scholarly journals Patient Choice and Willingness Toward Gatekeepers as First-Contact Medical Institutions in Chinese Tiered Healthcare Delivery System: A Cross-Sectional Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Xia Li ◽  
Liang Zhang ◽  
Zhong Li ◽  
Wenxi Tang
Keyword(s):  
Delivery System ◽  
Family Income ◽  
Healthcare Delivery ◽  
Binary Logistic Regression ◽  
Cross Sectional Study ◽  
Patient Choice ◽  
Healthcare Delivery System ◽  
Cross Sectional ◽  
Primary Care Institutions ◽  
First Contact

Introduction: Gatekeeping mechanism of primary care institutions (PCIs) is essential in promoting tiered healthcare delivery system in China. However, patients seeking for higher-level institutions instead of gatekeepers as their first contact has persisted in the past decade. This study aims to explain patients' choice and willingness and to provide potential solutions.Methods: A survey was conducted among residents who had received medical care within the previous 14 days. Patients' choice and willingness of PCIs for first contact together with influencing factors were analyzed using binary logistic regression.Results: Of 728 sampled patients in Hubei, 55.22% chose PCIs for first contact. Patients who are older, less educated, with lower family income, not living near non-PCIs, with better self-perceived health status, only buying medicines, and living in rural instead of urban area had significantly higher probability of choosing PCIs. As of willingness, over 90% of the patients inclined to have the same choice for their first contact under similar health conditions. Service capability was the primary reason limiting patients' choice of PCIs.Conclusions: The gatekeeper system did not achieve its goal which was 70% of PCIs among all kinds of institutions for first contact. Future measures should aim to improve gate-keepers' capability.

scholarly journals Evaluation of Drug Use Patterns of Out Patient Attendees in a Tertiary Care Teaching Hospital in Dermatology and Venereology Department as a Tool to Promote Rational Prescribing

2014 ◽  
Vol 4 (1) ◽  
pp. 4-9
Author(s):  
Nushrat Noor ◽  
Md Jamal Uddin ◽  
Mohammad Afsan ◽  
Hafiza Akhter ◽  
Farhana Kabir
Keyword(s):  
Tertiary Care ◽  
Inappropriate Prescribing ◽  
Healthcare Delivery ◽  
Essential Medicine ◽  
Cross Sectional Study ◽  
World Health ◽  
Carbon Paper ◽  
Healthcare Delivery System ◽  
Cross Sectional ◽  
Prescribing Indicators

Background: Drug utilization studies are pre requisite for the formulation of drug policies. They offer useful methods for teaching and training in drug therapy and also identify the problems that arise from drug usage in healthcare delivery system and highlight the current approaches to the rational use of medicines. Objectives: The main objective of the prescription audit or evaluation was to measures for improving the prescription practices and to generate information on the core prescribing indicators proposed by the World Health Organization (WHO). Methods: This was a descriptive type of cross sectional study. The study was conducted in the Out Patient Department (OPD) of Dermatology & Venereology in a tertiary care private hospital, Dhaka, Bangladesh in between January and March’2012. A total of 300 prescriptions were obtained with the help of a pre-inserted carbon paper in a special format using WHO core prescribing indicators. Results: The average number of drugs per encounter was 3.8 and no single drug was prescribed by generic name. Use of antibiotic (56% of encounters) was frequent, but injection use (2.67% of encounters) was within the recommendation of WHO. The use of fixed drug combinations (FDCs) was 15.28% of prescribed drugs. Only 22.08% drugs were prescribed from national essential medicine list. Conclusion: The findings from the current study showed a trend towards inappropriate prescribing. DOI: http://dx.doi.org/10.3329/updcj.v4i1.21158 Update Dent. Coll. j: 2014; 4 (1): 04-09

scholarly journals Morbidity profile and prescription audits using WHO core prescribing indicator in government hospitals of Province 1, Nepal

2021 ◽  
Vol 3 (2) ◽  
pp. 15-22
Author(s):  
Shambhu Shah ◽  
Prasanna Dahal ◽  
Anil Kumar Sah ◽  
Surya B. Parajuli ◽  
Naveen Shrestha
Keyword(s):  
Metabolic Diseases ◽  
Healthcare Delivery ◽  
Circulatory System ◽  
Essential Medicine ◽  
Cross Sectional Study ◽  
World Health ◽  
Healthcare Delivery System ◽  
Cross Sectional ◽  
Essential Medicine List ◽  
Tertiary Hospitals

Background: Periodic assessment of morbidity and drug use at various levels of healthcare delivery system is important to recognize common prevalent morbidities and rationalize the use of medicines. The study was conducted to determine the common morbidities and audit prescription using WHO prescribing indicator in government operated tertiary hospitals of eastern Nepal. Methods: A cross-sectional study was carried out in government tertiary hospitals of Province 1, Nepal, from March 2019 to August 2019. For analysis, descriptive statistics were used.  Prescribing characteristics were evaluated using recommended guidelines of the World Health Organization (WHO) prescribing indicators. Results: Six hundred prescriptions were analyzed. The most prevalent morbidity was endocrine, nutrition & metabolic diseases (21.5%) followed by diseases of the respiratory system (19.8%), circulatory system (17.6%), and digestive system (12.8%). The most frequently encountered individual disease entity were hypertension (18.7%), diabetes (15.5%), acid peptic disorders (14%). A total of 2072 drugs were prescribed with an average of 3.45 (± 1.39) drugs per consultation. About 30.2% of prescriptions encountered contain at least one antibiotics, whereas injectable were prescribed in 1.8%. Only 3.9% of total medicines were prescribed in generic name and 31.7% of drug prescribed were from essential medicine list. Conclusion: Among the prescriptions evaluated, diseases of the endocrine, respiratory, cardiovascular, and gastrointestinal systems were the most common morbidities. Polypharmacy was prevalent to some extent whereas prescribing in generic and essential medicine list was poor relative to standard WHO recommendations. However, the overall prescribing of antibiotics and injection were found to be satisfactory.

scholarly journals Assessment of infrastructure of first referral unit facilities in Surguja division: a responsibility of providing emergency obstetric care

2019 ◽  
Vol 6 (12) ◽  
pp. 5168
Author(s):  
Abha Ekka ◽  
Shubra A. Gupta ◽  
Divya Sahu ◽  
Anmol Madhur Minj ◽  
G. P. Soni
Keyword(s):  
Healthcare Delivery ◽  
Essential Medicine ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Cross Sectional Study ◽  
Civil Infrastructure ◽  
Healthcare Delivery System ◽  
Cross Sectional ◽  
Physical Infrastructure ◽  
Maternal And Newborn

Background: Availability of emergency obstetric care (EmOC) is one of interventions to reduce maternal and newborn deaths. The health system fails when effective and affordable health interventions do not reach the population, when Poor infrastructure, drugs and equipment are lacking, and qualified human resources are scarce. The objective of the present study was to assess the availability of EmOC infrastructure in first referral units (FRUs) of Surguja division, Chhattisgarh.Methods: A cross sectional study was designated with 13 FRUs of Surguja division. A semi structured, closed-ended questionnaires was observed on the basis of check list, reviewing record, and interview by available staff.Results: FRUs of Surguja division for physical infrastructure scored 68.5%, for essential medicine 69.2%, for equipments 50.7%, for instruments 45.3% and for availability of blood 34.6%, for health man power category of specialist score was 25.7% but for supportive staff 65.4%.Conclusions: Our study revealed three existing bottlenecks in the healthcare delivery system as inadequate civil infrastructure, short fall of specialists as well as inadequate supplies of drugs and equipment, hampering the function of facility.

scholarly journals Quality of care and patient safety at healthcare institutions in Oman: quantitative study of the perspectives of patients and healthcare professionals

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fatma Al-Jabri ◽  
Tarja Kvist ◽  
Reijo Sund ◽  
Hannele Turunen
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
Healthcare Professionals ◽  
Healthcare Delivery ◽  
Core Competency ◽  
Binary Logistic Regression ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Tertiary Hospitals

Abstract Background Oman’s healthcare system has rapidly transformed in recent years. A recent Report of Quality and Patient Safety has nevertheless highlighted decreasing levels of patient safety and quality culture among healthcare professionals. This indicates the need to assess the quality of care and patient safety from the perspectives of both patients and healthcare professionals. Objectives This study aimed to examine (1) patients’ and healthcare professionals’ perspectives on overall quality of care and patient safety standards at two tertiary hospitals in Oman and (2) which demographic characteristics are related to the overall quality of care and patient safety. Methods A cross-sectional study design was employed. Data were collected by two items: overall quality of care and patient safety, incorporated in the Revised Humane Caring Scale, and Healthcare Professional Core Competency Instrument. Questionnaires were distributed to (1) patients (n = 600) and (2) healthcare professionals (nurses and physicians) (n = 246) in three departments (medical, surgical and obstetrics and gynaecology) at two tertiary hospitals in Oman towards the end of 2018 and the beginning of 2019. Descriptive statistics and binary logistic regression were used for data analysis. Results A total of 367 patients and 140 healthcare professionals completed the questionnaires, representing response rates of 61.2% and 56.9%, respectively. Overall, quality of care and patient safety were perceived as high, with the healthcare professionals rating quality of care (M = 4.36; SD = 0.720) and patient safety (M = 4.39; SD = 0.675) slightly higher than the patients did (M = 4.23; SD = 0.706), (M = 4.22; SD = 0.709). The findings indicated an association between hospital variables and overall quality of care (OR = 0.095; 95% CI = 0.016–0.551; p = 0.009) and patient safety (OR = 0.153; 95% CI = 0.027–0.854; p = 0.032) among healthcare professionals. Additionally, an association between the admission/work area and participants’ perspectives on the quality of care (patients, OR = 0.257; 95% CI = 0.072–0.916; p = 0.036; professionals, OR = 0.093; 95% CI = 0.009–0.959; p = 0.046) was found. Conclusions The perspectives of both patients and healthcare professionals showed that they viewed both quality of care and patient safety as excellent, with slight differences, indicating a high level of patient satisfaction and competent healthcare delivery professionals. Such perspectives can provide meaningful and complementary insights on improving the overall standards of healthcare delivery systems.

A Stochastic Queueing Model for Capacity Allocation in the Hierarchical Healthcare Delivery System

2019 ◽  
Vol 36 (01) ◽  
pp. 1950005
Author(s):  
Jianpei Wen ◽  
Hanyu Jiang ◽  
Jie Song
Keyword(s):  
Delivery System ◽  
Optimal Allocation ◽  
Healthcare Delivery ◽  
Capacity Allocation ◽  
Patient Choice ◽  
Management Tool ◽  
Point Problem ◽  
Referral Process ◽  
Healthcare Delivery System ◽  
The Impact

We use the capacity allocation as a demand management tool to optimize the patient flow distribution on a hierarchical healthcare delivery system, which is a mixture of patient choice and gatekeeping. Capacity allocation for such service system can be challenging because of the inherent stochastic referral process and patients’ heterogeneous delay sensitivities. In this research, a stochastic queueing-based model is proposed to find the optimal allocation of the limited service capacity of the second level of experts. Considering the impact of the deficiency of the skill level and the amount of gatekeepers, the stochastic referral process is modeled with a tandem queue. By solving a fixed-point problem, we show that there is an unique optimal allocation and corresponding equilibrium demand. We carry out numerical studies and find that providing two alternatives for patients can be better than gatekeeper system, when the capacity of the gatekeeper is moderate compared to patients’ potential demand. Results also indicate that the optimal allocation is robust in terms of the referral rate and the mistreatment rate when two rates are less than corresponding thresholds.

scholarly journals Neonatal Cord Care Practices among Mothers and Caregivers in the Volta Region of Ghana

2019 ◽  
Vol 8 (1) ◽  
pp. 63-69
Author(s):  
Sybil S. Opoku Asiedu ◽  
Nana Abena Ansah Apatu ◽  
Rosemond Tetteh ◽  
Abraham Hodgson
Keyword(s):  
Umbilical Cord ◽  
Health Care Providers ◽  
Healthcare Delivery ◽  
Cross Sectional Study ◽  
Care Providers ◽  
Cord Care ◽  
Healthcare Delivery System ◽  
Cross Sectional ◽  
Volta Region ◽  
Care Practices

Background: The umbilical cord is a major route of infection among newborns. In Ghana, infections among neonates accounts for majority of under-five deaths. This study sought to investigate what mothers apply to the umbilical cord of their newborns and what motivates them to put such applications on the cord. Methods: This was a descriptive cross-sectional study of neonatal cord care practices among mothers and caregivers in the Nkwanta South District of the Volta region of Ghana. Quantitative and qualitative methods were used. Results: Majority of the mothers/caregivers used substances that have not been recommended for umbilical cord dressing (64.3%). Factors such as level of education [χ2=8.2, p=0.02], place of delivery [χ2 = 40.1, p<0.001], relationship with whoever has made a recommendation for a particular dressing to be used [χ2=95.2, p<0.001] and number of days it takes the umbilical cord to fall off [χ2=6.2, p=0.05] were found to influence the type of dressing used on the umbilical cord. Conclusion and Global Health Implications: In order to reduce the number of neonates who die due to avoidable cord-related infections, the type of substances used on the umbilical cord should be approved substances. Health education particularly on neonatal cord care targeting community members and health care providers at the lower levels of the healthcare delivery system should be intensified. Key words: • Umbilical cord • Neonates • Newborns • Rural • Dressing • Infections • Ghana   Copyright © 2019 Asiedu et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Quantifying Recent Upsurge in Covid-19 Incidence and Related Fatalities: An Implication of Delayed Response or State of Delivery Health Care System?

2020 ◽  
Vol 16 ◽  
pp. 47-61
Author(s):  
Taofik Olatunji Bankole ◽  
Glory Urhere
Keyword(s):  
Health Care ◽  
Delivery System ◽  
Growth Rates ◽  
Healthcare Delivery ◽  
Data Bank ◽  
Delayed Response ◽  
Series Method ◽  
Healthcare Delivery System ◽  
Cross Sectional ◽  
Times Series

Study Aim: To validate the recent upsurge in COVID-19 incidence and related fatalities in a retrospective to the state of the healthcare delivery system and delayed in response to the pandemic in Nigeria. Methods: The quantitative cross-sectional times series method was adopted. COVID-19 Data for Nigeria were extracted for reported cases and fatalities arising from COVID-19 complications from the WHO COVID-19 situational data bank between March 15 and July 15, 2020. The incidence and fatality growth rates were generated at intervals for four months. Data were analyzed with the Stata version 15. Results: Findings showed that the recent upsurge in COVID-19 accounted for 99.2%, 98.9%, 98.5%, 99.8%, 99.2%, 99.8%, and 97.3% complications that led to the death of infected patients in the Northcentral, Northeast, Northwest, Southeast, Southsouth. Southwest and the FCT. The results showed that there was a strong uphill linear (r = 0.991) and a significant association between COVID-19 incidence and fatalities arising from COVID-19 complications in Nigeria (ß = 0.022; t = 30.2; p<0.001).

Is there a relationship between gestational diabetes and postpartum depression?

2020 ◽  
Vol 16 ◽  
Author(s):  
Salman Khazaei ◽  
Erfan Ayubi ◽  
Saeid Bashirian ◽  
Ronak Hamzehei ◽  
Ensiyeh Jenabi
Keyword(s):  
Gestational Diabetes ◽  
Postpartum Depression ◽  
Odds Ratio ◽  
Depression Scale ◽  
Binary Logistic Regression ◽  
Cross Sectional Study ◽  
University Education ◽  
P Value ◽  
Cross Sectional ◽  
The Relationship

Background: The relationship between gestational diabetes and postpartum depression (PPD) is poorly understood and seldom studied. Objective: In an effort to explore this issue, the present study investigated the relationship between gestational diabetes and PPD. Methods: The present cross-sectional study was performed with 342 women who were referred to four urban health centers of Hamadan city, west of Iran. We used convenience sampling as a method to recruit women in each health center. We used a researcher-made checklist for gathering data on socio-demographic characteristics and potential risk factors of PPD. The Persian validated version of the Edinburgh Postnatal Depression Scale (EPDS) was used to assess PPD. Univariate and multivariable binary logistic regression was applied to estimate the odds ratio (OR) (95% confidence interval [CI]). Results: Gestational diabetes was identified as the most important risk factor for PPD with OR (95% CI) of 2.19 (1.11, 4.31); P-value=0.02 after adjusting for other variables. Moreover, the adjusted odds ratio showed that PPD among lesseducated women (primary school) was 3.5 times higher compared to women with a university education (OR=3.54, 95% CI: 1.27, 9.84; P-value=0.01). Conclusion: Our findings suggested that PPD is more likely among women with gestational diabetes and those who were less educated. Interventional and educational activities for reducing the risk of PPD can be targeted for use with this population.

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