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Bentes C, Canas N, Pedrosa H, Completo J, Pereira F, Carrilho M, Lopes Lima J, Pereira C, Rego R, Rocha H, Sá F, Sales F, Santos M, Teotónio R. Characterization and quantification of epilepsy patients with hospital episodes in Portugal: A multicenter retrospective study from Liga Portuguesa Contra a Epilepsia. Epilepsy Behav 2024; 155:109771. [PMID: 38642529 DOI: 10.1016/j.yebeh.2024.109771] [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: 10/23/2023] [Revised: 03/06/2024] [Accepted: 03/29/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Epilepsy affects around 50 million people worldwide and is associated with lower quality of life scores, an increased risk of premature death, and significant socio-economic implications. The lack of updated evidence on current epidemiology and patient characterization creates considerable uncertainty regarding the epilepsy burden in Portugal. The study aims to characterize and quantify the epilepsy patients who have been hospitalized, with medical or surgical procedures involved, and to analyze their associated comorbidities and mortality rates. METHODS A multicenter retrospective study was conducted using hospital production data of epilepsy patients. The study included all patients diagnosed with epilepsy-related International Classification of Diseases-9/10 codes between 2015 and 2018 in 57 Portuguese National Health Service (NHS) hospitals (n = 57 institutions). Patient characterization and quantification were done for all patients with an epilepsy diagnosis, with specific analyses focusing on those whose primary diagnosis was epilepsy. Baseline, demographic, and clinical characteristics were analyzed using descriptive statistics. RESULTS Between 2015 and 2018, a total of 80,494 hospital episodes (i.e., patient visit that generates hospitalization and procedures) were recorded, with 18 % to 19 % directly related to epilepsy. Among these epilepsy-related hospital episodes, 13.0 % led to short term hospitalizations (less than 24 h). Additionally, the average length of stay for all these epilepsy-related episodes was 8 days. A total of 49,481 patients were identified with epilepsy based on ICD-9/10 codes. The median age of patients was 64 years (min: 0; max: 104), with a distribution of 4.8 patients per 1,000 inhabitants. From the total of deaths (9,606) between 2015 and 2018, 14% were associated with patients whose primary diagnosis was epilepsy, with 545 of these being epilepsy-related deaths. Among patients with a primary diagnosis of epilepsy, the most common comorbidities were hypertension (24%) and psychiatric-related or similar comorbidities (15%), such as alcohol dependance, depressive and major depressive disorders, dementia and other convulsions. CONCLUSION This study showed similar results to other European countries. However, due to methodological limitations, a prospective epidemiological study is needed to support this observation. Furthermore, the present study provides a comprehensive picture of hospitalized epilepsy patients in Portugal, their comorbidities, mortality, and hospital procedures.
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Affiliation(s)
- Carla Bentes
- Reference Centre for Refractory Epilepsies (member of EpiCARE), Centro Hospitalar Universitário Lisboa Norte-Hospital de Santa Maria, Lisboa, Portugal; Department of Neurosciences and Mental Health (Neurology), Centro Hospitalar Universitário Lisboa Norte - Hospital de Santa Maria, Lisboa, Portugal; Egas Moniz Centre of Studies. Medical Faculty, Universidade de Lisboa, Lisboa, Portugal; Liga Portuguesa Contra a Epilepsia (Portuguese Chapter of the International League Against Epilepsy), Portugal.
| | - Nuno Canas
- Liga Portuguesa Contra a Epilepsia (Portuguese Chapter of the International League Against Epilepsy), Portugal; Neurology Department, Hospital Beatriz Ângelo, Lisboa, Portugal; Reference Centre for Refractory Epilepsies, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Hugo Pedrosa
- IQVIA Solutions Portugal, RWAS, Oeiras, Portugal
| | - João Completo
- IQVIA Solutions Portugal, IASIST - Payers, Providers and Government, Oeiras, Portugal
| | | | | | - José Lopes Lima
- Liga Portuguesa Contra a Epilepsia (Portuguese Chapter of the International League Against Epilepsy), Portugal; Neurology Department, Hospital Lusíadas Porto, Porto, Portugal; Neurology Department, Hospital da Misericórdia do Porto, Porto, Portugal; Neurology Department, Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal
| | - Cristina Pereira
- Liga Portuguesa Contra a Epilepsia (Portuguese Chapter of the International League Against Epilepsy), Portugal; Neuropediatrics and Neurophysiology Department - Pediatric Hospital, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Reference Centre for Refractory Epilepsies (member of EpiCARE), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ricardo Rego
- Liga Portuguesa Contra a Epilepsia (Portuguese Chapter of the International League Against Epilepsy), Portugal; Neurophysiology Unit, Neurology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal; Reference Centre for Refractory Epilepsies, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Helena Rocha
- Liga Portuguesa Contra a Epilepsia (Portuguese Chapter of the International League Against Epilepsy), Portugal; Neurophysiology Unit, Neurology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal; Reference Centre for Refractory Epilepsies, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Francisca Sá
- Liga Portuguesa Contra a Epilepsia (Portuguese Chapter of the International League Against Epilepsy), Portugal; Reference Centre for Refractory Epilepsies, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; Neurology Department, Hospital Egas Moniz, Lisboa, Portugal
| | - Francisco Sales
- Liga Portuguesa Contra a Epilepsia (Portuguese Chapter of the International League Against Epilepsy), Portugal; Reference Centre for Refractory Epilepsies (member of EpiCARE), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Neurophysiology Unit, Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Manuela Santos
- Liga Portuguesa Contra a Epilepsia (Portuguese Chapter of the International League Against Epilepsy), Portugal; Neuropediatrics Department, Centro Hospitalar e Universitário de Santo António, Porto, Portugal; Reference Centre for Refractory Epilepsies (member of EpiCARE), Centro Hospitalar e Universitário de Santo António, Porto, Portugal
| | - Rute Teotónio
- Liga Portuguesa Contra a Epilepsia (Portuguese Chapter of the International League Against Epilepsy), Portugal; Reference Centre for Refractory Epilepsies (member of EpiCARE), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Neurophysiology Unit, Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Doetsch JN, Almendra R, Severo M, Leão T, Teixeira R, Marques S, Pilot E, Krafft T, Barros H. The influence of the Great Recession on perinatal health-an ecological study on the trend changes and regional differences in Portugal. THE LANCET REGIONAL HEALTH. EUROPE 2023; 34:100735. [PMID: 37927436 PMCID: PMC10625015 DOI: 10.1016/j.lanepe.2023.100735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 11/07/2023]
Abstract
Background Few studies examine the relationship between socioeconomic factors and trends in mortality in high-income European countries. Due to the lack of regional-level data, most recent studies on social inequality in Portugal do not investigate regional differences. This study analyses time trends and regional disparities in the evolution of perinatal mortality (PMR) and infant mortality (IMR) associated with demographic and socioeconomic indicators following Portugal's 2008 economic and financial crisis. Methods Associations were assessed using generalised linear models. A Poisson joinpoint regression model was applied to identify relevant PMR and IMR changes between 2000 and 2018. Country regional disparities were analysed using Mixed Effect Multilevel models. Findings IMR and PMR significantly decreased in the pre-crisis period but not in the post-crisis period. The significant differences between regions in IMR and PMR in 2000 were followed by a different evolution of regional IMR after 2008. PMR and IMR were not significantly associated with socioeconomic indicators. A significant positive association with maternal age at first birth was identified. Interpretation Results confirm the influence of the crisis on PMR and IMR trends in Portugal, taking into account recurring associations between macroeconomic cycles, variations in mortality trends, macroeconomic volatility, and stagnation of IMR and PMR. Regional inequalities confirm the internal variability of the crisis influence and persistent spatial inequalities affecting IMR patterns. Funding FCT, under the Institute of Public Health of the University of Porto (ISPUP)-EPIUnit (UIDB/04750/2020) and ITR (LA/P/0064/2020), Maastricht University's external PhD programme under the Care and Public Health Research Institute (CAPHRI), and the RECAP preterm project (grant agreement no 733280).
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Affiliation(s)
- Julia Nadine Doetsch
- EPIUnit – Instituto de Saúde Pública da Universidade do Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Ricardo Almendra
- Department of Geography and Tourism, CEGOT-Centre of Studies on Geography and Spatial Planning, University of Coimbra, Portugal
| | - Milton Severo
- EPIUnit – Instituto de Saúde Pública da Universidade do Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal
| | - Teresa Leão
- EPIUnit – Instituto de Saúde Pública da Universidade do Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Faculdade de Medicina, Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Universidade do Porto (FMUP), Porto, Portugal
| | - Raquel Teixeira
- EPIUnit – Instituto de Saúde Pública da Universidade do Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Sandra Marques
- EPIUnit – Instituto de Saúde Pública da Universidade do Porto, Portugal
- ICNOVA, FCSH, Universidade Nova de Lisboa, Portugal
| | - Eva Pilot
- Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Thomas Krafft
- Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Henrique Barros
- EPIUnit – Instituto de Saúde Pública da Universidade do Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Faculdade de Medicina, Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Universidade do Porto (FMUP), Porto, Portugal
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Doetsch JN, Almendra R, Severo M, Leão T, Pilot E, Krafft T, Barros H. 2008 economic crisis impact on perinatal and infant mortality in Southern European countries. J Epidemiol Community Health 2023; 77:305-314. [PMID: 36813545 DOI: 10.1136/jech-2022-219639] [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: 08/02/2022] [Accepted: 02/05/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION The study of crisis events provides important lessons to prepare for upcoming events. The Great Recession's impact on perinatal health in Europe can provide relevant insights into the healthcare and social protection systems' response to the protection of the health of the most vulnerable groups. OBJECTIVE To assess time trends and international disparities in perinatal mortality rates (PMR) and infant mortality rates (IMR), following the Great Recession, and their association with socioeconomic indicators in Portugal, Greece, Italy and Spain. METHODS Associations were assessed through generalised linear models for all four countries. A Poisson joinpoint regression model was applied to explore PMR and IMR trend changes between 2000 and 2018. Country disparities were analysed using mixed-effects multilevel models. RESULTS IMR and PMR have decreased overall in the four selected countries between 2000 and 2018. Still, whereas in Spain, Italy and Portugal the decreasing pace was attenuated after 2009, in Greece a positive trend was found after the 2008 crisis. IMR and PMR were significantly associated with socioeconomic indicators in all four countries. National disparities in the evolution of IMR and PMR were significantly associated with most socioeconomic indicators between 2000 and 2018. CONCLUSION Our results confirm the impact of the Great Recession on PMR and IMR trends in all four countries, taking recurring associations between macroeconomic cycles, variations in mortality trends, macroeconomic volatility and stagnation of IMR and PMR into account. The association with socioeconomic indicators stresses the need to strengthen social protection and healthcare systems to better protect the population's health from the earliest days.
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Affiliation(s)
- Julia Nadine Doetsch
- Unidade de Investigação em Epidemiologia (EPIUnit), Instituto de Saúde Pública da Universidade do Porto (ISPUP), Porto, Portugal .,Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, Netherlands.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - Ricardo Almendra
- CEGOT-Centre of Studies on Geography and Spatial Planning, Department of Geography and Tourism, University of Coimbra, Coimbra, Portugal
| | - Milton Severo
- Unidade de Investigação em Epidemiologia (EPIUnit), Instituto de Saúde Pública da Universidade do Porto (ISPUP), Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Teresa Leão
- Unidade de Investigação em Epidemiologia (EPIUnit), Instituto de Saúde Pública da Universidade do Porto (ISPUP), Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal.,Predictive Medicine and Public Health Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto (FMUP), Porto, Portugal
| | - Eva Pilot
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University (UM), Maastricht, Netherlands
| | - Thomas Krafft
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University (UM), Maastricht, Netherlands
| | - Henrique Barros
- Unidade de Investigação em Epidemiologia (EPIUnit), Instituto de Saúde Pública da Universidade do Porto (ISPUP), Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal.,Predictive Medicine and Public Health Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto (FMUP), Porto, Portugal
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Simões de Almeida R, Trigueiro MJ, Portugal P, de Sousa S, Simões-Silva V, Campos F, Silva M, Marques A. Mental Health Literacy and Stigma in a Municipality in the North of Portugal: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3318. [PMID: 36834014 PMCID: PMC9962300 DOI: 10.3390/ijerph20043318] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/10/2023] [Accepted: 02/12/2023] [Indexed: 06/18/2023]
Abstract
Portugal has Europe's second-highest prevalence of psychiatric illnesses, and this is the reason why mental health literacy (MHL) and stigma should be addressed. This study aimed to investigate the mental health literacy and stigma levels among different groups of people from Póvoa de Varzim, a municipality in the north of Portugal. Students, retired people, and professionals (education, social, and healthcare fields) were recruited using a convenience sample from June to November 2022. Participants' MHL levels were evaluated using the Mental Health Promoting Knowledge Scale (MHPK), Mental Health Literacy Measure (MHLM) and Mental Health Knowledge Schedule (MAKS). Stigma levels were evaluated using Community Attitudes towards Mental Illness (CAMI) and the Reported and Intended Behaviour Scale (RIBS). A total of 928 questionnaires were filed. The respondents included 65.70% of women, a mean age of 43.63 (±26.71) years and 9.87 (±4.39) years of school education. MHL increased with age, education level and was higher in women (p < 0.001). A higher level of MHL was seen in health professionals (p < 0.001). Findings revealed that older people stigmatized people with mental illness more (p < 0.001), and the female gender stigmatize less (p < 0.001). In addition, results showed that stigma decreased with higher mental health literacy (r between 0.11 and 0.38; p < 0.001). To conclude, specific campaigns that promote mental health literacy should be tailored to specific profiles within this population to address those that have more stigma.
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Affiliation(s)
- Raquel Simões de Almeida
- Psychosocial Rehabilitation Laboratory, Center for Rehabilitation Research, School of Health, Polytechnic of Porto, 4200-072 Porto, Portugal
| | - Maria João Trigueiro
- Psychosocial Rehabilitation Laboratory, Center for Rehabilitation Research, School of Health, Polytechnic of Porto, 4200-072 Porto, Portugal
| | - Paula Portugal
- Psychosocial Rehabilitation Laboratory, Center for Rehabilitation Research, School of Health, Polytechnic of Porto, 4200-072 Porto, Portugal
| | - Sara de Sousa
- Psychosocial Rehabilitation Laboratory, Center for Rehabilitation Research, School of Health, Polytechnic of Porto, 4200-072 Porto, Portugal
- Department of Psychiatry and Mental Health, University Hospital Center of São João, 4200-319 Porto, Portugal
| | - Vítor Simões-Silva
- Psychosocial Rehabilitation Laboratory, Center for Rehabilitation Research, School of Health, Polytechnic of Porto, 4200-072 Porto, Portugal
| | - Filipa Campos
- Psychosocial Rehabilitation Laboratory, Center for Rehabilitation Research, School of Health, Polytechnic of Porto, 4200-072 Porto, Portugal
| | - Maria Silva
- Psychosocial Rehabilitation Laboratory, Center for Rehabilitation Research, School of Health, Polytechnic of Porto, 4200-072 Porto, Portugal
| | - António Marques
- Psychosocial Rehabilitation Laboratory, Center for Rehabilitation Research, School of Health, Polytechnic of Porto, 4200-072 Porto, Portugal
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Murteira R, Romano S, Teixeira I, Bulhosa C, Sousa S, Conceição MI, Fonseca-Silva A, Martins H, Teixeira Rodrigues A. Real-World Impact of Transferring the Dispensing of Hospital-Only Medicines to Community Pharmacies During the COVID-19 Pandemic. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1321-1327. [PMID: 35428552 PMCID: PMC9002297 DOI: 10.1016/j.jval.2022.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/09/2022] [Accepted: 03/04/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES In Portugal, the dispensing of most outpatient specialty medicines is performed exclusively through hospital pharmacies and totally financed by the National Health Service. During the COVID-19 first wave, the government allowed the transfer of the dispensing of hospital-only medicines (HOMs) to community pharmacies (CPs). This study aimed to measure the value generated by the intervention of CP in the dispensing of HOM. METHODS A single-arm, before-and-after study with 3-month follow-up was conducted enrolling a randomly selected sample of patients or caregivers with at least 1 dispensation of HOM through CP. Data were collected by telephone interview. Main outcomes were patients' self-reported adherence (Measure Treatment Adherence), health-related quality of life (EQ-5D 3-Level), satisfaction with the service, and costs related to HOM access. RESULTS Overall 603 subjects were recruited to participate in the study (males 50.6%) with mean 55 years old (SD = 16). The already high mean adherence score to therapy improved significantly (P < .0001), and no statistically significant change (P > .5757) was found in the mean EQ-5D score between baseline (0.7 ± 0.3) and 3-month follow-up (0.8 ± 0.3). Annual savings account for €262.1/person, arising from travel expenses and absenteeism reduction. Participants reported a significant increase in satisfaction levels in all evaluated domains-pharmacist's availability, opening hours, waiting time, privacy conditions, and overall experience. CONCLUSIONS Changing the dispense setting to CP may promote better access and satisfaction. Moreover, it ensures the persistence of treatments, promotes savings for citizens, and reduces the burden of healthcare services, representing a crucial public health measure.
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Affiliation(s)
- Rodrigo Murteira
- Centre for Health Evaluation & Research/Infosaúde, National Association of Pharmacies, Lisbon, Portugal
| | - Sónia Romano
- Centre for Health Evaluation & Research/Infosaúde, National Association of Pharmacies, Lisbon, Portugal
| | - Inês Teixeira
- Centre for Health Evaluation & Research/Infosaúde, National Association of Pharmacies, Lisbon, Portugal
| | - Carolina Bulhosa
- Centre for Health Evaluation & Research/Infosaúde, National Association of Pharmacies, Lisbon, Portugal
| | - Sérgio Sousa
- Centre for Health Evaluation & Research/Infosaúde, National Association of Pharmacies, Lisbon, Portugal
| | | | | | | | - António Teixeira Rodrigues
- Centre for Health Evaluation & Research/Infosaúde, National Association of Pharmacies, Lisbon, Portugal; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal.
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Romano S, Guerreiro JP, Teixeira Rodrigues A. Drug shortages in community pharmacies: Impact on patients and on the health system. J Am Pharm Assoc (2003) 2021; 62:791-799.e2. [DOI: 10.1016/j.japh.2021.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/29/2021] [Accepted: 12/29/2021] [Indexed: 11/15/2022]
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Sritart H, Tuntiwong K, Miyazaki H, Taertulakarn S. Disparities in Healthcare Services and Spatial Assessments of Mobile Health Clinics in the Border Regions of Thailand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10782. [PMID: 34682527 PMCID: PMC8535297 DOI: 10.3390/ijerph182010782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 01/21/2023]
Abstract
Reducing the disparities in healthcare access is one of the important goals in healthcare services and is significant for national health. However, measuring the complexity of access in truly underserved areas is the critical step in designing and implementing healthcare policy to improve those services and to provide additional support. Even though there are methods and tools for modeling healthcare accessibility, the context of data is challenging to interpret at the local level for targeted program implementation due to its complexity. Therefore, the purpose of this study is to develop a concise and context-specific methodology for assessing disparities for a remote province in Thailand to assist in the development and expansion of the efficient use of additional mobile health clinics. We applied the geographic information system (GIS) methodology with the travel time-based approach to visualize and analyze the concealed information of spatial data in the finer analysis resolution of the study area, which was located in the border region of the country, Ubon Ratchathani, to identify the regional differences in healthcare allocation. Our results highlight the significantly inadequate level of accessibility to healthcare services in the regions. We found that over 253,000 of the population lived more than half an hour away from a hospital. Moreover, the relationships of the vulnerable residents and underserved regions across the province are underlined in the study and substantially discussed in terms of expansion of mobile health delivery to embrace the barrier of travel duration to reach healthcare facilities. Accordingly, this research study addresses regional disparities and provides valuable references for governmental authorities and health planners in healthcare strategy design and intervention to minimize the inequalities in healthcare services.
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Affiliation(s)
- Hiranya Sritart
- Faculty of Allied Health Sciences, Thammasat University, Pathumthani 12120, Thailand;
| | - Kuson Tuntiwong
- School of Dentistry, King Mongkut’s Institute of Technology Ladkrabang, Bangkok 10520, Thailand;
| | - Hiroyuki Miyazaki
- Center for Spatial Information Science, Tokyo University, Chiba 277-8568, Japan;
| | - Somchat Taertulakarn
- Faculty of Allied Health Sciences, Thammasat University, Pathumthani 12120, Thailand;
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Assessing Health Resources Equipped with Hemodynamic Rooms in the Portuguese-Spanish Borderland: Cross-Border Cooperation Strategies as a Possible Solution. ISPRS INTERNATIONAL JOURNAL OF GEO-INFORMATION 2021. [DOI: 10.3390/ijgi10080514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Portugal and Spain share one of the greatest European borderland areas. This fact has direct impacts on a large territory and consequently on the communities’ living in it. Still, even if the border areas represent an essential fraction of the territory, planning policies have not resulted in specific cooperation programs that could enable sharing general leisure and recreation assets and infrastructures and collaboration in critical domains—i.e., the case of the health sector. The present study aims to assess the territorial accessibility to the hemodynamic rooms by the potential population of the Spanish-Portuguese transition areas that may suffer an acute myocardial infarction. Contextually, this study employed a spatial interaction model based on the three-step floating catchment area method (method-3SFCA). By applying these methods, it was possible to develop a map of accessibility to health infrastructures equipped with hemodynamics rooms on both sides of the border that may answer the Spanish-Portuguese border populations’ needs. Besides, while granting valuable information for decision-makers regarding the need to develop new infrastructures to guarantee that even considering cross border cooperation, everyone gets access to a hemodynamics room within the critical intervention period.
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Weiland M, Santana P, Costa C, Doetsch J, Pilot E. Spatial Access Matters: An Analysis of Policy Change and Its Effects on Avoidable Infant Mortality in Portugal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1242. [PMID: 33573190 PMCID: PMC7908299 DOI: 10.3390/ijerph18031242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 11/16/2022]
Abstract
In 2006, a policy reform restructured the maternal and perinatal healthcare system, including closing smaller maternity units, to further improve care in Portugal. This study aimed to investigate the effects of the 2006 National Program of Maternal and Neonatal Health policy on spatial inequalities in access to care and consequently avoidable infant mortality. A thematic analysis of qualitative data including interviews and surveys and a quantitative spatial analysis using Geographic Information Systems was applied. Spatial inequalities were found which may lead to avoidable infant mortality. Inequalities exist in freedom of choice and autonomy in care, within a medicalized system. Changes in approach to and organization of care would further enhance equitable spatial access to care in maternal health and reduce avoidable infant mortality.
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Affiliation(s)
- Morgan Weiland
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences (FHML), Care and Public Health Research Institute (CAPHRI), Maastricht University, 6220 MD Maastricht, The Netherlands; (M.W.); (J.D.)
- Centre of Studies in Geography and Spatial Planning (CEGOT), University of Coimbra, 3004-531 Coimbra, Portugal; (P.S.); (C.C.)
| | - Paula Santana
- Centre of Studies in Geography and Spatial Planning (CEGOT), University of Coimbra, 3004-531 Coimbra, Portugal; (P.S.); (C.C.)
| | - Claudia Costa
- Centre of Studies in Geography and Spatial Planning (CEGOT), University of Coimbra, 3004-531 Coimbra, Portugal; (P.S.); (C.C.)
| | - Julia Doetsch
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences (FHML), Care and Public Health Research Institute (CAPHRI), Maastricht University, 6220 MD Maastricht, The Netherlands; (M.W.); (J.D.)
- EPIUnit–Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal
| | - Eva Pilot
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences (FHML), Care and Public Health Research Institute (CAPHRI), Maastricht University, 6220 MD Maastricht, The Netherlands; (M.W.); (J.D.)
- Centre of Studies in Geography and Spatial Planning (CEGOT), University of Coimbra, 3004-531 Coimbra, Portugal; (P.S.); (C.C.)
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