scholarly journals Non-fatal injuries in rural Burkina Faso amongst older adults, disease burden and health system responsiveness: a cross-sectional household survey

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e045621
Author(s):  
John Whitaker ◽  
Guy Harling ◽  
Ali Sie ◽  
Mamadou Bountogo ◽  
Lisa R Hirschhorn ◽  
...  
Keyword(s):  
Health System ◽  
Burkina Faso ◽  
Disease Burden ◽  
Household Survey ◽  
Secondary Outcome ◽  
Cross Sectional ◽  
Patient Reported ◽  
Reported Health ◽  
System Responsiveness ◽  
Health System Responsiveness

ObjectivesThis study aimed to evaluate the epidemiology of injury as well as patient-reported health system responsiveness following injury and how this compares with non-injured patient experience, in older individuals in rural Burkina Faso.DesignCross-sectional household survey. Secondary analysis of the CRSN Heidelberg Ageing Study dataset.SettingRural Burkina Faso.Participants3028 adults, over 40, from multiple ethnic groups, were randomly sampled from the 2015 Nouna Health and Demographic Surveillance Site census.Primary and secondary outcome measuresPrimary outcome was incidence of injury. Secondary outcomes were incidence of injury related disability and patient-reported health system responsiveness following injury.Results7.7% (232/3028) of the population reported injury in the preceding 12 months. In multivariable analyses, younger age, male sex, highest wealth quintile, an abnormal Generalised Anxiety Disorder score and lower Quality of Life score were all associated with injury. The most common mechanism of injury was being struck or hit by an object, 32.8%. In multivariable analysis, only education was significantly negatively associated with odds of disability (OR 0.407, 95% CI 0.17 to 0.997). Across all survey participants, 3.9% (119/3028) reported their most recent care seeking episode was following injury, rather than for another condition. Positive experience and satisfaction with care were reported following injury, with shorter median wait times (10 vs 20 min, p=0.002) and longer consultation times (20 vs 15 min, p=0.002) than care for another reason. Injured patients were also asked to return to health facilities more often than those seeking care for another reason, 81.4% (95% CI 73.1% to 87.9%) vs 54.8% (95% CI 49.9% to 53.6%).ConclusionsInjury is an important disease burden in this older adult rural low-income and middle-income country population. Further research could inform preventative strategies, including safer rural farming methods, explore the association between adverse mental health and injury, and strengthen health system readiness to provide quality care.

scholarly journals Health services utilisation and responsiveness profiles in Iran: a provincial household study

2019 ◽  
Vol 7 (1) ◽  
pp. e000007 ◽  
Author(s):  
Mostafa Farahbakhsh ◽  
Homayoun Sadeghi Bazargani ◽  
Mohammad Saadati ◽  
Jafar Sadegh Tabrizi ◽  
Mina Golestani ◽  
...  
Keyword(s):  
Health Services ◽  
Health System ◽  
Health Resources ◽  
Cross Sectional ◽  
The Public ◽  
Significant Difference ◽  
System Responsiveness ◽  
Health System Responsiveness ◽  
East Azerbaijan ◽  
Barriers To Health

ObjectiveThe aim of this study was to describe health services utilisation and responsiveness in East Azerbaijan province, Iran.DesignA cross-sectional household study as part of a larger research on primary healthcare system.SettingWe carried out the study in East Azerbaijan Province, northwest Iran from July to September 2015.ParticipantsA total of 1318 households were included.ResultsMost of the participating households had social security health insurance. Heart failure or hypertension care, general outpatient care and arthritis care were the most used services. High services cost and inadequate medicine and medical equipment were introduced to be the main barriers to health services utilisation in Tabriz and province representative sample (PRS), respectively. Health system responsiveness mean score (the maximum is 100) was 33.71±16.15 (95% CI 32.45 to 34.97) in Tabriz and 32.02±14.3 (95% CI 30.9 to 33.13) in PRS, which showed significant difference (p≤0.02).ConclusionsDifferences in the utilisation and responsiveness of health services and distribution of health resources were observed between Tabriz and PRS. Evidently, health system responsiveness in both Tabriz and PRS was at low level. The results demonstrate the need for changing resource distribution policies and employing reactive health policies to response the public health.

scholarly journals Mapping the Multiple Health System Responsiveness Mechanisms in One Local Health System: A Scoping Review of the Western Cape Provincial Health System of South Africa

2021 ◽  
Author(s):  
Tammy Sutherns ◽  
Jill Olivier
Keyword(s):  
Health System ◽  
Scoping Review ◽  
Grey Literature ◽  
Secondary Analysis ◽  
Local Health ◽  
Western Cape ◽  
Cross Sectional ◽  
Middle Income ◽  
System Responsiveness ◽  
Health System Responsiveness

Background: Despite governments striving for responsive health systems and the implementation of mechanisms to foster better citizen feedback and strengthen accountability and stewardship, these mechanisms do not always function in effective, equitable, or efficient ways. There is also limited evidence that maps the diverse array of responsiveness mechanisms coherently across a particular health system, especially in low- and middle-income country (LMIC) contexts. Methods: This scoping review presents a cross-sectional ‘map’ of types of health system responsiveness mechanisms; the regulatory environment; and evidence available about these; and assesses what is known about their functionality in a particular local South African health system; the Western Cape (WC) province. Multiple forms of indexed and grey literature were synthesized to provide a contextualized understanding of current ‘formal’ responsiveness mechanisms mandated in national and provincial policies and guidelines (n = 379). Various forms of secondary analysis were applied across quantitative and qualitative data, including thematic and time-series analyses. An expert checking process was conducted, with three local field experts, as a final step to check the veracity of the analytics and conclusions made. Results: National, provincial and district policies make provision for health system responsiveness, including varied mechanisms intended to foster public feedback. However, while some are shown to be functioning and effective, there are major barriers faced by all, such as resource and capacity constraints, and a lack of clarity about roles and responsibilities. Most mechanisms exist in isolation, failing to feed into an overarching strategy for improved responsiveness. Conclusion: The lack of synergy between mechanisms or analysis of varied forms of feedback is a missed opportunity. Decision-makers are unable to see trends or gaps in the flow of feedback, check whether all voices are heard or fully understand whether/how systemic response occurs. Urgent health system work lies in the research of macro ‘whole’ systems responsiveness (levels, development, trends).

scholarly journals Listening to older voices: results of a cross-sectional survey of older patient-reported experiences of facility-based healthcare in Nouna, Burkina Faso

2021 ◽  
Author(s):  
Ellen Miriam Goldberg ◽  
Mamadou Bountogo ◽  
Guy Harling ◽  
Till Baernighausen ◽  
Justine R Davies ◽  
...  
Keyword(s):  
Decision Making ◽  
Health System ◽  
Burkina Faso ◽  
System Quality ◽  
Cross Sectional ◽  
Quality Outcomes ◽  
Healthcare Needs ◽  
Patient Reported ◽  
Aging Populations ◽  
Health System Quality

Abstract Background: Ensuring responsive healthcare which meets patient expectations and generates trust is important to increase rates of access and retention. This need is important for aging populations where non-communicable diseases (NCDs) are a growing cause of morbidity and mortality. Methods: We performed a cross-sectional household survey including socio-demographic, morbidities, and health system utilization, responsiveness, and quality outcomes in individuals over age 40 in northwestern Burkina Faso. We describe results and use exploratory factor analysis to derive a contextually appropriate grouping of health system responsiveness (HSR) variables. We used linear or logistic regression to explore associations between socio-demographics, morbidities, and the grouped-variable, then between these variables and health system quality outcomes. Results: Of 2,639 eligible respondents, 26.8% had least one NCD, 56.3% were frail or pre-frail and 23.9% had a recent visit, including only 1/3 of those with an NCD. Highest ratings of care experience (excellent/very good) included ease of following instructions (86.1%) and trust in provider skills (81.1%). The HSR grouping with the greatest factor loading included involvement in decision-making, clarity in communication, trust in the provider, and confidence in provider skills, termed as Shared Understanding and Decision Making (SUDM). In multivariable analysis, higher quality of life (OR 1.02,95%CI 1.01-1.04), frailty (OR 1.47,95%CI 1.00-2.16), and SUDM (OR 1.06,95%CI 1.05-1.09) were associated with greater health system trust and confidence. SUDM was associated with overall positive assessment of the healthcare system (OR 1.02,95%CI 1.01-1.03) and met healthcare needs (OR 1.09,95%CI 1.08-1.11). Younger age and highest wealth quintile were also associated with higher met needs. Conclusions: Recent healthcare access was low for people with existing NCDs, and SUDM was the most consistent factor associated with higher health system quality outcomes. Results highlight the need to increase continuity of care for aging populations with NCDs and explore strengthening SUDM to achieve this goal.

scholarly journals Health system responsiveness to refugees: a population-based, cross-sectional study in Germany

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L Biddle ◽  
J Wenner ◽  
K Bozorgmehr
Keyword(s):  
Health Status ◽  
Supportive Care ◽  
Health System ◽  
Population Based ◽  
Poor Health ◽  
Poor Health Status ◽  
Cross Sectional ◽  
Care Environment ◽  
System Responsiveness ◽  
Health System Responsiveness

Abstract Background Responsiveness, a critical component of health system performance, has received little attention in the context of international migration. Yet the concept provides a unique lens to study the system's ability to meet the legitimate expectations of its users. This study aims to identify predictors of responsiveness for asylum seekers and refugees (ASR) in Germany. Methods A population-based, cross-sectional health monitoring survey was conducted in Germany's third-largest federal state using random sampling at the level of all 1938 accommodation centers. Established instruments were used to measure responsiveness, health status, and socio-demographic factors. Data were weighted for sampling design and calibrated using asylum statistics. Adjusted logistic regression models were applied to identify predictors of responsiveness related to health status, structural, and socio-demographic variables. Results Of 560 respondents (response rate: 42%), 344 provided data on responsiveness. Combined weighted scores for responsiveness were 75% (CI: 69%-82%), with large variations between domains ranging from 86% (CI: 80%-90%) for cleanliness and 83% (CI: 76%-89%) for respect domains, to 56% (CI: 48%-63%) for choice and 52% (CI: 46%-59%) for timeliness domains. Overall responsiveness was worse for ASR with poor general health (OR 0.35; CI: 0.14-0.84), chronic illnesses (OR: 0.37; CI: 0.17-0.81), symptoms of depression (OR: 0.37; CI: 0.15-0.90) and anxiety (OR: 0.26; 0.10-0.68), and poor quality of life (OR: 0.18; 0.06-0.60). Socio-demographic and structural factors were not significantly associated with responsiveness. Conclusions There is room for improvement, especially regarding choice of provider and timeliness of care for ASR in Germany. Poor health status is a predictor of responsiveness, indicating that ASR most in need of a supportive care environment are being sold short. There is therefore an inequitable distribution of health system responsiveness among ASR. Key messages There is a large variation in scores across responsiveness domains, with choice of provider and timeliness of the health system being rated as particularly poor by ASR. Responsiveness is worse for individuals with poor health status, indicating that those most in need of a supportive care environment are being sold short.

Health System Responsiveness and Its Associated Factors Among Outpatients in Primary Health Care Facilities, Asagirt District, NorthShewa Zone, Ethiopia, 2021: Cross Sectional Study Design

2021 ◽  
Author(s):  
Wubshet Debebe Negash ◽  
Chalie Tadie Tsehay ◽  
Lake Yazachew ◽  
Desale Bihonegn Asmamaw ◽  
Dawit Zenamarkos Desta ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Associated Factors ◽  
Health Care Facilities ◽  
Cross Sectional ◽  
Primary Health ◽  
Care Facilities ◽  
System Responsiveness ◽  
Health System Responsiveness ◽  
Primary Health Care Facilities

Abstract Background: Health system responsiveness is defined as the outcome of designing health facility relationships in such a way that they are familiar and respond appropriately to patients’ universally legitimate expectations. Even though different strategies have been implemented to measure responsiveness, only scanty evidence exists in Sub-Saharan Africa. In Ethiopia information about the level of health system responsiveness among outpatients is scant. Assessing responsiveness could help facilities in improving service delivery based on patient expectations. Objective: The study aimed to assess health system responsiveness and associated factors among outpatients in primary health care facilities, Asagirt District, North Shewa Zone, Ethiopia, 2021. Methods: Facility-based cross-sectional quantitative study was implemented between 30th March and April 30/2021. A systematic random sampling technique was employed to select 423 participants, and interviewer-administered data were collected using a structured and pretested questionnaires. Both bivariable and multivariable logistic regressions were employed to identify factors that have an association with health system responsiveness. Adjusted Odds Ratio with their corresponding 95% CI was used to declare factors associated with health system responsiveness. A p-value less than 0.05 was used to declare statistical significance in this study. Results: The overall health system responsiveness was 66.2% (95% CI: 61.4% - 70.7%). Confidentiality and dignity domains were the highest responsiveness score. Health system responsiveness was higher among satisfied outpatients (AOR: 9.9, 95% CI: 5.11-19.46), utilized private clinics (AOR: 8.8, 95% CI: 4.32-18.25), and no transport cost (AOR: 1.7, 95% CI: 1.03-2.92) in the study setting. Conclusion: Overall health system responsiveness was higher as compared to other case-specific study in Ethiopia. The domains of Autonomy, Waiting time, Basic amenities, and Choice were identified as vital areas needing the effort to raise responsiveness of health care service in the District. HSR was higher in private than public healthcare facilities, among satisfied clients and those who didn’t pay for transport on their way to the health facility than their counterparts. Thus, enhancing patient satisfaction, using input from service users, Collaboration, and experience exchange between public and private facilities will be important interventions to improve HSR.

Patient Tolerability of Bowel Preparation is Associated with Polyp Detection Rate During Colonoscopy

2014 ◽  
Vol 23 (2) ◽  
pp. 135-140 ◽  
Author(s):  
Edward W. Holt ◽  
Kidist K. Yimam ◽  
Hanley Ma ◽  
Richard E. Shaw ◽  
Richard A. Sundberg ◽  
...  
Keyword(s):  
Bowel Preparation ◽  
Primary Outcome ◽  
Secondary Outcome ◽  
Polyp Detection ◽  
Cross Sectional ◽  
Quality Outcomes ◽  
Negative Experience ◽  
Polyp Detection Rate ◽  
Patient Reported ◽  
Bowel Prep

Background & Aims: A number of factors have been identified that influence the yield of screeningcolonoscopy. The perceived tolerability of bowel preparation has not been studied as a predictor of quality outcomes in colonoscopy. We aimed to characterize the association between patient-perceived tolerability of bowel preparation and polyp detection during colonoscopy.Methods: We performed a cross-sectional cohort study of 413 consecutive adult patients presenting foroutpatient colonoscopy at two outpatient endoscopy centers at our institution. We developed a standardized questionnaire to assess the patient's experience with bowel preparation. Bowel preparation quality was measured using the validated Ottawa scale and colonoscopic findings were recorded for each patient. The primary outcome was polyp detection and the secondary outcome was the quality of bowel preparation.Results: Patient-reported clarity of effluent during bowel preparation correlated poorly with Ottawa score during colonoscopy, k=0.15. Female gender was an independent risk factor for a poorly tolerated bowel prep (OR 3.93, 95% CI 2.30 - 6.72, p<0.001). Report of a poorly tolerated bowel prep was independently associated with the primary outcome, polyp detection (OR 0.39, 95% CI 0.18 - 0.84, p=0.02) and also with the secondary outcome, lower quality bowel preparation (OR 2.39, 95% CI 1.17 - 4.9, p=0.02).Conclusions: A patient-perceived negative experience with bowel preparation independently predicted both a lower quality bowel preparation and a lower rate of polyp of detection. Assessment of the tolerability of bowel preparation before colonoscopy may be a clinically useful predictor of quality outcomes during colonoscopy.

scholarly journals Health system responsiveness: a systematic evidence mapping review of the global literature

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Gadija Khan ◽  
Nancy Kagwanja ◽  
Eleanor Whyle ◽  
Lucy Gilson ◽  
Sassy Molyneux ◽  
...  
Keyword(s):  
Health System ◽  
Grey Literature ◽  
Feedback Loops ◽  
Theoretical Development ◽  
World Health ◽  
Evidence Map ◽  
Evidence Mapping ◽  
Mapping Review ◽  
System Responsiveness ◽  
Health System Responsiveness

Abstract Background The World Health Organisation framed responsiveness, fair financing and equity as intrinsic goals of health systems. However, of the three, responsiveness received significantly less attention. Responsiveness is essential to strengthen systems’ functioning; provide equitable and accountable services; and to protect the rights of citizens. There is an urgency to make systems more responsive, but our understanding of responsiveness is limited. We therefore sought to map existing evidence on health system responsiveness. Methods A mixed method systemized evidence mapping review was conducted. We searched PubMed, EbscoHost, and Google Scholar. Published and grey literature; conceptual and empirical publications; published between 2000 and 2020 and English language texts were included. We screened titles and abstracts of 1119 publications and 870 full texts. Results Six hundred twenty-one publications were included in the review. Evidence mapping shows substantially more publications between 2011 and 2020 (n = 462/621) than earlier periods. Most of the publications were from Europe (n = 139), with more publications relating to High Income Countries (n = 241) than Low-to-Middle Income Countries (n = 217). Most were empirical studies (n = 424/621) utilized quantitative methodologies (n = 232), while qualitative (n = 127) and mixed methods (n = 63) were more rare. Thematic analysis revealed eight primary conceptualizations of ‘health system responsiveness’, which can be fitted into three dominant categorizations: 1) unidirectional user-service interface; 2) responsiveness as feedback loops between users and the health system; and 3) responsiveness as accountability between public and the system. Conclusions This evidence map shows a substantial body of available literature on health system responsiveness, but also reveals evidential gaps requiring further development, including: a clear definition and body of theory of responsiveness; the implementation and effectiveness of feedback loops; the systems responses to this feedback; context-specific mechanism-implementation experiences, particularly, of LMIC and fragile-and conflict affected states; and responsiveness as it relates to health equity, minority and vulnerable populations. Theoretical development is required, we suggest separating ideas of services and systems responsiveness, applying a stronger systems lens in future work. Further agenda-setting and resourcing of bridging work on health system responsiveness is suggested.

Clinical Traits Characterizing an Exacerbation-Prone Phenotype in Chronic Rhinosinusitis

2019 ◽  
Vol 161 (5) ◽  
pp. 890-896 ◽  
Author(s):  
Katie M. Phillips ◽  
Eric Barbarite ◽  
Lloyd P. Hoehle ◽  
David S. Caradonna ◽  
Stacey T. Gray ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Disease Burden ◽  
Tertiary Care ◽  
Symptom Burden ◽  
Cross Sectional ◽  
Patient Reported ◽  
Oral Corticosteroids ◽  
Sinonasal Outcome Test ◽  
Snot 22

Objective Acute exacerbation of chronic rhinosinusitis (AECRS) is associated with significant quality-of-life decreases. We sought to determine characteristics associated with an exacerbation-prone phenotype in chronic rhinosinusitis (CRS). Study Design Cross-sectional. Setting Tertiary care rhinology clinic. Subjects Patients with CRS (N = 209). Methods Patient-reported number of sinus infections, CRS-related antibiotics, and CRS-related oral corticosteroids taken in the last 12 months were used as metrics for AECRS frequency. Sinonasal symptom burden was assessed with the 22-item Sinonasal Outcome Test (SNOT-22). Ninety patients reporting 0 for all AECRS metrics were considered to have had no AECRS in the prior 12 months. A total of 119 patients reported >3 on at least 1 AECRS metric and were considered as having an exacerbation-prone phenotype. Characteristics associated with patients with an exacerbation-prone phenotype were identified with exploratory regression analysis. Results An exacerbation-prone phenotype was positively associated with comorbid asthma (adjusted odds ratio [ORadj] = 3.68, 95% CI: 1.42-9.50, P = .007) and SNOT-22 (ORadj = 1.06, 95% CI: 1.04-1.09, P < .001). Polyps were negatively associated (ORadj = 0.27, 95% CI: 0.11-0.68, P = .005) with an exacerbation-prone phenotype. SNOT-22 score ≥24 identified patients with an exacerbation-prone phenotype with a sensitivity of 93.3% and a specificity of 57.8%. Having either a SNOT-22 score ≥24 with a nasal subdomain score ≥12 or a SNOT-22 score ≥24 with an ear/facial discomfort subdomain score ≥3 provided >80% sensitivity and specificity for detecting patients prone to exacerbation. Conclusions In total, these results point to a CRS exacerbation-prone phenotype characterized by high sinonasal disease burden with comorbid asthma but interestingly without polyps.

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