Assessment of Immunization Compliance Among Children in the Department of Defense Health Care System

PEDIATRICS ◽  
1996 ◽  
Vol 97 (3) ◽  
pp. 308-311 ◽  
Author(s):  
J. O. Lopreiato ◽  
M. C. Ottolini
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Department Of Defense ◽  
Parental Education ◽  
Haemophilus Influenzae Type ◽  
Cross Sectional Survey ◽  
Health Maintenance ◽  
Immunization Status ◽  
Immunization Rates ◽  
Care System

Objective. To describe immunization rates among children enrolled in the Department of Defense health care system and to determine risk factors for delay. Design. Cross-sectional survey of immunization records and demographic characteristics among parents of children presenting for acute care at seven pediatric clinics operated by the Department of Defense. Participants. Subjects were 1977 children aged 2 months to 18 years. Outcome Measures. Immunization rates were measured for various age strata from infancy to adolescence. Results. The overall immunization rate was 84%. By age 2 years, 86% of patients had received four diphtheriatetanus -pertussis, three oral polio, Haemophilus influenzae type b, and measles-mumps-rubella (MMR) vaccines. At school entry, 87% of children were fully immunized for diphtheria-tetanus-pertussis and MMR. However, only 50% of adolescents were up-to-date, primarily because of failure to receive booster doses of MMR. Seventy-nine percent of parents whose children were delayed thought that they were up-to-date. Factors associated with immunization delay included incorrect parental perception of immunization status, failure to keep routine health maintenance visits, and non-white race. Socioeconomic status, parental education level, access to care, and family mobility had no effect on immnization status. Conclusions. Although immunization rates for preschoolers approached national goals, accessibility to care and free vaccines did not guarantee immunization compliance, especially among adolescents. Most patients with delayed vaccinations were older children and adolescents whose school and parental reports of immunization status were incorrect. Immunization delay in our study was primarily the result of a failure to track patients and notify parents of when immunizations were due.

scholarly journals Does Dental Insurance Make a Difference in Type of Service Received by Iranian Dentate Adults?

2011 ◽  
Vol 05 (01) ◽  
pp. 068-076 ◽  
Author(s):  
Fariborz Bayat ◽  
Heikki Murtomaa ◽  
M Miira Vehkalahti ◽  
Heikki Tala ◽  
Walter Mautsch
Keyword(s):  
Health Care ◽  
Oral Health ◽  
Health Care System ◽  
Oral Health Care ◽  
Phone Call ◽  
Insurance Status ◽  
Dental Visit ◽  
Dental Insurance ◽  
Cross Sectional Survey ◽  
Care System

ABSTRACTObjectives: To assess the relationship between insurance status and type of service received among dentate adults in a developing oral health care system. Methods: A cross-sectional survey based on phone interviews in Tehran, Iran. Four trained interviewers collected data using a structured questionnaire. Of 1,531 subjects answering the phone call, 224 were <18 years; of the remaining 1,307, 221 (17%) refused to participate, and 85 (6%) were excluded as edentate or reporting no dental visit, leaving 1,001 eligible subjects in the sample. The questionnaire covered insurance status, socio-demographics, frequency of tooth brushing, dental attendance as reasons for, and time since last dental visit, and dental service received then. Data analysis included the chi-square test and logistic regression. Results: Of the subjects, 71% had a dental insurance. Those with no insurance were more likely to report tooth extractions (OR=1.5) than those with an insurance coverage; for all other treatments no differences according to the insurance status appeared. Among the insured subjects, extractions were more likely for those reporting a problem-based dental visit (OR=6.0) or having a low level of education (OR=2.3). Conclusions: In Iran, with its developing oral health care system, dental insurance had only a minor impact on dental services reported. (Eur J Dent 2011;5:68-76)

Motivational Factors Influencing Retention of Village Health Workers in Rural Communities of Bhutan

2019 ◽  
Vol 31 (5) ◽  
pp. 433-442
Author(s):  
Dolley Tshering ◽  
Phudit Tejativaddhana ◽  
Taweesak Siripornpibul ◽  
Mary Cruickshank ◽  
David Briggs
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Health Workers ◽  
Social Factor ◽  
Organizational Factors ◽  
Cluster Sampling ◽  
Cross Sectional Survey ◽  
Village Health Workers ◽  
Village Health ◽  
Care System

Village health workers (VHWs) are the first contact extending vital health services to unreached and underserved communities in Bhutan. VHWs truly embody the principles of primary health care and are effective catalysts in promoting community health. This study identifies and confirms factors motivating VHWs to remain in the health care system. This is a quantitative study with a cross-sectional survey design. Two-stage cluster sampling was used with VHWs from 12 districts representing 3 regions of Bhutan. Data were collected using pretested semistructured questionnaires. Confirmatory factor analysis was used for data analysis. Findings reveal a 4-factor model of motivations among VHWs that includes social, personal, job related, and organizational factors. Among these, the social factor most significantly motivates VHWs to remain in the health care system. VHW motivation can be further fostered by providing a holistic combination of financial and nonfinancial incentives that recognize intrinsic needs and empower innate altruism.

Advancing the Role of Nonprofit Health Care

2002 ◽  
Vol 39 (2) ◽  
pp. 96-100 ◽  
Author(s):  
Marcia Metcalfe
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Term Care ◽  
American Hospital ◽  
American Hospital Association ◽  
Health Maintenance ◽  
Blue Cross Blue Shield ◽  
Blue Shield ◽  
Care System

This article comes out of a series of discussions among a diverse group of chief executive officers (CEOs) and other leaders of nonprofit hospitals, long-term care facilities, health maintenance organizations, and other insurance providers, including several nonprofit Blue Cross Blue Shield (BCBS) plans. The group was convened as part of Howard Berman's Walter J. McNerney Fellowship project. (Berman is CEO of Excellus, Inc., a nonprofit Blue Cross Blue Shield affiliate that insures the health of more than 2.15 million people in upstate New York. He was awarded the McNerney Fellowship in April 2001 by the Health Research and Educational Trust, an American Hospital Association affiliate. The Fellowship goes annually to at least one fellow to highlight or pursue work that will provide new insights into how different sectors of the health care system can better work together for improved outcomes.) The group has met several times over the past year around a shared concern: the current challenges to nonprofit health care organizations and the future role for nonprofits in the re-visioning and creation of an American health care system that is characterized by universal access, patient-centered quality, and national affordability. Members have supported the public relations campaign of the “Alliance for Advancing Nonprofit Health Care,” an effort initiated by the Caucus, an independent group of nonprofit BCBS plans. The group continues to explore the need for a broad-based coalition of providers, insurers, and other organizations to effectively protect and enhance the role of nonprofit health care.

scholarly journals The New ASH ITP-Guideline Recommendations - Marching Separately, Beating Together

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 11-11
Author(s):  
Axel Matzdorff ◽  
Oliver Meyer
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Standard Of Care ◽  
Average Score ◽  
Human Beings ◽  
Physician Density ◽  
Cross Sectional Survey ◽  
Malpractice Claims ◽  
Universal Standard ◽  
Care System

Background:Immune thrombocytopenia (ITP) is rare. The 1996 American Society of Hematology (ASH) ITP-Guideline for many years set the standards of ITP-care. In 2019 ASH published a new ITP guideline. We wanted to assess the acceptance of these new guideline recommendations by German physicians. Methods:This is a cross-sectional survey presenting ten recommendations on adult ITP from the new ASH ITP guideline to German hematologist, internists and other specialists at 4 medical educational activities on ITP between September 2019 and January 2020. We asked the physicians to express their preference for each recommendation on a 5-point scale. Numeric values were assigned to the degrees of agreement or disagreement. The numeric values of the responses were summed and divided by the number of respondents to create an average score. This was compared with the degree of support ASH experts expressed for each of their recommendation. Results:One hundred thirty questionnaires were distributed and 56 were retrieved (43%). There was consensus in 7 of 10 management issues but there were obvious differences in 3. (1) German physicians were less likely to give corticosteroids in newly diagnosed but asymptomatic or only mildly symptomatic patients, but (2) in case corticosteroids were given, German physicians were more likely to prescribe longer corticosteroid treatment, and (3) German physicians clearly prefer 2nd line thrombopoietin receptor agonists (TPO-RAs) over splenectomy. The different approach may be explained by easier access to medical care for patients (higher hospital- and physician-density than in the US), universal coverage in a publicly funded health care system, and a less developed medicolegal network pushing malpractice claims in Germany. Conclusion: The example of the recent ASH ITP guideline shows that recommendations must not be separated from the context in which they are produced. They cannot define a universal standard of care. Instead they need to be adapted and individualized, respecting the traditions of each health care system, physicians' experiences, patients' preferences, and health literacy. Guideline recommendations do not define a 'best treatment' or any universal standard of care, all they do is providing guidance to the physician in daily practice. Th. Jefferson's sentence still holds that all human beings are created equal, but this does not mean that all patients must be treated equally. Disclosures Matzdorff: UCB Biopharma SRL:Consultancy, Other: Honoraria paid to institution;Swedish Orphan Biovitrium GmbH:Consultancy, Other: Honoraria paid to institution;Grifols Deutschland GmbH:Consultancy, Other: Honoraria paid to institution;Amgen GmbH:Consultancy, Other: Honoraria paid to institution;Novartis Oncology:Consultancy, Other: Honoraria paid to institution;Roche Pharma AG:Other: Family stockownership.Meyer:Novartis Pharma GmbH:Honoraria;Amgen GmbH:Honoraria;Grifols Germany:Consultancy, Honoraria.

scholarly journals Socioeconomic position and prediagnostic health care contacts in children with cancer in Denmark: a nationwide register study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Line Hjøllund Pedersen ◽  
Friederike Erdmann ◽  
Gitte Lerche Aalborg ◽  
Lisa Lyngsie Hjalgrim ◽  
Hanne Bækgaard Larsen ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Socioeconomic Position ◽  
Parental Education ◽  
Diagnostic Process ◽  
Children With Cancer ◽  
Parental Health ◽  
Stage Of Disease ◽  
Short Period ◽  
Care System

Abstract Background While underlying mechanisms and pathways of social inequalities in cancer survival have been extensively examined in adults, this is less so for children with cancer. Hypothesized mechanisms include prediagnostic utilization of and navigation through the health care system, which may differ by socioeconomic resources of the families. In this nationwide register-based study we investigated the association between measures of family socioeconomic position in relation to prediagnostic health care contacts and stage of disease at diagnosis in children with cancer in Denmark. Methods We identified all children diagnosed with a cancer at ages 0–15 years in 1998–2016 (N = 3043) from the Danish Childhood Cancer Registry. We obtained comprehensive information on measures of socioeconomic position, parental health and prediagnostic contacts to both general practitioners and hospitals 24 months prior to diagnosis from various national registries. We fitted multivariable conditional logistic regression models for the association of family socioeconomic and health-related variables with firstly, frequent health care contacts and secondly, advanced stage. Results We found higher odds ratios (OR) of frequent both overall and emergency health care contacts in the last 3 months before diagnosis in children from households with short parental education and mixed affiliation to work market, when compared to children with high family socioeconomic position. Further, children of parents with depression or of non-Western origin, respectively, had higher OR for frequent overall and emergency contacts. We found no association between socioeconomic position, parental health and stage of disease. Conclusion Families with socioeconomic disadvantage, non-Western origin or depression more frequently utilize prediagnostic health care services, both generally and in the acute setting, indicating that some disadvantaged families may struggle to navigate the health care system when their child is sick. Reassuringly, this was not reflected in disparities in stage at diagnosis. In order to improve the diagnostic process and potentially reduce health care contacts, attention and support should be given to families with a high number of health care contacts over a short period of time.

Observations on Potential Contributions of Health Planning

1976 ◽  
Vol 6 (4) ◽  
pp. 651-666
Author(s):  
Nancy N. Anderson ◽  
Leonard Robins
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Health Care System ◽  
Health Planning ◽  
The United States ◽  
Health Maintenance Organizations ◽  
General Purpose ◽  
Care Organization ◽  
Health Maintenance ◽  
Care System

The passage of the National Health Planning and Resources Development Act in the United States in 1974 is used to set the context for a new assessment of health planning as a change agent. In reviewing the record of health planning the most striking conclusion is that even its friends have been unable to establish that it has had any quantifiable impact. The authors suggest, however, that comprehensive health planning may have stimulated the belief that changes in medical care organization are crucial to improving the health care system. The authors next consider the role of health planning inferred from three widely espoused “models” of the health care system: professional, central planning, and market. Although market advocates generally deemphasize health planning as contrasted to those supporting a centrally planned system, none of the models is sufficiently developed to indicate specific roles and functions for health planning. Basing their argument on goals for health care reform generally espoused by students of medical care organization, the authors assert that health planning agencies will be most effective if they are organizationally linked to general-purpose governments, encourage the formation of Health Maintenance Organizations, consciously involve themselves in health system reorganization, and design their policies so they can be effectively evaluated.

Understanding the determinants of public trust in the health care system in China: an analysis of a cross-sectional survey

2018 ◽  
Vol 24 (1) ◽  
pp. 37-43 ◽  
Author(s):  
Dahai Zhao ◽  
Hongyu Zhao ◽  
Paul D Cleary
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Health Care Systems ◽  
Public Trust ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Research Attention ◽  
Positive Attitudes ◽  
Care Systems ◽  
Care System

Objectives Despite increasing research attention on public trust in health care systems, empirical evidence on this topic in the developing world is limited and inconclusive. This paper examines the level and determinants of public trust in the health care system in China. Methods We used data from a survey conducted with a sample of 5347 adults in all Chinese provincial areas between January and February 2016. Trust in the health care system was assessed with a question used by the 2011–2013 International Social Survey Programme (ISSP) to assess public trust in the health care systems of 29 industrialized countries and regions (‘In general, how much confidence do you have in the health care system in your country?’). Results Only 28% of respondents reported that they had a great deal or complete trust in China’s health care system. Respondents who reported to have more trust in other people in society, more trust in the local government and who were more satisfied with their most recent health care system experience and their health insurance were significantly more likely to trust the country’s health care system. Furthermore, respondents who reported a higher level of happiness, better health status and positive attitudes towards social equity were more likely to trust the health care system in China. Conclusions Our findings suggest that low public trust in China’s health care system is a potential problem. Improving health care experiences may be the most practical and effective way of improving trust in the health care system in China.

scholarly journals Applicability of Exercise and Education Programmes for Knee Osteoarthritis Management to Switzerland

2021 ◽  
Vol 1 ◽  
Author(s):  
Lea Ettlin ◽  
Anne-Kathrin Rausch Osthoff ◽  
Irina Nast ◽  
Karin Niedermann
Keyword(s):  
Health Care ◽  
Knee Osteoarthritis ◽  
Health Care System ◽  
Survey Study ◽  
Successful Implementation ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Supervised Exercise ◽  
Swiss Health ◽  
Care System

Objectives: The aim of this study was to assess the applicability of six OARSI (Osteoarthritis Research Society International) approved exercise and education programmes for the conservative management of knee osteoarthritis to the Swiss health care system.Methods: The RE-AIM framework was used in this cross-sectional survey study to analyse the characteristics of the six exercise and education programmes. A survey was developed based on the RE-AIM dimensions, “Reach, Effectiveness, Adoption, Implementation, and Maintenance,” for rating the applicability of the programmes (on a scale of 1 = “least applicable” to 10 = “most applicable”). Programme scores of ≥7 indicated applicability to the Swiss health care system. Nine selected physiotherapy experts for knee OA management in Switzerland were invited for the rating.Results: The six programmes were rated by six of the nine invited research experts with mean scores of between 5.9 and 9.45. Four programmes scored 7 or more. These four programmes all included supervised exercise sessions and education with the goal that the participants understand the diagnosis and the management of OA. The two lower rated programmes focused on exercise counselling or weight reduction.Conclusion: The programme with the highest scores consists of exercise and education and scored higher than 7 in all RE-AIM dimensions. Therefore, this programme is most applicable to the Swiss health care system as only a few adaptations would be needed for its successful implementation.

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