scholarly journals Impacts of a comprehensive tuberculosis control model on the quality of clinical services and the financial burden of treatment for patients with drug-resistant tuberculosis in China: a mixed-methods evaluation

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Wei-Xi Jiang ◽  
Zhi-Peng Li ◽  
Qi Zhao ◽  
Meng-Qiu Gao ◽  
Qian Long ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Financial Burden ◽  
Control Model ◽  
Phase Iii ◽  
Drug Resistant ◽  
Clinical Services ◽  
Political Commitment ◽  
Burden Of Treatment ◽  
Financing Policies

Abstract Background The China National Health Commission-Gates TB Project Phase III implemented a comprehensive TB control model including multiple interventions to address the burden of drug-resistant TB (DRTB). This study aims to evaluate the quality of DRTB clinical services and assess the financial burden of DRTB patients during the intervention period. Methods A mixed-methods approach was used to evaluate the effectiveness of interventions in the three project provinces: Zhejiang, Jilin and Ningxia Hui Autonomous Region. The quantitative data included de-identified DRTB registry data during 2015–2018 in project provinces from China CDC, medical records of DRTB patients registered in 2018 (n = 106) from designated hospitals, and a structured DRTB patient survey in six sample prefectures in 2019. The quality of clinical services was evaluated using seven indicators across patient screening, diagnosis and treatment. Logistic regression was conducted to explore factors associated with the extremely high financial burden. Semi-structured in-depth interviews with policymakers and focus group discussions with physicians and DRTB patients were conducted to understand the interventions implemented and their impacts. Results The percentage of bacterially confirmed patients taking a drug susceptibility test (DST) increased significantly between 2015 and 2018: from 57.4 to 93.6% in Zhejiang, 12.5 to 86.5% in Jilin, and 29.7 to 91.4% in Ningxia. The treatment enrollment rate among diagnosed DRTB patients also increased significantly and varied from 73 to 82% in the three provinces in 2018. Over 90% of patients in Zhejiang and Jilin and 75% in Ningxia remained in treatment by the end of the first six months’ treatment. Among all survey respondents 77.5% incurred extremely high financial burden of treatment. Qualitative results showed that interventions on promoting rapid DST technologies and patient referral were successfully implemented, but the new financing policies for reducing patients’ financial burden were not implemented as planned. Conclusions The quality of DRTB related clinical services has been significantly improved following the comprehensive interventions, while the financial burden of DRTB patients remains high due to the delay in implementing financing policies. Stronger political commitment and leadership are required for multi-channel financing to provide additional financial support to DRTB patients.

scholarly journals Impacts of a Comprehensive TB Control Model on the Quality of Clinical Services and the Financial Burden of Treatment for Patients with Drug-resistant Tuberculosis in China: A Mixed-methods Evaluation

2020 ◽  
Author(s):  
Weixi Jiang ◽  
Zhipeng Li ◽  
Qi Zhao ◽  
Mengqiu Gao ◽  
Qian Long ◽  
...  
Keyword(s):  
Financial Burden ◽  
Control Model ◽  
Drug Resistant ◽  
Clinical Services ◽  
Drug Resistant Tuberculosis ◽  
Tb Control ◽  
Burden Of Treatment ◽  
Financing Policies ◽  
Resistant Tuberculosis

Abstract IntroductionDrug-resistant tuberculosis (DRTB) has become a critical challenge to ending TB efforts worldwide. To help address the burden in China, the China National Health Commission-Gates TB Project Phase III implemented a comprehensive TB control model which includes multiple interventions to improve the quality of clinical services and reduce the financial burden for DRTB patients.MethodsA mixed-methods approach was used to evaluate the effectiveness of interventions. The quantitative data included three sources: de-identified DRTB registered data from 2015-2018 in project provinces, medical records of DRTB patients registered in 2018 (n=106), and a structured DRTB patient survey in six sample prefectures. The quality of clinical services was evaluated using seven indicators across patient screening, diagnosis and treatment. Logistic regression was conducted to explore factors associated with the extremely high financial burden (defined as out-of-pocket medical expenditure in the first six months of treatment over 30% of annual household income). Key informant interviews with policymakers and focus group discussions with physicians and DRTB patients were conducted to understand the interventions implemented and their impacts.ResultsThe percentage of bacterially confirmed patients taking a drug susceptibility test (DST) increased significantly between 2015 and 2018: from 57.4% to 93.6% in Zhejiang, 12.5% to 86.5% in Jilin, and 29.7% to 91.4% in Ningxia. The treatment enrollment rate among diagnosed DRTB patients also increased significantly and varied from 73% to 82% in the three provinces in 2018. Over 90% of patients in Zhejiang and Jilin and 75% in Ningxia remained in treatment by the end of the first six months’ treatment. Among all survey respondents 77.5% incurred extremely high financial burden of treatment. Qualitative results showed that interventions on promoting rapid DST technologies and patient referral were successfully implemented, but the new financing policies for reducing patients’ financial burden were not implemented as planned.ConclusionsThe quality of DRTB related clinical services has been significantly improved following the comprehensive interventions, while the financial burden of DRTB patients remains high due to the delay in implementing financing policies. Stronger political commitment and leadership are required for multi-channel financing to provide additional financial support to DRTB patients.

Communicating the Financial Burden of Treatment With Patients

2018 ◽  
pp. 524-531 ◽  
Author(s):  
Ryan D. Nipp ◽  
Ellen Miller Sonet ◽  
Gery P. Guy
Keyword(s):  
Cancer Care ◽  
Psychological Symptoms ◽  
Financial Burden ◽  
Patients With Cancer ◽  
Burden Of Treatment ◽  
The Cost ◽  
Care Costs ◽  
Financial Burden Of Cancer ◽  
Patient Concerns

In recent years, high health care costs and the financial burden of cancer care have received increased attention. In response to the financial burden of cancer care, patients may jeopardize their health outcomes by not properly adhering to prescribed therapies or even forgoing and delaying care in an effort to defray costs. In addition, the financial burden experienced by patients with cancer may negatively impact clinical outcomes, such as quality of life, physical and psychological symptoms, and potentially, even survival. Notably, in the current era of targeted treatment and immunotherapies for patients with cancer, the rising costs of cancer continue to remain at the forefront of patient concerns. Therefore, a critical need exists to determine how best to assist patients with the cost burden of cancer diagnosis and treatment

scholarly journals Four delays of child mortality in Rwanda: a mixed methods analysis of verbal social autopsies

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e027435 ◽  
Author(s):  
Sanam Roder-DeWan ◽  
Neil Gupta ◽  
Daniel M Kagabo ◽  
Lameck Habumugisha ◽  
Evrard Nahimana ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Mixed Methods ◽  
Traditional Medicine ◽  
Explanatory Models ◽  
Phase Iii ◽  
District Hospitals ◽  
Catchment Areas ◽  
Treatment Plans ◽  
Phase Iv

ObjectivesWe sought to understand healthcare-seeking patterns and delays in obtaining effective treatment for rural Rwandan children aged 1–5 years by analysing verbal and social autopsies (VSA). Factors in the home, related to transport and to quality of care in the formal health sector (FHS) were thought to contribute to delays.DesignWe collected quantitative and qualitative cross-sectional data using the validated 2012 WHO VSA tool. Descriptive statistics were performed. We inductively and deductively coded narratives using the three delays model, conducted thematic content analysis and used convergent mixed methods to synthesise findings.SettingThe study took place in the catchment areas of two rural district hospitals in Rwanda—Kirehe and Southern Kayonza. Participants were caregivers of children aged 1–5 years who died in our study area between March 2013 and February 2014.ResultsWe analysed 77 VSAs. Although 74% of children (n=57) had contact with the FHS before dying, most (59%, n=45) died at home. Many caregivers (44%, n=34) considered using traditional medicine and 23 (33%) actually did. Qualitative themes reflected difficulty recognising the need for care, the importance of traditional medicine, especially for ‘poisoning’ and poor perceived quality of care. We identified an additional delay—phase IV—which occurred after leaving formal healthcare facilities. These delays were associated with caregiver dissatisfaction or inability to adhere to care plans.ConclusionDelays in deciding to seek care (phase I) and receiving quality care in FHS (phase III) dominated these narratives; delays in reaching a facility (phase II) were rarely discussed. An unwillingness or inability toadhere to treatment plans after leaving facilities (phase IV) were an important additional delay. Improving quality of care, especially provider capacity to communicate danger signs/treatment plans and promote adherence in the presence of alternative explanatory models informed by traditional medicine, could help prevent childhood deaths.

An Overview of Facilities Providing Clinical Services for Persons Who Stutter in Kuwait

2016 ◽  
Vol 1 (4) ◽  
pp. 79-95
Author(s):  
Latifa Alsalmi ◽  
Robert Mayo
Keyword(s):  
Special Education ◽  
Department Heads ◽  
Clinical Services ◽  
Medical Settings ◽  
Non Profit ◽  
Future Studies ◽  
Language Services ◽  
Medical Centers ◽  
Clinical Directors

Presently, no clear picture is available about the facilities providing clinical services for persons who stutter (PWS) in Kuwait. This information is crucial for any awareness program to be established in the future. The purpose of this study was to identify clinical facilities and speech-language personnel that provide services for PWS in Kuwait. Participants consisted of 21 clinical directors of governmental medical centers, non-profit clinics, and private clinics as well as department heads of governmental school clinics where speech-language services were provided. Participants were interviewed regarding the availability of speech-language services within their centers and whether or not PWS receive services. The results revealed that four out of five governmental medical centers with a total of 32 speech-language pathologists (SLPs) provided services for PWS. Additionally, 12 schools of special education were found to have 62 SLPs on their staff providing fluency services for students. Finally, two stand-alone private clinics and one non-profit clinic provided services for PWS. Results indicated an overall shortage of SLPs in the country, especially in medical settings. This study sets the foundation for a series of future studies investigating the type and quality of stuttering services provided by the identified facilities in Kuwait.

scholarly journals Evaluating the success of the tele-pathology system in governmental hospitals in Kuwait: an explanatory sequential mixed methods design

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ali Jasem Buabbas ◽  
Tareq Mohammad ◽  
Adel K. Ayed ◽  
Hawraa Mallah ◽  
Hamza Al-Shawaf ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Mixed Methods ◽  
Support Services ◽  
User Satisfaction ◽  
Technical Support ◽  
Successful Implementation ◽  
System Quality ◽  
Mixed Methods Design ◽  
Telepathology System

Abstract Background Telepathology is the practice of reviewing and exchanging pathological images through telecommunication systems to obtain diagnoses remotely. Studying the factors that make such a system successful and favourable is important to ensure the merits of its implementation in clinical practice. Objective This study aims to evaluate the success of a telepathology system from the users’ perspectives, using specific evaluation criteria, namely: system quality, information quality, technical service quality, user satisfaction, and benefits. Methods A sequential explanatory mixed methods design was adopted in this study, which consists of two phases. Initially, a questionnaire was distributed via WhatsApp to all of the pathologists (total: 45) working at governmental hospitals in Kuwait. Followed by, semi-structured interviews with ten senior pathologists. Results Forty pathologists responded to the questionnaire, giving an 89% response rate. There were 42.5% of the respondents aged between 35–44 years old, and 52.5% were male. The quantitative results reveal that most of the respondents were satisfied with the quality of the telepathology system with a mean of 2.6025 (Standard Deviation (SD) = 0.47176), whereas they were dissatisfied with the quality of the information with a mean of 2.4100 (SD = 1.580) and the technical support services with a mean of 2.2750 (SD = 0.99535). In addition, there was disagreement on the benefits of telepathology in clinical practice among the pathologists with a mean of 2.4667 (SD = 0.77552). The qualitative results indicate that the lack of interest in and little experience with using the system were behind the general dissatisfaction of most of the respondents. All of the interviewees were satisfied with the performance of the telepathology system and considered it successful; however, the quality of the technical support services, including training workshops, was deemed deficient. Conclusion This study concluded that telepathology system in Kuwait is functioning well and has been successful in its implementation; however, pathologists are dissatisfied with it, mainly due to the deficient quality of the technical support services provided. In addition, the successful implementation of such advanced technologies requires careful steps to be taken on multiple levels: technical, organisational, and managerial. Recommendations were suggested.

scholarly journals Nairobi Early Childcare in Slums (NECS) Study Protocol: a mixed-methods exploration of paid early childcare in Mukuru slum, Nairobi

2020 ◽  
Vol 4 (1) ◽  
pp. e000822
Author(s):  
Robert C Hughes ◽  
Patricia Kitsao-Wekulo ◽  
Sunil Bhopal ◽  
Elizabeth W Kimani-Murage ◽  
Zelee Hill ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Focus Group ◽  
Early Years ◽  
Epidemiological Methods ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Early Childcare ◽  
Depth Interviews ◽  
Childcare Providers

IntroductionThe early years are critical. Early nurturing care can lay the foundation for human capital accumulation with lifelong benefits. Conversely, early adversity undermines brain development, learning and future earning.Slums are among the most challenging places to spend those early years and are difficult places to care for a child. Shifting family and work structures mean that paid, largely informal, childcare seems to be becoming the ‘new normal’ for many preschool children growing up in rapidly urbanising Africa. However, little is known about the quality of this childcare.AimsTo build a rigorous understanding what childcare strategies are used and why in a typical Nairobi slum, with a particular focus on provision and quality of paid childcare. Through this, to inform evaluation of quality and design and implementation of interventions with the potential to reach some of the most vulnerable children at the most critical time in the life course.Methods and analysisMixed methods will be employed. Qualitative research (in-depth interviews and focus group discussions) with parents/carers will explore need for and decision-making about childcare. A household survey (of 480 households) will estimate the use of different childcare strategies by parents/carers and associated parent/carer characteristics. Subsequently, childcare providers will be mapped and surveyed to document and assess quality of current paid childcare. Semistructured observations will augment self-reported quality with observable characteristics/practices. Finally, in-depth interviews and focus group discussions with childcare providers will explore their behaviours and motivations. Qualitative data will be analysed through thematic analysis and triangulation across methods. Quantitative and spatial data will be analysed through epidemiological methods (random effects regression modelling and spatial statistics).Ethics and disseminationEthical approval has been granted in the UK and Kenya. Findings will be disseminated through journal publications, community and government stakeholder workshops, policy briefs and social media content.

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