Research in health services & regions最新文献

Purpose: The purpose of this study is to analyse geographic variation in rates of patients and service utilisation for persons with substance use disorders (SUD) across Norwegian hospital catchment areas from 2017 to 2021, considering both outpatient and Inpatient care across substance use diagnosis.

Method and material: This registry-based study used data from the Norwegian Patient Registry and Statistics Norway, covering 58,889 unique patients and 121,495 patient-years. Adjusted for age and sex this material yields a national SUD treatment rate of 14.0 per 1,000 over five years, on average 5.8 per year with a declining annual rate from 6.1-5.5. Analyses included diagnoses related to alcohol, opioids, cannabis, and other substances, excluding tobacco and opioid maintenance treatment. Three variation measures-Extreme Quotient (EQ), Coefficient of Variation (CV), and Systematic Component of Variation (SCV)-were used to assess disparities.

Results: Geographic variation in SUD treatment rates ranged from 3.6 to 11.5 per 1,000 inhabitants reaching a threefold difference between areas (EQ = 3.1). We found that SCV values (8.7-23.5) and SCV _5-95 (5.7-14.5) for diagnose groups and service type consistently exceeded the threshold of high and extremely high variation. Procurement of private services increased capacity significantly but did not markedly reduce variation. Variation remained extremely high even when the highest and lowest rates were excluded (SCV 13.8, SCV_5-95 11.3).

Conclusion: Patient rates in SUD treatment fell every year between 2017-2021 and the geographic variation was high to extremely high. Treatment of substance use disorders in Norway may require stronger regional governance to reduce unwarranted variation and ensure equitable access to treatment. Substantial reductions in variation can be achieved by i) redistributing capacity among catchment areas, ii) purchasing fewer and shorter Inpatient stays and iii) increasing outpatient treatment. In addition, such means could dramatically increase patient rates. There is a need for more consistent clinical practices and adjusted capacity for treating specific substance diagnoses.

Background: Management pathways for chronic obstructive pulmonary disease (COPD) are complex, and stakeholders may need to consider different approaches that improve health and reduce inequalities, while also delivering value for money. We used the Socio-Technical Allocation of Resources (STAR) approach to identify opportunities for improving COPD resource allocation in five integrated care systems (ICS) in England.

Methods: STAR uses decision conferencing involving facilitated workshops and a decision analysis model of participants' perspectives. Two facilitated workshops involving key COPD management stakeholders were undertaken in each ICS. This allowed participants to gain an understanding of the value of the current care pathway and use this as a discussion point alongside an understanding of the ICSs priorities and patient preference to define a shortlist of potential pathway improvements. Modelling was then undertaken to understand the expected net costs and net health benefits of each pathway improvement, and these were then ranked.

Results: Potential COPD pathway improvements were identified within each ICS. These differed across the five ICSs based on local population and ICS priorities, but included: (1) more effective use of the virtual ward; (2) promoting additional respiratory services through social prescribing; (3) proactive case-finding/increased screening; (4) very brief advice for tobacco dependency; (5) increasing uptake of pulmonary rehabilitation services; (6) introducing patient COPD apps; (7) increasing uptake of smoking cessation services; and (8) conducting patients' yearly reviews through group consultations. Implementing the top-ranked interventions was predicted to provide notable improvements in COPD population health benefit while having a cost saving, neutral or minimal budget impact.

Conclusion: The STAR approach could provide a valuable resource allocation decision tool at a local level and consider potential areas for improving health outcomes while minimising budget impact. Such findings could be used to support decisions on where best to allocate resources in ICS disease programmes.

Background: Saxony-Anhalt (ST) has the oldest population in Germany, with partly above average and increasing prevalences of chronic diseases and multimorbidity. Vaccinations are crucial to prevent infections and severe disease outcomes in older adults, especially in rural areas. However, national immunisation recommendations for individuals aged 60 and above are only partially followed. This research aims to examine (1) actual vaccination utilization and (2) the determinants, reasons, and barriers to vaccination uptake in ST's elderly population (≥ 60 years).

Methods: (1) Vaccination utilization data from 760,868 individuals (aged ≥ 60 years ) for influenza, pneumococcus, and herpes zoster from 2011 to 2020 were analyzed using outpatient care data from the Central Research Institute for Outpatient Health Care in Germany (Zi). (2) Additionally, subjective vaccination behaviors, attitudes, and barriers were surveyed from 864 participants in two urban and two rural municipalities as part of the "Prevention in Old Age in Saxony-Anhalt" (PrimA LSA) project.

Results: The secondary data set included 760,868 individuals for influenza, pneumococcal, and herpes zoster vaccination. Immunisation rates for influenza and pneumococcus in ST were higher than the national average, but rates for herpes zoster were lower. A survey of 864 participants over 60 revealed that the subjective vaccination rate was overestimated. Key barriers included lack of information and limited access to vaccination services. The study also reaffirmed the central role of general practitioners in healthcare delivery.

Conclusion: Despite positive attitudes towards vaccination, targeted educational initiatives are necessary to increase vaccination rates. General practitioners need additional support, and improving health literacy in the elderly is crucial to enhance vaccine acceptance and disease prevention.

Introduction: Access to essential medicines is fundamental to achieving universal health coverage. According to WHO, these medicines should be consistently available and affordable. However, in many low- and middle-income countries, health facilities experience frequent stockouts and high prices, limiting access and affordability. Such barriers reduce adherence, increase out-of-pocket spending, and compromise health outcomes. Assessing availability and affordability in primary health care facilities is therefore crucial to inform policy and promote equitable access.

Objectives: To assess the availability and affordability of essential medicines and associated factors in Wolaita region, Ethiopia, 2022.

Methods: A facility-based cross-sectional study was conducted from February 1-30, 2022. Thirty public health facilities were selected, six from each of five districts. Sample size was determined using a single population proportion formula. Data were collected through patient exit interviews, entered into EpiData 3.1, and analyzed in SPSS version 25. Multivariable logistic regression was employed to identify factors associated with affordability.

Results: Of 601 patients, 98% participated. The average availability of 26 selected core essential medicines was 56.53%. Among patients, 58.1% reported prescribed medicines as unaffordable. Factors significantly associated with affordability included level of health facility [AOR (95% CI) = 3.450 (2.275-5.231)], health status [AOR = 1.807 (1.027-3.179)], educational status [AOR = 3.413 (1.363-8.548)], and place of residence [AOR = 1.596 (1.019-2.551)].

Conclusion: Essential medicine availability was low across facilities. Many patients were unable to obtain prescribed drugs due to unavailability and unaffordability. District and zonal health offices should ensure timely replenishment to strengthen access.