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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。
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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
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。
{"title":"Cloud Horizons: Strengthening Rural Healthcare Through Telemedicine's Digital Canopy.","authors":"Felician Andrew Kitole, Sameer Shukla","doi":"10.1177/11786329241284401","DOIUrl":"https://doi.org/10.1177/11786329241284401","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Method: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"17 ","pages":"11786329241284401"},"PeriodicalIF":2.4,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11439172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142345187","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
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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引用次数: 0
Understanding of Maternal Health Status in Different Social Groups in India Using NFHS Data. 利用 NFHS 数据了解印度不同社会群体的孕产妇健康状况。
IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-18 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241254206
Santosh Tamang, Uttam Kumar Sikder

Maternal health is a major public health concern in India. MMR of India has declined significantly but maternal health status has not much improved. The prevalence of anemia and low Body Mass Index (BMI) is more severe among the women belonging to the Scheduled Caste (SC) and Scheduled Tribe (ST) categories. In this paper, attempts have been made to examine the maternal health status and to identify the factors responsible for poor health status among SC and ST women. The study is purely based on secondary data taken from latest 3 rounds of NFHS (2005-6, 2015-16 & 2019-21). Multivariate analysis have been carried out using panel regression model to understand the impact of determinants on maternal healthcare. The study found that the SC and ST women are more prone to anemia than others (GENERAL category women). Maternal health status is mostly controlled by per capita health expenditure and health infrastructure variables like no. of hospitals and nurses, irrespective of social class. Thus poor maternal health status in India, especially among socially disadvantaged groups of society, have been major concern. The government should be more focused on existing policies related to maternal healthcare.

孕产妇健康是印度的一个主要公共卫生问题。印度的孕产妇死亡率已大幅下降,但孕产妇健康状况却没有多大改善。在册种姓(SC)和在册部落(ST)妇女中,贫血和身体质量指数(BMI)偏低的情况更为严重。本文试图研究在册种姓和在册部落妇女的孕产妇健康状况,并找出导致其健康状况不良的因素。本研究完全基于最新三轮 NFHS(2005-6 年、2015-16 年和 2019-21 年)的二手数据。使用面板回归模型进行了多变量分析,以了解决定因素对孕产妇保健的影响。研究发现,在册种姓和在册部落妇女比其他妇女(普通类别妇女)更容易贫血。孕产妇健康状况主要受人均医疗支出以及医院和护士数量等医疗基础设施变量的控制,与社会阶层无关。因此,印度孕产妇健康状况不佳,尤其是社会弱势群体的孕产妇健康状况不佳,一直备受关注。政府应更加重视与孕产妇保健有关的现行政策。
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引用次数: 0
The Use of Antibiotics at the End of Life: A Cross-Sectional Study. 生命末期抗生素的使用:一项横断面研究。
IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-15 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241280812
Brayan Miranda-Chavez, Andre Fuentes-Yufra, Miguel Hueda-Zavaleta, Cesar Copaja-Corzo, Javier A Flores-Cohaila, Marco Rivarola-Hidalgo

Objective: To identify and analyze antibiotics' prescription patterns and associated factors among terminally ill patients at a hospital in southern Peru.

Methodology: A cross-sectional analytical study was conducted on adult patients who died in Hospital III Daniel Alcides Carrion in Tacna, Peru, 2023. Data were collected from electronic medical records, focusing on antibiotic use during the last hospitalization. Univariate, bivariate, and multivariate analyses were performed using Poisson regression to adjust for potential confounders.

Results: The study included 239 patients with an average age of 76. Antibiotics were administered to 93.72% of patients, with 42.46% lacking an identified infectious focus. Ceftriaxone, Meropenem, and Vancomycin were the most used antibiotics. A lower use of antibiotics within 72 hours prior to death was associated with hospitalizations longer than 18 days and having 2 or more comorbidities.

Conclusion: The high prevalence of antibiotic use at the end of life, often without an infectious focus, suggests a need for better guidelines and education on palliative care to avoid inappropriate antibiotic prescribing. Improved communication between healthcare providers, patients, and families is essential for optimizing end-of-life care.

目的确定并分析秘鲁南部一家医院临终病人的抗生素处方模式及相关因素:对秘鲁塔克纳市丹尼尔-阿尔西德斯-卡里翁第三医院(Hospital III Daniel Alcides Carrion)2023年死亡的成年患者进行了横断面分析研究。数据来自电子病历,重点是最后一次住院期间抗生素的使用情况。使用泊松回归法进行了单变量、双变量和多变量分析,以调整潜在的混杂因素:研究共纳入 239 名患者,平均年龄为 76 岁。93.72%的患者使用了抗生素,42.46%的患者未发现感染病灶。头孢曲松、美罗培南和万古霉素是使用最多的抗生素。死亡前72小时内抗生素使用率较低与住院时间超过18天和患有2种或2种以上合并症有关:生命末期抗生素使用率较高,且通常没有感染病灶,这表明需要更好的姑息治疗指南和教育,以避免不适当的抗生素处方。加强医疗服务提供者、患者和家属之间的沟通对于优化临终关怀至关重要。
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引用次数: 0
Multi-Dimensional Analysis of Japanese Telemedicine Patient Satisfaction. 日本远程医疗患者满意度的多维分析。
IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-15 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241280864
Andrew N Mason, Toshio Naito, Shinichi Fukushima, Keiko Asano, Ken Yamaji, Ryohei Kuwatsuru

Introduction: Telemedicine is a growing segment of the healthcare industry. As telemedicine gains prominence in Japan, the importance of telemedicine patient satisfaction research will also grow. This study examines whether Japanese patients are equally impacted by the same latent dimensions discovered in the multi-dimensional service satisfaction model used by a United States (U.S.) study.

Methods: The subjects (n = 110) were patients who received telemedicine service between January and December 2023 at Juntendo University Hospital, Tokyo, Japan. Patient satisfaction perceptions were collected using a questionnaire composed of Likert scale items. Overall patient satisfaction served as the dependent variable, and patient perceptions of various aspects of the service were the independent variables. LASSO regression analysis was used to test the impact of the independent variables on overall patient satisfaction along with cluster analysis to examine the satisfaction ratings based upon patient characteristics.

Results: Japanese patient perceptions of telemedicine health benefits were the most impactful driver of overall satisfaction. Cluster analysis indicated that males were generally more satisfied than females. The least satisfied patients were predominately female and those experiencing telemedicine for the first time. Patients receiving service from a specialist physician were least satisfied with the telemedicine financial costs.

Discussion: Patient satisfaction levels were found to be highly impacted by perceptions of the health benefits received and the non-financial costs of service. These benefits could be highlighted by Japanese telemedicine providers to increase utilization of telemedicine services. Patient satisfaction was also found to be influenced by patient-centered care (ie, the "soft skills" of providers) to a lesser degree. Therefore, Japanese telemedicine providers may benefit from developing patient-centered communication skills.

Conclusion: The model used provides nuanced understandings of telemedicine patient satisfaction, which highlights where targeted improvements in Japanese telemedicine patient satisfaction are likely to be most impactful.

介绍:远程医疗是医疗保健行业中一个不断增长的细分市场。随着远程医疗在日本的日益突出,远程医疗患者满意度研究的重要性也将与日俱增。本研究探讨了日本患者是否同样受到美国一项研究使用的多维服务满意度模型中发现的潜在维度的影响:研究对象(n = 110)为 2023 年 1 月至 12 月期间在日本东京顺天堂大学医院接受远程医疗服务的患者。使用由李克特量表项目组成的问卷收集患者的满意度。患者总体满意度为因变量,患者对服务各方面的感知为自变量。我们使用 LASSO 回归分析来检验自变量对患者总体满意度的影响,同时使用聚类分析来检验基于患者特征的满意度评分:结果:日本患者对远程医疗健康益处的看法是对总体满意度影响最大的驱动因素。聚类分析显示,男性的满意度普遍高于女性。最不满意的患者主要是女性和首次使用远程医疗的患者。接受专科医生服务的患者对远程医疗的经济成本最不满意:讨论:研究发现,患者的满意度受其对所获健康益处和服务非经济成本的看法影响很大。日本远程医疗服务提供商可强调这些益处,以提高远程医疗服务的利用率。研究还发现,患者满意度受以患者为中心的护理(即提供者的 "软技能")的影响较小。因此,日本远程医疗提供者可能会从发展以患者为中心的沟通技能中受益:结论:所使用的模型提供了对远程医疗患者满意度的细微理解,突出了有针对性地提高日本远程医疗患者满意度最有可能产生影响的方面。
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引用次数: 0
Factors Associated With Willingness to Pay for Primary Health Care Services in South Africa: A Cross-Sectional Survey of Medical Schemes Members. 南非愿意为初级保健服务付费的相关因素:对医疗计划成员的横断面调查。
IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-11 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241274479
Evelyn Thsehla, Charles Hongoro, Jacqui Miot, Kate Kgasi, Edmore Marinda, Esnath Maramba, Alister Chabi, Barry Childs, Olurotimi Modupe, Olufunke Alaba

The cost of healthcare is an issue of concern for both consumers and funders of healthcare in South Africa. The country spends approximately 8% of GDP on health care. Health care is financed through the public sector which covers 86% of the population and the private sector which covers 14% of the population. Medical schemes are the main source of healthcare financing in the private sector. Services covered by medical schemes include chronic diseases, emergencies, diagnosis, and treatment of a selected number of diseases. Primary health care services such as screening are limited. The aim of this study was to assess factors associated with members of medical schemes' willingness to pay for a primary health care package in the private sector. A cross-sectional survey was conducted amongst principal members of medical schemes between July and September 2020. All principal members with access to an online questionnaire were eligible to participate in this study. Logistic regression was used to identify factors associated with willingness to pay for primary health care services. A total of 6512 members of medical schemes participated in the study. Thirty-five percent of the participants were willing to pay for the primary health care package. Factors influencing willingness to pay included marital status, employment status, income and household size. The study highlights the need for policymakers to consider socioeconomic factors when designing health care policies.

医疗费用是南非医疗消费者和资助者都关心的问题。南非的医疗费用约占国内生产总值的 8%。医疗保健的资金来源是覆盖 86% 人口的公共部门和覆盖 14% 人口的私营部门。医疗计划是私营部门医疗保健资金的主要来源。医疗计划所涵盖的服务包括慢性病、急诊、诊断和治疗部分疾病。筛查等初级医疗保健服务有限。本研究旨在评估与医疗计划成员是否愿意支付私立部门初级保健套餐费用相关的因素。我们在 2020 年 7 月至 9 月期间对医疗计划的主要成员进行了横断面调查。所有可访问在线问卷的主要成员均有资格参与本研究。研究采用逻辑回归法来确定与基层医疗服务付费意愿相关的因素。共有 6512 名医疗计划成员参与了研究。35%的参与者愿意为初级保健套餐付费。影响支付意愿的因素包括婚姻状况、就业状况、收入和家庭规模。这项研究强调了政策制定者在制定医疗保健政策时考虑社会经济因素的必要性。
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引用次数: 0
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