Quality of life and its influencing factors on children with asthma in China: a comparative study before and during the COVID-19 pandemic

OBJECTIVE

This study compares the level of quality of life (QoL) and its influencing factors on children with asthma before and during the COVID-19 pandemic.

METHODS

The study carried out cross-sectional surveys on children with asthma and their parents in China before and during the epidemic. Data were collected using a demographic questionnaire, the Family Management Scale for Children with Asthma (FMSCA), and the Pediatric Asthma Quality of Life Questionnaire (PAQLQ). Participants from before the epidemic were matched by their propensity score in a 1:1 ratio with individuals from during the epidemic. The level of QoL of children with asthma was subsequently analyzed. Both univariate analysis and multiple linear regression were employed to identify the influencing factors.

RESULTS

Compared to their level before the epidemic, the total score of PAQLQ and its three dimensions decreased during the epidemic. Regression analysis revealed that before the epidemic, the total score of PAQLQ was significantly associated with follow-up visits, attendance of asthma lectures, and the total score of FMSCA (p < 0.05). During the epidemic, the total score of the PAQLQ was significantly associated with three dimensions of the FMSCA (future expectation, children identity, and views of condition), and two classifications of the family management styles (FMS) (enduring and accommodating) (p < 0.05).

CONCLUSION

The QoL of children with asthma deteriorated during the epidemic. Influencing factors changed during the epidemic, with more emphasis on the family environment. Future intervention strategies need to take into account the development of interactions between children and environmental forces.

The relationship between individual-level socioeconomic status and preference for medical service in primary health institutions: a cross-sectional study in Jiangsu, China

Background

While China's primary health care (PHC) system covers all citizens, the use of medical services supplied by primary health institutions (PHIs) is not at ideal levels. This study explored the impact of socioeconomic status (SES) on residents' first choice of medical services provided by PHIs.

Methods

This community-based, cross-sectional study was conducted in Jiangsu Province, China, from October 2021 to March 2022. A custom-designed questionnaire was used to evaluate 4,257 adults, of whom 1,417 chose to visit a doctor when they were sick. Logistic regression was used to test the relationships among SES, other variables and the choice of medical services, and interaction effects were explored.

Results

A total of 1,417 subjects were included in this study (48.7% female; mean age 44.41 ± 17.1 years). The results showed that older age (p < 0.01), rural residence (p < 0.01), a preference for part-time medical experts in PHIs (p < 0.01), and lack of coverage by basic medical insurance (p < 0.05) were associated with the first choice to use PHIs. In the multiple logistic regression model, SES was not associated with the first choice of medical services supplied by PHIs (p > 0.05), but it interacted with three variables from the Commission on Social Determinants of Health Framework (material circumstances, behaviors and biological factors, and psychosocial factors).

Conclusion

Vulnerable individuals who are the target visitors to PHIs are older, live in rural areas, and suffer from chronic diseases. SES, as a single factor, did not impact whether medical services at PHIs were preferred, but it mediated relationships with other factors.

[Review of Research Advances in Medical Service Robotics]

With the progress of science and technology and the increase of clinical demand, medical robots have developed rapidly and played a important role in promoting the medical cause. Service robot is a branch of medical robot, which is mainly oriented to medical service and assistance needs, and has been applied in many medical scenarios and achieved demonstration effects. This research first describes the development of medical service robots, and then summarizes the key technologies and clinical applications of robots. Finally, it points out the challenges and directions that medical service robots face at present, and puts forward prospects for their further development in the medical field.

Medical and social factors influencing the utilization of healthcare services among older adults in Israel during the COVID-19 lockdown

Background

The corona virus disease 2019 (COVID-19) pandemic significantly impacted older adults. However, most older communities focused on the medical issues. The aims of this study were to identify the medical and social factors linked with the usage of medical services during the COVID-19 lockdown in Israel.

Methods

The study was conducted Over two periods of time from February to April in 2019 (P1), before the COVID-19 and from February to April in 2020 (P2), during the first lockdown. The study was conducted on people aged 65 and older in Israel. The variable statistics were analyzed using frequency tabulation, cross-tabulation frequencies, and t-tests. Two hierarchical logistic regressions were conducted over four steps for each period.

Results

The participants (n = 102,303) comprised 64.5% female (65,946) and 35.5% male (36,357) (mean age 80.5, SD- 7.46). It was found that participants who had not subscribed to the supportive community services were 7.47 times more likely to access medical services in P1 and 12.417 times more likely to access medical services during the lockdown. This variable was also found to be a strong predictor in the final model. The most significant variable for predicting the participants' needs during P2 was their previous needs in P1. Other social variables were living in assisted living home and living in community settlements. The presence of 12 diseases in this study did not predict service demand.

Conclusion

Community support reduces medical service demands during disasters and provides services for older adults. During pandemics, however, social services need to be expanded and made more easily accessible to older adults.

Privatization of Medical Services and Revenue Development Project: A Cross-Sectional Survey of Staff Perceptions at the University of Jeddah Medical Center

This study aimed to assess the perceptions of staff working at the University of Jeddah (UJ) Medical Center on the possibility of finding new financing methods for the administration and privatization of the primary and specialized medical care services it provides. A questionnaire link was sent online targeting all staff at the UJ Medical Center (n = 141). The questionnaire comprised 17 items under the following sections: demographic information, staff perceptions about the current status of the services provided by the UJ Medical Center and the possibility of finding new financing methods and additional sources of revenue for the administration. Of the 101 questionnaires returned, the majority were filled by males (n = 71; 70.3%). One-third of the participants (n = 39; 38.6%) have between 5 and 9 years of working experience in Medical Administration, and most of them (n = 42; 41.6%) reported that they have a background in the concept of revenue development/privatization/self-resources/paid treatment. Most were satisfied with the current status of the services provided (average rating = 3.39/5). However, most participants (n = 72; 71.3%) reported that the UJ Medical Center is not ready for the Revenue Development Project of privatization. The survey respondents demonstrated satisfaction with the medical services provided by the UJ Medical Center and the potential application of the Revenue Development Project. However, streamlining the privatization process according to the governmental structures is crucial for it to be implemented properly at the UJ Medical Center.

[The development of medical tourism in conditions of globalization health care]

The article considers impact of process of health care globalization on development of medical tourism. The main trends in health care that drastically changes the situation in conditions of COVID-19 pandemic and implementation of digitization are presented. The normative legal base in force regulating medical services export is analyzed. The study of conditions of development of medical tourism in Russia is carried out. The directions of development of medical services export in modern conditions are considered. The enumeration of issues of global health care is formed. It is accepted to consider health care sector as a part of economics that is most isolated and attached to place of rendering and consumption of services. The outbreak of COVID-19 pandemic and active implementation of digital technologies into processes of organization of health care and medical care provision launched transformation and urged globalization. The conclusion is drew that actual society exists in epoch of globalization and digitization of health care sector. Nowadays, borders of states are not insurmountable obstacle for patients in need of high-tech medical care. The world market of medical tourism demonstrates trend to continuous growth and development permitting largest medical clusters to compete for attention of patients. The purpose of the study is in considering directions of development of medical tourism under the influence of process of health care globalization in modern society.

Digital Maturity Consulting and Strategizing to Optimize Services: Overview

The National Health Service (NHS), the health care system of the United Kingdom, is one of the largest health care entities in the world and has been successfully serving the UK population for decades. The NHS is also the fourth-largest employer globally. True to its reputation, some of the most modern and technically advanced medical services are available in the United Kingdom. However, between the acute, primary, secondary, and tertiary care providers of the NHS, there needs to be seamless integration and interoperability to provide timely holistic care to patients at a national level. Various efforts have been taken and programs launched since 2002 to achieve digital transformation in the NHS but with partial success rates. As it is important to understand a problem before trying to solve it, in this paper, we focus on tools used to assess the digital maturity of NHS trusts and organizations. Additionally, we aim to present the impact of ongoing transformation attempts on secondary services, particularly mental health. This paper considered the literature on digital maturity and performed a rapid review of currently available tools to measure digital maturity. We have performed a multivocal literature review that included white papers and web-based documents in addition to peer-reviewed literature. Further, the paper also provides a perspective of the ground reality from a mental health service provider's point of view. Assessment tools adopted from the global market, later modified and tailor-made to suit local preferences, are currently being used. However, there is a need for a robust framework that assesses status, allows target setting, and tracks progress across diverse providers.

Collecting Patient Feedback as a Means of Monitoring Patient Experience and Hospital Service Quality - Learning from a Government-led Initiative

PURPOSE

Patient feedback plays a significant role in hospital service improvement. However, how to encourage patient feedback that can guide hospital service improvement is still being explored. By examining patient feedback data related to a tertiary hospital in China that was collected from the "12345" Government Service Convenience Hotline (GSCH), the paper discusses the learnings from GSCH in encouraging patient feedback and how quality improvement initiatives have effected the number and types of complaints made by patients and their families via GSCH.

METHODS

The study retrospectively collected and analyzed complaints on a Tertiary General University-affiliated hospital made via GSCH between 2016 and 2020. Patient care process-related complaints were coded using the health care complaint analysis tool (HCAT) and other complaint data were categorized based on the nature of the complaints. The autoregressive integrated moving average (ARIMA) models and mosaic plots were used to observe complaints trends and different complaint variables, respectively. The relationship between various quality improvement initiatives introduced since 2018 and patient complaints was also tested.

RESULTS

Close to 67% (n=2688) of calls made to the GSCH hotlines about the hospital were classified as a complaint including 60.6% vs 39.4% related to patient care process and nonpatient care process, respectively. For patient care process-related complaints, specifically against departments and personnel, 57.72% (n=961) were on clinical departments and 55.87% (n=471) were on doctors. Comparing the proportion of the complaint data in different categories in the two-year period of 2017-2018 and 2019-2020, an increase in management problems (47.73% vs 58.50%, P<0.001) and decrease in relationship problems (33.65% vs 25.69%, P=0.002) were recorded.

CONCLUSION

A unified, transparent, and impartial GSCH platform greatly encourages feedback from patients and families. Feedbacks provide evidence to guide health care organizations in improving the overall experience of patients and the quality of services that they provide.

Combined effects of cues influencing patients’ purchasing behavior in online health-care communities: qualitative comparative analysis based on cue utilization theory

Background

The sudden outbreak of COVID-19 in early 2020 pushed the online health-care communities (OHCs) into the public eye in China. However, OHCs is an emerging service model, which still has many problems such as low patient trust and low patient utilization rate. Patients are the users and recipients of web-based medical services, as well as the core of medical services. Thus, based on cue utilization theory, this paper studies combination effect of influencing factors in patients’ purchase of web-based medical services through the qualitative comparative analysis method of fuzzy sets (fsQCA).

Methods

This paper discards statistical methods based on variance theory-based relationships between explanatory and explained variables and uses a construct theory-based fuzzy set qualitative comparative analysis (fsQCA) approach to elucidate such complex relationships of patients' online purchasing behavior. We use a crawler to automatically download information from Haodf.com. This study crawled data in August 2020, involving 1210 physicians.

Results

Service price, reputation and service quality are the key factors for patients’ purchasing behavior. Physician’s online reputation, online medical service price, number of published articles, mutual-help group, and appointment registration affect patients' purchasing behavior by means of weighted variation. Only when a high scope of internal attribute-related cue elements and a low scope of external attribute-related cue elements are combined with each other in a specific form, patients will generate purchase behavior.

Conclusion

This paper clarifies the complex causes that promote to patients' purchasing behavior of web-based medical services, enriches and develops the relevant theories in the field of consumer purchasing behavior and online health-care communities market research, and has implications for governments, platforms, physicians and patients in the event of web-based medical service purchases.

The impact of medical service on the return behavior: A city-level study in China

Due to the constraints of the rural-urban household registration systems, the migrants of China currently receive varying degrees of medical services. The fact that many migrants choose to return to their hometowns due to the inequality in medical care has been a social phenomenon. Using data from the 2017 China Migrant Dynamic Survey (CMDS), this paper explores the effect of medical services on population migration. Probit regression analysis method was utilized to examine the relationship between medical service level (MSL) and medical service improvement (MSI) and return behavior (RB), as well as the interaction effect between MSL and MSI, and the moderating effect of health status (HS) and health education (HE). Multiple heterogeneity tests were performed. Grouping regressions were conducted using rural household registration (RHR), grouping regressions were conducted using new rural cooperative medical system (NRCMS), and multinomial Probit regressions were conducted using migration distance and age factors. The following findings were obtained. First, when MSL is low but MSI is high in the locality of household registration, the return probability of migrants will increase. MSL also has a positive interaction effect with MSI, and they jointly increase the return probability of migrants; Second, HS and HE have a positive moderating effect on the relationships between MSL and RB and between MSI and RB; Third, heterogeneity analysis indicates that the migrants with RHR or the migrants not covered by the NRCMS are more prone to return due to the reason of medical service. In addition, the analysis also shows that middle-aged and older people who return across provinces have the highest tendency to return due to medical services and young people have the lowest propensity to return across and within provinces. The study could help local governments change their public medical care policies and close the gap between medical services in different areas. As a result, it is necessary to understand population migration trends and promote New Urbanization Strategies.

An Automated Method of Causal Inference of the Underlying Cause of Death of Citizens

It is of great significance to correctly infer the underlying cause of death for citizens, especially under the current worldwide situation. The medical resources of all countries are overwhelmed under the impact of coronavirus disease 2019 (COVID-19) and countries need to allocate limited resources to the most suitable place. Traditionally, the cause-of-death inference relies on manual methods, which require a large resource cost and are not so efficient. To address the challenges, in this work, we present a mixed inference method named Sink-CF. The Sink-CF algorithm is based on confidence measurement and is used to automatically infer the underlying cause of death of citizens. The method proposed in this paper combines a mathematical statistics method and a collaborative filtering and analysis algorithm in machine learning. Thus, our method can not only effectively achieve a certain accuracy, but also does not rely on a large quantity of manually labeled data to continuously optimize the model, which can save computer computing power and time, and has the characteristics of being simple, easy and efficient. The experimental results show that our method generates a reasonable precision (93.82%) and recall (90.11%) and outperforms other state-of-the-art machine learning algorithms.

COVID-19 Pandemic and the Operation of a Tertiary Hospital in Tianjin-The Impact of Internet Healthcare on Hospital Business Indicators

Objective

To explore the impact of the COVID-19 pandemic on hospital business and the contribution of Internet healthcare to hospital operations during the epidemic by analyzing the degree of impact on major business indicators.

Methods

The three-year period from 2019 to 2021 was compared and analyzed, and the main medical business indicators such as outpatient and emergency visits, inpatients, operations, patient improvement rate, cure rate and fatality rate in tertiary hospitals were compared and analyzed, and the impact of the epidemic on medical services and hospital operation was analyzed. degree and the impact of Internet medical development on medical service capacity.

Results

During the outbreak of COVID-19, the number of hospital outpatient and emergency visits, inpatients, and operations decreased significantly; after the normalization of the epidemic, the main medical business indicators such as outpatient and emergency visits, inpatients, and operations gradually returned to pre-epidemic levels; patient improvement rate, the cure rate and mortality rate and other indicators did not change significantly. During the epidemic period, the number of visits to the Internet outpatient clinic has increased significantly, which has significantly improved the hospital's medical service capacity.

Conclusion

With the normalization of epidemic prevention and control, the main business indicators of Tianjin tertiary hospitals have gradually recovered. The operation of Internet medical care during the epidemic has changed the management and operation mode of the hospital to a certain extent, improved the main business indicators of the hospital, and eased the pressure on the hospital's economic operation.

A Game Model for Medical Service Pricing Based on the Diagnosis Related Groups

Background: Currently there are various issues that exist in the medical institutions in China as a result of the price-setting in DRGs, which include the fact that medical institutions tend to choose patients and that the payment standard for complex cases cannot reasonably compensate the cost.

Objective: The main objective is to prevent adverse selection problems in the operations of a diagnosis-related groups (DRGs) system with the game pricing model for scientific and reasonable pricing.

Methods: The study proposes an improved bargaining game model over three stages, with the government and patients forming an alliance. The first stage assumes the alliance is the price maker in the Stackelberg game to maximize social welfare. Medical institutions are a price taker and decide the level of quality of medical service to maximize their revenue. A Stackelberg equilibrium solution is obtained. The second stage assumes medical institutions dominate the Stackelberg game and set an optimal service quality for maximizing their revenues. The alliance as the price taker decides the price to maximize the social welfare. Another Stackelberg equilibrium solution is achieved. The final stage establishes a Rubinstein bargaining game model to combine the Stackelberg equilibrium solutions in the first and second stage. A new equilibrium between the alliance and medical institutions is established.

Results: The results show that if the price elasticity of demand increases, the ratio of cost compensation on medical institutions will increase, and the equilibrium price will increase. The equilibrium price is associated with the coefficient of patients' quality preference. The absolute risk aversion coefficient of patients affects government compensation and total social welfare.

Conclusion: In a DRGs system, considering the demand elasticity and the quality preference of patients, medical service pricing can prevent an adverse selection problem. In the future, we plan to generalize these models to DRGs pricing systems with the effects of competition of medical institutions. In addition, we suggest considering the differential compensation for general hospitals and community hospitals in a DRGs system, in order to promote the goal of hierarchical diagnosis and treatment.

Running an Internet Hospital in China: Perspective Based on a Case Study

Internet hospitals, as a new forum for doctors to conduct diagnosis and treatment activities based on the internet, are emerging in China and have become integral to the development of the medical field in conjunction with increasing reforms and policies in China's medical and health system. Here, we take the Internet Hospital of the First Affiliated Hospital, Zhejiang University (FAHZU Internet Hospital) as an example to discuss the operations and functional positioning of developing internet hospital medical services in relation to physical hospitals. This viewpoint considers the platform operation, management, and network security of FAHZU Internet Hospital, and summarizes the advantages and limitations in the operation to provide a reference for other areas with interest in developing internet hospitals.

Policy Interventions, Development Trends, and Service Innovations of Internet Hospitals in China: Documentary Analysis and Qualitative Interview Study

BACKGROUND

Internet hospitals have been encouraged by the Chinese government to develop an innovative medical service model that mainly uses new internet-based technologies to increase access to health care and improve the quality and efficiency of health care delivery. However, the academic exploration of the institutional and sectoral development of internet hospitals in China is scarce in the existing literature.

OBJECTIVE

This study aimed to investigate the policy interventions, development trends, and service innovations of internet hospitals in China. It is expected that the findings from this study will contribute to the further innovation of internet hospitals in China and provide references for the international development of internet hospitals for personalized digital health and patient-centric services.

METHODS

This study analyzed official policies related to internet hospitals that were implemented by the government in China since 2005. The data of formally approved internet hospitals were collected from official websites to analyze development trends. In-depth semistructured interviews were conducted with 58 key stakeholders who represented comprehensive viewpoints about the service innovations of internet hospitals between March and November 2019.

RESULTS

In total, 25 policies that promoted the development of internet hospitals in China were identified. These policies encompassed informatization infrastructure construction, medical resource integration, development model design, service model design, and payment model design. Of the 268 internet hospitals that had received an official license from the government, 153 public internet hospitals had been built mainly by medical institutions. Public tertiary hospitals were the main actors in founding internet hospitals that were created to provide services that targeted patients with common diseases or chronic diseases or patients living in remote and rural areas. Promoting convenient access to high-quality medical resources and saving patients' and their families' time were the key values of internet hospitals.

CONCLUSIONS

The policy interventions strongly promoted the development of internet hospitals in China. Public tertiary hospitals led the development of internet hospitals. However, internet hospitals in China have mainly played roles that are complementary to those of physical medical institutions. The service model of internet hospitals needs more distinguished innovations to provide personalized digital health and patient-centric services.

Patient violence, physicians treatment decisions, and patient welfare: Evidence from China

Although violence in healthcare settings has become a common occurrence worldwide, there is limited evidence on the spillover effects of patient violence on physicians' medical decisions. Utilizing microdata on inpatients from a major public hospital, we investigated how extreme patient violence-the murder of a physician in China-affected physicians' treatment decisions and patient welfare in a hospital geographically distant from the murder site. By matching this patient dataset to physician profiles, we performed a difference-in-differences analysis in which the treatment group comprised patients admitted shortly before and after the murder shock, and the control group consisted of patients admitted during the same months in the previous year. Immediately after the shock, the provision of medical treatment was notably higher, with a 16.9% increase in the number of surgeries and a 9.5% increase in the treatment expenditures. However, patient health outcomes were worse, with an increased mortality rate of 0.9% points. Findings suggest that patient violence dramatically changed physician behavior, causing negative consequences on patients even when the healthcare workers were not direct victims of patient violence.

Evaluating the Inequality of Medical Service Accessibility Using Smart Card Data

The measurement of medical service accessibility is typically based on driving or Euclidean distance. However, in most non-emergency cases, public transport is the travel mode used by the public to access medical services. Yet, there has been little evaluation of the public transport system-based inequality of medical service accessibility. This work uses massive real smart card data (SCD) and an improved potential model to estimate the public transport-based medical service accessibility in Beijing, China. These real SCD data are used to calculate travel costs in terms of time and distance, and medical service accessibility is estimated using an improved potential model. The spatiotemporal variations and patterns of medical service accessibility are explored, and the results show that it is unevenly spatiotemporally distributed across the study area. For example, medical service accessibility in urban areas is higher than that in suburban areas, accessibility during peak periods is higher than that during off-peak periods, and accessibility on weekends is generally higher than that on weekdays. To explore the association of medical service accessibility with socio-economic factors, the relationship between accessibility and house price is investigated via a spatial econometric analysis. The results show that, at a global level, house price is positively correlated with medical service accessibility. In particular, the medical service accessibility of a higher-priced spatial housing unit is lower than that of its neighboring spatial units, owing to the positive spatial spillover effect of house price. This work sheds new light on the inequality of medical service accessibility from the perspective of public transport, which may benefit urban policymakers and planners.

An Automatic Approach Designed for Inference of the Underlying Cause-of-Death of Citizens

It is very important to have a comprehensive understanding of the health status of a country’s population, which helps to develop corresponding public health policies. Correct inference of the underlying cause-of-death for citizens is essential to achieve a comprehensive understanding of the health status of a country’s population. Traditionally, this relies mainly on manual methods based on medical staff’s experiences, which require a lot of resources and is not very efficient. In this work, we present our efforts to construct an automatic method to perform inferences of the underlying causes-of-death for citizens. A sink algorithm is introduced, which could perform automatic inference of the underlying cause-of-death for citizens. The results show that our sink algorithm could generate a reasonable output and outperforms other stat-of-the-art algorithms. We believe it would be very useful to greatly enhance the efficiency of correct inferences of the underlying causes-of-death for citizens.

Healthcare Services: Patient Satisfaction and Loyalty Lessons from Islamic Friendly Hospitals

BACKGROUND

The study has aimed to investigate the Muslim patient's psychological factors related to healthcare services that influence their loyalty intention for further treatment at private hospitals in Malaysia.

METHODS

Data were collected from private hospitals in Klang Valley. A total of 379 responses from patients were analysed using the structural equation modelling approach.

RESULTS

The findings revealed that administrative behaviour, nurse's services and Shariah amenities have a highly significant impact on satisfaction. The healthcare technicality, hospital environment and physician's services have a significant relationship with patient satisfaction. Patient satisfaction has a significant impact on patient loyalty to healthcare services at the hospital. Administrative behaviour, physicians' services and healthcare technicality have a direct and positive relationship with loyalty intention, while Shariah amenity has a negative significant relationship with loyalty.

CONCLUSION

The results have important implications for product development and managerial considerations in hospitals. Service providers need to be mindful that all aspects, including Shariah amenities and generic healthcare service delivery, are important and need to be balanced and delivered satisfactorily to ensure customer satisfaction.

The Evolving Hospital Market in China After the 2009 Healthcare Reform

Since the initiation of national healthcare reform in 2009, China’s hospital market has witnessed significant change. To provide a brief description about its evolving process, China Health Statistical Yearbook data and Sichuan administrative data from 2009 to 2017 were used in this article. An overall upward trend of hospital delivery capacity was found in this study, which increased from 3.12 million beds and 1.09 million doctors in 2009 to 6.12 million and 1.80 million in 2017, respectively, while the primary healthcare institutions presented fairly slow development pace. Growing proportion of medical resources and patients gathered in hospitals, especially tertiary hospitals. While private hospitals demonstrated an increasingly important role in hospital market with growing share of capacity and service, their average capacity, especially the human resource, was found to be much lower than that of public hospitals and the gaps are still widening. The competition among hospitals grouped by homogeneous ownership types has predominated the increasingly intensified hospital market competition in China. In order to adapt to the raising demand of health care in China, it is highly recommended that strategies forged at governmental levels be focused on primary care promotion, guiding the development of private hospitals as well as on promoting orderly competition in the hospital market.

Healthcare Utilization, Unmet Service Needs, and Medication Adherence Among People Living with HIV/AIDS

BACKGROUND

Comorbidity rates and service needs are high among people living with HIV/AIDS (PLWHA). The effects of service utilization and unmet service needs on antiretroviral therapy (ART) adherence are not well understood. The purpose of this study was to investigate associations among PLWHA's service utilization, unmet service needs, and ART adherence.

METHODS

PLWHA (N=162) 18 years or older were recruited from a Nevada statewide needs assessment project in 2016. Participants completed a self-administered questionnaire on paper or online. The independent variables were service utilization and unmet service needs. The outcome variable was ART adherence. Multivariable logistic regression analyses were conducted to examine associations between the amount of utilized services and unmet service needs with ART adherence.

RESULTS

Only 12 (7.5%) participants reported they received all the needed services. The ART nonadherence group showed significantly higher unmet medical service needs compared to the ART adherence group (p=0.007). Unmet medical service needs (Adjusted Odds Ratio (AOR) 0.69, CI 0.53-0.90) and unmet support service needs (AOR 0.68, CI 0.48-0.97) were negatively associated with ART adherence. However, utilizing medical services (AOR 1.06, CI 0.87-1.30) and support services (AOR 0.88, CI 0.74-1.04) in the current year were not significantly associated with ART adherence.

CONCLUSION

The results of this study indicate that health promotion programming should focus not only on introducing new services at the community level, but also work to optimize the availability and awareness of current services. Furthermore, health promotion programs should focus on filling service coverage gaps and improving the facilitation of services.

How Do Patients and Doctors Perceive Medical Services for Rare Diseases Differently in China? Insights from Two National Surveys

Background: Increasing attention is being paid to improve the quality of life of patients with rare diseases in China. However, we are currently unaware of the problems encountered in the medical services of rare diseases from the viewpoints of doctors and patients. This study addressed the differences in the perceived barriers of diagnosis and treatments for rare diseases between doctors and patients in China. Methods: Two independent cross-sectional surveys on the perception of Chinese doctors’ and patients’ experiences with rare diseases were launched online between January and February 2018. A non-probability, convenience sampling method was employed to recruit participants. Results: In all, 45 rare diseases were reported by 139 doctors and 1853 patients. Patients with rare diseases faced significantly more difficulties in receiving accurate diagnosis (72.0%) and accessing information related to diagnosis and treatment (77.3%) as compared with doctors (34.5% and 40.3%, p < 0.0001, respectively). Specially, patients felt more difficulties than doctors in obtaining sustainable treatment for rare diseases (84.3% vs. 49.6%, p < 0.001). A higher percentage of patients (58.7%) than that of doctors (39.1%) had concerns in terms of the affordability of drugs. Further, 66.3% patients claimed that the drugs used to treat their conditions were not covered by their current medical insurances, whereas only 21.6% for doctors (p < 0.0001). Moreover, 35.3% of doctors responded that they recommended patients to visit the specialist they knew or were acquainted with, whereas 30.0% of patients said that their doctors chose to treat them based on their past experiences (p < 0.001). Conclusion: The perceived experience of patients with regard to diagnosis and treatment was significantly different from that of doctors. An integrated medical service platform should be established to facilitate better communication and mutual understanding of rare diseases between patients and doctors.

[Review of forensic medical examination commissions for some specialties in aesthetic medicine]

The purpose of the study is to identify features inherent in the specialties included in «aesthetic medicine». There has been an increase in the number of citizens turning to law enforcement agencies regarding shortcomings in the provision of medical care in general and in the field of plastic surgery and cosmetology in particular. Currently there is no clear regulation of the provision of medical care in the field of plastic surgery and cosmetology. The difficulty in assessing medical care in these areas lies in the fact that they are subjective in nature, which makes it difficult to assess the correctness of the provision of appropriate medical care. The necessity of developing a unified approach to the implementation of forensic medical examinations in assessing the medical care provided by plastic surgeons and cosmetologists is shown.

[The effect of advertising activity on patients' choice of medical organization]

The article presents theoretical propositions concerning placement and dissemination of information about medical organization and practical recommendations of the advertising campaign of medical services. The analysis of the advertising activities' influence on the patient choice of the medical organization out of top annual revenue medical institutions in Russia was carried out. In economically developed countries, the support of possibility of choosing particular medical organization and physician in economic theory and in practice of organization of health care system is targeted to improving medical care quality and health care efficiency. The process of expanding possibilities of choice is officially declared as one of the priorities of development of Russian health care. However, the influence of consumer choice of patient of medical organization while addressing for medical care is still to be an object of research study in Russia.

[The concept of patient-oriented approach as a key tool of social economic development]

The article considers the need for a new model of health care. In the provision of patient care, individual needs and desired outcomes are the driving force behind all decisions in health and quality measurement. Medical care should correspond to individual preferences, needs and values of patients and take into account patient's wishes when making clinical decisions. This approach contributes to improving the quality of medical services and improving the economic well-being of the country, as evidenced by foreign research.

Provision of Paid Web-Based Medical Consultation in China: Cross-Sectional Analysis of Data From a Medical Consultation Website

Background

Web-based medical consultation, which has been adopted by patients in many countries, requires a large number of doctors to provide services. However, no study has provided an overall picture of the doctors who provide online services.

Objective

This study sought to examine doctors’ participation in medical consultation practice in an online consultation platform. This paper aimed to address the following questions: (1) which doctors provide Web-based consultation services, (2) how many patients do the doctors get online, and (3) what price do they charge. We further explored the development of market segments in various departments and various provinces.

Methods

This study explored the dataset including all doctors providing consultation services in their spare time on a Chinese Web-based consultation platform. We also brought in statistics for doctors providing offline consultations in China. We made use of Bonferroni multiple comparison procedures and z test to compare doctors in each group.

Results

There are 88,308 doctors providing Web-based consultation in their spare time on Haodf, accounting for 5.25% (88,308/1,680,062) of all doctors in China as of September 23, 2017. Of these online doctors, 49.9% (44,066/88,308) are high-quality doctors having a title of chief physician or associate chief physician, and 84.8% (74,899/88,308) come from the top, level 3, hospitals. Online doctors had an average workload of 0.38 patients per doctor per day, with an online and offline ratio of 1:14. The average price of online consultation is ¥32.3. The online ratios for the cancer, internal medicine, ophthalmology-otorhinolaryngology, psychiatry, gynecology-obstetrics-pediatrics, dermatology, surgery, and traditional Chinese medicine departments are 16.1% (2,983/18,481), 4.4% (16,231/372,974), 6.3% (8,389/132,725), 9.5% (1,600/16,801), 5.8% (12,955/225,128), 18.0% (3,334/18,481), 10.8% (24,030/223,448), and 3.8% (8,393/22,3448), respectively. Most provinces located in eastern China have more than 4000 doctors online. The online workloads for doctors from most provinces range from 0.3 to 0.4 patients per doctor per day. In most provinces, doctors’ charges range from ¥20 to ¥30.

Conclusions

Quality doctors are more likely to provide Web-based consultation services, get more patients, and charge higher service fees in an online consultation platform. Policies and promotions could attract more doctors to provide Web-based consultation. The online submarket for the departments of dermatology, psychiatry, and gynecology-obstetrics-pediatrics developed better than other departments such as internal medicine and traditional Chinese medicine. The result could be a reference for policy making to improve the medical system both online and offline. As all the data used for analysis were from a single website, the data might be biased and might not be a representative national sample of China.

Medical services at the 2017 Sapporo Asian winter games: injury and illness epidemiology at a 34-nation multisport event

OBJECTIVES

We describe the medical services provided and report the injuries and illnesses that occurred at the eighth Asian Winter Games 2017.

METHODS

A total of 2010 athletes and team officials from 32 National Olympic Committees and 2 guest countries attended this event; medical services were provided for 16 days. Medical data (medical care and physiotherapy) were collected for the same period by the organising committee for athletes and non-athletes (team officials, workforce, media and spectators) and recorded on the electronic medical record system at the medical rooms in the venues and the team residences.

RESULTS

We recorded 745 medical encounters (medical care, 443; physiotherapy, 302), of which 549 (74%) were among athletes. There were 214 injuries as well as 144 illnesses and other medical conditions. Of the 1164 athletes, 549 (47%) utilised the services. Ice hockey, snowboarding and alpine skiing had high rate of medical encounters. More than half of the delegations were not accompanied by team doctor, and rate of medical encounters was high in these teams. The vast majority of patients transferred to hospital for further care were mostly athletes (n=36 out of 41), mostly alpine skiers and ice hockey players.

CONCLUSION

Injuries and illnesses varied depending on NOC medical staffing and sport events. These data will serve organisers of medical and physiotherapy services in the Asian Winter Games and similar large events.

Healthcare Utilization in a Large Cohort of Asylum Seekers Entering Western Europe in 2015

During the current period of immigration to Western Europe, national healthcare systems are confronted with high numbers of asylum seekers with largely unknown health status. To improve care taking strategies, we assessed healthcare utilization in a large, representative cohort of newly arriving migrants consisting of n = 1533 residents of a reception center in Northern Germany in 2015. Most asylum seekers were young, male adults, and the majority came from the Eastern Mediterranean region. Overall, we observed a frequency of 0.03 visits to the onsite primary healthcare ward per asylum seeker and day of camp residence (IQR 0.0–0.07, median duration of residence 38.0 days, IQR 30.0–54.25). Female asylum seekers showed higher healthcare utilization rates than their male counterparts, and healthcare utilization was particularly low in asylum seekers in their second decade of life. Furthermore, a significant correlation between time after camp entrance and healthcare utilization behavior occurred: During the first week of camp residence, 37.1 visits/100 asylum seekers were observed, opposed to only 9.5 visits/100 asylum seekers during the sixth week of camp residence. This first data on healthcare utilization in a large, representative asylum seeker cohort entering Western Europe during the current crisis shows that primary care is most needed in the first period directly after arrival. Our dataset may help to raise awareness for refugee and migrant healthcare needs and to adapt care taking strategies accordingly.

"There Is Always a Teacher Among Them": Reflections From an American Medical Student on Time Spent With Medical Providers in the United States, China, and Vietnam

There is a famous Chinese saying by Confucius that goes “With three men walking, there is always a teacher among them.” In this narrative essay, I recount the story of how curiosity led me to find lessons about medicine from research on complementary and alternative medicine and medical service experiences in the “three men walking” of China, Vietnam, and the United States. As we visit the many teachers I had along the way, we will draw out various lessons from each experience and reflect on the value in experiencing cross-cultural medicine as a medical provider-in-training, with the hope that it will inspire other aspiring healers to cultivate their own curiosity. Travel with me from a bench outside a traditional Chinese medicine clinic in Beijing to orphanages in Vietnam and unearth what the “three men walking” of the United States, China, and Vietnam have to teach us.

[The Optimization of Amount of Laboratory Analyses in the Federal Orthopedic Clinic]

The article presents the analysis of efficiency of medical services support related to laboratory analyses in case of alteration of system of Federal clinic financing. The analysis was implemented using the example of functioning of three departments of endoprosthesis replacement of the Federal State Budget Institution "The Academician G. A. Ilizarov Russian Research Center 'Restorative Traumatology and Orthopedics' " in 2013-2015. It is established that during examined period in the structure of laboratory analyses of the Center decreasing of total number of prescriptions to all types of laboratory analyses occurred. The observed decreasing of laboratory analyses had no impact to quality of treatment of patients of the departments of endoprosthesis replacement. In particular, percentage of post-surgery complications among patients of these departments was decreasing during the examined period. The study demonstrated that to the end of 2015 decreasing of average costs in rubles per patient of departments of endoprosthesis replacement related to laboratory analyses occurred up to 20.28% as compared with 2013. The proposals were made concerning structuring of laboratory analyses for patients with endoprosthesis replacement of large joints.

[The Risk Zone As A Factor Of Professional Burn-Out Of Medical Workers]

The article presents the results of study of risk zones and factors of professional burn-out of medical workers. The theoretical foundation of syndrome of emotional burn-out, features of professional activity and individual characteristics of public health professionals are revealed. The original study used the Maslach-Jackson technique adapted by N.E. Vodopyanova to determine levels of burn-out depending on age and career pattern. The risk zones of everyday professional activity include such external factors as unregulated duration of working time and high load per single specialist due to deficiency of physicians, inadequate level of social support and legal safety, absence of market mechanisms of compensation of health damage, absence of national patient-oriented system within the framework of health care modernization, unpredictability of behavior of patients. The given priorities and difficulties are studied on the example of the Republic of Mari-El. The Republic takes measures concerning training of physicians (a special faculty is organized) social support and stimulation of medical workers in rural area is developed. However, there is deficiency of physicians, load per single physician increases, level of salary did not fit requirements of the May decrees of the President of the Russian Federation. The reduction of risk zones of professional burn-out will favor development of national patient-oriented health care system, introduction of automated work places for physicians and increasing of their qualification, development of comfortable environment and atmosphere of friendliness in medical organizations.

On Line Service Composition in the Integrated Clinical Environment for eHealth and Medical Systems

Medical and eHealth systems are progressively realized in the context of standardized architectures that support safety and ease the integration of the heterogeneous (and often proprietary) medical devices and sensors. The Integrated Clinical Environment (ICE) architecture appeared recently with the goal of becoming a common framework for defining the structure of the medical applications as concerns the safe integration of medical devices and sensors. ICE is simply a high level architecture that defines the functional blocks that should be part of a medical system to support interoperability. As a result, the underlying communication backbone is broadly undefined as concerns the enabling software technology (including the middleware) and associated algorithms that meet the ICE requirements of the flexible integration of medical devices and services. Supporting the on line composition of services in a medical system is also not part of ICE; however, supporting this behavior would enable flexible orchestration of functions (e.g., addition and/or removal of services and medical equipment) on the fly. iLandis one of the few software technologies that supports on line service composition and reconfiguration, ensuring time-bounded transitions across different service orchestrations; it supports the design, deployment and on line reconfiguration of applications, which this paper applies to service-based eHealth domains. This paper designs the integration between ICE architecture and iLand middleware to enhance the capabilities of ICE with on line service composition and the time-bounded reconfiguration of medical systems based on distributed services. A prototype implementation of a service-based eHealth system for the remote monitoring of patients is described; it validates the enhanced capacity of ICE to support dynamic reconfiguration of the application services. Results show that the temporal cost of the on line reconfiguration of the eHealth application is bounded, achieving a low overhead resulting from the addition of ICE compliance.

Trends regarding percutaneous endoscopic gastrostomy: A nationwide population-based study from 1997 to 2010

Percutaneous endoscopic gastrostomy (PEG) is widely used in patients requiring long-term tube feeding. Traditional PEG studies usually focused on practical, technical, and ethical issues. There have been little epidemiological studies on PEG utilization and services in Asia. We evaluated the changes in PEG utilization, patient selection, patient characteristics, and medical service in Taiwan from 1997 to 2010.This retrospective study analyzed the data of patients admitted for PEG tube placement according to the International Classification of Diseases, Ninth Revision (procedure code 43.11) extracted from the National Health Insurance database between 1997 and 2010.From 1997 to 2010, the incidence of PEG increased from 0.1 to 3.8/10 population and incidence of PEG among aged patients increased from 0.9 to 19.0/10 population. Compared 1997-2004 to 2005-2010 periods, the percentage of cerebrovascular diseases decreased and esophageal cancer increased in the later period. PEG was mainly performed in male patients and at medical centers. Medical costs, Charlson Comorbidity Index (CCI) scores, and post-PEG mortality rates were higher in the 2005-2010 period than in the 1997-2004 period.PEG procedures are being increasingly performed in Taiwan, and changes in patient selection were noted. The seriousness of accompanying diseases, medical costs, and post-PEG mortality rates in patients undergoing PEG has increased. The present findings may help in the implementation of PEG, relocation of medical resources, and improvement of PEG-related care.

[Medical services at Paris-Charles-de-Gaulle airport]

Charles-de-Gaulle airport in Roissy, a 3 400 hectare citadel, contains a multitude of airlines, service companies, businesses, retailers and public services, including firefighters, police officers, customs officers, ministers and medical teams. This article presents its missions, notably with regard to health services.

Factors influencing the opinion of patients concerning the functioning of the Polish hospital before and after ownership transformation

Studies of satisfaction among patients are a popular and frequently obligatory tool used in improving the quality of medical services worldwide. Becoming familiar with the opinion of the patients enables to adjust the venue to their expectations, thus contributing to the increase in its competitiveness. We aimed to study patients' satisfaction understood as a tool used in increasing the quality of medical services; in addition, we assessed factors that affect a worse review patients gave about the functioning of this Polish hospital before and after its transformation into a commercial company. The study of satisfaction among patients was conducted using an anonymous questionnaire among 2702 respondents before and 2795 respondents after the hospital's transformation. Multivariate logistic regression analysis was applied to statistically analyze the collected empirical material, where the dependent variable was a worse evaluation of respondents concerning the functioning of the hospital. It was demonstrated that both before and after the hospital's transformation into a commercial company, it was education and conditions of housing of patients that determined their opinion about the functioning of the admission center and hospital wards. A higher level of education increases the risk of a worse evaluation of the admission center and hospital wards, whereas higher self-evaluation of housing conditions lowered the discussed risk. Factors that influence the opinion of patients concerning the functioning of the hospital are education, age, marital status, housing conditions of the respondents and also the number of stays at a given hospital, and a conscious choice of the facility in which a patient wished to be treated.

Effects of changes in ownership of the Polish hospital on the patients' opinion about its functioning

System changes in health care centers have been directed at introducing such marketing elements into the Polish health care system as managerial approach to managing the centers and contracting medical services and quality management. High quality of the medical services and patients’ satisfaction became the key factors deciding about “the brand” of a health care center. The aim of the work was to assess the effect of changes in ownership of the hospital on the patients’ opinion about its functioning. Patients’ satisfaction survey was carried out through an anonymous questionnaire among 2702 respondents before and 2795 respondents after the transformation of the hospital. Multivariate analysis of variance (MANOVA) was used to analyze the collected empirical material. The assessment of the functioning of the admission center and hospital wards was significantly higher among the respondents asked after the transformation of the hospital as opposed to the assessment before it. Transforming the public hospital in Poland into a commercial company helped improve its functioning in the opinion of patients. There is a need to carry out further systematic research into the patients’ satisfaction better adjust the hospital’s offer to the needs of the hospitalized people.

Availability of clean tap water and medical services prevents the incidence of typhoid Fever

Objective:

In this study, the factors that induced a decrease in the incidence of typhoid fever were analyzed. Based on the study results, we propose a quantitative and concrete solution to reduce the incidence of typhoid fever.

Methods:

We analyzed the incidence and fatality rate of typhoid fever in Korea. Tap water service rate and the number of pharmacies, which affect the incidence rate of typhoid fever, were used as environmental factors.

Results:

To prevent typhoid fever in the community, it is necessary to provide clean tap water service to 35.5% of the population, with an individual requiring 173 L of clean water daily. Appropriate access to clean water (51% service coverage, 307 L) helped the population to maintain individual hygiene and food safety practices, which brought about a decrease in the incidence of typhoid fever, and subsequently a decrease in fatality rate, which was achieved twice. During the 8-year study period, the fatality rate decreased to 1% when the population has access to proper medical service.

Conclusion:

The fatality rate was primarily affected by the availability of medical services as well as by the incidence of typhoid fever. However, an analysis of the study results showed that the incidence of typhoid fever was affected only by the availability of clean water through the tap water system.