scholarly journals Willingness of private general practitioners to refer suspected tuberculosis patients in Badung District

2017 ◽  
Vol 5 (2) ◽  
pp. 106
Author(s):  
Ni Putu Eka Purnama Dewi ◽  
Anak Agung Sagung Sawitri ◽  
Ni Wayan Arya Utami
Keyword(s):  
General Practitioner ◽  
General Practitioners ◽  
Laboratory Data ◽  
Significant Proportion ◽  
Reward System ◽  
Insurance Scheme ◽  
District Health ◽  
Cross Sectional ◽  
Willingness To Refer ◽  
Credit Points

Background and purpose: The national tuberculosis (TB) prevalence study showed that between 2013 and 2014 there was significant proportion of pulmonary TB patients received treatment from private healthcare facilities. Data from Bali Province and Badung District Health Offices revealed that of all suspected TB patients only a few were referred by their private general practitioner. A reward system was created in 2012 by providing credit points to every referral made by the private general practitioner. This study aims to examine association between the reward system, national health insurance scheme and willingness to refer suspected TB patients.Methods: A cross-sectional study was conducted from February to April 2017. A total of 111 private general practitioners who practice at Badung District were interviewed. In addition, medical record from these private general practitioners were also examined.Results: Our study found that as many as 55 (45.95%) of private general practitioners had ever referred suspected TB patients over the last year. The total suspected TB patient being reffered in the last year was 132 cases. A cross checking with the laboratory data revealed that only 47 cases (35.61%) presented at referral laboratory facilities. Multivariate analysis showed that the willingness of private general practitioners to refer suspected TB patient was associated to reward system (AOR=4.62; 95%CI: 1.23-17.32) and supervision from TB officials (AOR=13.07; 95%CI: 3.78-45.13). The enrollment of private general practitioners as a primary healthcare facility under the national insurance scheme was not associated with the willingness to refer suspected TB patients.Conclusions: About half of the private general practitioners have ever referred a suspected TB patient. Supervision from TB officials and a reward system in terms of credit points were associated with the willingness to refer suspected TB patients. Ongoing supervision, providing credit points, and improving referral systems are required to improve case findings and referral of suspected TB patients by private general practitioners.

scholarly journals The ecology of medical care in Norway: wide use of general practitioners may not necessarily keep patients out of hospitals

2012 ◽  
Vol 1 (2) ◽  
pp. 28 ◽  
Author(s):  
Anne Helen Hansen ◽  
Peder A. Halvorsen ◽  
Olav Helge Førde
Keyword(s):  
Health Care ◽  
General Practitioner ◽  
General Practitioners ◽  
Health Care Services ◽  
Medical Providers ◽  
Specialist Care ◽  
Cross Sectional ◽  
Care Services ◽  
And Gender ◽  
Complementary And Alternative

<em>Background</em>. Our aim was to investigate the pattern of self reported symptoms and utilisation of health care services in Norway. <em>Design and methods.</em> With data from the cross-sectional Tromsø Study (2007-8), we estimated population proportions reporting symptoms and use of seven different health services. By logistic regression we estimated differences according to age and gender. <em>Results</em>. 12,982 persons aged 30-87 years participated, 65.7% of those invited. More than 900/1000 reported symptoms or health problems in a year as well as in a month, and 214/1000 and 816/1000 visited a general practitioner once or more in a month and a year, respectively. The corresponding figures were 91/1000 and 421/1000 for specialist outpatient visits, and 14/1000 and 116/1000 for hospitalisations. Physiotherapists were visited by 210/1000, chiropractors by 76/1000, complementary and alternative medical providers by 127/1000, and dentists by 692/1000 in a year. Women used most health care services more than men, but genders used hospitalisations and chiropractors equally. Utilisation of all services increased with age, except chiropractors, dentists and complementary and alternative medical providers. <em>Conclusions</em>. Almost the entire population reported health related problems during the previous year, and most residents visited a general practitioner. Yet there were high rates of inpatient and outpatient specialist utilisation. We suggest that wide use of general practitioners may not necessarily keep patients out of specialist care and hospitals.

scholarly journals General practitioners’ and out-of-hours doctors’ role as gatekeeper in emergency admissions to somatic hospitals in Norway: registry-based observational study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jesper Blinkenberg ◽  
Sahar Pahlavanyali ◽  
Øystein Hetlevik ◽  
Hogne Sandvik ◽  
Steinar Hunskaar
Keyword(s):  
General Practitioners ◽  
Hospital Admissions ◽  
Significant Proportion ◽  
Emergency Admission ◽  
Public Healthcare ◽  
Malignant Neoplasms ◽  
Cross Sectional ◽  
Out Of Hours ◽  
Emergency Admissions ◽  
The Impact

Abstract Background Primary care doctors have a gatekeeper function in many healthcare systems, and strategies to reduce emergency hospital admissions often focus on general practitioners’ (GPs’) and out-of-hours (OOH) doctors’ role. The aim of the present study was to investigate these doctors’ role in emergency admissions to somatic hospitals in the Norwegian public healthcare system, where GPs and OOH doctors have a distinct gatekeeper function. Methods A cross-sectional analysis was performed by linking data from the Norwegian Patient Registry (NPR) and the physicians’ claims database. The referring doctor was defined as the physician who had sent a claim for a consultation with the patient within 24 h prior to an emergency admission. If there was no claim registered prior to hospital arrival, the admission was defined as direct, representing admissions from ambulance services, referrals from nursing home doctors, and admissions initiated by in-hospital doctors. Results In 2014 there were 497,587 emergency admissions to somatic hospitals in Norway after excluding birth related conditions. Direct admissions were most frequent (43%), 31% were referred by OOH doctors, 25% were referred by GPs, whereas only 2% were referred from outpatient clinics or private specialists with public contract. Direct admissions were more common in central areas (52%), here GPs’ referrals constituted only 16%. The prehospital paths varied with the hospital discharge diagnosis. For anaemias, 46–49% were referred by GPs, for acute appendicitis and mental/alcohol related disorders 52 and 49% were referred by OOH doctors, respectively. For both malignant neoplasms and cardiac arrest 63% were direct admissions. Conclusions GPs or OOH doctors referred many emergencies to somatic hospitals, and for some clinical conditions GPs’ and OOH doctors’ gatekeeping role was substantial. However, a significant proportion of the emergency admissions was direct, and this reduces the impact of the GPs’ and OOH doctors’ gatekeeper roles, even in a strict gatekeeping system.

scholarly journals Isolated intracranial hypertension associated with COVID-19

Cephalalgia ◽  
2020 ◽  
Vol 40 (13) ◽  
pp. 1452-1458 ◽  
Author(s):  
Marcus Tulius T Silva ◽  
Marco A Lima ◽  
Guilherme Torezani ◽  
Cristiane N Soares ◽  
Claudia Dantas ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Lumbar Puncture ◽  
Laboratory Data ◽  
Significant Proportion ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Csf Analysis ◽  
Refractory Headache ◽  
Choroid Plexuses ◽  
Persistent Headache

Background Headache is a frequent complaint in COVID-19 patients. However, no detailed information on headache characteristics is provided in these reports. Our objective is to describe the characteristics of headache and the cerebrospinal fluid (CSF) profile in COVID-19 patients, highlighting the cases of isolated intracranial hypertension. Methods In this cross-sectional study, we selected COVID-19 patients who underwent lumbar puncture due to neurological complaints from April to May 2020. We reviewed clinical, imaging, and laboratory data of patients with refractory headache in the absence of other encephalitic or meningitic features. CSF opening pressures higher than 250 mmH2O were considered elevated, and from 200 to 250 mmH2O equivocal. Results Fifty-six COVID-19 patients underwent lumbar puncture for different neurological conditions. A new, persistent headache that prompted a CSF analysis was diagnosed in 13 (23.2%). The pain was throbbing, holocranial or bilateral in the majority of patients. All patients had normal CSF analysis and RT-qPCR for SARS-CoV-2 was negative in all samples. Opening pressure >200 mmH2O was present in 11 patients and, in six of these, > 250 mmH2O. 6/13 patients had complete improvement of the pain, five had partial improvement, and two were left with a daily persistent headache. Conclusions In a significant proportion of COVID-19 patients, headache was associated to intracranial hypertension in the absence of meningitic or encephalitic features. Coagulopathy associated with COVID-19 could be an explanation, but further studies including post-mortem analysis of areas of production and CSF absorption (choroid plexuses and arachnoid granulations) are necessary to clarify this issue.

scholarly journals Stakeholders’ perspectives on the management of diabetic retinopathy for a district health system – South Africa

2017 ◽  
Vol 76 (1) ◽  
Author(s):  
Zaheera Abdool ◽  
Kovin S. Naidoo ◽  
Linda Visser
Keyword(s):  
Diabetic Retinopathy ◽  
General Practitioners ◽  
Primary Healthcare ◽  
Healthcare Workers ◽  
Primary Objective ◽  
Classification Systems ◽  
National Guidelines ◽  
District Health ◽  
Cross Sectional

Background: Clinical practice guidelines for the management of diabetic retinopathy (DR) adopted in various countries show variations in methods of examinations, screeners and classification systems. The South African National Guidelines for the frequency of referral of patients with diabetes mellitus (DM) for DR assessment were developed more than a decade ago. They do not specify the role of primary healthcare workers (PHCW) to manage DR at primary healthcare (PHC) level. The primary objective of this study was to establish the current role of PHCW in managing diabetic eye disease.Method: A cross-sectional study was conducted, and questionnaires were distributed to a total of 181 healthcare practitioners (HCPs) in public health institutions situated in the northern eThekwini district of KwaZulu-Natal. Clinics and community health centres (CHCs) were selected based on the assumption that PHC nurses, general practitioners or medical officers (MOs) and ophthalmic nurses practice at these institutions. The hospitals selected were the referral institutions for the selected clinics and CHCs. The questionnaires distributed included questions relating to the DR classification systems usage, HCP interaction and opinions on how HCPs could be valuable in managing DR.Results: Only two out of the five ophthalmic nurses were familiar with the grading classification systems for DR. Ophthalmic nurses had less interaction with general practitioners or MOs (40.0%) than the PHC nurses (60.0%). Only 2.4% of the PHC nurses interacted with ophthalmologists. Four of the five ophthalmic nurses indicated that PHC nurses would be valuable in the management of DR by taking visual acuity (VA) and conducting a pinhole test. More than 60% of the general practitioners or MOs (65.6%) suggested that ophthalmic nurses do a fundus examination. Ophthalmologists indicated that the PHC nurses were the least capable (17.7%) to screen for DR.Conclusion: Primary healthcare workers such as PHC nurses, ophthalmic nurses, general practitioners or MOs and optometrists have specific roles to play in DR management, which includes its prevention, detection, grading, referral and monitoring.

scholarly journals Policy Implementation Analysis on the Utilization of General Practitioners at Community Health Centers in Kemayoran from January 2013 to June 2014

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Indah Raksi Padmasari ◽  
Amila Megraini
Keyword(s):  
General Practitioner ◽  
Human Resources ◽  
Policy Implementation ◽  
Simulation Model ◽  
Community Health ◽  
General Practitioners ◽  
Community Health Centers ◽  
Health Centers ◽  
District Health ◽  
Lower Capacity

Abstract. Community Health Centers (CHCs) take the frontline position of health services in Indonesia. To be able to perform their functions properly, CHCs require human resources (HR) as a driving force. One of the human resources required is a general practitioner. The policy of utilization GP sat CHCs in Jakarta provides flexibility for sub-district health centers as the implementing agency in the management of human resources. One of the variables that influence the process of policy implementation is the capability of the implementing agencies indicated through their management capabilities.This study aims to describe the policy implementation on the utilization of general practitioners at Kemayoran sub-district health centers. The research was conducted using a mixed method combining qualitative and quantitative approach. The results confirm that there has been an imbalance proportion between the workload of general practitioners at village health centers and sub-district health centers, due to the absence of standardized rules regarding the placement of general practitioners, in addition to lower capacity of the human resources available. One of the recommendations proposed is the improvement of management using a simulation model of general practitioners based on balanced workload forecasting.Keywords: policy implementation, utilization of general practitioner, forecasting, simulation model

Cross-sectional analysis of hospital tasks handed over to general practitioners: workload delegation or dumping?

2021 ◽  
pp. postgradmedj-2020-139641
Author(s):  
Zahir Mughal ◽  
Rajib Maharjan
Keyword(s):  
General Practitioners ◽  
Significant Proportion ◽  
Hospital Setting ◽  
University Teaching ◽  
Cross Sectional ◽  
Blood Tests ◽  
Referral Practices ◽  
Sectional Analysis ◽  
Discharge Summaries

Purpose of the studyNew requirements for hospital clinicians to follow up and act on hospital-initiated investigations were introduced in 2016 in the National Health Service standard contract. We aimed to evaluate the tasks handed over from hospital clinicians to general practitioners (GPs).Study designA retrospective observation of all tasks in a random sample of electronic discharge summaries at a university teaching hospital over a 1 month period was conducted. A single-best-answer questionnaire was circulated among hospital clinicians over 3 months to gain an understanding of their follow-up and referral practices.ResultsThe total number of tasks found on discharge summaries (n=178) were 227, of which 39% were directed at GPs and 61% at the hospital team. Of 89 tasks delegated to GPs, 33% were inappropriate. Some tasks on discharge summaries were delegated more frequently to GPs such as blood tests (73%) and endoscopy requests (67%). While others were undertaken more often by hospitals clinicians including imaging requests (88%), follow-up appointments (87%) and onward referrals (71%). Surveyed doctors (n=72) admitted to asking GPs to follow up blood tests (52%), imaging and endoscopy (16%) and make onward referrals for related conditions (14%) and unrelated conditions (70%).ConclusionThe majority of outstanding tasks in the hospital setting were followed up by hospital clinicians. A considerable volume of tasks were delegated to GPs, of which a significant proportion were inappropriate. An increase in awareness and understanding among hospital clinicians of their responsibility to follow up hospital-initiated investigations is needed.

scholarly journals Knowledge about Danger Signs of Obstetric Complications and Associated Factors among Postnatal Mothers of Mechekel District Health Centers, East Gojjam Zone, Northwest Ethiopia, 2014

Scientifica ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Gedefa Amenu ◽  
Zerfu Mulaw ◽  
Tewodros Seyoum ◽  
Hinsermu Bayu
Keyword(s):  
Associated Factors ◽  
Significant Proportion ◽  
Northwest Ethiopia ◽  
Health Centers ◽  
Obstetric Complications ◽  
District Health ◽  
Cross Sectional ◽  
Danger Signs ◽  
Postnatal Mothers

Background. Developing countries like Ethiopia contributed highest level of maternal mortality due to obstetric complications. Women awareness of obstetric danger sign to recognize complications to seek medical care early is the first intervention in an effort to decrease maternal death.Objective. To assess knowledge about danger signs of obstetric complications and associated factors among postnatal mothers at Mechekel district health centers, East Gojjam zone, Northwest Ethiopia, 2014.Methods. An institution based cross-sectional study was conducted from August to October, 2014, in Mechekel district health centers. Systematic random sampling was used to select four hundred eleven study participants. A pretested structured questionnaire was used to collect data. Data were entered to Epi Info version 3.5.3 and exported to SPSS 20.0 for further analysis. Descriptive and summary statistics were done. Logistic regression analyses were used to see the association of different variables. Odds ratios and 95% confidence interval were computed to determine the presence and strength of association.Results. According to this study, 55.1% participants were knowledgeable about danger signs of obstetric complications. Maternal and husband educational level ((AOR = 1.977, 95% CI: 1.052, 3.716) and (AOR = 3.163, 95% CI: 1.860, 5.3770), resp.), family monthly income ≥ 1500 (AOR = 2.954, 95% CI: 1.289, 6.770), being multipara (AOR = 7.463, 95% CI: 1.301, 12.800), ANC follow-up during last pregnancy (AOR = 2.184, 95% CI: 1.137, 4.196), and place of last delivery (AOR = 1.955, 95% CI: 1.214, 3.150) were variables found to be significantly associated with women’s knowledge on danger signs of obstetric complications.Conclusion. Significant proportion of respondents were not knowledgeable about obstetric danger signs and factors like educational status, place of last delivery, and antenatal follow-up were found to be associated.

Postmarketing Surveillance Based on Electronic Patient Records: The IPCI Project

1999 ◽  
Vol 38 (04/05) ◽  
pp. 339-344 ◽  
Author(s):  
J. van der Lei ◽  
B. M. Th. Mosseveld ◽  
M. A. M. van Wijk ◽  
P. D. van der Linden ◽  
M. C. J. M. Sturkenboom ◽  
...  
Keyword(s):  
General Practitioner ◽  
General Practitioners ◽  
Validation Studies ◽  
Resource Planning ◽  
Routine Practice ◽  
Patient Records ◽  
Postmarketing Surveillance ◽  
Electronic Patient Records ◽  
Use Of Data ◽  
Data Requirements

AbstractResearchers claim that data in electronic patient records can be used for a variety of purposes including individual patient care, management, and resource planning for scientific research. Our objective in the project Integrated Primary Care Information (IPCI) was to assess whether the electronic patient records of Dutch general practitioners contain sufficient data to perform studies in the area of postmarketing surveillance studies. We determined the data requirements for postmarketing surveil-lance studies, implemented additional software in the electronic patient records of the general practitioner, developed an organization to monitor the use of data, and performed validation studies to test the quality of the data. Analysis of the data requirements showed that additional software had to be installed to collect data that is not recorded in routine practice. To avoid having to obtain informed consent from each enrolled patient, we developed IPCI as a semianonymous system: both patients and participating general practitioners are anonymous for the researchers. Under specific circumstances, the researcher can contact indirectly (through a trusted third party) the physician that made the data available. Only the treating general practitioner is able to decode the identity of his patients. A Board of Supervisors predominantly consisting of participating general practitioners monitors the use of data. Validation studies show the data can be used for postmarketing surveillance. With additional software to collect data not normally recorded in routine practice, data from electronic patient record of general practitioners can be used for postmarketing surveillance.

Kajian Kandungan Fe dalam Air Tanah Terhadap Kadar Ekskresi Yodium dalam Urin pada Anak Sekolah di Desa Cerme Kecamatan Panjatan Kabupaten Kulon Progo

2017 ◽  
Vol 19 (1) ◽  
pp. 7-11
Author(s):  
Vivi Linda Fristianti ◽  
Nur Hidayat ◽  
Slamet Iskandar
Keyword(s):  
Elementary School ◽  
Ground Water ◽  
School Children ◽  
Laboratory Data ◽  
Simple Random Sampling ◽  
Optimal Level ◽  
The Body ◽  
Design Data ◽  
Cross Sectional ◽  
Fe Content

Background : IDD problem is a serious problem, 33% of districts in Indonesia are endemic, 21% of endemic mild, moderate endemic 5% and 7% by weight endemic. Urine Iodine Excretion (EYU) illustrates the iodine intake of a person, because 90% of the iodine that enter the body are excreted through the urine. Blocking agents are substances certain minerals such as iron, manganese and calcium, which can bind iodine in groundwater. Objectives : This study aims to determine the relationship of Fe content in ground water sources against EYU levels in school children in the village of the District Cerme Panjatan Kulon Progo. Methods : An observational analytic research with cross sectional design. Data collection is done in May - June 2015. Location research Elementary School Cerme, District Panjatan Kulon Progo. The subjects of the study as many as 34 children in elementary school classroom Cerme 3, 4 and 5 were taken by simple random sampling. Well water and urine samples taken students then tested the iron in the Central Health Laboratory test Yogyakarta and iodine in urine in Magelang BP2GAKY Laboratory. Data analysis using Spearman Range test with significancy level : 0.05. Result : Fe content in the ground water is below the normal threshold is <0.3 mg / L. While levels EYU school children who are under the optimal level of 5.9%, the optimal level of 32.4%, and the optimum levels above 61.8% (optimal: 100 - 199μg / L). Conclusion : There was no significant relationship between the Fe content in groundwater with levels of EYU in school children in District Panjatan Kulon Progo (p = 0.447).   Keywords: Fe, EYU

PARTICIPATING IN HEALTH INSURANCE AND FACTORS AFFECTING AMONG PERSONS WHOSE ENROLMENT IS VOLUNTARY IN THUA THIEN HUE PROVINCE

2015 ◽  
pp. 89-95
Author(s):  
Thi Hoai Thuong Nguyen ◽  
Hoang Lan Nguyen ◽  
Mau Duyen Nguyen
Keyword(s):  
Health Insurance ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Health Insurance Scheme ◽  
Insurance Scheme ◽  
Cross Sectional ◽  
Factors Affecting ◽  
The People ◽  
Universal Health Insurance Coverage ◽  
The Social

Background:To provide information helps building policy that meets the practical situation and needs of the people with the aim at achieving the goal of universal health insurance coverage, we conducted this study with two objectives (1) To determine the rate of participating health insurance among persons whose enrolment is voluntary in some districts of ThuaThien Hue province; (2) To investigate factor affecting their participation in health insurance. Materials and Methodology:A cross-sectional descriptive study was conducted in three districts / towns / city of ThuaThien Hue in 2014. 480 subjects in the voluntary participation group who were randomly selected from the study settings were directly interviewed to collect information on the social, economic, health insurance participation and knowledge of health insurance. Test χ2 was used to identify factors related to the participation in health insurance of the study subjects. Results:42.5% of respondents were covered by health insurance scheme. Factors related to their participation were the resident location (p = 0.042); gender (p = 0.004), age (p <0.001), chronic disease (p <0.001), economic conditions (p<0.001) and knowledge about health insurance (p <0.001). Conclusion: The rate of participating health insurance among study subjects was low at 42,5%. There was "adverse selection" in health insurance scheme among voluntary participating persons. Providing knowledge about health insurance should be one of solutions to improve effectively these problems. Key words: Health insurance, voluntary, Thua Thien Hue

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