scholarly journals Low and unequal use of outpatient health services in public primary health care facilities in southern Ethiopia: a facility-based cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hiwot Abera Areru ◽  
Mesay Hailu Dangisso ◽  
Bernt Lindtjørn
Keyword(s):  
Health Service ◽  
Health Services ◽  
Health Facilities ◽  
Health Service Utilisation ◽  
Southern Ethiopia ◽  
Service Utilisation ◽  
Cross Sectional ◽  
Health Authorities ◽  
Utilisation Rate ◽  
Children Under 5

Abstract Background Outpatient department visits per individual for each year are one of the core indicators of healthcare delivery to assess accessibility or quality of services. In addition, this study aimed to assess health service utilisation and disease patterns in southern Ethiopia, by including the health authorities’ suggestions to improve the services. No study has assessed this in Ethiopia previously. Methods An institution-based cross-sectional design study was done in 65 primary health care units in Dale and Wonsho districts, in Sidama region, for all patients visiting health facilities from 1 July 2017 to 30 June 2018. We estimated the utilisation rate as visits per person per year, the odds ratio for health use and proportions of diseases’ diagnoses. The results of our study were presented to local health authorities, and their suggestions for improvements were incorporated into the analysis. Result A total of 81,129 patients visited the health facilities. The annual outpatient health service utilisation was 0.18 (95% CI: 0.18–0.19) new visits per person per year. The health service utilisation rate per year for the rural population was lower than the urban utilisation by 91% (OR = 0.09; 95% CI: 0.08–0.09). Children in the age group of 5–14 years had lower odds of health service utilisation by 78% (OR = 0.22; 95% CI: 0.21–0.23), compared to children under 5 years of age. Females were four times (OR = 4.17; 95% CI: 4.09–4.25) more likely to utilise health services than males. Febrile illness constituted 17.9% (14,847 of 83,148) of the diagnoses in all age groups. Almost half of the febrile cases, 46.5% (3827 of 8233), were among children under 5 years of age. There were very few cases of non-communicable diseases diagnosed in the health facilities. The health authorities suggested improving diagnostic capacities at health centres, enhancing health professionals’ skill and attitudes, and improving affordability and physical accessibility of the services. Conclusion The health service utilisation rate was low in Sidama. The use of health services was lower among rural residents, men, children and elderly, and health post users. Improving the quality, affordability and accessibility of the health services, by involving responsible stakeholders could increase service usage.

scholarly journals Health service utilisation associated with chronic breathlessness: random population sample

2021 ◽  
pp. 00415-2021
Author(s):  
David C. Currow ◽  
Sungwon Chang ◽  
Magnus Ekström ◽  
Ann Hutchinson ◽  
Tim Luckett ◽  
...  
Keyword(s):  
Health Service ◽  
Health Services ◽  
Hospital Admission ◽  
Demographic Data ◽  
Population Sample ◽  
Health Service Utilisation ◽  
Self Report ◽  
Systematic Sampling ◽  
Service Utilisation ◽  
Cross Sectional

Most health service utilisation studies are of people with specific diagnoses or demographic characteristics, and rarely of specific chronic symptoms. Does population-level health service utilisation increase in people with chronic breathlessness?MethodsCross-sectional analysis of the South Australian Health Omnibus Survey (HOS) 2017, a multi-stage, clustered area systematic sampling survey of adults where questions are administered face-to-face in respondents’ homes. Self-report of health service utilisation in the previous 3 months (medical consultations, ED, hospital admission), chronic breathlessness (severity, duration; modified Medical Research Council (mMRC) breathlessness scale) and demographic data were used to predict self-reported health service utilisation.ResultsA total of 2898 people were included (49.0% men; median age 48.0 years (IQR 32.0, 63.0); 64.1% educated beyond school; 55.4% in work; 73.5% had outpatient contact; 6.3% had a hospital admission in the previous three months). Chronic breathlessness (mMRC ≥1) was reported by 8.8% of respondents. In bivariable analyses, people with greater contact with health services were older, and a higher proportion were overweight/obese and had more severe chronic breathlessness. In multivariable analyses, chronic breathlessness and older age were positively associated with outpatient care and inpatient care, and people with chronic breathlessness were hospitalised for longer, incidence rate ratio 2.5 (95%CI: 1.4, 4.5).AnswerThere is a significant association between worse chronic breathlessness and increased health service utilisation. There is a need for greater understanding of factors that initiate contact with health services.

Barriers to and facilitators of health services utilisation by refugees in resettlement countries: an overview of systematic reviews

2020 ◽  
Vol 44 (1) ◽  
pp. 132 ◽  
Author(s):  
Jamuna Parajuli ◽  
Dell Horey
Keyword(s):  
Health Care ◽  
Health Service ◽  
Health Services ◽  
Systematic Reviews ◽  
Health Professionals ◽  
Health Service Utilisation ◽  
Barriers And Facilitators ◽  
Service Utilisation ◽  
Knowledge And Skills ◽  
Overview Of Systematic Reviews

Objective The aim of this study was to provide an overview of the previously reviewed research literature to identify barriers and facilitators to health service utilisation by refugees in resettlement countries. Methods An overview of systematic reviews was conducted. Seven electronic databases (Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, ProQuest Central, Scopus, EBSCO and Google Scholar) were searched for systematic reviews of barriers and facilitators to health-seeking behaviour and utilisation of health services by refugees following resettlement. The two authors independently undertook data selection, data extraction and quality assessment using a validated tool. Results Nine systematic reviews covered a range of study areas and refugee populations. Barriers to health service utilisation fell into three broad areas: (1) issues related to refugees, including refugee characteristics, sociocultural factors and the effects of previous experiences; (2) issues related to health services, including practice issues and the knowledge and skills of health professionals; and (3) issues related to the resettlement context, including policies and practical issues. Few facilitators were identified or evaluated, but these included approaches to care, health service responses and behaviours of health professionals. Conclusions Barriers to accessing health care include refugee characteristics, practice issues in health services, including the knowledge and skills of health professionals, and the resettlement context. Health services need to identify barriers to culturally sensitive care. Improvements in service delivery are needed that meet the needs of refugees. More research is needed to evaluate facilitators to improving health care accessibility for these vulnerable groups. What is known about the topic? Refugee health after resettlement is poor, yet health service use is low. What does this paper add? Barriers to accessing health services in resettlement countries are related not only to refugees, but also to issues regarding health service practices and health professionals’ knowledge and skill, as well as the context of resettlement. Few facilitators to improving refugee access to health services have been identified. What are the implications for practitioners? The barriers associated with health professionals and health services have been linked to trust building, and these need to be addressed to improve accessibility of care for refugees.

scholarly journals Using Linked Data to Estimate the True Number of Individuals Impacted by Residential Fire

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Nargess Ghassempour ◽  
Lara A Harvey ◽  
W. Kathy Tannous
Keyword(s):  
Emergency Department ◽  
Health Service ◽  
Health Services ◽  
Hospital Admissions ◽  
Population Based ◽  
Health Service Utilisation ◽  
Service Utilisation ◽  
Residential Fire ◽  
True Number ◽  
Residential Fires

IntroductionResidential fires remain a significant global public health problem. It is recognised that the reported number of residential fires, fire-related injuries and deaths significantly underestimate the true number. Australian population-based surveys show that around two-thirds of respondents who experience a residential fire are unwilling to call fire services, and studies from the US and New Zealand highlight that many individuals who access medical treatment for fire-related injuries do not have an associated fire incident report. Objectives and ApproachThis population-based study aimed to quantify the total number of residential fires, fire-related injuries and associated health service utilisation. The cohort included all persons residing at a residential address in New South Wales, Australia, which experienced a fire between 1 January 2005 - 31 December 2014. The cohort comprised linked person-level data from eight administrative datasets and includes information about nature of fire, first responder use (Fire and Rescue (FRNSW) and ambulance services), health service utilisation (emergency department, hospital and burns outpatient clinic) and health outcomes. ResultsOver the study period, FRNSW responded to 42,491 residential-fire incidents, involving 42,160 individuals with some individuals reporting multiple times. In total, 3,382 individuals used one or more health service and 154 individuals died. Of individuals who contacted FRNSW, 1,661 (3.9%) used health services;ambulance (n=1,101), emergency department (n=1,114), hospital admissions (n=168). There were 95 deaths. There were 1,721 (51%) additional individuals who used one or more health service as a result of a residential-fire that did not contact FRNSW and 59 additional deaths were identified. Conclusion / ImplicationsThis study found that more than half of individuals who used health services for residential fire-related injuries did not have an associated fire report, highlighting the importance of data linkage for accurate communication to policy makers and the public on the prevalence and impact of residential-fires.

Patterns of health service utilisation among the Australian population with cancer compared with the general population

2020 ◽  
Vol 44 (3) ◽  
pp. 470 ◽  
Author(s):  
Huah Shin Ng ◽  
Bogda Koczwara ◽  
David Roder ◽  
Raymond Javan Chan ◽  
Agnes Vitry
Keyword(s):  
General Population ◽  
Health Service ◽  
Health Services ◽  
Chronic Diseases ◽  
Health Service Utilisation ◽  
Control Group ◽  
Service Utilisation ◽  
Australian Population ◽  
Delivery Of Care ◽  
Barriers And Enablers

Objective The aim of this study was to describe patterns of health service utilisation among the Australian population with cancer compared with the general population. Methods Data for all respondents aged ≥25 years from two successive National Health Surveys conducted between 2011 and 2014 were analysed. Respondents with a history of cancer were identified as the cancer group, whereas all other respondents who did not report having had a cancer were included in the non-cancer control group. Comparisons were made between the two groups using logistic regression models. Results The population with cancer was more likely to report having consulted their general practitioner, specialist, chemist, dietician, naturopath, nurse, optometrist, dentist, audiologist and other health professionals than the non-cancer population. The cancer population was also more likely to be admitted to hospital and to have visited an out-patient clinic, emergency department and day clinic. The presence of comorbidity and a current cancer were associated with a greater likelihood of receiving health services among the population with cancer. Conclusion The population with cancer used health services significantly more than the non-cancer population. Further studies are urgently needed to identify optimal approaches to delivery of care for this population, including barriers and enablers for their implementation. What is known about the topic? Multimorbidity is highly prevalent among the cancer population due to risk factors shared between cancer and other chronic diseases, and the development of new conditions resulting from cancer treatment and cancer complications. However, the Australian healthcare system is not set up optimally to address issues related to multimorbidity. What does this paper add? This study is the first step in quantifying health services use by the population with cancer compared with the general population without cancer. Cancer survivors have an increased need for specific health services, particularly among those with multimorbidity. What are the implications for practitioners? The development of integrated care models to manage multiple chronic diseases aligned with the Australian National Strategic Framework for Chronic Conditions is warranted. Further studies are urgently needed to identify optimal approaches to delivery of care for this population, including barriers and enablers for their implementation.

scholarly journals The impact of a health facility construction campaign on health service utilisation and outcomes: analysis of spatially linked survey and facility location data in Ethiopia

2020 ◽  
Vol 5 (8) ◽  
pp. e002430
Author(s):  
Kevin Croke ◽  
Andualem Telaye Mengistu ◽  
Stephen D. O'Connell ◽  
Kibrom Tafere
Keyword(s):  
Caesarean Section ◽  
Health Service ◽  
Neonatal Mortality ◽  
Facility Delivery ◽  
Health Facilities ◽  
Health Service Utilisation ◽  
Service Utilisation ◽  
Percentage Points ◽  
Facility Construction ◽  
The Impact

BackgroundAccess to health facilities in many low-income and middle-income countries remains low, with a strong association between individuals’ distance to facilities and health outcomes. Yet plausibly causal estimates of the effects of facility construction programmes are rare. Starting in 2004, more than 2800 government health facilities were built in Ethiopia. This study estimates the impact of this programme on maternal health service utilisation and birth outcomes.MethodsWe analyse the impact of Ethiopia’s health centre construction programme on health service utilisation and outcomes, using a difference-in-difference design. We match facility opening years to child birth years in four rounds of Demographic and Health Surveys (DHS) using georeferenced data. We also use event study models to test for pre-trends in the outcomes of interest.ResultsOpening of new health facilities within 5 km increases facility delivery by 7.2 percentage points (95% CI 5.2 to 9.1) and antenatal care by 0.38 visits (95% CI 0.24 to 0.52). It is not significantly associated with changes in caesarean section births or neonatal mortality. Opening of district hospitals increases facility delivery by 18.2 percentage points (95% CI 12.7 to 23.7), and caesarean section births by 6.8 percentage points (95% CI 2.5 to 11.2), but is not associated with reduction of neonatal mortality.ConclusionsEthiopia’s facility construction program improved access to antenatal and delivery care. However, there was no detectable association between facility construction and neonatal mortality. Increased access to care must be combined with health system quality improvements and broader social development initiatives to sustainably improve health outcomes.

scholarly journals Help-Seeking Patterns Among the General Population in Singapore: Results from the Singapore Mental Health Study 2016

2020 ◽  
Author(s):  
Saleha Shafie ◽  
Mythily Subramaniam ◽  
Edimansyah Abdin ◽  
Janhavi Ajit Vaingankar ◽  
Rajeswari Sambasivam ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Mental Disorders ◽  
Health Service ◽  
Social Services ◽  
Help Seeking ◽  
Population Based ◽  
Health Service Utilisation ◽  
Service Utilisation ◽  
Cross Sectional

Abstract This study aimed to establish lifetime mental health service utilisation among the general population of Singapore. The sociodemographic correlates of those seeking help from different service provider groups and changes in lifetime mental health service utilisation between 2010 and 2016 among those with mental disorders were also explored. A population-based cross-sectional epidemiological household survey of the Singapore resident population aged 18 years and above was conducted from 2016 to 2018, using the World Mental Health Composite International Diagnostic Interview (CIDI) version 3.0. Data from two cross-sectional population-based studies were used for comparison of lifetime mental health service utilisation in 2010 (n = 6616) and 2016 (n = 6126). Chi square test and multiple logistic regression were used to analyse the data. A total of 6126 respondents completed the study in 2016. Overall 9.3% of the total sample, 32.0% of those with mental disorders, and 5.7% of those not meeting criteria for mental disorders, ever sought help for their mental health issues in their lifetime, from any treatment service sectors. Several sociodemographic characteristics were found to be correlated with different service provider groups. There was no change in mental health service utilisation between 2010 and 2016 for all mental disorders included in this study, with the exception of a significant increase in help sought from professionals in social services, among those with alcohol abuse. Even though the overall help-seeking rates are low, it is encouraging that those seeking help did so from mental health professionals and professionals working in the social services.

scholarly journals Health service utilisation lags behind maternal diseases or illnesses during pregnancy in rural south Ethiopia: A prospective cohort study

2019 ◽  
Author(s):  
Moges Tadesse ◽  
Eskindir Loha ◽  
Kjell Arne Johansson ◽  
Bernt Lindtjørn
Keyword(s):  
Cohort Study ◽  
Health Service ◽  
Pregnant Women ◽  
Repeated Measures ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Health Service Utilisation ◽  
Southern Ethiopia ◽  
Service Utilisation ◽  
Health Institution

AbstractMaternal survival has improved substantially in the last decades, but evidence on maternal morbidity and health service utilisation for various maternal diseases are scarce in low resource settings. We aimed to measure health service utilisation for maternal illnesses during pregnancy. A cohort study of 794 pregnant women in rural southern Ethiopia was carried-out from May 2017 to July 2018. Disease or illness identification criteria were: symptoms, signs, physical examination, and screening of anaemia. Follow-up was done every two weeks. Data on health service utilisation was obtained from women and confirmed by visiting the health facility. Multilevel, multiple responses, repeated measures, and generalized linear mixed model analysis were used. The cumulative incidence of women experiencing illness episodes was 91%, and there were 1.7 episodes of diseases or illnesses per woman. About 22% of pregnant women were anaemic and 8% hypertensive. Fourteen pregnant women experienced abortions, 6 had vaginal bleeding, 48% pain in the pelvic area, 4% oedema, and 72% tiredness. However, health service utilisation was only 7%. About 94% of anaemic women did not get iron-folic-acid tablet supplementation. Only two mothers with blurred vision and severe headache were referred for further treatment. The main reasons for not using the health services were: the perception that symptoms would heal by themselves (47%), illness to be minor (42%), financial constraints (10%), and lack of trust in health institutions (1%). Risk factors were being older women, poor, having a history of abortion, living far away from the health institution, travelled longer time to reach a health institution, and monthly household expenditure >=30 USD. In Conclusion, there was a high incidence of diseases or illnesses; however health service utilisation was low. Poor understanding of severe and non-severe symptoms was an important reason for low health service utilisation. Therefore, community-based maternal diseases or illness survey could help for early detection. Ministry of Health should promote health education that encourages women to seek appropriate and timely care.

scholarly journals Effect of household relocation on child vaccination and health service utilisation in Dhaka, Bangladesh: a cross-sectional community survey

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e026176
Author(s):  
Lily Horng ◽  
Nadira Sultana Kakoly ◽  
Jaynal Abedin ◽  
Stephen P Luby
Keyword(s):  
Health Services ◽  
Respiratory Illness ◽  
Community Survey ◽  
Service Utilisation ◽  
Medical Provider ◽  
Cross Sectional ◽  
Total N ◽  
Household Relocation ◽  
The Impact ◽  
Children Under 5

ObjectiveTo explore the relationship between household relocation and use of vaccination and health services for severe acute respiratory illness (ARI) among children in Dhaka, Bangladesh.DesignAnalysis of cross-sectional community survey data from a prior study examining the impact ofHaemophilus influenzaetype b vaccine introduction in 2009 on meningitis incidence in Bangladesh.SettingCommunities surrounding two large paediatric hospitals in Dhaka, Bangladesh.ParticipantsHouseholds with children under 5 years old who either recently relocated<12 months or who were residentially stable living>24 months in their current residence (total n=10 020) were selected for this study.Primary outcome measuresFull vaccination coverage among children aged 9-59 months and visits to a qualified medical provider for severe ARI among children under 5 years old.ResultsUsing vaccination cards with maternal recall, full vaccination was 80% among recently relocated children (n=3795) and 85% among residentially stable children (n=4713; χ2=37.2, p<0.001). Among children with ARI in the prior year, 69% of recently relocated children (n=695) had visited a qualified medical provider compared with 82% of residentially stable children (n=763; χ2=31.9, p<0.001). After adjusting for demographic and socioeconomic characteristics, recently relocated children were less likely to be fully vaccinated (prevalence ratio [PR] 0.97; 95% CI 0.95 to 0.99; p=0.016) and to have visited a qualified medical provider for ARI (PR 0.88; 95% CI 0.84 to 0.93; p<0.001).ConclusionsChildren in recently relocated households in Dhaka, Bangladesh, have decreased use of vaccination and qualified health services for severe ARI.

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