study. Musculoskelet Sci Pract 2023; 67:102838. [PMID: 37556916 DOI: 10.1016/j.msksp.2023.102838] [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: 06/15/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Non-specific low back pain is a common musculoskeletal condition that often requires the involvement of physiotherapists for effective management. However, there is limited understanding of the factors influencing physiotherapists' implementation of high-value care in the management of non-specific low back pain (NSLBP), particularly in Indian healthcare settings. OBJECTIVE The aim of this study was to explore the barriers and facilitators of implementation of high-value care in managing NSLBP from the perspective of physiotherapists practicing in Indian healthcare settings. DESIGN Descriptive qualitative design. METHODS We adopted a descriptive phenomenological approach and purposefully selected physiotherapists (N = 15) from diverse healthcare settings, encompassing varying years of clinical experience, to capture a broad range of perspectives. Semi-structured face-to-face interviews were conducted via the Zoom video conferencing platform. Each interview lasted on average for 30-45 min, and no follow-up interviews were conducted. Data were analyzed using thematic analysis with an inductive approach. RESULTS Our analysis revealed three major themes and seven sub-themes uncovering barriers and facilitators of implementation of high-value care. These themes include misconceptions about low back pain and its management among physiotherapists, their perceived lack of autonomy in clinical decision-making due to external influences, and the significance of aligning treatment plans with patient goals while considering evidence-based care. CONCLUSION The study results provide insights into the unique challenges associated with implementation of high-value care for non-specific low back pain in Indian healthcare settings.
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Affiliation(s)
- Sweni Shah
- Ashok & Rita Patel Institute of Physiotherapy, Charotar University of Science and Technology, Changa, Anand, Gujarat, India.
| | - V Prakash
- Ashok & Rita Patel Institute of Physiotherapy, Charotar University of Science and Technology, Changa, Anand, Gujarat, India
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Kishindo M, Kamano J, Mwangi A, Andale T, Mwaura GW, Limo O, Too K, Mugo R, Maree E, Aruasa W. Are outpatient costs for hypertension and diabetes care affordable? Evidence from Western Kenya. Afr J Prim Health Care Fam Med 2023; 15:e1-e9. [PMID: 37916717 PMCID: PMC10546227 DOI: 10.4102/phcfm.v15i1.3889] [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: 10/24/2022] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Diabetes and hypertension pose a significant socio-economic burden in developing countries such as Kenya, where financial risk-protection mechanisms remain inadequate. This proves to be a great barrier towards achieving universal health care in such settings unless mechanisms are put in place to ensure greater access and affordability to non-communicable disease (NCD) management services. AIM This article aims to examine outpatient management services costs for patients with diabetes and hypertension attending public primary healthcare facilities. SETTING The study was conducted in Busia and Trans-Nzoia counties in Western Kenya in facilities supported by the PIC4C project, between August 2020 and December 2020. METHODS This cross-sectional survey included 719 adult participants. Structured interviewer-administered questionnaires were used to collect information on healthcare-seeking behaviour and associated costs. The annual direct and indirect costs borne by patients were computed by disease type and level of healthcare facility visited. RESULTS Patients with both diabetes and hypertension incurred higher annual costs (KES 13 149) compared to those with either diabetes (KES 8408) or hypertension (KES 7458). Patients attending dispensaries and other public healthcare facilities incurred less direct costs compared to those who visited private clinics. Furthermore, a higher proportionate catastrophic healthcare expenditure of 41.83% was noted among uninsured patients. CONCLUSION Despite this study being conducted in facilities that had an ongoing NCDs care project that increased access to subsidised medication, we still reported a substantially high cost of managing diabetes and hypertension among patients attending primary healthcare facilities in Western Kenya, with a greater burden among those with comorbidities.Contribution: Evidenced by the results that there is enormous financial burden borne by patients with chronic diseases such as hypertension and diabetes; we recommend that universal healthcare coverage that offers comprehensive care for NCDs be urgently rolled out alongside strengthening of lower-level public healthcare systems.
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Chijioke-Akaniro O, Onyemaechi S, Kuye J, Ubochioma E, Omoniyi A, Urhioke O, Lawanson A, Ombeka VO, Hassan A, Asuke S, Anyaike C, Merle CS. Challenges in engaging the private sector for tuberculosis prevention and care in Nigeria: a mixed methods study. BMJ Open 2023; 13:e069123. [PMID: 37709312 PMCID: PMC11148675 DOI: 10.1136/bmjopen-2022-069123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVES This study aimed to assess the practices of private practitioners regarding tuberculosis (TB), and to ascertain factors related to the low contribution of private healthcare providers to TB prevention and care in Nigeria. DESIGN This is a mixed methods study comprising a quantitative retrospective review and qualitative study. SETTING Private health facilities (HF) in Oyo State and the Federal Capital Territory (FCT), Nigeria. PARTICIPANTS We used routinely collected data on patients with tuberculosis (TB) notified between 1 January 2017 and 31 December 2018. In-depth interviews were also conducted with the clinical staff of the facilities. PRIMARY AND SECONDARY OUTCOME MEASURES The study outcomes are practices of TB case notification and treatment outcome, as well as the barriers and enablers of TB notification. RESULTS A total of 13 (11.0%) out of 118 private HF were designated as 'engaged' TB care facilities in Oyo State and none (0%) of the 198 private HF in the FCT held this designation. From the 214 patients with presumptive TB, 75 (35%) were diagnosed with TB, 42 (56%) had a bacteriological test done, 12 (16%) had an X-ray of the chest alone and 21 (28%) had other non-specific investigations. Most patients diagnosed were referred to a public HF, while 19 (25%) patients were managed at the private HF. Among them, 2 (10.5%) patients were treated with unconventional regimens, 4 (21%) were cured, 2 (11%) died, 3 (16%) lost to follow-up and 10 (53%) were not evaluated. The general practitioners did not have up-to-date knowledge of TB with a majority not trained on TB. Most referred patients with presumptive and confirmed TB to the public sector without feedback and were unclear regarding diagnostic algorithm and relevant tests to confirm TB. CONCLUSION Most private facilities were not engaged to provide TB services although with knowledge and practice gaps. The study has been used to develop plans for strategic engagement of the private sector in Nigeria.
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Affiliation(s)
| | | | | | | | | | - Ochuko Urhioke
- National Tuberculosis and Leprosy Control Programme, Abuja, Nigeria
| | - Adebola Lawanson
- National Tuberculosis and Leprosy Control Programme, Abuja, Nigeria
| | - Victor O Ombeka
- National Tuberculosis and Leprosy Control Programme, Abuja, Nigeria
| | | | | | - Chukwuma Anyaike
- National Tuberculosis and Leprosy Control Programme, Abuja, Nigeria
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Lee E, Kim S, Lee SY, Jeong J, Bang J, Oh J, Shin SD, Kim NJ, Choe PG, Oh MD. Risk Factors for the Prescription of Ineffective Antiviral Candidates for COVID-19 During the Early Pandemic Period in Korea. J Korean Med Sci 2023; 38:e280. [PMID: 37698205 PMCID: PMC10497349 DOI: 10.3346/jkms.2023.38.e280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/14/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Although the evidence of treatment for coronavirus disease 2019 (COVID-19) changed rapidly, little is known about the patterns of potential pharmacological treatment during the early period of the COVID-19 pandemic in Korea and the risk factors for ineffective prescription. METHODS Using claims data from the Korean National Health Insurance System, this retrospective cohort study included admission episodes for COVID-19 from February to December 2020. Ineffective antiviral prescriptions for COVID-19 were defined as lopinavir/ritonavir (LPN/r) and hydroxychloroquine (HCQ) prescribed after July 2020, according to the revised National Institute of Health COVID-19 treatment guidelines. Factors associated with ineffective prescriptions, including patient and hospital factors, were identified by multivariate logistic regression analysis. RESULTS Of the 15,723 COVID-19 admission episodes from February to June 2020, 4,183 (26.6%) included prescriptions of LPN/r, and 3,312 (21.1%) included prescriptions of HCQ. Of the 48,843 admission episodes from July to December 2020, after the guidelines were revised, 2,258 (4.6%) and 182 (0.4%) included prescriptions of ineffective LPN/r and HCQ, respectively. Patient factors independently associated with ineffective antiviral prescription were older age (adjusted odds ratio [aOR] per 10-year increase, 1.17; 95% confidence interval [CI], 1.14-1.20) and severe condition with an oxygen requirement (aOR, 2.49; 95% CI, 2.24-2.77). The prescription of ineffective antiviral drugs was highly prevalent in primary and nursing hospitals (aOR, 40.58; 95% CI, 31.97-51.50), public sector hospitals (aOR, 15.61; 95% CI, 12.76-19.09), and regions in which these drugs were highly prescribed before July 2020 (aOR, 10.65; 95% CI, 8.26-13.74). CONCLUSION Ineffective antiviral agents were prescribed to a substantial number of patients during the first year of the COVID-19 pandemic in Korea. Treatment with these ineffective drugs tended to be prolonged in severely ill patients and in primary and public hospitals.
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Affiliation(s)
- Eunyoung Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Infectious Diseases, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Seungyeon Kim
- Transdisciplinary Department of Medicine and Advanced Technology, Seoul National University Hospital, Seoul, Korea
- College of Pharmacy, Dankook University, Cheonan, Korea
| | - Sun Young Lee
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Jeong
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jihwan Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Infectious Diseases, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Juhwan Oh
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Fatma N, Ramamohan V. Healthcare seeking behavior among patients visiting public primary and secondary healthcare facilities in an urban Indian district: A cross-sectional quantitative analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001101. [PMID: 37669247 PMCID: PMC10479939 DOI: 10.1371/journal.pgph.0001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 07/17/2023] [Indexed: 09/07/2023]
Abstract
In this work, we examined healthcare seeking behavior (HSB) of patients visiting public healthcare facilities in an urban context. We conducted a cross-sectional survey across twenty-two primary and secondary public healthcare facilities in the South-west Delhi district in India. The quantitative survey was designed to ascertain from patients at these facilities their HSB-i.e., on what basis patients decide the type of healthcare facility to visit, or which type of medical practitioner to consult. Based on responses from four hundred and forty-nine participants, we observed that factors such as wait time, prior experience with care providers, distance from the facility, and also socioeconomic and demographic factors such as annual income, educational qualification, and gender significantly influenced preferences of patients in choosing healthcare facilities. We used binomial and multinomial logistic regression to determine associations between HSB and socioeconomic and demographic attributes of patients at a 0.05 level of significance. Our statistical analyses revealed that patients in the lower income group preferred to seek treatment from public healthcare facilities (OR = 3.51, 95% CI = (1.65, 7.46)) irrespective of the perceived severity of their illness, while patients in the higher income group favored directly consulting specialized doctors (OR = 2.71, 95% CI = (1.34, 5.51)). Other factors such as having more than two children increased the probability of seeking care from public facilities. This work contributes to the literature by: (a) providing quantitative evidence regarding overall patient HSB, especially at primary and secondary public healthcare facilities, regardless of their presenting illness, (b) eliciting information regarding the pathways followed by patients visiting these facilities while seeking care, and (c) providing operational information regarding the surveyed facilities to facilitate characterizing their utilization. This work can inform policy designed to improve the utilization and quality of care at public primary and secondary healthcare facilities in India.
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Affiliation(s)
- Najiya Fatma
- Department of Mechanical Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | - Varun Ramamohan
- Department of Mechanical Engineering, Indian Institute of Technology Delhi, New Delhi, India
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Kalita A, Bose B, Woskie L, Haakenstad A, Cooper JE, Yip W. Private pharmacies as healthcare providers in Odisha, India: analysis and implications for universal health coverage. BMJ Glob Health 2023; 8:e008903. [PMID: 37778756 PMCID: PMC10546140 DOI: 10.1136/bmjgh-2022-008903] [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: 02/24/2022] [Accepted: 10/15/2022] [Indexed: 10/03/2023] Open
Abstract
INTRODUCTION In India, as in many low-income and middle-income countries, the private sector provides a large share of health care. Pharmacies represent a major share of private care, yet there are few studies on their role as healthcare providers. Our study examines: (1) What are the characteristics of and services provided by private pharmacies and how do these compare with other outpatient care providers? (2) What are the characteristics of patients who opted to use private pharmacies? (3) What are the reasons why people seek healthcare from private pharmacies? (4) What are the quality of services and cost of care for these patients? Based on our findings, we discuss some policy implications for universal health coverage in the Indian context. METHODS We analyse data from four surveys in Odisha, one of India's poorest states: a household survey on health-seeking behaviours and reasons for healthcare choices (N=7567), a survey of private pharmacies (N=1021), a survey of public sector primary care facilities (N=358), and a survey of private-sector solo-providers (N=684). RESULTS 17% of the households seek outpatient care from private pharmacies (similar to rates for public primary-care facilities). 25% of the pharmacies were not registered appropriately under Indian regulations, 90% reported providing medical advice, and 26% reported substituting prescribed drugs. Private pharmacies had longer staffed hours and better stocks of essential drugs than public primary-care facilities. Patients reported choosing private pharmacies because of convenience and better drug stocks; reported higher satisfaction and lower out-of-pocket expenditure with private pharmacies than with other providers. CONCLUSION This is the first large-scale study of private pharmacies in India, with a comparison to other healthcare providers and users' perceptions and experiences of their services. To move towards universal health coverage, India, a country with a pluralistic health system, needs a comprehensive health systems approach that incorporates both the public and private sectors, including private pharmacies.
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Affiliation(s)
- Anuska Kalita
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Bijetri Bose
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Liana Woskie
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Tufts University School of Arts and Sciences, Medford, MA, USA
| | - Annie Haakenstad
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Jan E Cooper
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Winnie Yip
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Wagner Z, Banerjee S, Mohanan M, Sood N. Does the market reward quality? Evidence from India. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2023; 23:467-505. [PMID: 36477343 DOI: 10.1007/s10754-022-09341-w] [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: 04/28/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
There are two salient facts about health care in low and middle-income countries; (1) the private sector plays an important role and (2) the care provided is often of poor quality. Despite these facts we know little about what drives quality of care in the private sector and why patients seek care from poor quality providers. We use two field studies in India that provide insight into this issue. First, we use a discrete choice experiment to show that patients strongly value technical quality. Second, we use standardized patients to show that better quality providers are not able to charge higher prices. Instead providers are able to charge higher prices for elements of quality that the patient can observe, which are less important for health outcomes. Future research should explore whether accessible information on technical quality of local providers can shift demand to higher quality providers and improve health outcomes.
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Affiliation(s)
| | | | - Manoj Mohanan
- Sanford School of Public Policy, Duke University, Durham, NC, USA
| | - Neeraj Sood
- Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
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Peano A, Politano G, Gianino MM. Determinants of COVID-19 vaccination worldwide: WORLDCOV, a retrospective observational study. Front Public Health 2023; 11:1128612. [PMID: 37719735 PMCID: PMC10501313 DOI: 10.3389/fpubh.2023.1128612] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/19/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction The COVID-19 pandemic has resulted in numerous deaths, great suffering, and significant changes in people's lives worldwide. The introduction of the vaccines was a light in the darkness, but after 18 months, a great disparity in vaccination coverage between countries has been observed. As disparities in vaccination coverage have become a global public health issue, this study aimed to analyze several variables to identify possible determinants of COVID-19 vaccination. Methods An ecological study was conducted using pooled secondary data sourced from institutional sites. A total of 205 countries and territories worldwide were included. A total of 16 variables from different fields were considered to establish possible determinants of COVID-19 vaccination: sociodemographic, cultural, infrastructural, economic and political variables, and health system performance indicators. The percentage of the population vaccinated with at least one dose and the total doses administered per 100 residents on 15 June 2022 were identified as indicators of vaccine coverage and outcomes. Raw and adjusted values for delivered vaccine doses in the multivariate GLM were determined using R. The tested hypothesis (i.e., variables as determinants of COVID-19 vaccination) was formulated before data collection. The study protocol was registered with the grant number NCT05471635. Results GDP per capita [odds = 1.401 (1.299-1.511) CI 95%], access to electricity [odds = 1.625 (1.559-1.694) CI 95%], political stability, absence of violence/terrorism [odds = 1.334 (1.284-1.387) CI 95%], and civil liberties [odds = 0.888 (0.863-0.914) CI 95%] were strong determinants of COVID-19 vaccination. Several other variables displayed a statistically significant association with outcomes, although the associations were stronger for total doses administered per 100 residents. There was a substantial overlap between raw outcomes and their adjusted counterparts. Discussion This pioneering study is the first to analyze the association between several different categories of indicators and COVID-19 vaccination coverage in a wide complex setting, identifying strong determinants of vaccination coverage. Political decision-makers should consider these findings when organizing mass vaccination campaigns in a pandemic context to reduce inequalities between nations and to achieve a common good from a public health perspective.
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Affiliation(s)
- Alberto Peano
- Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy
| | - Gianfranco Politano
- Department of Control and Computer Engineering, Polytechnic of Turin, Turin, Italy
| | - Maria Michela Gianino
- Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy
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Chirinos Muñoz MS, Orrego C, Montoya C, Sunol R. Relationship between adverse events prevalence, patient safety culture and patient safety perception in a single sample of patients: a cross-sectional and correlational study. BMJ Open 2023; 13:e060695. [PMID: 37620259 PMCID: PMC10450132 DOI: 10.1136/bmjopen-2021-060695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/24/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVE To assess the relationship between adverse events prevalence (AEP), patient safety culture (PSC) and patient safety perception (PSP). DESIGN Cross-sectional, ex post facto comparative study on a single sample of patients. SETTING Four medium-high-level hospitals were included in the study-two public and two private from Zulia State in Venezuela. PARTICIPANTS 556 medical records and patients were studied for the prevalence and PSP study, and 397 of the healthcare providers involved in the care of these patients were surveyed for the PSC study, at two public and two private hospitals. OUTCOME MEASUREMENT The primary outcome of this study was the association between AEP, PSC and PSP, and according to hospital funding type, private and public. RESULTS An inverse association was observed between AEP and its severity and Patient Safety Culture Index (rho=-0.8, p=0.5) (95% CI 0.26-0.10) and Patient Safety Perception Index (rho=-0.6, p=0.18) (95% CI 0.10-0.28), which were protective factors for patient safety. No association was identified between PSC and PSP (rho=0.0001). No statistical differences were identified by hospital type (p=0.93) (95% CI 0.70-1.2). CONCLUSIONS The analysis of the variable correlations studied (AEP, PSC and PSP) within the same sample offers an interesting and useful perspective. In this sample, although no correlation was observed between the three variables as an interacting set, some correlation patterns were observed between pairs of variables that could guide further studies.
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Affiliation(s)
- Mónica Susana Chirinos Muñoz
- Health Sector Administration Program, University of Zulia, Maracaibo, Zulia, Bolivarian Republic of Venezuela
- Doctorate, Autonomous University of Barcelona, Barcelona, Spain
- Scientific and Humanistic Development Council of the University of Zulia, University of Zulia, Maracaibo, Zulia, Bolivarian Republic of Venezuela
| | - Carola Orrego
- Avedis Donabedian Research Institute (FAD) - Universitat Autonoma de Barcelona, Barcelona, Spain
- RICAPPS, Network for Research on Chronicity, Primary Care, and Health Promotion, Barcelona, Spain
| | - Cesar Montoya
- Data Analysis Center, Rafael Belloso Chacin University, Maracaibo, Zulia, Bolivarian Republic of Venezuela
| | - Rosa Sunol
- Avedis Donabedian Research Institute (FAD) - Universitat Autonoma de Barcelona, Barcelona, Spain
- RICAPPS, Network for Research on Chronicity, Primary Care, and Health Promotion, Barcelona, Spain
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Brindley C, Wijemunige N, Dieteren C, Bom J, Engel M, Meessen B, Bonfrer I. Health seeking behaviours and private sector delivery of care for non-communicable diseases in low- and middle-income countries: protocol for a systematic review. BMJ Open 2023; 13:e066213. [PMID: 37620272 PMCID: PMC10450129 DOI: 10.1136/bmjopen-2022-066213] [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: 06/30/2022] [Accepted: 07/22/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION The burden of non-communicable diseases (NCDs) has increased substantially in low- and middle-income countries (LMICs), and adapting health service delivery models to address this remains a challenge. Many patients with NCD seek private care at different points in their encounters with the health system, but the determinants and outcomes of these choices are insufficiently understood. The proposed systematic review will help inform the governance of mixed health systems towards achieving the goal of universal health coverage. This protocol details our intended methodological and analytical approaches, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). METHODS AND ANALYSIS Following the PRISMA approach, this systematic review will develop a descriptive synthesis of the determinants and outcomes of private healthcare utilisation for NCDs in LMICs. The databases Embase, Medline, Web of Science Core Collection, EconLit, Global Index Medicus and Google Scholar will be searched for relevant studies published in English between period 1 January 2010 and 30 June 2022 with additional searching of reference lists. The study selection process will involve a title-abstract and full-text review, guided by clearly defined inclusion and exclusion criteria. A quality and risk of bias assessment will be done for each study using the Mixed Methods Appraisal Tool. ETHICS AND DISSEMINATION Ethical approval is not required because this review is based on data collected from publicly available materials. The results will be published in a peer-reviewed journal and presented at related scientific events. PROSPERO REGISTRATION NUMBER CRD42022340059.
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Affiliation(s)
- Callum Brindley
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Nilmini Wijemunige
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Institute for Health Policy, Colombo, Sri Lanka
| | - Charlotte Dieteren
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Judith Bom
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Maarten Engel
- Erasmus Medical Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Igna Bonfrer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Bokolo S, Mabaso S, Kruger W, Mistri P, Schmucker L, Chetty-Makkan C, Pascoe SJS, Buttenheim A, Thirumurthy H, Long L. Applying behavioural economics principles to increase demand for free HIV testing services at private doctor-led clinics in Johannesburg, South Africa: A randomised controlled trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.07.23293635. [PMID: 37609154 PMCID: PMC10441509 DOI: 10.1101/2023.08.07.23293635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Background Expanding free HIV testing service (HTS) access to include private clinics could increase testing rates. A donor funded programme, GP Care Cell, offered free HIV testing at selected private doctor-led clinics but uptake was low. We investigated whether HTS demand creation materials that used behavioural economics principles could increase demand for HIV testing at these clinics. Methods We conducted a randomised controlled trial in Johannesburg, South Africa (January-April 2022) distributing brochures promoting HTS to adults in five private doctor-led clinic catchment areas. Individuals were randomised to receive three brochure types: (1) "Standard of care" (SOC) advertising a free HIV test and ART; (2) "Healthy lifestyle screening" promoted free low-cost health screenings in addition to HTS; and (3) "Recipient of care voucher" leveraged loss aversion and the endowment effect by highlighting the monetary value of free HTS. The primary outcome was presenting at the clinic following exposure to the brochures. Logistic regression compared outcomes between arms. Results Of the 12,129 brochures distributed, 658 were excluded because of errors or duplicates and 11,471 were analysed. About 59% of brochure recipients were male and 50,3% were aged 25-34 years. In total, 448 (3.9%) brochure recipients presented at the private doctor-led clinics of which 50.7% were males. There were no significant differences in clinic presentation between the healthy lifestyle screening and SOC arm (Adjusted Odds Ratio [AOR] 1.02; 95% CI 0.79-1.32), and similarly between the recipient of care voucher and SOC arm (AOR 1.08; 95% CI 0.84-1.39). Individuals were more likely to attend clinics that were centrally located with visible branding for HTS (AOR=5.30; 95% CI: 4.14-6.79). Conclusion Brochures that used behavioural insights did not increase demand for HTS at private doctor-led clinics. However, consistent distribution of the brochures may have potential to increase HIV testing uptake at highly visible private doctor-led clinics.
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Affiliation(s)
- Simamkele Bokolo
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Suzanne Mabaso
- Foundation for Professional Development (FPD), Pretoria, South Africa
| | - Wentzel Kruger
- Foundation for Professional Development (FPD), Pretoria, South Africa
| | - Preethi Mistri
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Laura Schmucker
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Candice Chetty-Makkan
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sophie J S Pascoe
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alison Buttenheim
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia PA, USA
| | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lawrence Long
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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Suwantika AA, Zakiyah N, Abdulah R, Diantini A. Assessment of childhood immunization services at private healthcare facilities in Indonesia: a case study in a highly-populated city. Front Public Health 2023; 11:1093387. [PMID: 37575096 PMCID: PMC10415032 DOI: 10.3389/fpubh.2023.1093387] [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: 11/25/2022] [Accepted: 07/07/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction The need to enhance the utilization of the private sector for immunization programs in Indonesia while maintaining the high quality of services provided is evident. This study aimed to rapidly assess immunization services at private healthcare facilities in Indonesia by using Bandung, the most densely populated city, as the reference case. Methods Initially, a situation analysis was conducted by collecting data from selected healthcare facilities (n = 9). Furthermore, a qualitative study was taken into account by developing framework approaches and conducting interviews with different layers, such as mid-level managers at healthcare facilities (n = 9), professional organizations (n = 4), and public stakeholders (n = 7). Results The situation analysis showed that private healthcare facilities had provided sufficient time for essential childhood immunization services with adequate staff. Nevertheless, the number of limited staff the Ministry of Health (MoH) has trained remains a programmatic problem. Furthermore, private healthcare facilities have used the MoH guidelines and additional internal guidelines for immunization services as the primary reference, including in the efforts to provide complete and reliable equipment. Vaccine availability at private healthcare facilities is manageable with an acceptable out-of-stock level. The results of our interviews highlighted three key findings: the lack of coordination across public and private sectors, the need for immunization service delivery improvement at private healthcare facilities, and the urgency to strengthen institutional capacity for advocacy and immunization systems support. Conclusion Even though private healthcare facilities have been shown to make a modest contribution to childhood immunization services in Indonesia, efforts should be made to expand the role of private healthcare facilities in improving the performance of routine immunization programs.
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Affiliation(s)
- Auliya A. Suwantika
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation (PHARCI), Universitas Padjadjaran, Bandung, Indonesia
- Center for Health Technology Assessment, Universitas Padjadjaran, Bandung, Indonesia
| | - Neily Zakiyah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation (PHARCI), Universitas Padjadjaran, Bandung, Indonesia
| | - Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation (PHARCI), Universitas Padjadjaran, Bandung, Indonesia
| | - Ajeng Diantini
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation (PHARCI), Universitas Padjadjaran, Bandung, Indonesia
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Herath T, Perera M, Kasturiratne A. Factors influencing the decision to use state-funded healthy lifestyle centres in a low-income setting: a qualitative study from Sri Lanka. BMJ Open 2023; 13:e067464. [PMID: 37407056 DOI: 10.1136/bmjopen-2022-067464] [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] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVE Healthy lifestyle centres (HLCs) in Sri Lanka provide screening and lifestyle modification services targeting major non-communicable diseases (NCDs). Even though the service is highly accessible and affordable, HLCs are underused by its target population (adults >35 years). We aimed to explore the factors that influence the decision-making process of utilisation of HLCs in Sri Lanka. SETTING Two districts (Gampaha and Kalutara) from the highest populous province (Western) located adjacent to the capital district of Sri Lanka. PARTICIPANTS Nine service providers, 37 HLC clients and 52 community participants were selected using judgemental, convenient and purposive sampling methods. Theoretical sampling method was used to decide the sample size for each category. METHOD A qualitative study design based on constructivist grounded theory was used. Data collected using in-depth interviews and focus group discussions during January to July 2019 and were analysed using the constant comparison method. RESULTS The decision-making process of utilisation of HLCs was found to be a chain of outcomes with three main steps, such as: intention, readiness and utilisation. Awareness of HLCs, positive attitudes on health, intrinsic or extrinsic motivators, positive attitudes on NCDs and screening were internal factors with a positive influence on intention. Readiness was positively influenced by positive characteristics of the HLCs. It was negatively influenced by negative attitudes on staff and services of HLCs and negative past experiences related to services in state healthcare institutions and HLCs, service provider-related barriers and employment-related barriers. Family-related factors, social support and norms influenced both intention and readiness, either positively or negatively. CONCLUSION The decision-making process of utilisation of HLCs links with factors originating from internal, family, service provider and societal levels. Thus, a multifactorial approach that addresses all these levels is needed to improve the utilisation of HLCs in Sri Lanka.
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Affiliation(s)
- Thilini Herath
- Department of Primary Health Care, Faculty of Health-Care Sciences, Eastern University Sri Lanka, Chenkalady, Eastern, Sri Lanka
| | - Manuja Perera
- Department of Public Health, Faculty of Medicine, University of Kelaniya Sri Lanka, Ragama, Western, Sri Lanka
| | - Anuradhani Kasturiratne
- Department of Public Health, Faculty of Medicine, University of Kelaniya Sri Lanka, Ragama, Western, Sri Lanka
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Singh VV, Dutta BK, Singhal A, Patra P, Gupta AK, Mani RN. Anxiety, depression, professional fulfilment and burnout: Public and private doctors' differential response to CoVID-19 pandemic. Ind Psychiatry J 2023; 32:431-436. [PMID: 38161485 PMCID: PMC10756606 DOI: 10.4103/ipj.ipj_17_22] [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: 01/26/2022] [Accepted: 11/18/2022] [Indexed: 01/03/2024] Open
Abstract
Introduction Covid-19 pandemic has been a challenge for healthcare system; the doctors in public and private setups are at the center of this challenge. Public and private doctors differ in personality and some occupational aspects. Do these differences reflect in their response to Covid? Aim To study the difference in anxiety, depression, burnout, and professional fulfillment between doctors in public and private setup during Covid-19 second wave and to assess their coping strategies. Methods A cross-sectional Internet-based observational study was conducted using Stanford PFI, GAD-7, PHQ-2, BFI-10, and brief COPE questionnaires. Results A total of 114 public and 37 private doctors participated in the study. Doctors in private were older in age and deferred in personality profile. Significantly, more private doctors screened for anxiety disorder. 62.2% of private and 41.2% public doctors felt professionally fulfilled. Burnout and depression were not significantly different between groups. Active coping, acceptance, and planning coping were significantly more used by private doctors. Conclusion There are differences how doctors in different setups respond to Covid-19, and there is need to understand these factors.
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Affiliation(s)
| | - Bikram K. Dutta
- Department of Psychiatry, Base Hospital Delhi Cantt, Delhi, India
| | - Ankit Singhal
- Department of Psychiatry, Command Hospital (SC), Pune, Maharashtra, India
| | | | | | - Raghu N. Mani
- Department of Psychiatry, Base Hospital Delhi Cantt, Delhi, India
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Negero MG, Sibbritt D, Dawson A. Women's utilisation of quality antenatal care, intrapartum care and postnatal care services in Ethiopia: a population-based study using the demographic and health survey data. BMC Public Health 2023; 23:1174. [PMID: 37337146 DOI: 10.1186/s12889-023-15938-8] [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: 05/06/2022] [Accepted: 05/19/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVE This study sought to investigate the level and determinants of receiving quality antenatal care (ANC), intrapartum care, and postnatal care (PNC) services by women in Ethiopia. The quality of care a woman receives during ANC, intrapartum care, and PNC services affects the health of the woman and her child and her likelihood of seeking care in the future. METHODS Data from the nationally representative Ethiopia Mini Demographic and Health Survey 2019 were analysed for 5,527 mothers who gave birth within five years preceding the survey. We defined quality ANC as having: blood pressure measurement, urine and blood tests, informed of danger signs, iron supplementation, and nutritional counselling during ANC services; quality intrapartum care as having: a health facility birth, skilled birth assistance, and a newborn put to the breast within one hour of birth during intrapartum care services; and quality PNC as having: PNC within two days; cord examination; temperature measurement, and counselling on danger signs and breastfeeding of the newborn; and healthcare provider's observation of breastfeeding during PNC services. We used multilevel mixed-effects logistic regression analyses specifying three-level models: a woman/household, a cluster, and an administrative region to determine predictors of each care quality. The analyses employed sampling weights and were adjusted for sampling design. RESULTS Thirty-six percent (n = 1,048), 43% (n = 1,485), and 21% (n = 374) women received quality ANC, intrapartum care and PNC services, respectively. Private healthcare facilities provided higher-quality ANC and PNC but poor-quality intrapartum care, compared to public health facilities. Having four or more ANC visits, commencing ANC during the first trimester, and higher women's education levels and household wealth indices were positive predictors of quality ANC use. Government health posts were less likely to provide quality ANC. Wealthier, urban-residing women with education and four or more ANC contacts were more likely to receive quality intrapartum care. Women who received quality ANC and skilled birth assistance were more likely to receive quality PNC. Teenage mothers were more likely to receive quality intrapartum care, but were less likely to receive quality PNC than mothers aged 20-49. CONCLUSIONS We recommend standardizing the contents of ANC provided in all healthcare facilities; and promoting early and four or more ANC contacts, effectiveness, sensitivity and vigilance of care provided to teenage mothers, and women's education and economic empowerment.
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Affiliation(s)
- Melese Girmaye Negero
- School of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.
| | - David Sibbritt
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Angela Dawson
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Sodhi K, Chanchalani G, Arya M, Shrestha GS, Chandwani JN, Kumar M, Kansal MG, Ashrafuzzaman M, Mudalige AD, Al Tayar A, Mansour B, Saeed HM, Hashmi M, Das M, Al Shirawi NN, Mathias R, Ahmed WO, Sharma A, Agarwal D, Nasa P. Knowledge and awareness of infection control practices among nursing professionals: A cross-sectional survey from South Asia and the Middle East. World J Crit Care Med 2023; 12:176-187. [PMID: 37397590 PMCID: PMC10308336 DOI: 10.5492/wjccm.v12.i3.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/15/2023] [Accepted: 05/31/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND The proficiency of nursing professionals in the infection prevention and control (IPC) practices is a core component of the strategy to mitigate the challenge of healthcare associated infections.
AIM To test knowledge of nurses working in intensive care units (ICU) in South Asia and Middle East countries on IPC practices.
METHODS An online self-assessment questionnaire based on various aspects of IPC practices was conducted among nurses over three weeks.
RESULTS A total of 1333 nurses from 13 countries completed the survey. The average score was 72.8% and 36% of nurses were proficient (mean score > 80%). 43% and 68.3% of respondents were from government and teaching hospitals, respectively. 79.2% of respondents worked in < 25 bedded ICUs and 46.5% in closed ICUs. Statistically, a significant association was found between the knowledge and expertise of nurses, the country’s per-capita income, type of hospitals, accreditation and teaching status of hospitals and type of ICUs. Working in high- and upper-middle-income countries (β = 4.89, 95%CI: 3.55 to 6.22) was positively associated, and the teaching status of the hospital (β = -4.58, 95%CI: -6.81 to -2.36) was negatively associated with the knowledge score among respondents.
CONCLUSION There is considerable variation in knowledge among nurses working in ICU. Factors like income status of countries, public vs private and teaching status of hospitals and experience are independently associated with nurses’ knowledge of IPC practices.
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Affiliation(s)
- Kanwalpreet Sodhi
- Department of Critical Care, Deep Hospital, Ludhiana 141001, Punjab, India
| | - Gunjan Chanchalani
- Critical Care Medicine, Somaiya Hospital and Research Centre, Mumbai 400001, Maharashtra, India
| | - Muktanjali Arya
- Department of Microbiology and Infection Control, Deep Hospital, Ludhiana 141001, India
| | - Gentle S Shrestha
- Department of Critical Care Medicine, Tribhuvan University Teaching Hospital, Kathmandu 44600, Nepal
| | - Juhi N Chandwani
- Anaesthesia and Intensive Care Unit, Royal Hospital, Muscat 112, Oman
| | - Manender Kumar
- Department of Cardiac Anaesthesia, Fortis Hospital, Ludhiana 141002, Punjab, India
| | - Monika G Kansal
- Intensive Care Medicine, Ng Teng Fong General Hospital, Singapore 609606, Singapore
| | - Mohammad Ashrafuzzaman
- Intensive Care Unit, Bangabandhu Sheikh Mujib Medical University, Dhaka 1000, Bangladesh
| | - Anushka D Mudalige
- Intensive Care Unit, Colombo North Teaching Hospital, Ragama 11010, Sri Lanka
| | - Ashraf Al Tayar
- Intensive Care Unit and Respiratory Therapy Department, Security Forces Hospital, Damman 34223, Saudi Arabia
| | - Bassam Mansour
- Pulmonary and Critical Care Division, Zahraa Hospital-University Medical Center, Beirut 1007, Lebanon
- Pulmonary Division, Faculty of Medical Sciences, Lebanese University, Beirut 1007, Lebanon
| | - Hasan M Saeed
- Department of Critical Care, Salmaniyah Medical Complex, Manama 323, Bahrain
| | - Madiha Hashmi
- Department of Critical Care Medicine, Ziauddin University, Karachi 75530, Pakistan
| | - Mitul Das
- Anaesthesia and Critical Care, Swasti Hospital, Rangia 781354, India
| | - Nehad N Al Shirawi
- Department of Critical Care Medicine, Al Fujairah Hospital, Fujairah 0000, United Arab Emirates
| | - Ranjan Mathias
- Department of Anesthesia and Intensive Care, Hamad Medical Corporation, Doha 974, Qatar
| | - Wagih O Ahmed
- Intensive Care Unit, Sulaiman Al Habib Medical Group, Buraidah 52211, Saudi Arabia
| | - Amandeep Sharma
- Department of Nursing, Deep Hospital, Ludhiana 141001, India
| | - Diptimala Agarwal
- Anesthesia and Intensive Care, Shantived Institute of Medical Sciences, Agra 282007, India
| | - Prashant Nasa
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai 7832, United Arab Emirates
- Internal Medicine, College of Medicine and Health Sciences, Al Ain 15551, Abu Dhabi, United Arab Emirates
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Sodhi K, Chanchalani G, Arya M, Shrestha GS, Chandwani JN, Kumar M, Kansal MG, Ashrafuzzaman M, Mudalige AD, Al Tayar A, Mansour B, Saeed HM, Hashmi M, Das M, Al Shirawi NN, Mathias R, Ahmed WO, Sharma A, Agarwal D, Nasa P. Knowledge and awareness of infection control practices among nursing professionals: A cross-sectional survey from South Asia and the Middle East. World J Crit Care Med 2023; 12:176-187. [DOI: 10.5492/wjccm.v12.i3.176 sodhi k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
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Alghamdi RS, Perra O, Boyle B, Stockdale J. Perceived treatment of respectful maternity care among pregnant women at healthcare facilities in the Kingdom of Saudi Arabia: A cross-sectional study. Midwifery 2023; 123:103714. [PMID: 37229839 DOI: 10.1016/j.midw.2023.103714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 04/13/2023] [Accepted: 05/04/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Mistreatment of women during childbirth is a global issue and a violation of fundamental human rights. Respectful maternity care has been affirmed as a universal right of childbearing women. However, little is known about the level of respect experienced by women in the Kingdom of Saudi Arabia (KSA); which is undergoing key reforms in the scope of its healthcare provision. We explored the occurrence of respect perceived by women giving birth in the KSA and compared results between national healthcare sectors, as well as with previous international studies. METHOD We conducted a cross-sectional study using an online survey. The online questionnaire included demographic questions, a translation of the internationally validated Mother on Respect index (MORi) scale, which we adapted to investigate KSA women's experiences, and questions to further investigate women's experiences (e.g. respect of privacy). Women who gave birth within five years at a Saudi healthcare facility were recruited through social media using a snowballing approach. RESULTS Overall, 586 participants were recruited, 54% of whom had been cared for in government hospitals, 65% were aged between 25 and 34, and almost 79% had a BSc or higher qualification. Overall, women's perception about respectful maternity care was positive, however, opinions varied between governmental and private sectors. Women cared for in the government sector reported significantly lower levels of respect compared to those cared for in the private sector (β = -.132, p = .001). The results also highlighted an issue of concern: one in five women (21.8%) reported having been physically abused. Our participants perceived their childbirth experiences to be less respectful compared to those in other high-income countries. CONCLUSION Women birthing in the private sector reported a more respectful experience, which may be explained by the private sector being more consumer-focused. Women who gave birth in the KSA perceived their care to be less respectful than women giving birth in Canada and the USA. Beginning to understand what has provoked the occurrences of mistreatment in childbirth worldwide will inevitably contribute to the development of a solution. Respectful maternity care should be focused on providing women-centred care and quality of care which meets the WHO vision for women's and their families' needs being fulfilled and respected.
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Affiliation(s)
- Reem Saeed Alghamdi
- Maternal and Child Health Care Department, College of Nursing, Building 12, King Saud University, 12372, Riyadh, Kingdom of Saudi Arabia.
| | - Oliver Perra
- The Faculty of Medicine, Health, and Life Sciences, School of Nursing & Midwifery, Queen's University, MBC Building, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, United Kingdom
| | - Breidge Boyle
- The Faculty of Medicine, Health, and Life Sciences, School of Nursing & Midwifery, Queen's University, MBC Building, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, United Kingdom
| | - Janine Stockdale
- The Faculty of Medicine, Health, and Life Sciences, School of Nursing & Midwifery, Queen's University, MBC Building, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, United Kingdom
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Varela T, Zamorano P, Muñoz P, Rain C, Irazoqui E, Sapag JC, Tellez A. Evaluation of the implementation progress through key performance indicators in a new multimorbidity patient-centered care model in Chile. BMC Health Serv Res 2023; 23:439. [PMID: 37143071 PMCID: PMC10159678 DOI: 10.1186/s12913-023-09412-9] [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: 11/03/2022] [Accepted: 04/17/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Complex health interventions involve deep organizational, structural, and cultural changes that challenge health teams and decision-makers. The explosion of chronic diseases has made the multimorbidity approach a global priority. The Centro de Innovación en Salud ANCORA UC implemented a Multimorbidity Patient-Centered Care Model in the Chilean public health system. OBJECTIVE This study aims to evaluate the progress of the implementation of the Multimorbidity Patient-Centered Care Model in seven primary care centers through key performance indicators. METHODS a set of indicators was designed to evaluate change management, operations, installation of new roles, and services and activities of the intervention strategy of the model. Key performance indicators were identified to monitor the implementation progress on minimal components for the model's sustainability. Each item was assigned against an expected minimum score of 67% of progress from the overall score. They were monitored twice in seven primary health centers in 2019 and 2020, which intervened 22,642 patients with the intervention. RESULTS The results showed that six of the seven primary care centers reached the minimum implementation threshold. The main advances were in operational conditions, and those with minor progress in implementation were the clinical services. Population size, organization, coordination of the health care teams, additional training, and decision-makers support were key factors that determined the degree of progress in a complex intervention. CONCLUSION It was possible to measure the progression of the implementation of a complex intervention through key performance indicators delivering relevant information for decision-makers that pursue a successful and faithful implementation. This study provides a valuable tool for the national scale-up of a similar model started in Chile by the Ministry of Health and other countries.
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Affiliation(s)
- Teresita Varela
- Centro de Innovación en Salud ANCORA UC, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paula Zamorano
- Centro de Innovación en Salud ANCORA UC, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
- Health Technology Assessment Unit, Center of Clinical Research, Pontificia Universidad Católica de Chile, Santiago, Chile.
- Current Address: Diagonal Paraguay, Santiago, 362, Chile.
| | - Paulina Muñoz
- Centro de Innovación en Salud ANCORA UC, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carolina Rain
- Department of Family Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Esteban Irazoqui
- Centro de Innovación en Salud ANCORA UC, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jaime C Sapag
- Department of Family Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Public health, Pontificia Universidad Católica de Chile, Santiago, Chile
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Alvaro Tellez
- Centro de Innovación en Salud ANCORA UC, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Family Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Kumar A. The Transformation of The Indian Healthcare System. Cureus 2023; 15:e39079. [PMID: 37378105 PMCID: PMC10292032 DOI: 10.7759/cureus.39079] [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: 05/16/2023] [Indexed: 06/29/2023] Open
Abstract
The Indian healthcare system is a diverse and complex network of public and private sectors that provide a wide range of medical services to India's 1.4 billion inhabitants. Despite undergoing significant changes over the years, the system continues to face multiple challenges. These challenges include inadequate infrastructure, a shortage of healthcare professionals, urban-rural disparities, limited health insurance coverage, insufficient public healthcare funding, and a fragmented healthcare system. India is grappling with a growing burden of non-communicable diseases, which poses a significant challenge to its healthcare system. The Indian government has initiated multiple programs to improve the healthcare system. The National Health Mission improves the availability of medical equipment and supplies. This also promotes community participation and engagement in healthcare decision-making and service delivery. The Ayushman Bharat scheme is a health insurance program that provides coverage of up to INR 5 lakhs per family per year for secondary and tertiary care hospitalization. The Indian healthcare system is also witnessing multiple healthcare innovations, ranging from low-cost medical devices to innovative healthcare delivery models. The country's healthcare regulatory system is evolving to ensure patient safety, promote high-quality care, and control costs. Furthermore, India has emerged as a leading destination for medical tourism due to the relatively low cost of medical procedures, the availability of skilled doctors, and advanced technology. Factors such as cost-effective treatment, advanced technology, a wide range of specialities, alternative medicine, English language proficiency, and ease of travel have contributed to India's growing medical tourism industry. The Indian healthcare system has made significant progress in recent years. The positive transformation of the Indian healthcare system involves a range of changes and initiatives. Despite challenges, the continued investment in healthcare and innovation provides reasons to be optimistic about the future of healthcare in India.
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Affiliation(s)
- Ankit Kumar
- Respiratory Medicine, King George's Medical University, Lucknow, IND
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Ogale YP, Kennedy CE, Nalugoda F, Mpagazi J, Jackson JC, Galiwango R, Ssekubugu R, Kigozi G, Denison JA, Gaydos CA, Kagaayi J, Grabowski MK. Nearly half of adults with symptoms of sexually transmitted infections (STIs) did not seek clinical care: A population-based study of treatment-seeking behavior among adults in Rakai, Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001626. [PMID: 37126490 PMCID: PMC10150988 DOI: 10.1371/journal.pgph.0001626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/02/2023] [Indexed: 05/02/2023]
Abstract
Understanding treatment-seeking behavior is critical to the treatment and control of sexually transmitted infections (STIs), yet current data on STI treatment seeking in low-resource settings is rare. This population-based study aimed to describe STI treatment-seeking behavior and identify factors associated with seeking treatment at a clinic among adults with STI-related symptoms in rural Uganda. The STI prevalence study (STIPS) conducted a survey and STI testing among all consenting adults aged 18-49 in two communities in rural south-central Uganda. Of 1,825 participants, 962 individuals self-reported STI symptoms in the past six months; we present descriptive data on treatment seeking and STI prevalence among these individuals. We used multivariable Poisson regressions with robust variance to determine the sociodemographic and symptom-related factors independently associated with seeking STI treatment at a clinic and assessed the association with previous clinic treatment seeking and current STI diagnosis. Forty-three percent of adults who reported STI-related symptoms in the past six months said they did not seek any treatment. Among those who did, 58% sought treatment at a private clinic, 28% at a government clinic, 9% at a pharmacy/drug store, 3% at a traditional healer, 2% at a market/shop, and 5% at another location. Among both males and females, having multiple STI related symptoms was positively associated with clinic treatment seeking (males = PRR: 1.73, 95%CI: 1.36-2.21; females = PR: 1.41, 95%CI: 1.12-1.78). Approximately one-third of males and females who reported previously seeking clinic treatment for their symptoms were diagnosed with a curable STI at the time of the survey. In this setting, nearly half of adults with STI-related symptoms are not seeking clinical care and many who report having sought treatment for recent STI symptoms have curable STIs. Future studies should explore barriers to care-seeking and strategies to improve STI services.
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Affiliation(s)
- Yasmin P. Ogale
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Caitlin E. Kennedy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | | | | | - Jade C. Jackson
- Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | | | | | | | - Julie A. Denison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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