scholarly journals Improving the continuum of care monitoring in Brazilian HIV healthcare services: An implementation science approach

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0250060
Author(s):  
Ana Paula Loch ◽  
Simone Queiroz Rocha ◽  
Mylva Fonsi ◽  
Joselita Maria de Magalhães Caraciolo ◽  
Artur Olhovetchi Kalichman ◽  
...  
Keyword(s):  
Implementation Science ◽  
Virologic Failure ◽  
Healthcare Services ◽  
Continuum Of Care ◽  
Public Healthcare ◽  
Treatment Gap ◽  
Positive Effects ◽  
Number Of Patients ◽  
The Impact ◽  
The Continuum

Objective To evaluate the impact of an intervention improving the continuum of care monitoring (CCM) within HIV public healthcare services in São Paulo, Brazil, and implementing a clinical monitoring system. This system identified three patient groups prioritized for additional care engagement: (1) individuals diagnosed with HIV, but not receiving treatment (the treatment gap group); (2) individuals receiving treatment for >6 months with a detectable viral load (the virologic failure group); and (3) patients lost to follow-up (LTFU). Methods The implementation strategies included three training sessions, covering system logistics, case discussions, and development of maintenance goals. These strategies were conducted within 30 HIV public healthcare services (May 2019 to April 2020). After each training session, professionals shared their experiences with CCM at regional meetings. Before and after the intervention, providers were invited to answer 23 items from the normalization process theory questionnaire (online) to understand contextual factors. The mean item scores were compared using the Mann–Whitney U test. The RE-AIM implementation science framework (evaluating reach, effectiveness, adoption, implementation, and maintenance) was used to evaluate the integration of the CCM. Results In the study, 47 (19.3%) of 243 patients with a treatment gap initiated treatment, 456 (49.1%) of 928 patients with virologic failure achieved suppression, and 700 of 1552 (45.1%) LTFU patients restarted treatment. Strategies for the search and reengagement of patients were developed and shared. Providers recognized the positive effects of CCM on their work and how it modified existing activities (3.7 vs. 4.4, p<0.0001, and 3.9 vs. 4.1, p<0.05); 27 (90%) centers developed plans to sustain routine CCM. Conclusion Implementing CCM helped identify patients requiring more intensive attention. This intervention led to changes in providers’ perceptions of CCM and care and management processes, which increased the number of patients engaged across the care continuum and improved outcomes.

scholarly journals Cost-effectiveness of conditional cash transfers to retain women in the continuum of care during pregnancy, birth and the postnatal period: protocol for an economic evaluation of the Afya trial in Kenya

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e032161
Author(s):  
Neha Batura ◽  
Jolene Skordis ◽  
Tom Palmer ◽  
Aloyce Odiambo ◽  
Andrew Copas ◽  
...  
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Care Facility ◽  
Continuum Of Care ◽  
Postnatal Period ◽  
Cash Transfers ◽  
Conditional Cash Transfers ◽  
Sensitivity Analyses ◽  
The Impact ◽  
The Continuum

IntroductionA wealth of evidence from a range of country settings indicates that antenatal care, facility delivery and postnatal care can reduce maternal and child mortality and morbidity in high-burden settings. However, the utilisation of these services by pregnant women, particularly in low/middle-income country settings, is well below that recommended by the WHO. The Afya trial aims to assess the impact, cost-effectiveness and scalability of conditional cash transfers to promote increased utilisation of these services in rural Kenya and thus retain women in the continuum of care during pregnancy, birth and the postnatal period. This protocol describes the planned economic evaluation of the Afya trial.Methods and analysisThe economic evaluation will be conducted from the provider perspective as a within-trial analysis to evaluate the incremental costs and health outcomes of the cash transfer programme compared with the status quo. Incremental cost-effectiveness ratios will be presented along with a cost-consequence analysis where the incremental costs and all statistically significant outcomes will be listed separately. Sensitivity analyses will be undertaken to explore uncertainty and to ensure that results are robust. A fiscal space assessment will explore the affordability of the intervention. In addition, an analysis of equity impact of the intervention will be conducted.Ethics and disseminationThe study has received ethics approval from the Maseno University Ethics Review Committee, REF MSU/DRPI/MUERC/00294/16. The results of the economic evaluation will be disseminated in a peer-reviewed journal and presented at a relevant international conference.Trial registration numberNCT03021070

scholarly journals Integrated Resistance Analysis of CERTAIN-1 and CERTAIN-2 Studies in Hepatitis C Virus-Infected Patients Receiving Glecaprevir and Pibrentasvir in Japan

2017 ◽  
Vol 62 (2) ◽  
Author(s):  
Preethi Krishnan ◽  
Gretja Schnell ◽  
Rakesh Tripathi ◽  
Jill Beyer ◽  
Thomas Reisch ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Virologic Failure ◽  
Virologic Response ◽  
Fixed Dose ◽  
Resistance Testing ◽  
Combination Regimen ◽  
Resistance Analysis ◽  
Number Of Patients ◽  
The Impact

ABSTRACT Glecaprevir and pibrentasvir are hepatitis C virus (HCV) pangenotypic inhibitors targeting NS3/4A protease and NS5A, respectively. This once-daily, fixed-dose combination regimen demonstrated high sustained virologic response 12 weeks postdosing (SVR12) rates in CERTAIN-1 and CERTAIN-2 studies in Japanese HCV-infected patients, with a low virologic failure rate (1.2%). There were no virologic failures among direct-acting antiviral (DAA)-treatment-naive genotype 1a (GT1a) (n = 4)-, GT1b (n = 128)-, and GT2 (n = 97)-infected noncirrhotic patients treated for 8 weeks or among GT1b (n = 38)- or GT2 (n = 20)-infected patients with compensated cirrhosis treated for 12 weeks. Two of 33 DAA-experienced and 2 of 12 GT3-infected patients treated for 12 weeks experienced virologic failure. Pooled resistance analysis, grouped by HCV subtype, treatment duration, prior treatment experience, and cirrhosis status, was conducted. Among DAA-naive GT1b-infected patients, the baseline prevalence of NS3-D168E was 1.2%, that of NS5A-L31M was 3.6%, and that of NS5A-Y93H was 17.6%. Baseline polymorphisms in NS3 or NS5A were less prevalent in GT2, with the exception of the common L/M31 polymorphism in NS5A. Among DAA-experienced GT1b-infected patients (30/32 daclatasvir plus asunaprevir-experienced patients), the baseline prevalence of NS3-D168E/T/V was 48.4%, that of NS5A-L31F/I/M/V was 81.3%, that of the NS5A P32deletion was 6.3%, and that of NS5A-Y93H was 59.4%. Common baseline polymorphisms in NS3 and/or NS5A had no impact on treatment outcomes in GT1- and GT2-infected patients; the impact on GT3-infected patients could not be assessed due to the enrollment of patients infected with diverse subtypes and the limited number of patients. The glecaprevir-pibrentasvir combination regimen allows a simplified treatment option without the need for HCV subtyping or baseline resistance testing for DAA-naive GT1- or GT2-infected patients. (The CERTAIN-1 and CERTAIN-2 studies have been registered at ClinicalTrials.gov under identifiers NCT02707952 and NCT02723084, respectively.)

scholarly journals The impact of the obstetrical risk insurance scheme in Mauritania on maternal healthcare utilization: a propensity score matching analysis

2020 ◽  
Vol 35 (4) ◽  
pp. 388-398 ◽  
Author(s):  
Marion Ravit ◽  
Andrainolo Ravalihasy ◽  
Martine Audibert ◽  
Valéry Ridde ◽  
Emmanuel Bonnet ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Neonatal Mortality ◽  
Estimation Method ◽  
Healthcare Services ◽  
Child Health Services ◽  
Public Healthcare ◽  
Payment Scheme ◽  
Risk Insurance ◽  
The Impact

Abstract In Mauritania, obstetrical risk insurance (ORI) has been progressively implemented at the health district level since 2002 and was available in 25% of public healthcare facilities in 2015. The ORI scheme is based on pre-payment scheme principles and focuses on increasing the quality of and access to both maternal and perinatal healthcare. Compared with many community-based health insurance schemes, the ORI scheme is original because it is not based on risk pooling. For a pre-payment of 16–18 USD, women are covered during their pregnancy for antenatal care, skilled delivery, emergency obstetrical care [including caesarean section (C-section) and transfer] and a postnatal visit. The objective of this study is to evaluate the impact of ORI enrolment on maternal and child health services using data from the Multiple Indicator Cluster Survey (MICS) conducted in 2015. A total of 4172 women who delivered within the last 2 years before the interview were analysed. The effect of ORI enrolment on the outcomes was estimated using a propensity score matching estimation method. Fifty-eight per cent of the studied women were aware of ORI, and among these women, more than two-thirds were enrolled. ORI had a beneficial effect among the enrolled women by increasing the probability of having at least one prenatal visit by 13%, the probability of having four or more visits by 11% and the probability of giving birth at a healthcare facility by 15%. However, we found no effect on postnatal care (PNC), C-section rates or neonatal mortality. This study provides evidence that a voluntary pre-payment scheme focusing on pregnant women improves healthcare services utilization during pregnancy and delivery. However, no effect was found on PNC or neonatal mortality. Some efforts should be exerted to improve communication and accessibility to ORI.

Disaster-related communication preferences of homeless and nonhomeless VA patients

2018 ◽  
Vol 16 (1) ◽  
pp. 49 ◽  
Author(s):  
Alicia R. Gable, MPH ◽  
Claudia Der-Martirosian, PhD ◽  
Laura N. Pinnock, MSPH, PMP ◽  
Aram Dobalian, PhD, JD, MPH
Keyword(s):  
Natural Disasters ◽  
Medical Center ◽  
Healthcare Services ◽  
Veterans Affairs ◽  
Communication Strategy ◽  
Communication Preferences ◽  
Number Of Patients ◽  
Communication Modes ◽  
The Impact ◽  
E Mail

Objective: To identify the communication preferences of homeless (H) and nonhomeless (NH) Veterans Affairs (VA) patients for receiving information about the impact of natural disasters on VA healthcare services. Design: Probability-based sampling design stratified on age categories, urban/rural, coastal/noncoastal, and homelessness. Setting: Northeast United States.Participants: Eligible NH and H participants included those who lived in and had at least one healthcare visit to a VA medical center/clinic in the region in the previous 24 months. Homeless participants included those receiving VA homeless services or having ICD9-CM V60.0 (Lack of Housing). 2,264/6,088 NH and 383/2,000 H completed the survey.Intervention: Cross-sectional, mixed-mode survey administered August-November 2015.Main Outcome Measures: Helpfulness of ten communication modes for receiving information about the impact of natural disasters on VA healthcare services.Results: Despite sociodemographic and health status differences, the top five communication modes rated extremely/very helpful were the same for both groups: telephone (76 percent H; 81 percent NH), TV (63 percent H; 60 percent NH), text (62 percent H; 50 percent NH), e-mail (56 percent H; 58 percent NH), radio (54 percent H; 47 percent NH). Newspaper and online modes (VA/other Web sites, Twitter, Facebook, MyHealtheVet) were rated substantially lower. Conclusions: H and NH patients prefer similar communication modes for receiving updates about the impact of natural disasters on VA healthcare services. Findings suggest that a multimodal communication strategy that incorporates phone, TV, text, e-mail, and radio will help Veterans Affairs (VA) reach its diverse patient population during natural disasters. Dissemination of messages via online modes, while rated less helpful, may augment the number of patients reached.

scholarly journals A magánkiadások hatása a hazai egészségügyi diagnosztikai szolgáltatók pénzügyi helyzetére : The Impact of Private Healthcare Spending on the Hungarian Medical Diagnostic Companies

2021 ◽  
Vol 16 (4) ◽  
pp. 115-132
Author(s):  
Gábor Dávid Kiss ◽  
Andreász Kosztopulosz ◽  
Dániel Szládek
Keyword(s):  
Regression Models ◽  
Annual Report ◽  
Healthcare Spending ◽  
Healthcare Services ◽  
Public Healthcare ◽  
Technological Environment ◽  
Financial Conditions ◽  
Medical Diagnostic ◽  
Report Data ◽  
The Impact

A magánfinanszírozás modellje a kilencvenes évek kezdete óta része a hazai egészségügynek. A 2000-es évektől azonban komolyan előtérbe kerültek ezek a csatornák, különösen a képalkotó diagnosztika és laborszolgáltatások területén, ami az itt szolgáltató vállalkozások közelebbi vizsgálatát teszi szükségessé. Elsőként az Ohlson-féle O csődkockázati mutatók által adott jelzéseket vizsgáljuk meg egy öt vállalkozásból álló mintán 2006 és 2017 között. Ezt követően az Ohlson-féle O csődkockázati mutató változásának magyarázhatóságát vizsgáljuk az egészségügyi finanszírozási környezet, a tőkepiaci helyzet és a technológiai környezetet lefedő modellek keretében, panelregressziós eljárásokkal. Megállapítható, hogy az egészségügyi finanszírozás GDP-arányos változása, illetve a kórházi ágyszám változásai gyakorolták a legkomolyabb hatást a mintában szereplő vállalatok pénzügyi helyzetének alakulására. The Hungarian healthcare services are partially financed on private basis since the 1990s. This channel gained increasing popularity in the 2000s especially on the fields of medical imaging and labour diagnostics – what motivates a deeper corporate analysis on annual report data between 2006 and 2017. Financial conditions were studied with the assumption of the Ohlson O bankruptcy ratio, and their changes were monitored trough three different panel regression models: one focused on general and public healthcare spending and hospital capacities, while the second contained the financial market-related variables as the third referred on the technological environment. The changes of healthcare funding to GDP ratios and hospital bed numbers surpassed all other variables on the financial conditions of the sample companies.

Hospital-acquired infections in Belgian acute-care hospitals: an estimation of their global impact on mortality, length of stay and healthcare costs

2011 ◽  
Vol 140 (1) ◽  
pp. 126-136 ◽  
Author(s):  
F. VRIJENS ◽  
F. HULSTAERT ◽  
S. DEVRIESE ◽  
S. VAN DE SANDE
Keyword(s):  
Length Of Stay ◽  
Acute Care ◽  
Excess Mortality ◽  
National Level ◽  
Acute Care Hospitals ◽  
Public Healthcare ◽  
Hospital Acquired Infections ◽  
Number Of Patients ◽  
Hospital Acquired ◽  
The Impact

SUMMARYAssessing the overall burden of disease which can be attributed to hospital-acquired infections (HAIs) remains a challenge. A matched cohort study was performed to estimate excess mortality, length of stay and costs attributable to HAIs in Belgian acute-care hospitals, using six matching factors (hospital, diagnosis-related group, age, ward, Charlson score, estimated length of stay prior to infection). Information was combined from different sources on the epidemiology and burden of HAIs to estimate the impact at national level. The total number of patients affected by a HAI each year was 125 000 (per 10·9 million inhabitants). The excess mortality was 2·8% and excess length of stay was 7·3 days, corresponding to a public healthcare cost of €290 million. A large burden was observed outside the intensive-care unit setting (87% of patients infected and extra costs, 73% of excess deaths).

scholarly journals Satisfaction With Healthcare: The Changes And Features Of Patients Making Aknowledgements For Doctors And Nurses Wiews

2016 ◽  
Vol 26 (5) ◽  
pp. 5-12
Author(s):  
Vinsas Janušonis
Keyword(s):  
Response Rate ◽  
Healthcare Services ◽  
University Hospital ◽  
Women Patients ◽  
Persons With Disabilities ◽  
Patients Satisfaction ◽  
Number Of Patients ◽  
The Right ◽  
The Impact ◽  
Doctors And Nurses

The aim of the study – to estimate patients, who gave thanks for medics – doctors and nurses opinion changes and singularity of right healthcare, satisfaction and fruition their expectations. Material and methods. From January 2004 to December 2015 a survey was performed in Klaipeda University Hospital (KUH). The study included 197755 patients who were undergoing treatment in KUH. Information was collected via questionnaires (response rate 81,4%). The patients who gave thanks for medics group was analyzed apart. The survey was analyzed and compared for the periods 2004-2006 and 2013-2015. Results and discussion. The most part of patients who gave thanks for medics was aged 50-69 (15, 8%), at work, women. The time of healthcare services, information for patients, good contact and communication between patients and medics, patients’ satisfaction influenced the number of thanks. The number of thanksgiving have not direct correlation with healthcare quality. Conclusions. Patients thanksgiving has confirmed the KUH provided healthcare for the majority of patients are appropriate to meet their expectations and they are satisfied with it. Comparison of both analyzed periods has shown that over 10 years fell acknowledgments for medics. Age, gender and social status had the impact on the number of acknowledgments - more thanksgiving was from women, patients 50-59 year age, retired and persons with disabilities. The right cooperation between medics and patients, provision of healthcare information to patients increased the number of thanksgiving. The number of patients who satisfied with healthcare results and meet their expectations directly correlated with number of patients who gave thanks for medics.

scholarly journals The Impact of COVID-19 Vaccination on Anxiety Levels of Turkish Dental Professionals and Their Attitude in Clinical Care: A Cross-Sectional Study

2021 ◽  
Vol 18 (19) ◽  
pp. 10373
Author(s):  
Fatih Karayürek ◽  
Ahmet Taylan Çebi ◽  
Aydın Gülses ◽  
Mustafa Ayna
Keyword(s):  
Personal Protective Equipment ◽  
Clinical Care ◽  
Protective Equipment ◽  
Main Concern ◽  
Positive Effects ◽  
Number Of Patients ◽  
Anxiety Levels ◽  
Fear And Anxiety ◽  
The Impact ◽  
Dental Professionals

Background: The current study aimed to assess the anxiety and fear levels and the attitude towards clinical care, such as the use of personal protective equipment and number of patients examined, before and after COVID-19 vaccination among Turkish dental professionals. Methods: A questionnaire including socio-demographical characteristics and clinical data regarding the number of patients, the use of personal protective equipment, vaccine confidence interval, positive or negative COVID-19 diagnosis, and fear and anxiety levels were examined. Results: A total of 475 dentists (196 men and 279 women) participated. Overall, the vaccination had a positive effect on the decrease of fear and anxiety levels of dental professionals. It was observed that the number of interventional procedures significantly increased after vaccination. Besides that, the amount of personal protective equipment used in patients, especially after the vaccination, has decreased. Conclusion: Despite the positive effects of vaccination on the anxiety levels of dental professionals, protective measurements should further be the main concern, regardless of the vaccination status of both the dental professional and the patient.

scholarly journals TO SEE THE IMPACT OF LOCKDOWN IN COVID19 PANDEMIC ON TUBERCULAR PATIENTS IN A TERTIARY CARE CENTRE OF HILLY AREA.

2020 ◽  
pp. 33-34
Author(s):  
Subhash Chander ◽  
Ritin Sharma ◽  
Ankit Chaudhary ◽  
Rakesh Chauhan
Keyword(s):  
Health Centre ◽  
Tertiary Care ◽  
Healthcare Services ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Tuberculosis Patients ◽  
Hilly Area ◽  
Number Of Patients ◽  
Group B ◽  
The Impact

Aim: To see the impact of lockdown in Covid19 Pandemic on Tubercular patients in a Tertiary care Centre of hilly area. Material and Methods: The study was conducted among adult patients in a tertiary health centre in a rural area. Study was conducted through lockdown period, comparing it with corresponding period in 2019. Tuberculosis patients or suspects were categorized in two groups. Group A was designated for participants in the year 2020 during lockdown period. Group B was data taken from time period similar to lockdown period in the year 2019. Data from two groups was compared. Observations: There was a 44.1% decline in number of male patients, whose sputum was examined by microscopy for tuberculosis. In case of female patients, decline was 68.6%. This decrease was present in all phases, more in 1st phase, 69.1%. During lockdown period number of patients presenting to medicine department were 45% compared to previous year ( 5129 vs 11280), sputum positive diagnosed during lockdown and similar period in 2019 were (84.4%) 27 vs 32 ( p 0.016). OPD declined by 54.5% during lockdown, however diagnosed tubercular cases by CBNAAT declined by 44.4%. Conclusion: COVID 19 pandemic greatly affected the routine healthcare services. Lockdown period saw a decline in number of patients presenting to outdoor as well as indoor patients. There was a decline in number of tuberculosis suspects as well as number of diagnosed tuberculosis patients. However decline in tuberculosis patients was less as compared to overall patients.

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