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Corrigendum to "Healthcare Professionals' Resilience during the COVID-19 and Organizational Factors That Improve Individual Resilience: A Mixed-Method Study". 医疗保健专业人员在 COVID-19 考试中的应变能力与提高个人应变能力的组织因素》的更正:混合方法研究 "的更正。
IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-04 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241298050

[This corrects the article DOI: 10.1177/11786329231198991.].

[This corrects the article DOI: 10.1177/11786329231198991.].
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引用次数: 0
A Fuzzy Bi-objective Mathematical Model for Perishable Medical Goods Supply Chain Network Considering Crisis Situations: An Empirical Study. 考虑危机情况的易腐医疗用品供应链网络模糊双目标数学模型:实证研究。
IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-02 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241288772
Fereshteh Shahrabadi, Hamidreza Kia, Ali Heidari, Mohammad Khalilzadeh

In case of crisis, the salvation of injuries depends on the timely provision of medical goods, relief supplies, and equipment. The aim of this study is to present a mathematical model for the supply chain network of perishable medical goods in crisis situation considering the uncertain environment. In this paper, a three-level supply chain including suppliers, intermediate warehouses, and final customers is developed for perishable medical items. The uncertainty of customer demand for service and the spent time in the intermediate warehouses are considered using the exponential distribution functions. Also, it is assumed that the life-cycle of perishable medical goods follow the Weibull distribution function. The model attempts to minimize the total costs of the supply chain and total presence time of perishable items in the whole chain. The LP-Metric method is employed for solving small-sized problems. Due to the NP-Hardness of the problem, the modified Multi-objective Particle Swarm Optimization (MOPSO) and Non-dominated Sorting Genetic Algorithm (NSGA-II) are utilized as 2 well-known and efficient meta-heuristic algorithms for solving large-sized problems. The findings indicate that the meta-heuristic algorithms are efficient in achieving close to the optimal solution for large-size problems in a reasonable time. Also, the results demonstrate that NSGA-II outperforms MOPSO in terms of the high quality solution. Finally, the applicability of the model to real-world problems is demonstrated using a real case study. This paper can assist the planners and decision-makers of perishable drugs supply chain networks in crisis conditions with on-time supplying and distributing the required emergency items.

在危机情况下,伤员的救治取决于医疗物资、救援物资和设备的及时供应。本研究的目的是在考虑不确定环境的情况下,提出危机情况下易腐医疗物品供应链网络的数学模型。本文针对易腐医疗物品建立了包括供应商、中间仓库和最终客户在内的三级供应链。使用指数分布函数考虑了客户服务需求和中间仓库停留时间的不确定性。此外,还假设易腐医疗物品的生命周期遵循 Weibull 分布函数。该模型试图最小化供应链的总成本和易腐物品在整个供应链中的总停留时间。该模型采用 LP-Metric 方法解决小型问题。由于问题的 NP-Hardness,我们采用了改进的多目标粒子群优化算法(MOPSO)和非支配排序遗传算法(NSGA-II)这两种著名且高效的元启发式算法来解决大型问题。研究结果表明,元启发式算法能在合理的时间内高效地为大型问题找到接近最优的解决方案。此外,研究结果还表明,NSGA-II 在高质量解方面优于 MOPSO。最后,本文通过一个实际案例研究证明了该模型在实际问题中的适用性。本文可以帮助易腐药品供应链网络的规划者和决策者在危机条件下及时供应和分发所需的应急物品。
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引用次数: 0
Procedure Prioritization During a Nationwide Ban on Non-Urgent Healthcare: A Quasi-Experimental Retrospective Study of Hospital Data in Switzerland. 在全国范围内禁止非急诊医疗期间的手术优先顺序:瑞士医院数据的准实验性回顾研究》。
IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-10-23 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241293534
Thomas Grischott, Tarun Mehra, Matthias R Meyer, Oliver Senn, Yael Rachamin

Background: During the COVID-19 lockdown in spring 2020, Switzerland restricted non-urgent healthcare services to safeguard capacity. While prioritization of care was supposed to be driven by medical urgency, demographic factors or economic incentives might have influenced the hospitals' resource allocation decisions.

Objectives: This study investigates potential determinants of procedure prioritization in hospitalized patients during the lockdown period.

Design: Quasi-experimental retrospective study of hospital data in Switzerland.

Methods: We analyzed 496 456 adult patients with known insurance status and a recorded procedure, admitted for cardiovascular, orthopedic/musculoskeletal or oncological reasons from January 2017 (3 years before the COVID-19 outbreak) to mid-April 2020 (in the first year of the COVID-19 pandemic), to obtain admission rate ratios (ARRs, "lockdown" admission rates divided by "normal" rates) from negative binomial regression analysis of fortnightly admissions for frequent procedure-diagnosis combinations. Quade and Wilcoxon signed-rank tests compared ARRs between sex×age, insurance and comorbidity strata.

Results: Admission rates showed significant reductions for 29 of 53 procedure-diagnosis combinations. Reductions varied strongly by emergency, with largest decreases in orthopedic procedures for arthrosis (osteoarthritis) and non-arthritic joint disorders, and the smallest in cerebral imaging for stroke patients and surgical procedures for malignant neoplasms. The only difference in ARRs between strata was a stronger decrease in admission rates for cardiovascular combinations for patients with private versus basic health insurance.

Conclusion: While medical procedures were affected to varying degrees by the ban on non-urgent healthcare during the COVID-19 lockdown, we found no robust evidence that factors other than medical urgency influenced healthcare prioritization.

背景:在 2020 年春季 COVID-19 封锁期间,瑞士限制了非紧急医疗服务,以保障医疗能力。虽然医疗服务的优先顺序应由医疗紧迫性决定,但人口因素或经济激励可能会影响医院的资源分配决策:本研究调查了封锁期间住院病人手术优先顺序的潜在决定因素:设计:瑞士医院数据的准实验性回顾研究:我们分析了2017年1月(COVID-19疫情爆发前3年)至2020年4月中旬(COVID-19大流行的第一年)期间因心血管、骨科/肌肉骨骼或肿瘤原因入院的496 456名已知保险状况且有手术记录的成年患者,通过对频繁手术-诊断组合的每两周入院情况进行负二项回归分析,得出入院率比(ARRs,"封锁 "入院率除以 "正常 "入院率)。Quade和Wilcoxon符号秩检验比较了性别×年龄、保险和合并症分层之间的ARR:在 53 种手术-诊断组合中,29 种的入院率明显下降。不同急诊病人的入院率差异很大,其中关节病(骨关节炎)和非关节炎性关节紊乱的骨科手术入院率降幅最大,中风病人的脑成像和恶性肿瘤的外科手术入院率降幅最小。各阶层之间平均住院日率的唯一差异是,私人医疗保险患者与基本医疗保险患者的心血管组合入院率降幅更大:虽然在 COVID-19 封锁期间,医疗程序在不同程度上受到了非紧急医疗禁令的影响,但我们没有发现有力的证据表明医疗紧急性以外的因素影响了医疗优先级的确定。
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引用次数: 0
Navigating Rehabilitation Transitions at Street Level: A Qualitative Analysis of Municipal Service Allocation to Individuals With Complex Needs. 在街道一级引导康复过渡:为有复杂需求的个人分配市政服务的定性分析。
IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-10-20 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241293347
Maren Ekenes, Eike Wehling, Olin Oldeide

The transition of patients with complex needs from hospital to municipal rehabilitation following moderate and severe brain injury is challenging. This qualitative study explored the municipal service allocation processes within such transitions. The caseworkers' comprehensive task of combining patients' preferences and needs, healthcare providers' recommendations and municipal guidelines and service allocation were analysed. Data comprised of patients' health records, meeting observations and semi-structured interviews with municipal staff, patients and next of kin. Results demonstrated that the issue of most concern was the location of where the patient was to continue municipal rehabilitation. Municipal caseworkers gathered extensive information, including recommendations from healthcare providers and preferences of patients and next of kin. These were frequently in contrast to the municipal guidelines' requirements and the services' organisational structure. The discrepancies led to tension, which was difficult to manoeuvre. This study indicates that incorporating individually tailored services into the daily service allocation practice can be demanding and even dilemmatic. The designated focus on the transition of patients with complex rehabilitation needs gives insights into how service allocation, user involvement and coordination policies are acted out in practice and may directly influence rehabilitation trajectories.

中度和重度脑损伤后,有复杂需求的患者从医院向市政康复机构的过渡是一项挑战。这项定性研究探讨了这种过渡中的市政服务分配过程。研究分析了个案工作者将患者的偏好和需求、医疗服务提供者的建议和市政指南与服务分配相结合的综合任务。数据包括患者的健康记录、会议观察以及对市政工作人员、患者和近亲进行的半结构化访谈。结果表明,最受关注的问题是患者继续市政康复的地点。市政个案工作者收集了大量信息,包括医疗服务提供者的建议以及病人和近亲的偏好。这些信息往往与市政指南的要求和服务机构的组织结构相悖。这些差异导致了紧张局势,很难加以控制。这项研究表明,在日常服务分配实践中纳入为个人量身定制的服务可能要求很高,甚至会陷入两难境地。对有复杂康复需求的病人的过渡情况进行专门关注,有助于深入了解服务分配、用户参与和协调政策在实践中是如何执行的,并可能直接影响康复轨迹。
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引用次数: 0
Patterns of Antidepressant and Anxiolytic Use and Spending in 14 European Countries (2012-2021): A Comprehensive Time Series Analysis. 14 个欧洲国家抗抑郁药和抗焦虑药的使用和支出模式(2012-2021 年):综合时间序列分析》。
IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-10-08 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241282526
Manuela Martella, Ettore Minutiello, Maria Michela Gianino

Background: The assessment of antidepressant and anxiolytic consumption and expenditures represents a reliable barometer of the burden of such mental health disorders and the effectiveness of relative healthcare services.

Objectives: The current analysis aims to evaluate trajectories of consumption and expenditures of antidepressant and anxiolytic drugs to define patterns of usage and spending across 14 European countries between 2012 and 2021.

Methods: A retrospective longitudinal study was performed based on pooled time series secondary data analysis over 2012/2021. Defined Daily Doses (DDD) per 1000 inhabitants and health expenditure per capita were analysed. Linear and quadratic trends were computed to determine relationships between the variables of interest.

Results: Only 2 patterns of consumption/expenditure of antidepressants can be identified: consumption and expenditure both grow; consumption grows, and spending decreases. Consumption and expenditures registered 2 main patterns, decreasing in most European countries and increasing only in 2 cases.

Conclusion: Prevailing patterns of consumption and spending show an increase in antidepressants and a decrease in anxiolytics. The variation in consumption of such drugs during this timeframe is attributable to several reasons, such as the epidemiological characteristics of mental disease, for instance, the prevalence and incidence of disorders, the accessibility of drugs and alternative treatments, like psychotherapy, different clinical practices and national guidelines. However, such analyses deserve attention for targeted policies and strategies for promoting mental health.

背景:抗抑郁药和抗焦虑药的消费和支出评估是此类精神疾病负担和相关医疗服务有效性的可靠晴雨表:目前的分析旨在评估抗抑郁和抗焦虑药物的消费和支出轨迹,以确定 2012 年至 2021 年期间 14 个欧洲国家的使用和支出模式:方法:在对 2012/2021 年的时间序列二级数据进行汇总分析的基础上,开展了一项回顾性纵向研究。对每 1000 名居民的定义日剂量(DDD)和人均医疗支出进行了分析。计算了线性和二次趋势,以确定相关变量之间的关系:结果:抗抑郁药物的消费/支出只有两种模式:消费和支出同时增长;消费增长,支出减少。消费和支出有 2 种主要模式,在大多数欧洲国家呈下降趋势,只有 2 个国家呈上升趋势:结论:消费和支出的主要模式显示,抗抑郁药的消费增加,抗焦虑药的消费减少。这一时期此类药物消费的变化可归因于多种原因,如精神疾病的流行病学特征,如精神疾病的流行率和发病率、药物和替代疗法(如心理疗法)的可及性、不同的临床实践和国家指导方针。不过,这些分析值得关注,以便制定有针对性的政策和战略,促进心理健康。
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引用次数: 0
Exploring the Impediments: Investigating Barriers to Participation in Phase-2 Cardiac Rehabilitation Following Coronary Artery Bypass Graft Among Thai Patients. 探索障碍:调查泰国患者参与冠状动脉旁路移植术后第二阶段心脏康复的障碍。
IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-10-05 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241287397
Sarissa Rangkla, Tanawat Petrutchatachart, Timporn Vitoonpong, Thanapoom Rattananupong, Jirapa Champaiboon

Background: Despite the known benefits of cardiac rehabilitation (CR), the rate of participation is low following coronary artery bypass graft (CABG). The reasons for this lack of participation are unclear and there have been few studies investigating this, particularly in Asian countries. The present study aimed to address this lack of information and identify reasons for non-participation in phase-2 CR among patients who underwent CABG.

Methods: We enrolled 42 patients who underwent CABG or CABG combined with valvular heart surgery in a university hospital between October 2016 to September 2018. Patients who participated in phase-1 but not phase-2 CR were interviewed by phone following an 11-item questionnaire.

Results: The rate of participation in phase-2 CR was only 12.5%. The most frequently reported reason for non-participation was "Did not know that there was phase-2 CR" (61.9%), followed by "Transportation problems" (31%). "Unable to take leave due to work schedule" was fairly frequently reported (19%) as was "Did not participate due to chronic diseases and complications" (14.3%).

Conclusion: Our study revealed low participation in phase-2 CR, despite its well-known benefits. The primary reason identified was a lack of awareness and understanding among patients regarding phase-2 CR. This highlights the need for targeted interventions aimed at increasing knowledge and awareness of the benefits and availability of CR. Additionally, it is crucial to establish an efficient referral system that ensures seamless transitions from the initial cardiac treatment to the rehabilitation phase. Implementing these strategies is expected to boost CR participation, leading to improved patient outcomes and overall cardiac health.

背景:尽管心脏康复(CR)的益处众所周知,但冠状动脉旁路移植术(CABG)后的参与率却很低。不参加康复的原因尚不清楚,对此进行调查的研究也很少,尤其是在亚洲国家。本研究旨在解决这一信息缺乏的问题,并找出接受 CABG 手术的患者未参与 2 期 CR 的原因:我们招募了 2016 年 10 月至 2018 年 9 月期间在一家大学医院接受 CABG 或 CABG 联合瓣膜性心脏手术的 42 名患者。我们通过电话对参加了第一阶段但未参加第二阶段CR的患者进行了访谈,访谈中使用了11个项目的调查问卷:结果:参与第二阶段 CR 的比例仅为 12.5%。未参与的最常见原因是 "不知道有第二阶段 CR"(61.9%),其次是 "交通问题"(31%)。"因工作安排无法休假"(19%)和 "因慢性病和并发症未参加"(14.3%)也是相当常见的原因:我们的研究表明,尽管第二阶段 CR 的益处众所周知,但其参与率却很低。结论:我们的研究表明,尽管第二阶段 CR 的益处众所周知,但其参与率却很低。发现的主要原因是患者对第二阶段 CR 缺乏认识和了解。这突出表明,有必要采取有针对性的干预措施,以提高人们对 CR 的益处和可用性的了解和认识。此外,建立高效的转诊系统,确保从最初的心脏治疗无缝过渡到康复阶段也至关重要。实施这些策略有望提高 CR 的参与率,从而改善患者的治疗效果和整体心脏健康状况。
{"title":"Exploring the Impediments: Investigating Barriers to Participation in Phase-2 Cardiac Rehabilitation Following Coronary Artery Bypass Graft Among Thai Patients.","authors":"Sarissa Rangkla, Tanawat Petrutchatachart, Timporn Vitoonpong, Thanapoom Rattananupong, Jirapa Champaiboon","doi":"10.1177/11786329241287397","DOIUrl":"10.1177/11786329241287397","url":null,"abstract":"<p><strong>Background: </strong>Despite the known benefits of cardiac rehabilitation (CR), the rate of participation is low following coronary artery bypass graft (CABG). The reasons for this lack of participation are unclear and there have been few studies investigating this, particularly in Asian countries. The present study aimed to address this lack of information and identify reasons for non-participation in phase-2 CR among patients who underwent CABG.</p><p><strong>Methods: </strong>We enrolled 42 patients who underwent CABG or CABG combined with valvular heart surgery in a university hospital between October 2016 to September 2018. Patients who participated in phase-1 but not phase-2 CR were interviewed by phone following an 11-item questionnaire.</p><p><strong>Results: </strong>The rate of participation in phase-2 CR was only 12.5%. The most frequently reported reason for non-participation was \"Did not know that there was phase-2 CR\" (61.9%), followed by \"Transportation problems\" (31%). \"Unable to take leave due to work schedule\" was fairly frequently reported (19%) as was \"Did not participate due to chronic diseases and complications\" (14.3%).</p><p><strong>Conclusion: </strong>Our study revealed low participation in phase-2 CR, despite its well-known benefits. The primary reason identified was a lack of awareness and understanding among patients regarding phase-2 CR. This highlights the need for targeted interventions aimed at increasing knowledge and awareness of the benefits and availability of CR. Additionally, it is crucial to establish an efficient referral system that ensures seamless transitions from the initial cardiac treatment to the rehabilitation phase. Implementing these strategies is expected to boost CR participation, leading to improved patient outcomes and overall cardiac health.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11456183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cloud Horizons: Strengthening Rural Healthcare Through Telemedicine's Digital Canopy. 云地平线:通过远程医疗的数字天幕加强农村医疗保健。
IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-28 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241284401
Felician Andrew Kitole, Sameer Shukla

Introduction: Cloud-based telemedicine holds promise for improving healthcare accessibility and delivery, particularly in rural areas of developing countries like Tanzania. However, little is known about its determinants and benefits in such contexts. This study investigates the factors influencing the usage of telemedicine in Mvomero district, Morogoro region, Tanzania, focusing on both supply and demand sides.

Method: Using structured interviews and key informant interviews, the study examines various cloud-based telemedicine platforms, including remote monitoring, electronic health records, cloud-based storage, and machine learning algorithms. The study used descriptive statistics to analyze quantitative data, while thematic analysis was used to analyze qualitative data.

Results: Results reveal several factors influencing telemedicine usage. On the demand side, perceived benefits (53.96%), technology cost (62.79%), legal practices (62.79%), and resource availability and affordability (49.77%) are crucial. On the supply side, technological innovation (35%) and access to financial resources (43%) play pivotal roles. Environmental and institutional factors such as political willingness (38%) and regulatory support (34%) also impact telemedicine usage. Moreover, results reveal that cloud-based telemedicine platforms in rural healthcare facilities have several benefits including improved access (32.74% to 57.44%), cost efficiency (37.88% to 54.82%), timely consultations (56.83% to 65.21%), health monitoring, and prescription management (43.89% to 75.90%). Private facilities particularly emphasize health monitoring.

Conclusion: Adopting telemedicine technologies can revolutionize rural healthcare by providing customized and easily accessible services. Policymakers can use these findings to develop targeted strategies, including subsidized infrastructure, innovative financing models, and clear regulatory frameworks. Clear guidelines on data transfer and privacy are essential to ensure legal compliance and equitable access to telemedicine benefits. Simplifying registration requirements and implementing explicit consent mechanisms are recommended to address data privacy concerns. These measures aim to promote operational efficiency, data safety, and enhanced health outcomes in resource-limited settings.

导言:基于云的远程医疗有望改善医疗服务的可及性和交付,尤其是在坦桑尼亚等发展中国家的农村地区。然而,人们对其在此类环境中的决定因素和益处知之甚少。本研究调查了影响坦桑尼亚莫罗戈罗地区姆沃梅罗区使用远程医疗的因素,重点关注供需双方:本研究采用结构化访谈和关键信息提供者访谈的方法,研究了各种基于云的远程医疗平台,包括远程监控、电子健康记录、云存储和机器学习算法。研究使用描述性统计来分析定量数据,同时使用专题分析来分析定性数据:结果:研究结果显示了影响远程医疗使用的几个因素。在需求方面,感知到的益处(53.96%)、技术成本(62.79%)、法律惯例(62.79%)以及资源可用性和可负担性(49.77%)至关重要。在供给方面,技术创新(35%)和获得财政资源(43%)起着关键作用。政治意愿(38%)和监管支持(34%)等环境和制度因素也影响着远程医疗的使用。此外,研究结果表明,农村医疗机构基于云的远程医疗平台具有多种优势,包括改善就医途径(32.74% 至 57.44%)、成本效率(37.88% 至 54.82%)、及时就诊(56.83% 至 65.21%)、健康监测和处方管理(43.89% 至 75.90%)。私营机构尤其重视健康监测:采用远程医疗技术可以通过提供个性化和便捷的服务彻底改变农村医疗保健。政策制定者可以利用这些发现制定有针对性的战略,包括补贴基础设施、创新融资模式和明确的监管框架。明确的数据传输和隐私准则对于确保合法合规和公平享受远程医疗福利至关重要。建议简化注册要求并实施明确的同意机制,以解决数据隐私问题。这些措施的目的是在资源有限的环境中提高运行效率、数据安全和增强医疗成果。
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引用次数: 0
Knowledge, Attitude, and Practice of Geriatric Care Among Health Care Professionals in Kumasi, Ghana. 加纳库马西医护人员对老年病护理的认识、态度和实践。
IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-28 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241285529
Emmanuel Amoateng, Manasseh B Wireko, Augustine Y Assah, Michael Darko Ashaley, Samudeen Sani, Henry S Opare-Addo, Gordon A Manu

Background: The Ghanaian elderly population is increasing at the fastest rate and this has become a burden as the rate is not proportional to the investment in health to meet their deteriorating health needs. This creates discrepancies and inequalities in healthcare access and coupled with poor healthcare provider services, the inequalities widen. Poor care services are related to poor knowledge and bad attitudes of care providers hence this study seeks to explore the health practitioners' level of knowledge, attitude, and practice (KAP) toward geriatric care.

Methods: The study used a cross-sectional survey design with a simple stratified random technique to select study participants. Out of 257 participants who were sampled for the study, 215 responses were received, representing 83.6% response rate. However, 200 questionnaires were complete (93%) and valid for analysis, which consisted of 166 nurses, representing 83% valid responses, and 34 medical officers, physician assistants, and other allied health care providers, representing 17% valid responses from these professionals. A structured questionnaire was used to assess KAP using the knowledge about Older Patients Quiz (KOP-Q) and Kogan's Attitudes toward Old People Scale (KAOP). Using a mean score of 80%, knowledge, attitude, and practice were dichotomized into good or bad. The Kruskal-Wallis H test was used to compare mean rank across health professionals' knowledge, attitude, and practice of geriatric care.

Results: It shows that the majority (94%) of participants have low levels of knowledge in geriatric care. The majority (84%) of participants do not practice good geriatric care. Differences in knowledge exist among health providers and were statistically significant (P = .045). Doctors had the lowest mean knowledge score (78.61). Nurses (100.27) and physician assistants (106.15) had moderate mean knowledge score ranks. Although not statistically significant, the rank order for practice scores from highest to lowest was: physician assistants (112.95), nurses (99.19), and doctors (79.21). There were however no statistically significant differences between professions in practice scores (P = .067), or attitude scores (P = .097).

Conclusion: Health care providers have low knowledge and, bad attitude toward aged care and this may be related to their service delivery which may affect the aged patronage of healthcare services. This is a wake-up call for authorities to organize continuous professional development to enable care providers to improve their service delivery.

背景:加纳老年人口正以最快的速度增长,这已成为一种负担,因为增长速度与为满足老年人日益恶化的健康需求而进行的医疗投资不成正比。这就造成了在获得医疗服务方面的差异和不平等,再加上医疗服务提供者的服务质量差,不平等就进一步扩大了。医疗服务差与医疗服务提供者的知识贫乏和态度恶劣有关,因此,本研究旨在探讨医疗从业人员对老年病护理的知识、态度和实践(KAP)水平:本研究采用横断面调查设计和简单的分层随机技术来选择研究对象。在抽取的 257 名参与者中,共收到 215 份回复,回复率为 83.6%。其中,护士 166 人,占有效问卷的 83%;医务人员、医生助理和其他专职医疗人员 34 人,占有效问卷的 17%。采用结构化问卷调查法,使用老年患者知识测验(KOP-Q)和科根老年态度量表(KAOP)对老年患者知识和态度进行评估。以平均得分 80% 为标准,将知识、态度和实践分为好坏两类。采用 Kruskal-Wallis H 检验比较医务人员对老年护理的知识、态度和实践的平均等级:结果表明,大多数参与者(94%)对老年病护理的了解程度较低。大多数参与者(84%)没有进行良好的老年病护理。医疗服务提供者之间的知识水平存在差异,且差异具有统计学意义(P = .045)。医生的知识平均得分最低(78.61)。护士(100.27)和医生助理(106.15)的平均知识得分排名中等。尽管没有统计学意义,但实践得分从高到低的排序依次为:医生助理(112.95)、护士(99.19)和医生(79.21)。然而,在实践得分(P = .067)或态度得分(P = .097)方面,不同职业之间没有明显的统计学差异:结论:医疗服务提供者对老年护理的认识不足,态度不端正,这可能与他们提供的服务有关,从而影响老年人对医疗服务的光顾。这为有关当局敲响了警钟,要求他们组织持续的专业培训,使医疗服务提供者能够改善他们的服务。
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引用次数: 0
Economic Impact of Ambulatory Blood Pressure Monitoring Compared With Clinical Blood Pressure Monitoring: A Simulation Model. 非卧床血压监测与临床血压监测相比的经济影响:模拟模型。
IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-24 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241283797
Michelle A Hayek, Alejandro Catacora, Mark A Lawley, Hye-Chung Kum, Robert L Ohsfeldt

Background: Ambulatory blood pressure monitoring (ABPM) is considered the gold standard for proper diagnosis of hypertension. Yet, access to ABPM in the U.S. is limited, and the extent of coverage by commercial health plans remains uncertain, potentially limiting access to ABPM among commercially insured patients.

Objective: This study aims to assess the net cost impact of using ABPM in comparison to clinical blood pressure monitoring (CBPM) in the U.S. over a 5-year time period.

Design methods: Using a Markov Model, we estimate the 5-year cumulative cost impact of using ABPM to confirm a prior diagnosis of primary hypertension using CBPM to avoid treatment for white-coat hypertension (WCH) in a hypothetical cohort of 1000 patients from a U.S. healthcare system perspective. The probability and cost inputs for the model were derived from available literature. Base-case model parameters were varied to account for different scenarios.

Results: Base-case results indicate using ABPM instead of CBPM over 5 years saves a total of $348,028, reflecting an average per-person-per-year (PPPY) cost saving of $70. In sensitivity analyses, almost all cases reveal ABPM as a cost-saving approach compared to CBPM, with cost savings reaching up to $228 PPPY in the highest hypertension treatment cost model. Regression results reveal that ABPM was cost-saving compared to CBPM if ABPM annual payment rates are $100 or less and annual hypertension treatment costs are ⩾$300.

Conclusion: The potential cost-savings of using ABPM instead of CBPM found in our simulation model underscores the need for confirmatory research using real-world data to support increased use of ABPM as the standard diagnostic approach for hypertension.

背景:非卧床血压监测 (ABPM) 被认为是正确诊断高血压的黄金标准。然而,在美国获得 ABPM 的机会有限,而且商业健康计划的覆盖范围仍不确定,这可能会限制商业保险患者获得 ABPM:本研究旨在评估在美国使用 ABPM 与临床血压监测 (CBPM) 相比在 5 年时间内的净成本影响:使用马尔可夫模型,我们从美国医疗保健系统的角度出发,估算了在一个由 1000 名患者组成的假设队列中,使用 ABPM 确认原发性高血压的既往诊断,使用 CBPM 避免白大衣高血压 (WCH) 治疗的 5 年累计成本影响。该模型的概率和成本输入来自现有文献。基础案例模型参数根据不同情况而变化:基本情况结果表明,使用 ABPM 代替 CBPM 5 年共可节省 348028 美元,反映出平均每人每年 (PPPY) 可节省 70 美元的成本。在敏感性分析中,几乎所有病例都显示 ABPM 比 CBPM 更能节省成本,在高血压治疗成本最高的模型中,ABPM 节省的成本高达 228 美元/人-年。回归结果显示,如果 ABPM 的年支付率为 100 美元或更低,且每年的高血压治疗费用为 300 美元,则 ABPM 比 CBPM 更能节约成本:在我们的模拟模型中发现,使用 ABPM 而非 CBPM 有可能节省成本,这突出表明有必要使用真实世界的数据进行确证研究,以支持更多使用 ABPM 作为高血压的标准诊断方法。
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引用次数: 0
Cost Analysis of Outpatient Colectomy in a Tertiary Center: A Projected Medico-Economic Evaluation. 一家三级医院门诊结肠切除术的成本分析:医学经济评估预测。
IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-24 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241284400
Fabio Agri, William Möller, Philip Deslarzes, Charles André Vogel, Dieter Hahnloser, Martin Hubner, Nicolas Demartines, Fabian Grass

Aim of the study: Short stay processes are incentives to unburden chronically stressed healthcare systems. The aim of this study is to analyze financial implications of day admission (DAS) and outpatient strategies for colon resections in a prospective payment system (PPS) using Diagnosis Related Group (DRG) coding.

Methods: Consecutive patients undergoing left and right colonic resections between January 1, 2019 and December 31, 2020 were included. Medico-economic evaluations of the virtual outpatient and day admission surgery groups based on predefined criteria were compared to the identical group of patients who underwent surgery in the actual traditional inpatient setting. In a second step, postoperative complications of the virtual outpatient group were assessed. Cost-revenue analysis was performed using a micro-costing approach including direct medical costs.

Results: Overall (N = 257), 97 (37.7%) colectomies would have been potentially eligible for an outpatient strategy. The global costs of the actual inpatient strategy totaled USD 3 634 392 with a global revenue of USD 3 571 069, corresponding to a cost coverage rate of 98%. The result of the virtual DAS strategy would have been a net loss of USD 15 800 (coverage rate of 99%) due to 4 low length of stay outliers triggering a reimbursement reduction and preventing a positive net result of USD 16 208. The pilot reference outpatient case's revenue and cost amounted to respectively USD 7479 and USD 6911 (cost coverage of 108%).

Conclusion: From both any given hospital and healthcare system point of view, elective outpatient colectomy for selected patients is the most cost-saving option. However, in a prospective payment system implemented to avoid bad incentives, the latter can unintentionally disadvantage best performing hospitals and impede widespread adoption of high-value strategies.

研究目的缩短住院时间是减轻医疗系统长期压力的激励措施。本研究旨在利用诊断相关组(DRG)编码,分析日间入院(DAS)和门诊策略对前瞻性支付系统(PPS)中结肠切除术的财务影响:方法:纳入2019年1月1日至2020年12月31日期间接受左右结肠切除术的连续患者。根据预定义标准对虚拟门诊和日间入院手术组与在实际传统住院环境中接受手术的同组患者进行医疗经济评估比较。第二步,对虚拟门诊组的术后并发症进行评估。成本收入分析采用微观成本计算法,包括直接医疗成本:总体而言(N = 257),97 例(37.7%)结肠切除术可能符合门诊策略。实际住院策略的总成本为 3 634 392 美元,总收入为 3 571 069 美元,成本覆盖率为 98%。虚拟 DAS 策略的结果是净损失 15 800 美元(覆盖率为 99%),原因是 4 个住院时间较短的异常值导致报销额度减少,无法实现 16 208 美元的正净结果。试点参考门诊病例的收入和成本分别为 7479 美元和 6911 美元(成本覆盖率为 108%):结论:从任何一家医院和医疗系统的角度来看,为选定患者实施门诊结肠切除术都是最节约成本的选择。然而,在为避免不良激励而实施的前瞻性支付系统中,不良激励会无意中使表现最好的医院处于不利地位,并阻碍高价值策略的广泛采用。
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