Transferability of international knowledge and experience for the management of low-risk Emergencies, in on-call Primary Healthcare Centers (PHC) in Greece

2020 ◽  
Vol 13 (4) ◽  
pp. 3-18
Author(s):  
Κyriakos Martakis ◽  
George Manomenidis ◽  
Thaleia Bellali

Overcrowding in hospital Emergency Departments (ED) is a major problem of public healthcare systems both in Greece and internationally, leading to delay in provision of adequate and high-quality healthcare. During the COVID-19 pandemic a significant reduction in ED overcrowding was observed, as many relative urgent cases, usually at lower risk reduced their visits to the ED, in fear of a possible infection. Several healthcare systems abroad have tried to tackle with the problem, establishing or redesigning Primary Health Care (PHC) centers, both rural and urban, which would manage both low-risk emergencies of the general population, but also the routine care of patients with chronic diseases. The purpose of this article was twofold and included on the one hand the presentation of the characteristics such PHC centers treating low risk emergencies and on the other hand the preparation of a transferability plan for these centers in the PHC of the Greek healthcare system. For the study of the transferability we used a new methodology, which includes and assesses a number of criteria that should be considered to facilitate of effective health interventions from a primary context to a specific target context. The researchers identified obstacles, but also opportunities for the transferability of PHC centers that should be established to manage low-risk emergencies in the Greek healthcare system. Further research is needed to evaluate the effectiveness of such centers to improve overcrowding in hospital ED, patient satisfaction, and to ensure an effective, as well as cost-effective emergency management, for instance through a small-scale pilot program in urban centers in Greece.

Author(s):  
Nilmini Wickramasinghe ◽  
Elie Geisler

The importance of knowledge management (KM) to organizations in today’s competitive environment is being recognized as paramount and significant. This is particularly evident for healthcare both globally and in the U.S. The U.S. healthcare system is facing numerous challenges in trying to deliver cost effective, high quality treatments and is turning to KM techniques and technologies for solutions in an attempt to achieve this goal. While the challenges facing the U.S. healthcare are not dissimilar to those facing healthcare systems in other nations, the U.S. healthcare system leads the field with healthcare costs more than 15% of GDP and rising exponentially. What is becoming of particular interest when trying to find a solution is the adoption and implementation of KM and associated KM technologies in the healthcare setting, an arena that has to date been notoriously slow to adopt technologies and new approaches for the practice management side of healthcare. We examine this issue by studying the barriers encountered in the adoption and implementation of specific KM technologies in healthcare settings. We then develop a model based on empirical data and using this model draw some conclusions and implications for orthopaedics.


Author(s):  
Luqman Raji ◽  
Zhigilla Y.I ◽  
Wadai J

Nigeria is one of developing countries in the world that experience shortage of electricity for her economic and social development. In Nigeria, most of the small-scale industries use diesel/petrol-based systems to generate their electricity. However, due to the cost fluctuation of oil and gas fuel, an alternative power generation should be considered. This paper targets to examine the cost analysis of system for supplying electricity to LUMATEC Aluminium products shop in Mubi, Adamawa state Nigeria. Hybrid Optimization Model for Electric Renewable (HOMER) is used as a tool for cost analysis. The scenario consider in this study was only stand-alone with battery system. Results revealed that the system have 10kW PV with cost of electricity (COE) of $0.312/kW. The initial capital cost and total net present cost (NPC) are $21.775 and $26.148 respectively, with payback period of 5.8years. In conclusion, this study provides the solution of power supply to the small-scale industries at cost effective and available throughout the year and it is feasible to solve the small-scale industries, rural and urban electricity supplying in this country (Nigeria). It is recommended that Nigerian Government & Law makers should promotes the use of standalone PV system for domestic and small-scale industry by providing financial assistance through soft loans, subsides and grants.


2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18849-e18849
Author(s):  
Yoanna S Pumpalova ◽  
Alexandra M. Rogers ◽  
Sarah Xinhui Tan ◽  
Candice-Lee Herbst ◽  
Paul Ruff ◽  
...  

e18849 Background: Colon cancer incidence and mortality rates are increasing in low- and middle-income countries, such as South Africa (SA). Adjuvant chemotherapy after curative resection for stage III colon cancer prolongs overall survival, but it is unclear which regimen is most cost-effective in resource-constrained settings, such as the SA public healthcare system. Methods: A decision-analytic Markov model was developed to compare lifetime costs and health outcomes for 60-year-old stage III colon cancer patients treated with six adjuvant chemotherapy regimens in a public hospital in SA: fluorouracil, leucovorin, and oxaliplatin (FOLFOX) for 3 and 6 months, capecitabine and oxaliplatin (CAPOX) for 3 and 6 months, capecitabine for 6 months, and fluorouracil/leucovorin (5-FU/LV; Mayo regimen) for 6 months. Transition probabilities were derived from clinical trials to estimate risks of toxicity, disease recurrence, and survival. Costs from a SA societal perspective and utility estimates were obtained from literature and local expert opinion. The primary outcome was the incremental cost-effectiveness ratio (ICER) in international dollars (I$) per disability-adjusted life year (DALY) averted, with a willingness-to-pay (WTP) threshold of one times the 2020 GDP per capita of SA (I$13,006.57; ZAR89,225). Results: Our model found CAPOX for 3 months to be the most cost-effective strategy, at a lifetime cost below the local WTP threshold (I$5,380.82; ZAR36,912.44) and 5.74 DALYs averted, compared to no chemotherapy. FOLFOX for 6 months was also on the efficiency frontier, with a higher total cost (I$22,747.47; ZAR156,047.64) and 0.18 additional DALYs averted (ICER = I$99,021.35/DALY averted). All other strategies were absolutely dominated. One-way sensitivity analyses found that FOLFOX for 6 months is optimal when the administration cost (i.e.: port and pump) falls to 20% of the base case price. Conclusions: In the SA public healthcare system, CAPOX for 3 months is the most cost-effective adjuvant treatment for stage III colon cancer. FOLFOX for 6 months, with a greater effectiveness, may be cost-effective if the administration cost decreases significantly. The optimal strategy in other settings may vary according to the local WTP threshold.[Table: see text]


2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Felippe Leopoldo Dexheimer Neto ◽  
Regis Goulart Rosa ◽  
Bruno Achutti Duso ◽  
Jaqueline Sanguiogo Haas ◽  
Augusto Savi ◽  
...  

Purpose.The long-term outcomes of patients after discharge from tertiary ICUs as they relate to the public versus private healthcare systems in Brazil have not yet been evaluated.Materials and Methods.A multicenter prospective cohort study was conducted to compare the all-cause mortality and the physical functional status (PFS) 24 months after discharge from the ICU between adult patients treated in the public and private healthcare systems. A propensity score- (PS-) matched comparison of all causes of mortality and PFS 24 months after discharge from the ICU was performed.Results.In total, 928 patients were discharged from the ICU including 172 (18.6%) patients in the public and 756 (81.4%) patients in the private healthcare system. The results of the PS-matched comparison of all-cause mortality revealed higher mortality rates among the patients of the public healthcare system compared to those of the private healthcare system (47.3% versus 27.6%,P=0.003). The comparison of the PS-matched Karnofsky performance and Lawton activities of daily living scores between the ICU survivors of the public and private healthcare systems revealed no significant differences.Conclusions.The patients of private healthcare system exhibited significantly greater survival rates than the patients of the public healthcare system with similar PFS following ICU discharge.


2021 ◽  
Vol 6 (6) ◽  
pp. e004707
Author(s):  
Mark W Moses ◽  
Julius Korir ◽  
Wu Zeng ◽  
Anita Musiega ◽  
Joyce Oyasi ◽  
...  

IntroductionA well performing public healthcare system is necessary for Kenya to continue progress towards universal health coverage (UHC). Identifying actionable measures to improve the performance of the public healthcare system is critical to progress towards UHC. We aimed to measure and compare the performance of Kenya’s public healthcare system at the county level and explore remediable drivers of poor healthcare system performance.MethodsUsing administrative data from fiscal year 2014/2015 through fiscal year 2017/2018, we measured the technical efficiency of 47 county-level public healthcare systems in Kenya using stochastic frontier analysis. We then regressed the technical efficiency measure against a set of explanatory variables to examine drivers of efficiency. Additionally, in selected counties, we analysed surveys and focus group discussions to qualitatively understand factors affecting performance.ResultsThe median technical efficiency of county public healthcare systems was 84% in fiscal year 2017/2018 (with an IQR of 79% to 90%). Across the four fiscal years of data, 27 out of the 47 Kenyan counties had a declining technical efficiency score. Our regression analysis indicated that impediments to the flow of funding—measured by the budget absorption rate which is the ratio between funds spent and funds released—were significantly related to poor healthcare system performance. Our analysis of interviews and surveys yielded a similar conclusion as nearly 50% of respondents indicated issues stemming from poor budget absorption were significant drivers of poor healthcare system performance.ConclusionPublic healthcare systems at the county-level in Kenya general performed well; however, addressing delays in the flow of funding is a concrete step to improve healthcare system performance. As Kenya—and other countries—provides additional funding to meet their UHC goals, establishing a strong and robust public financial management system is critical to ensure that the benefits of UHC are realised.


2021 ◽  
Vol 71 (2) ◽  
pp. 715-18
Author(s):  
Sikandar Hayat Khan

Conventional medicine with direct patient-medic suffers stagnation and may become redundant without any innovative oxygen of ideas. Current healthcare practices will ultimately need newer gateways for evolution, more cost-effective medical businesses and evidence-based healthcare at doorsteps. Though promising, the practice may face additional kick starts for changing patient-physician approach, infrastructural development, ethical and regulatory guidelines to help pave the way forward. In the opinion of author the successful deployment of “Tele-Health” will economize finances, patient referrals, physician/paramedical move to casualty site, improve clinical decisions, quality healthcare provision at country‟s periphery, and can dawn upon new learning avenues by distant learning programs.


Healthcare ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 467
Author(s):  
Silvia Prieto-Herraez ◽  
Teresa González-Arteaga ◽  
Rocío de Andrés Calle

This paper analyzes the stability of citizens’ preferences on public healthcare services in Spain. Nowadays, the increasing privatization of some healthcare services and the rapid emergence of private hospitals have caused changes in people’s preferences on public healthcare systems. This paper focuses on analyzing the preferences of Spaniards on their healthcare system over time under the assumption that citizens’ preferences are represented by complete pre-orders. Data for this study were collected from the Spanish Health Barometer survey, and they were searched from 1995 until 2018. The results show that preferences on the public healthcare system are very stable along time.


2021 ◽  
Vol 65 (4) ◽  
pp. 302-309
Author(s):  
Nina V. Zaitseva ◽  
Dmitriy A. Kiryanov ◽  
Marat R. Kamaltdinov ◽  
Olga Yu. Ustinova ◽  
Svetlana V. Babina ◽  
...  

Introduction. Preservation and growth of the country population is the top national priority in the Russian Federation. A contemporary approach focuses on several especially urgent demographic issues that can be resolved, among other things, due to public healthcare systems becoming more efficient. The present research work is vital due to the necessity to achieve target medical and demographic parameters fixed in the national and federal projects and regional programs. These parameters include life expectancy and mortality caused by cardiovascular and oncologic diseases. The goal of this work is a development of new approaches for the complex evaluation of potential management reserves of health population indicators and the prognosis of efficiency of targeted activities performed within public healthcare systems and aimed at increasing life expectancy through reducing mortality among the population caused by cardiovascular diseases and oncologic diseases. Material and methods. The work dwells on solving a “direct” task in the “medical activities - morbidity - mortality” triple analysis system; the solution involves predicting changes in morbidity and mortality under preset, planned, or scenario changes in parameters related to the public healthcare system. We modelled cause-and-effect relations in the above system, applying mathematical statistics techniques (correlation-regression analysis and factor analysis) with the consequent medical expertise of obtained results. Results. These procedures allow assessing health losses and spot out priorities in activities performed within the public healthcare system as well as ranking managerial decisions, already taken or only planned, as per their efficiency, taking into account territories; sex and age structure of the population; diseases, their subclasses and gravity; specific activities performed within the public healthcare system (prevention, diagnostics, or treatment). We should stress that the most significant potential management reserves of reducing mortality are achieved on territories with maximum mortality levels due to reserves for the reduction in it; these reserves are manageable due to prevention and early diagnostics. Conclusion. Research techniques and results described in the present work can be used in practice to achieve target parameters fixed by national and regional priorities and to select an optimal set of activities aimed at reducing mortality among the population.


2020 ◽  
Vol 49 (7) ◽  
pp. 423-433
Author(s):  
Ivandito Kuntjoro ◽  
Edgar Tay ◽  
Jimmy Hon ◽  
James Yip ◽  
William Kong ◽  
...  

Introduction: Singapore has the world’s second most efficient healthcare system while costing less than 5% GDP. It remains unclear whether transcatheter aortic valve implantation (TAVI) is cost-effective for treating intermediate-low risk severe aortic stenosis (AS) patients in a highly efficient healthcare system. Materials and Methods: A two-phase economic model combining decision tree and Markov model was developed to assess the costs, effectiveness, and the incremental cost-effectiveness ratio (ICER) of transfemoral (TF) TAVI versus surgical aortic valve replacement (SAVR) in intermediate-low risk patients over an 8-year time horizon. Mortality and complications rates were based on PARTNER 2 trial cohort A and Singapore life table. Costs were mainly retrieved from Singapore National University Health System database. Health utility data were obtained from Singapore population based on the EuroQol-5D (EQ-5D). A variety of sensitivity analyses were conducted. Results: In base case scenario, the incremental effectiveness of TF-TAVI versus SAVR was 0.19 QALYs. The ICER of TF-TAVI was S$33,833/QALY. When time horizon was reduced to 5 years, the ICER was S$60,825/QALY; when event rates from the propensity analysis was used, the ICER was S$21,732/QALY and S$44,598/QALY over 8-year and 5-year time horizons, respectively. At a willingness to pay threshold of S$73,167/QALY, TF-TAVI had a 98.19% probability of being cost-effective after 100,000 simulations. The model was the most sensitive to the costs of TF-TAVI procedure. Conclusion: TF-TAVI is a highly cost-effective option compared to SAVR for intermediate-low risk severe AS patients from a Singapore healthcare system perspective. Increased procedure experience, reduction in device cost, and technology advance may have further increased the cost-effectiveness of TF-TAVI per scenario analysis. Keywords: Surgical aortic valve replacement, Quality of life, Transfemoral TAVI, Reimbursement


2022 ◽  
pp. 222-244
Author(s):  
Pushpalatha M. N. ◽  
Parkavi A. ◽  
Sini Anna Alex

The healthcare scheme in India has a lot of differences between rural and urban areas in terms of quality along with changes in private and public healthcare systems. The healthcare system is massive in India and full of inconsistencies and complexities like the other countries. Predictive analytics will help to improve the healthcare systems by providing valuable insight in healthcare. A huge amount of different data sets is generated because of the digitization of healthcare. This digitization allows us to use predictive analytics for better patient outcomes. Predictive analytics is utilized in decision-making activities and prediction making about the future events which are unknown. In this chapter, a brief overview of the Indian healthcare systems is given, along with data representations, challenges, issues, and risks associated with applying predictive analytics in healthcare and case studies with respect to regression and classification models.


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