Socioeconomic determinants of unmet need for outpatient healthcare services in Iran: a national cross-sectional study

Abstract Background Unmet need is a critical indicator of access to healthcare services. Despite concrete evidence about unmet need in Iran’s health system, no recent evidence of this negative outcome is available. This study aimed to measure the subjective unmet need (SUN), the factors associated with it and various reasons behind it in Iran. Methods We used the data of 13,005 respondents over the age of 15 from the Iranian Utilization of Healthcare Services Survey in 2016. SUN was defined as citizens whose needs were not sought through formal healthcare services, while they did not show a history of self-medication. The reasons for SUN were categorized into availability, accessibility, responsibility and acceptability of the health system. The multivariable logistic regression was used to determine significant predictors of SUN and associated major reasons. Results About 17% of the respondents (N = 2217) had unmet need for outpatient services. Nearly 40% of the respondents chose only accessibility, 4% selected only availability, 78% chose only responsibility, and 13% selected only acceptability as the main reasons for their unmet need. Higher outpatient needs was the only factor that significantly increased SUN, responsibility-related SUN and acceptability-related SUN. Low education was associated with higher SUN and responsibility-related SUN, while it could also reduce acceptability-related SUN. While SUN and responsibility-related SUN were prevalent among lower economic quintiles, having a complementary insurance was associated with decreased SUN and responsibility-related SUN. The people with basic insurance had lower chances to face with responsibility-related SUN, while employed individuals were at risk to experience SUN. Although the middle-aged group had higher odds to experience SUN, the responsibility-related SUN were prevalent among elderly, while higher age groups had significant chance to be exposed to acceptability-related SUN. Conclusion It seems that Iran is still suffering from unmet need for outpatient services, most of which emerges from its health system performance. The majority of the unmet health needs could be addressed through improving financial as well as organizational policies. Special attention is needed to address the unmet need among individuals with poor health status.

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Socioeconomic Determinants of Unmet Need for Outpatient Healthcare Services in Iran: A National Cross-sectional Study

10.21203/rs.3.rs-18662/v2 ◽

2020 ◽

Author(s):

Sajad Vahedi ◽

Amin Torabipour ◽

Amirhossein Takian ◽

Saeed Mohammadpur ◽

Alireza Oliaeemanesh ◽

...

Keyword(s):

Health System ◽

Unmet Need ◽

The Elderly ◽

Healthcare Services ◽

Cross Sectional Study ◽

Outpatient Services ◽

Self Medication ◽

Cross Sectional ◽

Organizational Policies ◽

Utilization Of Healthcare

Abstract Background: Unmet need is a critical indicator of access to healthcare services. Despite concrete evidence about unmet need in Iran’s health system, no recent evidence of this negative outcome is available. This study aimed to measure the subjective unmet need (SUN), the factors associated with it and various reasons behind it in Iran. Methods: We used the data of 13005 respondents over the age of 15 from the Iranian Utilization of Healthcare Services Survey in 2016. SUN was defined as citizens whose needs were not sought through formal healthcare services, while they did not show a history of self-medication. The reasons for SUN were categorized into availability, accessibility, responsibility and acceptability of the health system. The multivariate logistic regression was used to determine significant predictors of unmet need and associated major reasons. Results: About 17% of the respondents (N=2,217) had unmet need for outpatient services. Nearly 40% of the respondents chose only accessibility, 4% selected only availability, 78% chose only responsibility, and 13% selected only acceptability as the main reasons for their unmet need. Low education was associated with higher responsibility-related SUN, while it could also reduce acceptability-related SUN. While SUN and responsibility-related SUN were prevalent among lower economic quintiles and people with higher outpatient needs, having a complementary insurance was associated with decreased SUN and responsibility-related SUN. The elderly and those with basic insurance had lower chances to face with responsibility-related SUN, while employed individuals were at risk to experience SUN. Conclusion: It seems that Iran is still suffering from unmet need for outpatient services, most of which emerges from its health system performance. The majority of the unmet health needs could be addressed through improving financial as well as organizational policies. Special attention is needed to address the unmet need among individuals with poor health status.

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Socioeconomic Determinants of Unmet Healthcare Needs in Iran

10.21203/rs.3.rs-18662/v1 ◽

2020 ◽

Author(s):

Sajad Vahedi ◽

Amin Torabipour ◽

Amirhossein Takian ◽

Saeed Mohammadpur ◽

Alireza Oliaeemanesh ◽

...

Keyword(s):

Health System ◽

Unmet Need ◽

The Elderly ◽

Healthcare Services ◽

Outpatient Services ◽

Self Medication ◽

Organizational Policies ◽

Healthcare Needs ◽

Unmet Healthcare Needs ◽

Utilization Of Healthcare

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Maternal Healthcare Services Along Indo-Bangladesh Bordering Districts: Exploring Effects of Social Determinants on Access to Maternal Healthcare Services.

10.21203/rs.3.rs-165636/v1 ◽

2021 ◽

Author(s):

Nayan Jyoti Nath ◽

Bedanga Talukdar ◽

Tanu Shukla ◽

Sangeeta Sharma

Keyword(s):

Geographical Location ◽

Well Being ◽

Healthcare Services ◽

Cross Sectional Study ◽

Peripheral Region ◽

Easy Access ◽

Maternal Healthcare ◽

Cross Sectional ◽

Younger Women ◽

Utilization Of Healthcare

Abstract Background Regardless of government efforts toward ameliorating easy access and utilization of healthcare services, the disparity in Maternal Mortality Rate (MMR) is significantly higher across states of India. Post-Sustainable Development Goals (SDGs), equity in healthcare largely remain in the health policy discourse. The policy implementation's effectiveness remained confined to the central geographical location, remotely reaching the peripheral region. The study seeks to assess socio-demographic and household wealth's effect on the access and utilization of healthcare services among women. A cross-sectional study was conducted among 355 women aged 15–49 years in three Indian districts of Assam that share an international border with Bangladesh. Results The study's findings reported that utilization and accessibility are primarily influenced by households' wealth and women's age. Education qualification has no significant effect on healthcare utilization. Younger women from wealthier households are more likely to utilize government healthcare services in India's borderline regions. Conclusion Besides educating women, the availability of healthcare resources and empowering the livelihood resources in the peripheral region should be prioritized. In these fragile areas, efforts to empower women and their families to seek healthcare should be strengthened, which shall enhance well-being.

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Patient Satisfaction in the Peruvian Health Services: Validation and Application of the HEALTHQUAL Scale

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17145111 ◽

2020 ◽

Vol 17 (14) ◽

pp. 5111

Author(s):

Fernando Barrios-Ipenza ◽

Arturo Calvo-Mora ◽

Félix Velicia-Martín ◽

Fernando Criado-García ◽

Antonio Leal-Millán

Keyword(s):

User Satisfaction ◽

Health Sector ◽

Healthcare Services ◽

Cross Sectional Study ◽

Healthcare Personnel ◽

Attractive Alternative ◽

Path Modeling ◽

Outpatient Services ◽

Cross Sectional ◽

The Relationship

During recent years, public–private partnerships (PPPs) in the health sector have been an attractive alternative for improving healthcare services in developing countries such as Peru. Therefore, it is fundamental to consider a comprehensive set of healthcare qualities, like the HEALTHQUAL scale, when we measure dimensions of healthcare service quality. Currently, no studies have applied HEALTHQUAL in Peruvian hospitals. The purposes of this study were to (1) validate and evaluate the application of the HEALTHQUAL scale to measure user satisfaction in outpatient services at two PPP hospitals in Peru; and (2) test the relationship between user satisfaction, efficiency, and loyalty. A descriptive, cross-sectional study based on the HEALTHQUAL scale was carried out at the end of 2018. The measurement items were satisfaction with healthcare personnel, satisfaction with nonhealthcare personnel, satisfaction with facilities and equipment, perception of efficiency, and trust. The scale was administered to a nonprobability sample of 250 users who attended one of two PPP hospitals—Barton and Kaelin. The application of partial least squares path modeling significantly impacted on the perceived efficiency in the items of healthcare personnel, nonhealthcare personnel, and facilities and equipment. The HEALTQUAL scale demonstrated sufficient validity and thus can be applied for measuring user satisfaction in PPP hospitals.

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Trend of unintentional suffocation death for infants under 1 year of age from 2009 to 2018 in Hunan, China: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2020-038666 ◽

2020 ◽

Vol 10 (12) ◽

pp. e038666

Author(s):

Fanjuan Kong ◽

Aihua Wang ◽

Jian He ◽

Lili Xiong ◽

Donghua Xie ◽

...

Keyword(s):

Mortality Rate ◽

Age Groups ◽

Healthcare Services ◽

Cross Sectional Study ◽

Urban Children ◽

Infant Mortality Rate ◽

Hunan Province ◽

Rural Children ◽

Sectional Study ◽

Cross Sectional

ObjectiveFew studies have addressed the unintentional suffocation of infants in China. This study is to assess the mortality rate of unintentional suffocation among infants and the differences across age groups, gender, rural versus urban locations and related healthcare services.DesignA cross-sectional study on unintentional suffocation death of infants under 1 year of age in Hunan Province from 2009 to 2018.SettingHunan Province, with a population of 74 million, has an area of 210 000 square kilometres and 123 counties/districts.ParticipantsThe total data of 4109 unintentional suffocation deaths of infants in Hunan Province from 2009 to 2018 was collected, including 2331 boys, 1766 girls, 12 infants of unknown gender, 2906 rural children and 1203 urban children.Main outcome measureThe unintentional suffocation mortality rate of infants is defined as the number of unintentional suffocation deaths of children under 1 year of age per 100 000 live births in the same year.ResultsThe infant mortality rate showed a downward trend from 2009 to 2018. Infant unintentional suffocation death decreased first and then fluctuated. The proportion of unintentional suffocation death to infant death showed an upward trend in fluctuation. Boys and rural children had higher mortality rates than those of girls and urban children. A total of 43.5% of the deaths occurred in winter. Forty-eight per cent of the unintentional suffocations were infants between 1 and 4 months of age. A total of 46.4% of the deaths occurred at home, and 71.6% were not treated; approximately 81.8% of the untreated cases were mainly due to a lack of time to get to the hospital. A total of 65.2% of the deaths were diagnosed postmortem.ConclusionThe mortality rate of unintentional suffocation among infants in Hunan Province should attract the attention of the population, and measures should be taken according to epidemiological investigations.

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Telegeriatrics during the COVID-19 pandemic

QJM ◽

10.1093/qjmed/hcab119 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Hoda Wahba ◽

Tamer Emara ◽

Ahmed Elbokl

Keyword(s):

Elderly Population ◽

Geriatric Patients ◽

Geriatric Medicine ◽

Age Groups ◽

The Elderly ◽

Healthcare Services ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Insignificant Difference

Abstract Background Ain Shams University Virtual Hospital (AVH) has been offering telemedicine services since 2016. During the COVID-19 pandemic it has become essential to offer healthcare services in a safe way. Telemedicine was the perfect choice worldwide to compensate for the deficiency of physical healthcare services. Limitations especially in the elderly population questioned the feasibility of the telegeriatrics model. Aim To study the feasibility and acceptability of the AVH telemedicine model in geriatric patients. Methodology A cross-sectional study performed from April to October 2020 recruiting patients above 60 years receiving telemedicine services as part of the telemedicine program delivered via AVH. Data was collected via Google forms that were sent to the patients and physicians via Whats app. Results 1471 patients were triaged via the Whats app managed by geriatric consultants and 64 received video consultations. 849 patients responded to the surveys from all age groups of which 21.8% were above 60 years. From the responders 19.7% consulted geriatric medicine while the 2.1% consulted other specialties. Most satisfaction domains were 85% and above positive responses with an insignificant difference between age groups. 90% of physicians felt confident in their medical management using telemedicine. Conclusion: telegeriatrics is feasible as it is well accepted, easily used and preferred over clinic visits during the COVID-19 pandemic and after, by patients. Physicians are confident in their management using it.

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Factors associated with self-medication in Spain: a cross-sectional study in different age groups

International Journal of Pharmacy Practice ◽

10.1111/ijpp.12387 ◽

2017 ◽

Vol 26 (3) ◽

pp. 258-266 ◽

Cited By ~ 5

Author(s):

Gracia Niclós ◽

Teresa Olivar ◽

Vicent Rodilla

Keyword(s):

Age Groups ◽

Cross Sectional Study ◽

Sectional Study ◽

Self Medication ◽

Cross Sectional ◽

Factors Associated

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The Impact of COVID-19 in Older People in Portugal: Results from the Survey of Health, Ageing and Retirement (SHARE)

Acta Médica Portuguesa ◽

10.20344/amp.16209 ◽

2021 ◽

Vol 34 (11) ◽

pp. 761

Author(s):

Filipa Novais ◽

Catarina Cordeiro ◽

Pedro Câmara Pestana ◽

Beatriz Côrte-Real ◽

Teresa Reynolds Sousa ◽

...

Keyword(s):

Sleep Problems ◽

Age Groups ◽

The Elderly ◽

Healthcare Services ◽

Cross Sectional Study ◽

World Health ◽

International Studies ◽

Cross Sectional ◽

Health Organization ◽

The Impact

Introduction: In March 2020, the World Health Organization declared COVID-19 as a pandemic, and Portugal reported its initial cases. In this study, we aimed to determine the impact of COVID-19 on Portuguese individuals aged over 60 years old.Material and Methods: We performed a cross-sectional study using data from the Survey of Health, Ageing and Retirement in Europe (SHARE 8: COVID-19 Survey). We selected a sample of 1080 noninstitutional Portuguese individuals aged ≥ 60 years.Results: The study sample consisted of 605 (56%) women and 475 (44%) men, with a mean age of 70 ± 9.1 years. In total, 80% of the participants experienced higher levels of anxiety, 73% felt more depressed and 30% experienced additional sleep problems comparedto the period before the pandemic. Interestingly, there were no statistically significant differences between the sexes or the two selected age groups (60 - 74 and over 75 years old) regarding the incidence of these changes. Only 23%, of those that were interviewed maintained their walking routines. In addition, only 8% of the participants continued visiting family members as frequently as before. While 8% of the participants were refused some form of medical treatment, 56% claimed that they experienced healthcare delays. However,only 15% of the participants reported that their health status worsened during the pandemic.Discussion: The pandemic has had a significant impact on Portuguese individuals aged ≥ 60 years; which is in agreement with the findings of previous international studies. It changed the participants’ routines and increased their anxiety and depression levels. Despite the deterioration of healthcare services, most participants did not experience worsening of their health status.Conclusion: In conclusion, a COVID-19 pandemic had a significant impact on the elderly population, particularly regarding their mental health.

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Beyond COVID-19: a cross-sectional study in Italy exploring the Covid Collateral Impacts

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.209 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M R Gualano ◽

A Corradi ◽

G Voglino ◽

F Bert ◽

R Siliquini

Keyword(s):

Chronic Conditions ◽

Stress Test ◽

Healthcare Services ◽

Cross Sectional Study ◽

Medical Services ◽

Sectional Study ◽

Access To Health Services ◽

Online Questionnaire ◽

Self Medication ◽

Cross Sectional

Abstract Background The COVID-19 pandemic is a calamity affecting many aspects. In particular healthcare services (HCS) are facing a great stress-test worldwide. The present work aims to explore what were health needs, beyond COVID, not covered among Italian citizens, due to fear, lockdown measures and overload of HCS, also in order to understand if there are specific subgroups of populations that will need urgent access to health services in the next future. Methods COCOS (COvid COllateral impactS) is a cross-sectional study performed during the Italian lockdown between April and May 2020. A forty-nine items online questionnaire was filled by the respondents. Participation was voluntary and without compensation. Informed consents were obtained. Descriptive, univariable and multivariable (logistic regression models) analyses were performed: results are expressed in ORs. Results Totally, 1,515 questionnaires were collected. Median age was 42 years, 65.6% were females. Around 22% declared to suffer from chronic diseases. Interestingly, 32.4% of the sample faced a delay of a scheduled Medical Service (MS) by provider decision, while 25.6% reported that this issue hit a family member. More than 13% refused to access scheduled MS for the fear of contagion, and the 6.5% avoided HCS even if having an acute onset issue: this behavior was associated with scarce trust in physicians (AdjOR 0.75); alarmingly, 1.5% avoided Emergency Department when in need and 5% of the sample took medications without consulting any physician: patients suffering from chronic conditions resulted to be more prone to self-medication (AdjOR: 2.16; 95% C.I.: 1.16-4.02). Conclusions COVID-19 immediate effects are just the tip of the iceberg. Large groups of population suffered delays and interruptions of medical services, and the most vulnerable were the most affected. To estimate the effects of the pandemic on non-COVID-19 patients is required, leading to aimed efforts, to reduce the backlog that HCS incurred in. Key messages COVID-19 biggest toll on public health is still to come if not prevented, due to temporary but widespread suspensions of scheduled medical services and the avoidance of these for fear of contagion. The most in need are the most vulnerable: older patients and those with chronic conditions are the most affected by suspension of medical services and will potentially pay the greatest cost.

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Use of dietary supplements in Denmark is associated with health and former smoking

Public Health Nutrition ◽

10.1079/phn2001276 ◽

2002 ◽

Vol 5 (3) ◽

pp. 463-468 ◽

Cited By ~ 44

Author(s):

Vibeke K Knudsen ◽

Lone B Rasmussen ◽

Jóhanna Haraldsdóttir ◽

Lars Ovesen ◽

Inge Bülow ◽

...

Keyword(s):

Dietary Supplements ◽

Elderly Women ◽

Age Groups ◽

Participation Rate ◽

Perceived Health ◽

Cross Sectional Study ◽

Iodine Intake ◽

Self Medication ◽

Cross Sectional ◽

Supplement Use

AbstractObjectives:To describe the use of dietary supplements in a group of Danish adults and to investigate the differences between users and non-users with respect to age, gender, health and lifestyle factors.Design:Cross-sectional study in two Danish cities.Setting:The Danish Investigation on Iodine Intake and Thyroid Diseases, 1997–1998.Subjects:Participants were 3707 women (selected age groups between 18 and 65 years) and 942 men (60–65 years). Participation rate was 50%. Supplement data were collected in a personal interview. Data on education, smoking, alcohol intake, physical activity, use of medication and self-perceived health were derived from a self-administered questionnaire. Multiple logistic regression was used for the statistical analysis.Results:Participants were asked about all kinds of supplements, ranging from products containing vitamins and minerals, to fish oils and products of herbal origin. On average 59% reported use of some kind of dietary supplement. Most common were combined multivitamin/mineral products (48%) followed by single vitamin C products (10%). Twelve per cent used three or more different supplements. Supplement use was strongly associated with age and gender, being highest among elderly women (78%). Ex-smokers were more likely to use supplements than subjects who had never smoked (odds ratio (OR) 1.36, 95% confidence interval (CI) 1.09–1.76). Supplement use was more likely among subjects who had many days of illness (OR = 1.37, 95% CI 1.12–1.66) and among users of medication (OR = 1.22, 95% CI 1.04–1.42). Subjects who perceived their health as poor were more likely to use supplements other than just a multivitamin/mineral tablet (OR = 2.2, 95% CI 1.31–3.77).Conclusions:Use of dietary supplements was related to age, gender and smoking, but also to poor self-perceived health status and absence from work. This indicates that a group of people use supplements as a form of self-medication.

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