scholarly journals Investigating the factors behind differences in ‘lay’ and ‘expert’ medical knowledge in the context of fever treatment in Yangon, Myanmar.

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Onubha Hoque Syed
Keyword(s):  
Health System ◽  
Medical Knowledge ◽  
Cross Sectional Study ◽  
Treatment Seeking ◽  
Cross Sectional ◽  
Traditional Health ◽  
Medical Discourses ◽  
Fever Treatment ◽  
Health Discourse ◽  
Biomedical Treatment

How is treatment seeking behaviour influenced by contrasting medical discourses? This paper uses the context of fever patients in Yangon, Myanmar to investigate the factors behind differences between ‘lay’ and ‘expert’ medical knowledge, which consequently guide the treatment seeking behaviour of hospital and clinic patients in Myanmar’s second largest city. By conducting the deductive thematic analysis of secondary qualitative data from both patients and medical doctors using an adapted form of Amartya Sen’s capability approach framework, this cross-sectional study uncovers how: education, socially rooted collective knowledge and unregulated pharmacies drive differences between ‘lay’ and ‘expert’ medical knowledge and therefore dictate treatment seeking behaviour. The results of this paper highlight the interdisciplinary nature of health, meaning health systems should be considered within their sociological, political and economic contexts. The current omission of traditional health discourse within the prevailing Burmese health system may limit the successfulness of biomedical treatment. Appreciating the complexity of how health is understood by populations, specifically how traditional medicine and biomedicine coexist within the Burmese context can allow policymakers to form a stronger health system by creating contextualised policies and health interventions for the general public that cater to the diversity of narratives within health.  

scholarly journals Socioeconomic determinants of unmet need for outpatient healthcare services in Iran: a national cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sajad Vahedi ◽  
Amin Torabipour ◽  
Amirhossein Takian ◽  
Saeed Mohammadpur ◽  
Alireza Olyaeemanesh ◽  
...  
Keyword(s):  
Health System ◽  
Age Groups ◽  
Unmet Need ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Outpatient Services ◽  
Self Medication ◽  
Cross Sectional ◽  
Organizational Policies ◽  
Utilization Of Healthcare

Abstract Background Unmet need is a critical indicator of access to healthcare services. Despite concrete evidence about unmet need in Iran’s health system, no recent evidence of this negative outcome is available. This study aimed to measure the subjective unmet need (SUN), the factors associated with it and various reasons behind it in Iran. Methods We used the data of 13,005 respondents over the age of 15 from the Iranian Utilization of Healthcare Services Survey in 2016. SUN was defined as citizens whose needs were not sought through formal healthcare services, while they did not show a history of self-medication. The reasons for SUN were categorized into availability, accessibility, responsibility and acceptability of the health system. The multivariable logistic regression was used to determine significant predictors of SUN and associated major reasons. Results About 17% of the respondents (N = 2217) had unmet need for outpatient services. Nearly 40% of the respondents chose only accessibility, 4% selected only availability, 78% chose only responsibility, and 13% selected only acceptability as the main reasons for their unmet need. Higher outpatient needs was the only factor that significantly increased SUN, responsibility-related SUN and acceptability-related SUN. Low education was associated with higher SUN and responsibility-related SUN, while it could also reduce acceptability-related SUN. While SUN and responsibility-related SUN were prevalent among lower economic quintiles, having a complementary insurance was associated with decreased SUN and responsibility-related SUN. The people with basic insurance had lower chances to face with responsibility-related SUN, while employed individuals were at risk to experience SUN. Although the middle-aged group had higher odds to experience SUN, the responsibility-related SUN were prevalent among elderly, while higher age groups had significant chance to be exposed to acceptability-related SUN. Conclusion It seems that Iran is still suffering from unmet need for outpatient services, most of which emerges from its health system performance. The majority of the unmet health needs could be addressed through improving financial as well as organizational policies. Special attention is needed to address the unmet need among individuals with poor health status.

scholarly journals Retrospective study of the distribution of doctors in municipalities of extreme poverty in Brazil

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
B L O Luizeti ◽  
E M M Massuda ◽  
L F G Garcia
Keyword(s):  
Public Health ◽  
Health System ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Extreme Poverty ◽  
The Public ◽  
The North ◽  
Unified Health System ◽  
Shortage Of Doctors ◽  
Demographic Distribution

Abstract In view of the national scenario of scarcity of material and human resources in public health in Brazil, the survey verified the demographics of doctors who attend the Unified Health System (SUS) in municipalities of extreme poverty. An observational, analytical and cross-sectional study was carried out, based on secondary quantitative data from the Department of Informatics of the SUS using the TABNET of December 2019. The care networks variable was restricted to infer the number of physicians who attend the SUS in extreme poverty municipalities in Brazil. Municipalities of extreme poverty are those that at least 20% of the population have a household income of up to 145 reais per capita monthly. In Brazil, there are 1526 municipalities in extreme poverty, 27.4% of the country's total municipalities. 14,907 doctors linked to SUS work in this condition, 3.19% of the total of these professionals in Brazil. There is still disproportion between regions: North concentrates 11.2% of the municipalities in extreme poverty and 8.61% of the total number of doctors; Northeast, with 61.33% of these municipalities, for 61.5% of doctors; Southeast, with 15.46% of the municipalities in this condition, has 20.6% of doctors; South concentrates 10.87% of the municipalities under discussion with 5.61% of doctors and the Midwest, with 4.87% of these municipalities, has 3.54% of doctors. Between 2009 and 2018, there was a 39% increase in the number of doctors in these locations, however, for 2019, there was a decrease of 3.89%. The medical demographic distribution in Brazil is uneven, especially in the North. There is also the vulnerability of this population in view of the observed reduction in the number of professionals between 2018 and 2019 in municipalities of extreme poverty, for political reasons. It is evident the need to restructure the health system to guarantee access to health for this population, through the attraction and fixation of doctors in needy regions in Brazil. Key messages Shortage of doctors in extreme poverty municipalities reinforces the health vulnerability of the population in Brazil. The uneven medical demography in Brazil requires restructuring in the public health system.

scholarly journals A cross-sectional study of malaria endemicity and health system readiness to deliver services in Kenya, Namibia and Senegal

2017 ◽  
Vol 32 (suppl_3) ◽  
pp. iii75-iii87 ◽  
Author(s):  
Elizabeth H Lee ◽  
Cara H Olsen ◽  
Tracey Koehlmoos ◽  
Penny Masuoka ◽  
Ann Stewart ◽  
...  
Keyword(s):  
Health System ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Malaria Endemicity ◽  
System Readiness

scholarly journals Frequency and Severity of Adverse Drug Reactions to Medications Prescribed for Alzheimer’s Disease in a Brazilian City: Cross-Sectional Study

2020 ◽  
Vol 11 ◽  
Author(s):  
Tânia Regina Ferreira ◽  
Luciane Cruz Lopes ◽  
Cristiane de Càssia Bergamaschi
Keyword(s):  
Public Health ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Health System ◽  
Psychiatric Disorders ◽  
Public Health System ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Drug Reactions ◽  
Cross Sectional

Background: There is lack of national studies that assess the risks associated with the drugs provided under the Brazilian public health system for treating Alzheimer’s disease. Then, this study determined the prevalence and severity of self-reported adverse drug reactions (ADRs) prescribed to patients with Alzheimer’s disease in the Brazilian public health system.Methods: A cross-sectional study was carried out based on public data from the MEDEX system (information on dispensing data, known as exceptional dispensing medications) and interviews with patients and/or caregivers who get access to Alzheimer’s drugs at a public pharmacy in a large Brazilian city, between July and September 2017, inquiring about ADRs and serious adverse events (SAEs).Results: The subjects were asked about ADRs and SAEs related to the use of donepezil, galantamine, rivastigmine and memantine. Out of 285 patients enrolled on the database, 250 participated in the study (87.7%). Among the participants, approximately 63.0% were female, 70.3% aged ≥75 years and 70.3% had comorbidities. Overall, 209 patients (83.6%) reported at least one ADR (total 1,149 ADRs) and rivastigmine was associated with the largest number of ADRs per patient (7.9 ADRs/patient). The predominant adverse effects were psychiatric disorders with common frequency (57.1%) and mild severity (89.0%). Six patients (2.4%) had SAEs that required hospitalization. The use of antipsychotics was the variable associated with ADR (OR = 4.95; 95% CI: 1.45–16.93; p = 0.011).Conclusion: There was a large number of reported ADRs and most of them were of common frequency and mild severity, being mainly related to psychiatric disorders. Considering the fragility of these patients, it is important to improve safety-related care in the use of drugs for treating this disease.

scholarly journals Early Malaria Diagnosis and Treatment Seeking Behavior Among Clients Attending Outpatient Department Sekou-Toure Regional Referral Hospital in Mwanza, Tanzania; A Cross-Sectional Study

2021 ◽  
Author(s):  
Samson Mvandal ◽  
Godfrida Marandu
Keyword(s):  
Health Facility ◽  
Early Treatment ◽  
Malaria Diagnosis ◽  
Cross Sectional Study ◽  
Referral Hospital ◽  
Treatment Seeking ◽  
Sectional Study ◽  
Cross Sectional ◽  
Regional Referral Hospital ◽  
Seeking Behavior

Early diagnosis of malaria and treatment seeking behavior play key role in controlling and preventing further complication related to malaria disease. Aim of this study was to determine the responses on early malaria diagnosis and treatment seeking behavior among outpatient clients attending at Sekou toure regional referral hospital in Mwanza, Tanzania. Methods: A cross-sectional study was conducted among outpatient client at Sekou-Touré regional referral hospital, convenient simple random sampling used and self-administered questionnaire were used to collect data and data was entered into Microsoft excel and then exported to SPSS version 25.0 for further analysis and presented on the percentages and table. The analysis of strength of relationships between categorical variables was conducted using the Chi-square test. A p-value of ≤ 0.05 was considered to be statistically significant. Results: A total of 192 respondents completed the study with a response rate of 97.6%. The study revealed that Most of the respondents about 90.6% stated they would seek treatment from health facility when symptoms appear. However, only 6.3% seek treatment within 24 hours of onset of illness (p= 0.017). Half of respondents (50.5%) experienced malaria symptoms in the past six months and only 30% seek for treatment at health facility. Preference of health facility, (51%) respondents were going direct to pharmacy to buy medicine for self-treatment. Overall, cost of service, time consumed and distance of health facility especially health center shows significant with such delay. Conclusion: A low proportion of malaria-suspected patients sought treatment within 24 h of fever onset compared to the national target. Distance from the health facility, cost of service and time consumed were found to be predictors of early treatment-seeking behavior for malaria. Strengthening strategies tailored to increasing awareness for communities about malaria, importance of going hospital and early treatment-seeking behavior is essential.

scholarly journals Treatment-Seeking Behavior Towards Epilepsy Among Rural Residents in Ethiopia: A Cross-Sectional Study

2020 ◽  
Vol Volume 16 ◽  
pp. 433-439 ◽  
Author(s):  
Alemayehu Molla ◽  
Birhanie Mekuriaw ◽  
Endashaw Habtamu ◽  
Moges Mareg
Keyword(s):  
Cross Sectional Study ◽  
Treatment Seeking ◽  
Sectional Study ◽  
Rural Residents ◽  
Cross Sectional ◽  
Seeking Behavior

Quality in the Context of Value: Reliability of Quality Metrics in an Academic Health System Shifting Toward Value-Based Payments

2020 ◽  
Vol 35 (6) ◽  
pp. 465-473
Author(s):  
Linnaea Schuttner ◽  
Ashok Reddy ◽  
Andrew A. White ◽  
Edwin S. Wong ◽  
Joshua M. Liao
Keyword(s):  
Health System ◽  
Health Care Organizations ◽  
Cross Sectional Study ◽  
Quality Metrics ◽  
Cross Sectional ◽  
Primary Care Clinics ◽  
Level Measurement ◽  
Level Performance ◽  
Individual Clinician ◽  
Statistical Noise

Quality metrics are fundamental to value-based payment reforms. Because metrics are key components used to drive performance, health care organizations participating in payment reforms should consider metric reliability—a measure of true performance versus statistical “noise.” This cross-sectional study examined reliability, variation from patient and clinician characteristics, and volume thresholds for 9 ambulatory quality metrics in a health system engaged in value-based payment reforms. Hierarchical mixed models were used to analyze data from 276 316 patients attributed to 4373 clinicians in 31 primary care clinics from 2015 to 2017. Reliability was lower for all metrics at the clinician level (range 6%-64%) than at the clinic level (84%-99%), with little variation related to patient or clinician characteristics. Few clinicians, but the majority of clinics, contributed sufficient volumes of patient encounters to meet a 70% reliability threshold. These findings suggest that clinic-level performance measurement may be more appropriate than individual clinician-level measurement, particularly in low-volume contexts.

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