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Lam CSP, Harding E, Bains M, Chin A, Kanumilli N, Petrie MC, Pohja-Hutchison P, Yang J, Butler J. Identification of urgent gaps in public and policymaker knowledge of heart failure: Results of a global survey. BMC Public Health 2023; 23:1023. [PMID: 37254075 DOI: 10.1186/s12889-023-15405-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 03/08/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Despite advances in the treatment of heart failure (HF) with reduced ejection fraction, people with HF continue to have a high risk of mortality and hospitalisation. Patients also suffer from poor quality of life, with reduced societal and economic participation. The burden of HF on patients and healthcare systems is extraordinary, yet awareness remains low. This survey was conducted to identify gaps in general public and policymaker knowledge around HF. METHODS A closed-question web-based survey of the general public and policymakers was conducted between February and October 2020. Study outcomes assessed the participants' awareness and understanding of HF symptoms, risk factors and mortality, and views around hospital admissions in their country. Responses were collected using multiple-choice questions. RESULTS The survey was completed by 26,272 general public respondents in 13 countries and 281 government and public sector policymakers in nine countries. While 99% of general public respondents had heard of HF, their understanding of the condition and its symptoms was poor, and only 6% identified that shortness of breath, fatigue, and leg swelling were the main symptoms of HF. Of policymaker respondents, 14% identified HF as the leading cause of avoidable hospitalisations, and only 4% recognised that ~ 87% of government spending on HF is related to hospitalisations. CONCLUSIONS Major gaps were identified in the understanding of HF and the burden it places on patients and their caregivers, healthcare systems and society. This study confirms an ongoing need for national policy strategies and investment to raise awareness of the importance of HF prevention, early diagnosis, and implementation of effective treatments to reduce hospitalisations and death.
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Affiliation(s)
- Carolyn S P Lam
- National Heart Centre Singapore, Duke-NUS Medical School, 169857, Singapore, Singapore.
| | - Ed Harding
- The Health Policy Partnership, WC2N 4JS, London, UK
| | - Marc Bains
- The HeartLife Foundation, V5X 1E7, Vancouver, BC, Canada
| | - Alex Chin
- AstraZeneca, Global Medical Affairs, 20878, Gaithersburg, MD, USA
| | | | - Mark C Petrie
- Institute of Cardiovascular and Medical Sciences, The University Court of the University of Glasgow, G12 8QQ, Glasgow, UK
| | | | - Jiefu Yang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology China, 100730, Beijing, China
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, 39216, Jackson, MS, USA.
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Using Ambulatory Care Sensitive Conditions to Assess Primary Health Care Performance during Disasters: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159193. [PMID: 35954559 PMCID: PMC9367847 DOI: 10.3390/ijerph19159193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/17/2022]
Abstract
Ambulatory care sensitive conditions (ACSCs) are health conditions for which appropriate primary care intervention could prevent hospital admission. ACSC hospitalization rates are a well-established parameter for assessing the performance of primary health care (PHC). Although this indicator has been extensively used to monitor the performance of PHC systems in peacetime, its consideration during disasters has been neglected. The World Health Organization (WHO) has acknowledged the importance of PHC in guaranteeing continuity of care during and after a disaster for avoiding negative health outcomes. We conducted a systematic review to evaluate the extent and nature of research activity on the use of ACSCs during disasters, with an eye toward finding innovative ways to assess the level of PHC function at times of crisis. Online databases were searched to identify papers. A final list of nine publications was retrieved. The analysis of the reviewed articles confirmed that ACSCs can serve as a useful indicator of PHC performance during disasters, with several caveats that must be considered. The reviewed articles cover several disaster scenarios and a wide variety of methodologies showing the connection between ACSCs and health system performance. The strengths and weaknesses of using different methodologies are explored and recommendations are given for using ACSCs to assess PHC performance during disasters.
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Gastos com internações por condições sensíveis à atenção primária: estudo ecológico. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Tiguman GMB, Silva MT, Galvão TF. Health services utilization in the Brazilian Amazon: panel of two cross-sectional studies. Rev Saude Publica 2022; 56:2. [PMID: 35239925 PMCID: PMC8849293 DOI: 10.11606/s1518-8787.2022056003663] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/19/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate the use of health services among adults living in Manaus, Amazonas. METHODS This was a panel of two cross-sectional studies conducted in Manaus in 2015 and 2019. Individuals aged ≥ 18 years were selected by probabilistic sampling and interviewed at home. The study outcomes were doctor visits and hospitalizations in the previous 12 months, and unmet surgical needs. Variations between 2015 and 2019 were tested using chi-squared goodness-of-fit test. Poisson regression with robust variance was employed to calculate the prevalence ratios (PR) of the outcomes with 95% confidence intervals (95%CI). RESULTS The surveys included 5,800 participants in total. Visits to the doctor decreased from 2015 (78.7%) to 2019 (76.3%; p < 0.001), hospital admissions increased from 2015 (7.9%) to 2019 (11.5%; p < 0.001), and unmet surgical needs decreased in the period (15.9% to 12.1%; p < 0.001). These variations were particularly observed in vulnerable individuals – sicker; poorer; non-whites; and those belonging to lower social classes, with less access to education, formal jobs, and health insurance (p < 0.05). Doctor visits were higher in people with fair health status (PR = 1.09; 95%CI 1.06–1.12), health insurance (PR = 1.13; 95%CI 1.09–1.17), and chronic diseases (p < 0.001) but lower in men (PR = 0.87; 95%CI 0.84–0.90) and informal workers (PR = 0.89; 95%CI 0.84–0.94). Hospitalizations were higher in people with worse health statuses (p < 0.001), without partners (PR = 1.27; 95%CI 1.05–1.53), and with multimorbidity (PR = 1.68; 95%CI 1.33–2.12) but lower in men (PR = 0.55; 95%CI 0.44–0.68), older adults (p < 0.001), informal workers (PR = 0.67; 95%CI 0.51–0.89), and unemployed (PR = 0.72; 95%CI 0.53–0.97). Unmet surgical needs were higher in older adults (p < 0.001), middle-class people (PR = 1.24; 95%CI 1.01–1.55), worse health statuses (p < 0.001), and chronic diseases (p < 0.001) but lower in men (PR = 0.76; 95%CI 0.65–0.86). CONCLUSIONS From 2015 to 2019, less people visited the doctor, more were admitted to hospitals, and less were in need of surgery or aware of that need, potentially indicating poorer access to health services.
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Affiliation(s)
| | - Marcus Tolentino Silva
- Universidade de Sorocaba. Programa de Pós-Graduação em Ciências Farmacêuticas. Sorocaba, São Paulo, Brasil
| | - Taís Freire Galvão
- Universidade Estadual de Campinas. Faculdade de Ciências Farmacêuticas. Campinas, São Paulo, Brasil
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Mendonça Guimarães R, Pimenta Ribeiro Dos Santos L, Gonçalves Pereira A, Graever L. The effect of primary care policy changes on hospitalisation for ambulatory care sensitive conditions: notes from Brazil. Public Health 2021; 201:26-34. [PMID: 34742114 DOI: 10.1016/j.puhe.2021.09.028] [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: 05/24/2021] [Revised: 09/04/2021] [Accepted: 09/22/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to assess the effect of the Primary Health Care Reform and the impact of recent national policy changes on the trend in hospitalisation rates for Ambulatory Conditions Sensitive to Primary Care (ACSC) in the city of Rio de Janeiro, Brazil. STUDY DESIGN Ecological study with data from the Brazilian National Health Information System. METHODS This study performed an interrupted time-series analysis, comparing three different time periods related to important changes in primary care policies in Brazil: Baseline (2008-2009); Primary Health Care Reform (RCAPS) (2010-2017); and National Primary Health Care Policy (PNAB) (2018-2019). Data included total monthly admissions for ACSC and rates for 19 groups of causes for hospitalisation. RESULTS There was a non-significant increasing trend in ACSC hospital admissions between January 2008 and December 2009 (β = 4.01, 95% confidence interval [CI] -12.14 to 20.15). The Primary Health Care Reform (RCAPS), which commenced in January 2010, resulted in a significant reduction in ACSC hospital admission trends during this time period (β = -7.97, 95% CI -9.78 to -6.16). Change in the PNAB did not change the declining ACSC hospital admission trend but it did reduce the rate of decline. In addition, the coefficient was no longer significant (β = -1.93, 95% CI -2.46 to 0.59), suggesting that monitoring of the historical series for a long time may show a reversal of the downward trend in some months. The most consistent change in ACSC hospital admission trend occurred between baseline and the RCAPS (β slope = -0.143, P < 0.001) and the level between the RCAPS period and the new PNAB (β step = 7.00, P = 0.008). Trends and differences in the time periods vary in the different ACSC hospitalisation-cause groups. CONCLUSION Changes in public health policies impact ACSC hospitalisation rates, which can thus be used as an indicator for monitoring primary health care. We also recommend analysing admission rates by the individual ACSC hospitalisation-cause groups.
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Affiliation(s)
- Raphael Mendonça Guimarães
- Oswaldo Cruz Foundation, Avenida Brasil, 4365, Polytechnic School Joaquim Venâncio, Suite #318, Rio de Janeiro, RJ, Brazil.
| | | | - Aline Gonçalves Pereira
- Health Secreteriat of City of Rio de Janeiro, 455 Afonso Cavalcante Street, Cidade Nova, Rio de Janeiro, RJ, Zipcode: 20211-110, Rio de Janeiro, Brazil.
| | - Leonardo Graever
- Health Secreteriat of City of Rio de Janeiro, 455 Afonso Cavalcante Street, Cidade Nova, Rio de Janeiro, RJ, Zipcode: 20211-110, Rio de Janeiro, Brazil.
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Pinto A, Santos JV, Souza J, Viana J, Costa Santos C, Lobo M, Freitas A. Comparison and Impact of Four Different Methodologies for Identification of Ambulatory Care Sensitive Conditions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8121. [PMID: 33153171 PMCID: PMC7662634 DOI: 10.3390/ijerph17218121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 11/30/2022]
Abstract
Ambulatory care sensitive conditions (ACSCs) are conditions for which hospitalizations are thought to be avoidable if effective and accessible primary health care is available. However, to define which conditions are considered ACSCs, there is a considerable number of different lists. Our aim was to compare the impact of using different ACSC lists considering mainland Portugal hospitalizations. A retrospective study with inpatient data from Portuguese public hospital discharges between 2011 and 2015 was conducted. Four ACSC list sources were considered: Agency for Healthcare Research and Quality (AHRQ), Canadian Institute for Health Information (CIHI), the Victorian Ambulatory Care Sensitive Conditions study, and Sarmento et al. Age-sex-adjusted rates of ACSCs were calculated by district (hospitalizations per 100,000 inhabitants). Spearman's rho, the intraclass correlation coefficient (ICC), the information-based measure of disagreement (IBMD), and Bland and Altman plots were computed. Results showed that by applying the four lists, different age-sex-adjusted rates are obtained. However, the lists that seemed to demonstrate greater agreement and consistency were the list proposed by Sarmento et al. compared to AHRQ and the AHRQ method compared to the Victorian list. It is important to state that we should compare comparable indicators and ACSC lists cannot be used interchangeably.
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Affiliation(s)
- Andreia Pinto
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (J.V.S.); (J.S.); (J.V.); (C.C.S.); (M.L.); (A.F.)
- CINTESIS–Center for Health Technology and Services Research, 4200-450 Porto, Portugal
| | - João Vasco Santos
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (J.V.S.); (J.S.); (J.V.); (C.C.S.); (M.L.); (A.F.)
- CINTESIS–Center for Health Technology and Services Research, 4200-450 Porto, Portugal
- Public Health Unit, ACES Grande Porto VIII–Espinho/Gaia, 4500-330 Porto, Portugal
| | - Júlio Souza
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (J.V.S.); (J.S.); (J.V.); (C.C.S.); (M.L.); (A.F.)
- CINTESIS–Center for Health Technology and Services Research, 4200-450 Porto, Portugal
| | - João Viana
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (J.V.S.); (J.S.); (J.V.); (C.C.S.); (M.L.); (A.F.)
- CINTESIS–Center for Health Technology and Services Research, 4200-450 Porto, Portugal
| | - Cristina Costa Santos
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (J.V.S.); (J.S.); (J.V.); (C.C.S.); (M.L.); (A.F.)
- CINTESIS–Center for Health Technology and Services Research, 4200-450 Porto, Portugal
| | - Mariana Lobo
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (J.V.S.); (J.S.); (J.V.); (C.C.S.); (M.L.); (A.F.)
- CINTESIS–Center for Health Technology and Services Research, 4200-450 Porto, Portugal
| | - Alberto Freitas
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (J.V.S.); (J.S.); (J.V.); (C.C.S.); (M.L.); (A.F.)
- CINTESIS–Center for Health Technology and Services Research, 4200-450 Porto, Portugal
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