Public Health in Practice最新文献_第5页

Mobile health clinics for distribution of vaccinations to underserved communities during health emergencies: A COVID-19 case study 在卫生紧急情况下为服务不足的社区分发疫苗的流动医疗诊所：COVID-19 案例研究

IF 2.2 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health in Practice

Pub Date : 2024-09-27 DOI: 10.1016/j.puhip.2024.100550

Lior Rennert , Fatih Gezer , Iromi Jayawardena , Kerry A. Howard , Kevin J. Bennett , Alain H. Litwin , Kerry K. Sease

Objectives

Mobile health clinics (MHCs) effectively provide healthcare to underserved communities. However, their application during health emergencies is understudied. We described the implementation of an MHC program delivering vaccinations during the COVID-19 pandemic, examined the program's reach to medically underserved communities, and investigated characteristics of vaccination uptake in order to inform the utility of MHCs during health emergencies.

Study design

The study observed COVID-19 MHC vaccination rates and factors associated with uptake between February 20th, 2021, and February 17th, 2022.

Methods

Prisma Health deployed six MHCs to underserved communities. We described the characteristics of individuals who utilized the MHCs and evaluated census tract-level community factors associated with use of the MHCs through generalized linear mixed effects models.

Results

The MHCs conducted 260 visits at 149 unique sites in South Carolina, providing 12,102 vaccine doses to 8545 individuals: 2890 received a partial dose, 4355 received a primary series, and 1300 received a booster dose. Among individuals utilizing the MHC, the median age was 42 years (IQR: 22–58), 44.0 % were Black, 49.2 % were male, and 44.2 % were uninsured. Black, Hispanic, and uninsured individuals were significantly more likely to utilize MHC services for COVID-19 vaccination. During periods when vaccines were limited, MHC utilization was significantly greater in communities facing access barriers to healthcare.

Conclusions

The high COVID-19 vaccination uptake at MHCs demonstrated that the MHC framework is an effective and acceptable intervention among medically underserved populations during health emergencies, especially when resources are scarce. The identified factors associated with vaccination uptake demonstrated that the MHCs had the greatest impact in higher-risk communities and can be used to inform allocation of such field-level interventions in future health emergencies.

目标移动医疗诊所（MHC）能有效地为服务不足的社区提供医疗保健服务。然而，人们对其在卫生紧急情况下的应用研究不足。我们介绍了在 COVID-19 大流行期间提供疫苗接种的移动医疗诊所计划的实施情况，检查了该计划对医疗服务不足社区的覆盖情况，并调查了疫苗接种率的特征，以便为移动医疗诊所在卫生紧急情况下的应用提供参考。研究设计该研究观察了 2021 年 2 月 20 日至 2022 年 2 月 17 日期间 COVID-19 移动医疗诊所的疫苗接种率以及与接种率相关的因素。方法Prisma Health 在医疗服务不足的社区部署了六个移动医疗诊所。我们描述了使用 MHC 的个人特征，并通过广义线性混合效应模型评估了与使用 MHC 相关的人口普查区级社区因素。结果MHC 在南卡罗来纳州的 149 个独特地点进行了 260 次访问，为 8545 人提供了 12102 剂疫苗：2890 人接种了部分剂量，4355 人接种了初级系列，1300 人接种了加强剂量。在使用 MHC 的个人中，年龄中位数为 42 岁（IQR：22-58），44.0% 为黑人，49.2% 为男性，44.2% 无保险。黑人、西班牙裔和无保险者更有可能利用 MHC 服务接种 COVID-19 疫苗。结论MHC 的 COVID-19 疫苗接种率很高，这表明在卫生紧急情况下，特别是在资源匮乏的情况下，MHC 框架是医疗服务不足人群中有效且可接受的干预措施。已确定的疫苗接种率相关因素表明，大型健康中心对高风险社区的影响最大，可用于在未来的突发卫生事件中分配此类实地干预措施。

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引用次数: 0

Mapping vulnerability to climate-related hazards to inform local authority action in adaptation: A feasibility study 绘制与气候相关危害的脆弱性图，为地方当局的适应行动提供信息：可行性研究

IF 2.2 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health in Practice

Pub Date : 2024-09-21 DOI: 10.1016/j.puhip.2024.100549

J. Howkins , Daniela N. Schmidt , James Thomas , Robert Hayward , Y.T. Eunice Lo , Jeffrey Neal , James Lewis , Elspeth Carruthers , Samuel Coleborn , Virginia Murray , Isabel Oliver

Background

Local authorities have a crucial role in building community resilience to the health effects of a changing climate. Support in achieving local action can be provided through improving available public health intelligence to inform decision making. We aimed to co-develop with a local authority a tool mapping vulnerability to climate related hazards.

Methods

We conducted a feasibility study, exploring through stakeholder engagement local priorities and levers for action in adaptation that could be informed by provision of increased intelligence. This informed co-development of a proof-of-concept tool.

Results

Stakeholders reported needs in better understanding the intersection between vulnerability and hazard to facilitate partnership working, decision making, and targeting of interventions. We developed a mapping tool, using nationally available data, overlaying a vulnerability index with hazard (heat and flooding) exposure.

Conclusions

Mapping tools are feasible methods by which public health intelligence to support climate change adaptation planning can be shared. Barriers to action may result from the complexity of vulnerability, concerns of unintended consequences, and resource constraints. Co-development with local expertise is necessary to ensure that outputs add value to local response. This tool will now be piloted to gather feedback on useability, usefulness, and potential improvements.

背景地方当局在建设社区抵御气候变化对健康影响的能力方面发挥着至关重要的作用。可以通过改善现有的公共卫生情报为决策提供信息，从而为实现地方行动提供支持。方法我们进行了一项可行性研究，通过利益相关者的参与，探索了地方适应行动的优先事项和杠杆，这些优先事项和杠杆可以通过提供更多的情报来了解。结果利益相关者表示需要更好地了解脆弱性和灾害之间的交叉点，以促进合作、决策和有针对性的干预。我们开发了一种绘图工具，利用国内现有数据，将脆弱性指数与灾害（高温和洪水）暴露程度进行叠加。结论绘图工具是一种可行的方法，可用于共享支持气候变化适应规划的公共卫生情报。采取行动的障碍可能来自脆弱性的复杂性、对意外后果的担忧以及资源限制。有必要与当地专家共同开发，以确保产出为当地应对措施增添价值。现在将对该工具进行试点，以收集有关可用性、实用性和潜在改进的反馈意见。

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引用次数: 0

Embedding work coaches in GP practices: Findings from an interview-based study in the UK 将工作教练纳入全科医生诊所：英国基于访谈的研究结果

IF 2.2 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health in Practice

Pub Date : 2024-09-12 DOI: 10.1016/j.puhip.2024.100548

Shriti Pattani , Marie Line El Asmar , Manisha Karki , Eva Riboli Sasco , Lara Shemtob , Kabir Varghese , Austen El-Osta

Background

The integration of work coaches (WCs) and disability employment advisors (DEAs) into General Practitioner (GP) practices in the UK aims to address the interplay between health and employment by facilitating access to employment support, especially to people with disabilities and health conditions affecting their ability to work. This study seeks to explore the perspectives and perceptions of WCs, DEAs and GPs regarding the benefits and challenges of embedding WCs and DEAs in GP practices.

Methods

Data was collected between May and July 2023 through semi-structured interviews with four GPs, four WCs and four DEAs working in NHS GP practices. The interviews were audio-recorded, transcribed verbatim and thematically analysed using the Thematic Framework method. Emergent themes were pre-structured and classified as perceived benefits, barriers and challenges or drivers and strategies.

Results

The integration of WCs & DEAs within GP practices was perceived by respondents as fostering a direct collaboration between professionals as well as a greater openness of patients which benefited patients, WCs/DEAs and GPs. While all respondents emphasised the various benefits, they also identified several barriers and challenges. The implementation stage was perceived as particularly challenging, especially by WCs and DEAs, whereas the lack of human, financial and logistical resources hindered the service beyond this stage. Several strategies and drivers to support the service were identified, including the importance of receiving support from all professionals involved as well as making the service visible to both healthcare professionals and patients.

Conclusion

Embedding WCs and DEAs in GP practices emerges as a promising approach which can benefit patients, GPs and WCs/DEAs. Exploring patients' perspectives directly is crucial to fully assess this type of service and identify any additional challenges and benefits.

背景在英国，将工作教练（WCs）和残疾人就业顾问（DEAs）纳入全科医生（GP）实践的目的是通过促进就业支持的获得来解决健康和就业之间的相互作用，特别是对残疾人和健康状况影响其工作能力的人。本研究旨在探讨残疾人中心、残疾人就业促进者和全科医生对将残疾人中心和残疾人就业促进者纳入全科医生诊所的益处和挑战的观点和看法。方法在 2023 年 5 月至 7 月期间通过半结构式访谈收集数据，访谈对象包括在国家医疗服务体系全科医生诊所工作的四名全科医生、四名残疾人中心工作人员和四名残疾人就业促进者。对访谈进行了录音、逐字记录，并使用主题框架法进行了主题分析。结果受访者认为，在全科医生诊所内整合 WCs & DEAs 可促进专业人员之间的直接合作，并使患者更加开放，从而使患者、WCs/DEAs 和全科医生受益。所有受访者在强调各种益处的同时，也指出了一些障碍和挑战。特别是 WC 和 DEA 认为，实施阶段尤其具有挑战性，而人力、财力和后勤资源的缺乏则阻碍了这一阶段之后的服务。研究发现了一些支持该服务的策略和驱动力，包括获得所有相关专业人员的支持以及让医护人员和患者了解该服务的重要性。直接探讨患者的观点对于全面评估此类服务并确定任何额外的挑战和益处至关重要。

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引用次数: 0

Rapid review: Ten ways to improve support for minoritised informal adult carers at local government policy level to redress inequality 快速审查：在地方政府政策层面改善对少数群体非正式成年照顾者支持的十种方法，以纠正不平等现象

IF 2.2 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health in Practice

Pub Date : 2024-08-26 DOI: 10.1016/j.puhip.2024.100543

A. Barnes , F. Phillips , K. Pickett , A.J. Haider , J. Robinson-Joyce , S. Ahmed

Objective

To rapidly identify and summarise evidence on key factors that affect access to support for minoritised informal adult carers which could be addressed at the level of local government policy-making.

Study design

Rapid evidence review.

Methods

A rapid umbrella review was undertaken of systematic reviews of qualitative, quantitative and/or mixed method studies. Systematic reviews were identified through database searches (Medline, Cochrane, Proquest), key author searching, referrals by experts (n = 2) of key reviews, and citation and reference checking of identified reviews in September–October 2023. Systematic review evidence was supplemented with grey literature identified by practitioners (n = 2) as locally-relevant. Data was extracted directly into a table and findings synthesised narratively by theme.

Results

Many factors were identified as affecting access to support for minoritised unpaid adult carers, including: inattention to socio-cultural diversity; issues of representation, racism and discrimination; and socio-economic inequality. Factors were themed around ten areas for local action, including: the importance of recognising intersectional disadvantage and diversity; ensuring support is socio-culturally appropriate; paying attention to gendered hierarchies in service design; identifying and ‘designing out’ racism and discrimination; addressing exclusions that minoritised carers with additional communication needs face; mitigating socio-economic inequality; and taking a ‘whole system’ approach that improves integration, routine data collection and support service evaluation.

Conclusions

We identified ten potential ways in which inequalities in support for minoritised unpaid adult carers could be addressed locally. Although the existing evidence base is limited, these ten areas could usefully be targeted for further investigation in research and within local policy development.

研究设计快速证据综述。方法对定性、定量和/或混合方法研究的系统综述进行快速综述。通过数据库搜索（Medline、Cochrane、Proquest）、关键作者搜索、专家（n = 2）推荐关键综述，以及对 2023 年 9 月至 10 月期间确定的综述进行引文和参考文献检查，确定了系统综述。在系统综述证据的基础上，补充了由从业人员（2 人）确定的与当地相关的灰色文献。数据被直接提取到表格中，研究结果按主题进行了叙述性综合。结果发现许多因素会影响少数群体无偿成年照护者获得支持，包括：对社会文化多样性的忽视；代表性、种族主义和歧视问题；以及社会经济不平等。这些因素围绕十个地方行动领域展开，其中包括：认识到交叉弱势和多样性的重要性；确保提供的支持与社会文化相适应；在服务设计中关注性别等级；识别并 "设计出 "种族主义和歧视；解决有额外交流需求的少数群体照护者所面临的排斥问题；缓解社会经济不平等；以及采取 "全系统 "方法，改善整合、日常数据收集和支持服务评估。结论我们发现了十种潜在的方法，可以在当地解决少数群体无偿成年照护者在支持方面的不平等问题。虽然现有的证据基础有限，但这十个领域可以作为研究和地方政策制定中进一步调查的目标。

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引用次数: 0

How much do local health systems matter? Variations in amenable mortality across health districts in Aotearoa New Zealand 地方卫生系统有多重要？新西兰奥特亚罗瓦各卫生区可治疗死亡率的差异

IF 2.2 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health in Practice

Pub Date : 2024-08-26 DOI: 10.1016/j.puhip.2024.100545

Pushkar Silwal , Daniel Exeter , Tim Tenbensel , Arier Lee

引用次数: 0

Einstein's combinatory play: A promising practice for creativity and well-being among public health professionals 爱因斯坦的组合游戏：促进公共卫生专业人员创造力和幸福感的可行做法

IF 2.2 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health in Practice

Pub Date : 2024-08-24 DOI: 10.1016/j.puhip.2024.100546

Abby M. Steketee , Samantha M. Harden

The purpose of this commentary is to describe combinatory play as a practice for elevating creativity and well-being among public health professionals. Albert Einstein introduced combinatory play in a letter to a colleague, and, in this commentary, we define it as engagement in an intrinsically enjoyable, cognitively stimulating artistic activity that is distinct from one's job tasks and conducive to connecting ideas toward insight and creative problem-solving. Combinatory play aligns with empirical and experiential evidence demonstrating connections between art and science. We present combinatory play in the context of research on creativity and well-being, including the growing issue of work-related stress among public health professionals. To provide an example of combinatory play, we recount how Robert Frost's poem “Mending Wall” inspired email blackout periods and an intervention for health researchers. Finally, we outline concrete strategies for public health professionals to integrate combinatory play into their lives. Overall, combinatory play is a promising practice for catalyzing novel solutions to public health issues while fueling the well-being of public health professionals themselves.

本评论旨在将组合游戏描述为提升公共卫生专业人员创造力和幸福感的一种实践。阿尔伯特-爱因斯坦在给一位同事的信中介绍了组合游戏，而在本评论中，我们将其定义为参与一种内在愉悦、刺激认知的艺术活动，这种活动有别于个人的工作任务，有利于将各种想法联系起来，从而获得洞察力并创造性地解决问题。组合游戏与证明艺术和科学之间联系的经验和体验证据相一致。我们在创造力和幸福感研究的背景下介绍了组合游戏，包括公共卫生专业人员中与工作相关的压力这一日益严重的问题。为了提供一个组合游戏的例子，我们讲述了罗伯特-弗罗斯特的诗《补墙》如何激发了电子邮件停电期和对健康研究人员的干预。最后，我们概述了公共卫生专业人员将组合游戏融入生活的具体策略。总之，组合游戏是一种很有前途的做法，它可以催化新的公共卫生问题解决方案，同时促进公共卫生专业人员自身的福祉。

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引用次数: 0

A case-crossover analysis to quantify the impact of wildfire smoke on hospital respiratory admissions in the Rogue Valley, Oregon 通过病例交叉分析量化野火烟雾对俄勒冈州罗格山谷呼吸道入院治疗的影响

IF 2.2 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health in Practice

Pub Date : 2024-08-23 DOI: 10.1016/j.puhip.2024.100540

A Lee Mitchell , Kyle Chapman , Kerry Farris , Pooya Naderi , Ashley Hansen

Background

With the increasing prevalence of wildfire smoke in the Pacific Northwest, it is important to quantify health impacts to plan for adequate health services. The Rogue Valley region has historically faced some of the greatest wildfire threats in the state. Health impacts from smoke have been estimated in several recent studies that include Oregon's Rogue Valley, but the results between studies are conflicting.

Objective

The objective is to critically examine impacts of wildfire smoke on health in the Rogue Valley area and translate the results to support hospital staffing decisions.

Study design

The study adopts a case-crossover approach.

Methods

Apply a conditional Poisson regression to analyze time stratified counts while controlling for mean temperature.

Results

Every 10 μ/m³ increase in PM_2.5 is associated with a 2% increase in same-day hospital or emergency room admission rates for respiratory conditions during fire season after adjusting for temperature and time (OR = 1.020; 95% CI: 1.004–1.034); a 10 μ/m³ increase in PM_2.5 lasting nine days is associated with a 4% increase in admission rates (OR = 1.041; 95% CI: 1.018–1.065). In other words, for each 10 μ/m³ single day increase in pollution from smoke, an additional 0.26 respiratory patients would be expected in the area hospitals. With a single day increase from 10 μ/m³ to 150 μ/m³, hospitals could expect an additional four patients.

Conclusions

There are small but significant health impacts in the Rogue Valley. These impacts are smaller than some statewide estimates. We need further research to understand these differences.

背景随着西北太平洋地区野火烟雾的日益普遍，量化对健康的影响以规划适当的健康服务非常重要。罗格河谷地区历来面临着该州最大的一些野火威胁。最近的几项研究对烟雾对健康的影响进行了估计，其中包括俄勒冈州的罗格山谷，但不同研究之间的结果相互矛盾。研究设计研究采用个案交叉法。方法应用条件泊松回归分析时间分层计数，同时控制平均温度。结果在对温度和时间进行调整后，PM2.5每增加10 μ/m3，火灾季节因呼吸系统疾病的当天入院率或急诊室入院率就会增加2%（OR = 1.020；95% CI：1.004-1.034）；PM2.5每增加10 μ/m3持续9天，入院率就会增加4%（OR = 1.041；95% CI：1.018-1.065）。换句话说，烟雾污染每增加 10 μ/m3 单日，预计该地区医院的呼吸道疾病患者将增加 0.26 人。如果单日烟雾污染从 10 μ/m3 增加到 150 μ/m3，医院预计将增加 4 名病人。这些影响小于一些全州范围的估计值。我们需要进一步的研究来了解这些差异。

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引用次数: 0

20 years on from the Dublin Declaration: European Committee for the Prevention of Torture and Inhuman or Degrading Treatment reporting on the provision of prison needle and syringe programmes in the Council of Europe region 都柏林宣言》发表 20 周年：欧洲防止酷刑和不人道或有辱人格待遇委员会关于在欧洲委员会地区提供监狱针头和注射器方案的报告

IF 2.2 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health in Practice

Pub Date : 2024-08-23 DOI: 10.1016/j.puhip.2024.100544

Marie Claire Van Hout , Ulla-Britt Klankwarth , Simon Fleißner , Heino Stöver

Background

Prisons in Europe remain high-risk environments and conducive for infectious disease transmission, often related to injection drug use. Many infected people living in prison unaware of their infection status (HIV, hepatitis C). Despite all Council of Europe (CoE) member states providing community needle and syringe programmes (NSP), prison NSP are limited to seven countries. The study aim was to scrutinise the Committee for the Prevention of Torture and Inhuman or Degrading Treatment (CPT) reporting of periodic and ad hoc country mission visits to prisons, with an explicit focus on the extent to which member states are/were fulfilling obligations to protect prisoners from HIV/hepatitis C; and implementing prison NSP under the non-discriminatory equivalence of care principle.

Study design

Socio-legal review.

Methods

A systematic search of the CPT database was conducted in 2024 with no date restriction. All CPT reports were screened in chronological order with the terms; “needle”, “syringe”, “harm reduction” and “NSP”. Relevant narrative content on prison NSP operations, including repeat CPT reminders and any official/publicly expressed reasons for not implementing is presented.

Results

CPT reporting reveals limited prison NSP provision in selected prisons visited on mission, with little change in status over time, despite documented evidence of prior observations around absent/insufficient harm reduction measures and explicit (often longstanding) recommendations to address deficits. Reasons for not implementing prison NSP include; existing availability of opioid substitute treatment, lack of evidence for injecting drug use, for security and maintenance of order, and contradiction with prison protocols sanctioning drug use.

Conclusions

Prison health is public health. Regular research and evaluations of prison NSP in Europe are warranted. Future CPT visits should also continue to assess availability and standards of provision; recommend where appropriate including when opioid substitute treatment is already provided, and in line with broad availability of community NSP in Europe.

背景欧洲的监狱仍然是传染病传播的高危环境和温床，通常与注射吸毒有关。许多生活在监狱中的感染者并不知道自己的感染状况（艾滋病毒、丙型肝炎）。尽管欧洲委员会（CoE）所有成员国都提供社区针头和注射器计划（NSP），但监狱 NSP 仅限于七个国家。研究目的是仔细审查防止酷刑和不人道或有辱人格待遇委员会（CPT）定期和特别国家特派团访问监狱的报告，明确重点关注成员国在多大程度上履行了保护囚犯免受艾滋病毒/丙型肝炎感染的义务；以及根据非歧视性同等护理原则实施监狱 NSP 的情况。以 "针头"、"注射器"、"减低伤害 "和 "NSP "为关键词，按时间顺序筛选所有 CPT 报告。结果CPT报告显示，在执行任务时访问的部分监狱中，监狱NSP的提供非常有限，而且随着时间的推移，状况几乎没有变化，尽管有文件证据表明以前观察到的减低伤害措施缺失/不足，以及解决不足的明确（通常是长期）建议。未实施监狱 NSP 的原因包括：现有的阿片类替代治疗、缺乏针对注射毒品使用、安全和秩序维护的证据，以及与制裁毒品使用的监狱规程相矛盾。有必要定期研究和评估欧洲的监狱国家战略计划。欧洲防止酷刑委员会今后的访问还应继续评估提供情况和标准；酌情提出建议，包括在已经提供阿片类替代治疗的情况下，并与欧洲广泛提供的社区 NSP 保持一致。

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引用次数: 0

First-trimester medication abortion via telemedicine: A retrospective cohort study 通过远程医疗进行头胎药物流产：回顾性队列研究

IF 2.2 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health in Practice

Pub Date : 2024-08-23 DOI: 10.1016/j.puhip.2024.100539

Leonardo Cely-Andrade , Luis Carlos Enríquez-Santander , Karen Cárdenas-Garzón , Biani Saavedra-Avendaño , Guillermo Antonio Ortiz Avendaño

Background

Following the decriminalization of abortion in Colombia and amidst a global health crisis due to COVID-19, Profamilia implemented a telemedicine-assisted first-trimester Medication Abortion (MAB) program. This is an opportunity to reduce inequalities in access and to promote empowerment and sexual and reproductive rights. This study aims to describe socio-demographic and clinical characteristics of users and to assess its effectiveness and safety.

Study design

A retrospective cohort study.

Methods

The study analyzed data from users who received Profamilia's telemedicine abortion services between August 2021 and August 2022 (n = 3073). A descriptive analysis of their sociodemographic and clinical characteristics was performed, grouping, and comparing them according to follow-up status and abortion outcome. Effectiveness was assessed by the percentage of complete abortions without surgical intervention, and safety by the incidence of complications, potential adverse events, and potentially dangerous signs.

Results

Most of the users were less than 8 weeks gestation at the start of treatment (88.3 %), from low socioeconomic strata (84.8 %), affiliated to the subsidized healthcare system (87.6 %), with educational levels up to secondary school (81.6 %), between 18 and 35 years (87.4 %), from urban areas (97.8 %) and singles (90,8 %). 94.9 % of users had a complete abortion using medication, and 0.3 % of cases reported complications.

Conclusions

First-trimester MAB through telemedicine in the Latin American context is an effective and safe choice. Telehealth is an important strategy to expand access to safe abortion care, especially for those with limited financial means or educational backgrounds. Rural and marginalized populations need more attention to improve access.

背景在哥伦比亚人工流产合法化之后，在 COVID-19 引发全球健康危机之际，Profamilia 实施了一项远程医疗辅助第一胎药物流产（MAB）计划。这是一个减少获取机会不平等、促进赋权以及性权利和生殖权利的机会。本研究旨在描述用户的社会人口学和临床特征，并评估其有效性和安全性。研究设计回顾性队列研究方法本研究分析了 2021 年 8 月至 2022 年 8 月期间接受 Profamilia 远程医疗流产服务的用户（n = 3073）的数据。对他们的社会人口学和临床特征进行了描述性分析，并根据随访情况和流产结果对他们进行了分组和比较。疗效根据无手术干预的完全流产百分比进行评估，安全性根据并发症、潜在不良事件和潜在危险征兆的发生率进行评估。3 %），来自社会经济地位较低的阶层（84.8 %），隶属于补贴医疗系统（87.6 %），受教育程度达到中学（81.6 %），年龄在 18 至 35 岁之间（87.4 %），来自城市地区（97.8 %），单身（90.8 %）。94.9%的用户使用药物进行了完全流产，0.3%的病例报告了并发症。远程医疗是扩大安全人工流产护理覆盖面的重要策略，尤其是对那些经济能力或教育背景有限的人群而言。农村和边缘化人群需要得到更多关注，以改善其获得服务的机会。

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引用次数: 0

Reduction of healthcare access inequity using telehealth and patient travel cost subsidisation 利用远程医疗和患者差旅费补贴减少医疗服务不公平现象

IF 2.2 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health in Practice

Pub Date : 2024-08-23 DOI: 10.1016/j.puhip.2024.100542

Edwin Phillip Greenup, Daniel Best

Objective

Telehealth and patient travel cost subsidisation are two strategies used to reduce the effects of healthcare access inequity. Despite this shared goal, these programs are usually run independently, and their effects are infrequently compared in evaluation. Understanding how these programs are used helps ensure services are delivered efficiently.

Methods

Counts of telehealth outpatient service events (TH) (n = 250171) and patient travel subsidy scheme claims (PTSS) (n = 270933) for the 2022-23 financial year were captured. Comparisons of PTSS and TH activity were made by postcode, rurality (The Accessibility/Remoteness Index of Australia (ARIA)) and health jurisdiction (Hospital and Health Service (HHS)).

Results

Correlation analysis conducted on PTSS and TH activity revealed a statistically significant, moderate positive correlation (r = 0.449, p < 0.01). TH (coefficient = 0.650, p < 0.001) and rurality (coefficient = 26.208, p = 0.686) also retained their significance.

Conclusions

This study established that increases in TH activity is correlated with increases in PTSS, with both programs reporting greater activity as rurality increases.

目标远程医疗和患者交通费用补贴是用于减少医疗服务不公平影响的两种策略。尽管有着共同的目标，但这些计划通常都是独立运行的，在评估中也很少对其效果进行比较。方法收集了 2022-23 财年远程医疗门诊服务活动（TH）（n = 250171）和患者差旅补贴计划申请（PTSS）（n = 270933）的数量。根据邮编、乡村地区（澳大利亚可达性/偏远指数（ARIA））和卫生管辖区（医院和卫生服务（HHS））对PTSS和TH活动进行了比较。结果对PTSS和TH活动进行的相关性分析表明，两者在统计学上存在显著的中度正相关（r = 0.449，p < 0.01）。结论这项研究证实，TH 活动的增加与 PTSS 的增加相关，随着乡村地区的增加，这两个项目都报告了更多的活动。

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