The Health Outcomes in Recession

2014 ◽  
Vol 3 (4) ◽  
pp. 55-65 ◽  
Author(s):  
Vassilis Fragoulakis ◽  
Elena Athanasiadi ◽  
Antonia Mourtzikou ◽  
Marilena Stamouli ◽  
Athanassios Vozikis
Keyword(s):  
Health Outcomes ◽  
Healthcare System ◽  
Significant Rise ◽  
Real Patient ◽  
Public Servants ◽  
Significant Drop ◽  
Maternity Hospitals ◽  
Healthcare Reforms ◽  
Dental Offices

The aim of the present study is to provide an overview of recent reforms in Greece as imposed by the fiscal adjustments. Potential harmful consequences of these vast healthcare reforms are also discussed, as a collateral victim of the recession, in which case the real “patient” is the overall healthcare system. Based on an extended review of the related literature, the economic crisis, currently numbering five years in Greece, was accompanied by vast healthcare reforms and significant cuts in spending. In particular, austerity measures implemented, impose that health expenditure should not exceed 6% as a share of GDP. Savings were expected to be accomplished through vast changes, including the redetermination of both pharmaceutical reimbursement and pricing, reduction of public servants and cost containment regarding payments to the private sector. So far, there is a significant rise in demand for public hospital services, following a significant drop for private providers, including maternity hospitals, dental offices and surgery clinics. At the same time, elevated prevalence of certain diseases is already reported, although many researchers dispute over a causal association between recession and these health outcomes. Conclusively, it can be argued that the financial crisis is a no easy way out, and the Greek healthcare system is challenged as both resources and demand are rapidly changing. What is yet to answer is whether these reforms, along with a co-existing rise in demand of health services, could jeopardize the quality of the system.

The Health Outcomes in Recession

2018 ◽  
pp. 98-108
Author(s):  
Vassilis Fragoulakis ◽  
Elena Athanasiadi ◽  
Antonia Mourtzikou ◽  
Marilena Stamouli ◽  
Athanassios Vozikis
Keyword(s):  
Health Outcomes ◽  
Healthcare System ◽  
Significant Rise ◽  
Real Patient ◽  
Public Servants ◽  
Significant Drop ◽  
Maternity Hospitals ◽  
Healthcare Reforms ◽  
Dental Offices

The aim of the present study is to provide an overview of recent reforms in Greece as imposed by the fiscal adjustments. Potential harmful consequences of these vast healthcare reforms are also discussed, as a collateral victim of the recession, in which case the real “patient” is the overall healthcare system. Based on an extended review of the related literature, the economic crisis, currently numbering five years in Greece, was accompanied by vast healthcare reforms and significant cuts in spending. In particular, austerity measures implemented, impose that health expenditure should not exceed 6% as a share of GDP. Savings were expected to be accomplished through vast changes, including the redetermination of both pharmaceutical reimbursement and pricing, reduction of public servants and cost containment regarding payments to the private sector. So far, there is a significant rise in demand for public hospital services, following a significant drop for private providers, including maternity hospitals, dental offices and surgery clinics. At the same time, elevated prevalence of certain diseases is already reported, although many researchers dispute over a causal association between recession and these health outcomes. Conclusively, it can be argued that the financial crisis is a no easy way out, and the Greek healthcare system is challenged as both resources and demand are rapidly changing. What is yet to answer is whether these reforms, along with a co-existing rise in demand of health services, could jeopardize the quality of the system.

scholarly journals Trends of Diabetes-Related Hospital Admission in Emerging Adults in the State of California

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A431-A431
Author(s):  
Angel Siu-ying Nip ◽  
Maya Beth Lodish
Keyword(s):  
Young Adults ◽  
Health Outcomes ◽  
Emerging Adults ◽  
Healthcare System ◽  
Transition To Adulthood ◽  
Significant Rise ◽  
The State ◽  
Hospital Charges ◽  
Public Insurance ◽  
System Perspective

Abstract Background: As adolescents with diabetes transition to adulthood, they may demonstrate poorer adherence to treatment regimens and may be vulnerable to complications such as diabetic ketoacidosis (DKA) or severe hypoglycemia. A number of important factors have been identified as risk factors for these poor outcomes, including loss of health insurance coverage, increased risk-taking behaviors, and difficulty coping with added responsibility. National data may inform efforts to improve health outcomes and prevent complications for vulnerable young adults during this challenging transition to independence. Objectives: To estimate the incidence of diabetes-related admissions and to describe the characteristics among youth and young adults with type 1 (T1D) and type 2 diabetes (T2D) in the state of California. Study design and method: This is a retrospective cohort study using the inpatient database from the Office of Statewide Health Planning and Development during the years 2014 to 2018. Individuals aged 13–24 years hospitalized with DKA, or hypoglycemia, were identified by ICD codes. Results: A total 28,754 admission encounters were recorded. Mean ages for T1D and T2D were 17.3±5.6 years and 17.9±4.6 years, respectively. Hospitalization rates increased with age with a significant rise during the transition to adulthood, from 70.3/100,000 population at age 17 to 132.2/100,000 population at age 19 in T1D. Among hospital admissions in T1D and T2D, 16.3% and 18.7% were Black young adults respectively (p <.001). More young adults were on public insurance when compared to youth (64.1% vs 45.1% in T1D; 68.4% vs 50.4% in T2D, p <.001), and approximately 48.8% and 41.6% were from the lowest income quartile in T1D and T2D respectively (p <.001). There was no difference in mean length of hospital stay, but hospital charges were higher among young adults with both types of diabetes when compared to youth ($41,370 vs $36,160 in T1D; $37,218 vs $30,991 in T2D, p <.001). More young adults were admitted for severe cases such as DKA or hypoglycemia with coma in T1D, with rates tripling from 0.3/100,000 population in youth to 1.0/100,000 population in young adults. Conclusion: We demonstrated a significant rise in admission rates during the transition to adulthood in individuals with T1D. Among admissions in both types of diabetes, there were significantly more Black young adults who were on public insurance with lower socioeconomic status. This population group had poorer health outcomes with higher incidence for moderate and severe complications, and they cost more hospital charges than the youth population with both types of diabetes. Our findings suggest that the US healthcare system fails many emerging adults with diabetes, particularly for people of color, and that improving the medical transition is crucial. More resources should be focused on this at-risk population from a healthcare system perspective.

How Does Mindfulness Affect Cognition? A Reflection on Confounding Issues Surrounding Mindfulness-based Intervention Research Targeting Cognitive Outcomes

2018 ◽  
Author(s):  
David R Vago ◽  
Resh Gupta ◽  
Sara Lazar
Keyword(s):  
Systematic Review ◽  
Health Outcomes ◽  
Cognitive Functioning ◽  
Cognitive Processes ◽  
Methodological Quality ◽  
Cognitive Outcomes ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Existing Data

One potential pathway by which mindfulness-based meditation improves health outcomes is through changes in cognitive functioning. A systematic review of randomized controlled trials of mindfulness-based interventions (MBIs) was conducted with a focus on assessing the state of the evidence for effects on cognitive processes and associated assays. Here, we comment on confounding issues surrounding the reporting of these and related findings, including 1) criteria that appropriately define an MBI; 2) limitations of assays used to measure cognition; and 3) methodological quality of MBI trials and reporting of findings. Because these issues contribute to potentially distorted interpretations of existing data, we offer constructive means for interpretation and recommendations for moving the field of mindfulness research forward regarding the effects on cognition.

scholarly journals Clinical, behavioural and social factors associated with racial disparities in COVID-19 patients from an integrated healthcare system in Georgia: a retrospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e044052
Author(s):  
Felipe Lobelo ◽  
Alan Bienvenida ◽  
Serena Leung ◽  
Armand Mbanya ◽  
Elizabeth Leslie ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Racial Disparities ◽  
Clinical Outcomes ◽  
Healthcare System ◽  
Retrospective Cohort ◽  
Chronic Obstructive ◽  
Integrated Healthcare ◽  
Icu Admission ◽  
Hospitalised Patients

ObjectivesTo identify sociodemographic, clinical and behavioural drivers of racial disparities and their association with clinical outcomes among Kaiser Permanente Georgia (KPGA) members with COVID-19.DesignRetrospective cohort of patients with COVID-19 seen from 3 March to 29 October 2020. We described the distribution of underlying comorbidities, quality of care metrics, demographic and social determinants of health (SDOH) indicators across race groups. We also described clinical outcomes in hospitalised patients including length of stay, intensive care unit (ICU) admission, readmission and mortality. We performed multivariable analyses for hospitalisation risk among all patients with COVID-19 and stratifyied by race and sex.SettingKPGA, an integrated healthcare system.Participants5712 patients who all had laboratory-confirmed COVID-19. Of them, 57.8% were female, 58.4% black, 29.5% white, 8.5% Hispanic and 3.6% Asian.ResultsBlack patients had the highest proportions of living in neighborhoods under the federal poverty line (12.4%) and in more deprived locations (neighbourhood deprivation index=0.4). Overall, 14.4% (n=827) of this cohort was hospitalised. Asian patients had the highest rates of ICU admission (53.1%) and mechanical ventilation (21.9%). Among all patients, Hispanics (adjusted 1.60, 95% CI (1.08, 2.37)), blacks (1.43 (1.13, 1.83)), age in years (1.03 (1.02, 1.04)) and living in a zip code with high unemployment (1.08 (1.03, 1.13)) were associated with higher odds of hospitalisation. COVID-19 patients with chronic obstructive pulmonary disease (2.59 (1.67, 4.02)), chronic heart failure (1.79 (1.31, 2.45)), immunocompromised (1.77 (1.16, 2.70)), with glycated haemoglobin >8% (1.68 (1.19, 2.38)), depression (1.60 (1.24, 2.06)), hypertension (1.5 (1.21, 1.87)) and physical inactivity (1.25 (1.03, 1.51)) had higher odds of hospitalisation.ConclusionsBlack and Hispanic KPGA patients were at higher odds of hospitalisation, but not mortality, compared with other race groups. Beyond previously reported sociodemographics and comorbidities, factors such as quality of care, lifestyle behaviours and SDOH indicators should be considered when designing and implementing interventions to reduce COVID-19 racial disparities.

The impact of sex, gender and healthcare system on quality of care among young adults with acute myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V Raparelli ◽  
L Pilote ◽  
H Behlouli ◽  
J Dziura ◽  
H Bueno ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Young Adults ◽  
Quality Of Care ◽  
Healthcare System ◽  
Quality Indicators ◽  
Funding Source ◽  
Post Discharge ◽  
Single Payer

Abstract Background The quality of care among young adults with acute myocardial infarction (AMI) may be related to biological sex, psycho-socio-cultural (gender) determinants or healthcare system-level factors. Purpose To examine whether sex, gender, and the type of healthcare system influence the quality of AMI care among young adults. Methods A total of 4,564 AMI young adults (<55 years) (59% women, 47 years, 66% US) were analyzed from the VIRGO and GENESIS-PRAXY studies consisting of single-payer (Canada, Spain) versus multipayer (US) systems. For each patient treated in each system we calculated a quality of care score (QCS) for pre-AMI (1-year pre admission), in-hospital, and post-AMI (1-year post discharge) phases of care (number of quality indicators received divided by the total number [range=0–100%], with higher scores indicating better quality). Ordinal logistic or linear regression models, and 2-way interactions between sex, gender and healthcare system were tested. Results Women in the multipayer system had the highest risk factor burden. Across the phases of care for AMI, 20% of quality indicators were missed in both sexes. High stress, earner status, and social support were associated with a higher QCS in the pre-AMI phase, whereas only employment and earner status were associated with QCS in all other phases. In the pre-AMI phase, women had higher QCS than men, mainly in the single-payer system (adjusted-OR=1.85, 95% CI 1.46,2.35 vs. 1.07, 95% CI 0.84,1.36, P-interaction= 0.002). Regardless of sex, only employment status had a greater effect in the multipayer system (adjusted-OR=0.59, 95% CI 0.44,0.78 vs 1.13, 95% CI 0.89,1.44, P-interaction <0.001). In the in-hospital phase, women had a lower QCS than men, especially in the multipayer system (adjusted-mean-difference: −2.48, 95% CI-3.87, −1.08). Employment was associated with a higher QCS (2.0, 95% CI 0.9–3.17, P-interaction >0.05). Finally, in the post-AMI phase, men and women had a lower QCS, predominantly in the multipayer system. However, primary earners had higher QCS regardless of system. Conclusion Sex, gender, and healthcare system affected the quality of care after AMI. Women had a poorer in-hospital than men and both women and men had suboptimal post-discharge care. Being unemployed lowered the quality of care, more so in the multipayer system. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health and Research (CIHR)

Changing trends in quality of media reporting of suicide in the community following a celebrity suicide in India

2021 ◽  
pp. 000486742110096
Author(s):  
Vikas Menon ◽  
Sujita Kumar Kar ◽  
Ramdas Ransing ◽  
Ginni Sharma ◽  
Jigyansa Ipsita Pattnaik ◽  
...  
Keyword(s):  
Online News ◽  
Significant Rise ◽  
Warning Signs ◽  
World Health ◽  
Media Reporting ◽  
Exact Test ◽  
Reporting Practices ◽  
Before And After ◽  
Celebrity Suicide

Objective: Little is known about changes in quality of media reporting of suicide in the community following a celebrity suicide. Our objective was to compare trends in quality of media reporting of suicide, before and after the suicide of an Indian entertainment celebrity, against the World Health Organization suicide reporting guidelines. Method: Online news portals of English and local language newspapers, as well as television channels, were searched to identify relevant suicide-related news articles. Comparison of reporting characteristics before and after the celebrity suicide was performed using chi-square test or Fisher’s exact test. Results: A total of 3867 eligible news reports were retrieved. There was a significant increase in harmful reporting characteristics, such as reporting the name, age and gender of the deceased ( p < 0.001 for all comparisons), mentioning the location ( p < 0.001) and reason for suicide ( p = 0.04) and including photos of the deceased ( p = 0.002) following the celebrity suicide. Helpful reporting practices were less affected; there was a significant rise in inclusion of expert opinion ( p = 0.04) and mention of suicide-related warning signs ( p = 0.02). Conclusion: Following a celebrity suicide, significant changes in the quality of media reporting of suicide were noted with an increase in several potentially harmful reporting characteristics.

scholarly journals Quality of care for people with multimorbidity: a focus group study with patients and their relatives

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e047025
Author(s):  
Nadine Janis Pohontsch ◽  
Josefine Schulze ◽  
Charlotte Hoeflich ◽  
Katharina Glassen ◽  
Amanda Breckner ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Focus Groups ◽  
Healthcare System ◽  
Qualitative Content Analysis ◽  
Coordinated Care ◽  
Treatment Standards ◽  
Focus Group Study ◽  
Treatment Regimens ◽  
Quality Aspects

BackgroundPrevalence of people with multimorbidity rises. Multimorbidity constitutes a challenge to the healthcare system, and treatment of patients with multimorbidity is prone to high-quality variations. Currently, no set of quality indicators (QIs) exists to assess quality of care, let alone incorporating the patient perspective. We therefore aim to identify aspects of quality of care relevant to the patients’ perspective and match them to a literature-based set of QIs.MethodsWe conducted eight focus groups with patients with multimorbidity and three focus groups with patients’ relatives using a semistructured guide. Data were analysed using Kuckartz’s qualitative content analysis. We derived deductive categories from the literature, added inductive categories (new quality aspects) and translated them into QI.ResultsWe created four new QIs based on the quality aspects relevant to patients/relatives. Two QIs (patient education/self-management, regular updates of medication plans) were consented by an expert panel, while two others were not (periodical check-ups, general practitioner-coordinated care). Half of the literature-based QIs, for example, assessment of biopsychosocial support needs, were supported by participants’ accounts, while more technical domains regarding assessment and treatment regimens were not addressed in the focus groups.ConclusionWe show that focus groups with patients and relatives adding relevant aspects in QI development should be incorporated by default in QI development processes and constitute a reasonable addition to traditional QI development. Our QI set constitutes a framework for assessing the quality of care in the German healthcare system. It will facilitate implementation of treatment standards and increase the use of existing guidelines, hereby helping to reduce overuse, underuse and misuse of healthcare resources in the treatment of patients with multimorbidity.Trial registration numberGerman clinical trials registry (DRKS00015718), Pre-Results.

scholarly journals Need to Intervene: An Exploratory Study of Nurses’ Experiences With Patienthood

2021 ◽  
Vol 8 ◽  
pp. 237437352199884
Author(s):  
Marian A O Cohen ◽  
Jim McQuaid ◽  
Ruth Remington
Keyword(s):  
Patient Satisfaction ◽  
Quality Of Care ◽  
Healthcare System ◽  
Family Caregiver ◽  
Exploratory Study ◽  
Medical Personnel ◽  
Healthcare Personnel ◽  
Coordination Of Care ◽  
Professional Perspective

Much has been written about the patient experience, but there is little information about experiences of providers as patients. Since lay patients and providers have differing perspectives and expectations, it is important to identify those elements shared by those in each group and those that diverge. This study identified experiences of nurses as being a patient or a family caregiver of a patient as well as identified assessments of the healthcare system by nurses. An exploratory study using a self-administered electronic questionnaire with a group of registered nurses was conducted. Assessments of the system by responders were positive when addressing quality of care, interactions among healthcare personnel, and interactions with patients. However, when discussing their experiences as patient, nurses reported they encountered problems with coordination of care, responses of medical personnel, attention to details of care, and responses to their attempts to become more involved. Results confirm issues raised by patients who are not medical experts in patient satisfaction studies. Adding a professional perspective highlights where problems with the healthcare system lie.

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