scholarly journals Implications of the introduction of laboratory demand management at primary care clinics in South Africa on laboratory expenditure

2016 ◽  
Vol 5 (1) ◽  
Author(s):  
Ozayr H. Mahomed ◽  
Ruth Lekalakala ◽  
Shaidah Asmall ◽  
Naseem Cassim
Keyword(s):  
South Africa ◽  
National Health ◽  
Laboratory Tests ◽  
Clinical Laboratory ◽  
Demand Management ◽  
Cost Savings ◽  
Full Blood Count ◽  
Potential Cost ◽  
Cross Sectional ◽  
Laboratory Service

Background: Diagnostic health laboratory services are regarded as an integral part of the national health infrastructure across all countries. Clinical laboratory tests contribute substantially to health system goals of increasing quality of care and improving patient outcomes.Objectives: This study aimed to analyse current laboratory expenditures at the primary healthcare (PHC) level in South Africa as processed by the National Health Laboratory Service and to determine the potential cost savings of introducing laboratory demand management.Methods: A retrospective cross-sectional analysis of laboratory expenditures for the 2013/2014 financial year across 11 pilot National Health Insurance health districts was conducted. Laboratory expenditure tariff codes were cross-tabulated to the PHC essential laboratory tests list (ELL) to determine inappropriate testing. Data were analysed using a Microsoft Access database and Excel software.Results: Approximately R35 million South African Rand (10%) of the estimated R339 million in expenditures was for tests that were not listed within the ELL. Approximately 47% of expenditure was for laboratory tests that were indicated in the algorithmic management of patients on antiretroviral treatment. The other main cost drivers for non-ELL testing included full blood count and urea, as well as electrolyte profiles usually requested to support management of patients on antiretroviral treatment.Conclusions: Considerable annual savings of up to 10% in laboratory expenditure are possible at the PHC level by implementing laboratory demand management. In addition, to achieve these savings, a standardised PHC laboratory request form and some form of electronic gatekeeping system that must be supported by an educational component should be implemented.

scholarly journals Cancer in HIV-positive and HIV-negative adolescents and young adults in South Africa: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e043941
Author(s):  
Tafadzwa Dhokotera ◽  
Julia Bohlius ◽  
Matthias Egger ◽  
Adrian Spoerri ◽  
Jabulani Ronnie Ncayiyana ◽  
...  
Keyword(s):  
South Africa ◽  
Young Adults ◽  
Cross Sectional Study ◽  
Adolescents And Young Adults ◽  
Hiv Positive ◽  
Sectional Study ◽  
Hiv Status ◽  
Cross Sectional ◽  
Laboratory Service ◽  
Living With Hiv

ObjectiveTo determine the spectrum of cancers in adolescents and young adults (AYAs) living with and without HIV in South Africa.DesignCross-sectional study with cancer records provided by the National Cancer Registry (NCR) and HIV records from the National Health Laboratory Service (NHLS).Setting and participantsThe NHLS is the largest provider of pathology services in the South African public sector. The NCR is a division of the NHLS. We included AYAs (aged 10–24 years) diagnosed with cancer by public health sector laboratories between 2004 and 2014 (n=8479). HIV status was obtained through record linkages and text mining.Primary and secondary outcomesWe determined the spectrum of cancers by HIV status in AYAs. We used multivariable logistic regression to describe the association of cancer in AYAs with HIV, adjusting for age, sex, ethnicity and calendar period. We imputed (post hoc) the HIV status for AYA with unknown HIV status.Results8479 AYAs were diagnosed with cancer, HIV status was known for 45% (n=3812). Of those whose status was known, about half were HIV positive (n=1853). AYAs living with HIV were more likely to have Kaposi’s sarcoma (adjusted OR (aOR) 218, 95% CI 89.9 to 530), cervical cancer (aOR 2.18, 95% CI 1.23 to 3.89), non-Hodgkin’s lymphoma (aOR 2.12, 95% CI 1.69 to 2.66) and anogenital cancers other than cervix (aOR 2.73, 95% CI 1.27 to 5.86) than AYAs without HIV. About 44% (n=1062) of AYAs with HIV-related cancers had not been tested for HIV.ConclusionsTargeted HIV testing for AYAs diagnosed with cancer, followed by immediate start of antiretroviral therapy, screening for cervical precancer and vaccination against human papilloma virus is needed to decrease cancer burden in AYAs living with HIV in South Africa.

scholarly journals Laboratory Diagnostics Performance in Uganda: A Survey of Test Availability and Constraints Across 100 Laboratories

2021 ◽  
Author(s):  
Noel Namuhani ◽  
Suzanne N Kiwanuka ◽  
Martha Akulume ◽  
Simeon Kalyesubula ◽  
William Bazeyo ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Disease Diagnosis ◽  
Sub Saharan Africa ◽  
Essential Medicines ◽  
Full Blood Count ◽  
Laboratory Diagnostics ◽  
Cross Sectional ◽  
Laboratory Services ◽  
Control And Prevention ◽  
Sub Saharan

Abstract Background Clinical laboratory services are a critical component of the health system for effective disease diagnosis, treatment, control and prevention. However, many laboratories in Sub Saharan Africa remain dysfunctional. The high costs of tests in the private sector also remain a hindrance to accessing testing services. This study aimed at assessing the functionality of laboratories based on test menus and the associated constraints in Uganda. Methods This cross sectional quantitative study involved an assessment of 100 laboratories randomly selected in 20 districts from four regions of the country. Sixteen percent of the studied laboratories were regional hub laboratories. Laboratory in charges and managers in each of the selected laboratories were interviewed. A checklist for laboratory supplies adapted from the Essential Medicines and Health supplies list for Uganda, (2012) was used to assess availability of testing supplies. Data was analyzed using excel and STATA 14. Results At the point of assessment, generally, all laboratories were able to perform malaria tests and HIV tests. All the hub laboratories conducted malaria tests and TB screening. Less than half had electrolytes tests due to lack of equipment, nonfunctioning equipment and lack of reagents. Full blood count tests were missing in 25% of the hub laboratories mainly due to lack of equipment. The lack of reagents (66.7%) and the lack of equipment (58.3%) caused the majority 10/16 of the hubs to routinely referred specimens for tests that are supposed to be carried out in these laboratories due to lack of reagents (66.7%) and non-functional equipment (58.3%). Although officially recognized as an operational structure, Hub laboratories lacked a list of essential and vital supplies. Conclusions Most laboratories performed well for the common tests. However, many laboratories did not meet testing requirements especially for the advanced tests according to standard testing menus for Uganda due to non-functioning equipment, lack of equipment and reagents. Hubs lack list of essential supplies. Therefore, there is need to provide equipment to laboratories, repair the non-functional ones and develop an essential list of supplies for the hub laboratories.

scholarly journals In-depth investigation of turn-around time of full blood count tests requested from a clinical haematology outpatient department in Cape Town, South Africa

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Leonard Mutema ◽  
Zivanai Chapanduka ◽  
Fungai Musaigwa ◽  
Nomusa Mashigo
Keyword(s):  
South Africa ◽  
Blood Count ◽  
Cape Town ◽  
Outpatient Department ◽  
Full Blood Count ◽  
Academic Hospital ◽  
Time Intervals ◽  
Laboratory Service ◽  
Retrospective Audit ◽  
Turn Around Time

Background: The performance of laboratories can be objectively assessed using the overall turn-around time (TAT). However, TAT is defined differently by the laboratory and clinicians; therefore, it is important to determine the contribution of all the different components making up the laboratory test cycle.Objective: We carried out a retrospective analysis of the TAT of full blood count tests requested from the haematology outpatient department at Tygerberg Academic Hospital in Cape Town, South Africa, with an aim to assess laboratory performance and to identify critical steps influencing TAT.Methods: A retrospective audit was carried out, focused on the full blood count tests from the haematology outpatient department within a period of 3 months between 01 February and 30 April 2018. Data was extracted from the National Health Laboratory Service laboratory information system. The time intervals of all the phases of the test cycle were determined and total TAT and within-laboratory (intra-lab) TAT were calculated.Results: A total of 1176 tests were analysed. The total TAT median was 275 (interquartile range [IQR] 200.0–1537.7) min with the most prolonged phase being from authorisation to review by clinicians (median 114 min; IQR: 37.0–1338.5 min). The median intra-lab TAT was 55 (IQR 40–81) min and 90% of the samples were processed in the laboratory within 134 min of registration.Conclusion: Our findings showed that the intra-lab TAT was within the set internal benchmark of 3 h. Operational phases that were independent of the laboratory processes contributed the most to total TAT.

scholarly journals Potential cost-savings from the use of the biosimilars filgrastim, infliximab and insulin glargine in Canada: a retrospective analysis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Kerry Mansell ◽  
Hishaam Bhimji ◽  
Dean Eurich ◽  
Holly Mansell
Keyword(s):  
Insulin Glargine ◽  
Retrospective Analysis ◽  
Healthcare System ◽  
Healthcare Providers ◽  
Cost Savings ◽  
Sensitivity Analyses ◽  
Potential Cost ◽  
Biologic Drugs ◽  
Cross Sectional ◽  
Time Period

Abstract Background In 2014 and 2015, biosimilars for the drugs filgrastim, infliximab, and insulin glargine were approved for use in Canada. The introduction of biosimilars in Canada could provide significant cost savings for the Canadian healthcare system over originator biologic drugs, however it is known that the use of biosimilars varies widely across the world. The aim of this study was to estimate the use of biosimilars in Canada and potential cost-savings from their use. Methods We performed a retrospective analysis of Canadian drug purchases for filgrastim, infliximab, and insulin glargine from July 2016 to June 2018. This was a cross-sectional study and the time horizon was limited to the study period. As a result, no discounting of effects over time was included. Canadian drugstore and hospital purchases data, obtained from IQVIA™, were used to estimate the costs per unit and unit volume for biosimilars and originator biologic drugs within each province. Potential cost-savings were calculated as a product of the units of reference originator product purchased and the cost difference between the originator biologic and its corresponding biosimilar. Results The purchase of biosimilars varied by each province in Canada, ranging from a low of 0.1% to a high of 81.6% of purchases. In total, $1,048,663,876 Canadian dollars in savings could have been realized with 100% use of biosimilars over the originator products during this 2 year time period. The potential savings are highest in the province of Ontario ($349 million); however, even in smaller markets (PEI and Newfoundland), $28 million could have potentially been saved. Infliximab accounted for the vast majority of the potential cost-savings, whereas the purchases of the biosimilar filgrastim outpaced that of the originator drug in some provinces. In sensitivity analyses assuming only 80% of originator units would be eligible for use as a biosimilar, $838 million dollars in cost savings over this two-year time period would still have been realized. Conclusions The overall use of biosimilar drugs in Canada is low. Policy makers, healthcare providers, and patients need to be informed of potential savings by increased use of biosimilars, particularly in an increasingly costly healthcare system.

scholarly journals Dynamic active telepathology over National Health Laboratory service network, South Africa: feasibility study using Nikon Coolscope

2008 ◽  
Vol 3 (Suppl 1) ◽  
pp. S3 ◽  
Author(s):  
Lech Banach ◽  
Andrzej Stepien ◽  
Johann Schneider ◽  
Elizabeth Wichrzycka-Lancaster
Keyword(s):  
South Africa ◽  
Feasibility Study ◽  
National Health ◽  
Service Network ◽  
Laboratory Service

scholarly journals Awareness of Health Care Practitioners About the National Health Insurance in Tshwane District, South Africa

2018 ◽  
Vol 11 (1) ◽  
pp. 93-103 ◽  
Author(s):  
L.H. Mabuza ◽  
G.A. Ogunbanjo ◽  
K.E. Hlabyago ◽  
M. Mogotsi
Keyword(s):  
South Africa ◽  
Health Care ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
School Health ◽  
Health Coverage ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Health Care Practitioners

Background: In 2012, the National Department of Health of South Africa launched the National Health Insurance (NHI) pilot program in 11 districts, towards universal health coverage for all South Africans. Health Care Practitioners (HCPs) are important role-players in its implementation. We decided to evaluate to what extent the HCPs were aware of the NHI program after three years of the pilot phase. Objective: To evaluate the awareness of HCPs about the NHI in the pilot Tshwane district of South Africa. Method: A cross-sectional survey was conducted among 1753 HCPs in Tshwane district. At 95% confidence level and 5% error margin, the sample size was 315 HCPs, but we over-sampled to 480. The study was conducted in 25 health facilities within the district. A pre-tested self-administered questionnaire was used. Results: A high proportion of HCPs were unaware of the objectives of the NHI program (p < 0.001); number of NHI pilot sites [(281; 59.4%) versus (145; 30.7%), p < 0.001]; rationale used to select pilot sites [(223; 46.9%) versus (193; 40.5%), p = 0.047]; role of the Integrated School Health Services (ISHP) [(250; 52.7%) versus (70; 14.8%), p < 0.001]; and specialists constituting the District Clinical Specialist Team (DCST) (p < 0.001). However, awareness regarding the Ward-Based Outreach Team (WBOT) leader was high [(236; 49.9%) versus (135; 28.5%), p < 0.001]. Conclusion: HCPs in Tshwane district demonstrated poor awareness of the NHI. This reveals that any awareness effort towards the NHI has not taken effect among the HCPs in this district.

scholarly journals KEPUASAN PELANGGAN INTERNAL

2018 ◽  
Vol 14 (1) ◽  
pp. 47
Author(s):  
Rosni Faika ◽  
O Sianipar
Keyword(s):  
Customer Satisfaction ◽  
Clinical Laboratory ◽  
Corrective Action ◽  
Satisfaction Survey ◽  
Improve Quality ◽  
Hospital Data ◽  
Cross Sectional ◽  
Laboratory Service ◽  
Internal Customer ◽  
Customer Satisfaction Survey

Customer satisfaction survey is one of efforts of continuously quality improvement of care and also can be used to maintain customers that already utilize available services. Efforts of corrective action should be done based on result of this survey. The objective of this surveyis to assess desired-service and reality of the service undergone by internal customer and to improve quality of service of laboratorymedicine in Clinical Laboratory of Dr. Sardjito Hospital, Yogyakarta. This is cross sectional customer satisfaction survey. Subject of thissurvey are 23 doctors work in Dr Sardjito Hospital. Data collected by questionnaire that contain 18 items about desired-service andreality of service undergone by internal customer from service given by Clinical Laboratory of Dr. Sardjito Hospital. Respondents assessdesired-service and reality of service using Likert scale. The obtained data are analyzed by Cartesius diagram. Result of the survey showsthat average concordant between desired-service and reality of service is 85.5%. Main priority corrective action to improve quality ofservice are: 1) readiness of registry staff; 2) easiness of registration procedure; 3) skill of laboratory staff in explaining and recordingtest parameter; 4) service of cito service; 5) 24 hours laboratory service and 6) timely laboratory test.

scholarly journals The growth patterns of the medical technology profession in South Africa

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Malcolm T. Ellapen ◽  
Terry J. Ellapen ◽  
Yvonne Paul
Keyword(s):  
South Africa ◽  
National Health ◽  
Medical Technology ◽  
Growth Patterns ◽  
Annual Reports ◽  
Laboratory Service ◽  
Medical Technologists ◽  
Technology Profession ◽  
Public And Private Sector ◽  
Student Intern

Background: Constant appraisal of healthcare workforce trends is vital; this measure determines the adequacy of the workforce in meeting its society’s healthcare demands. This includes determining the number of the incoming workforce (students, interns) and the active or practising workforce relevant registries.Objective: This study aimed to examine patterns of workforce growth in the medical technology profession (students, interns and practitioners) from 2008 to 2018 in South Africa.Methods: Student, intern and practitioner medical technology registries, from the 2012/2013, 2016/2017 and 2017/2018 Health Professions Council of South Africa (HPCSA) annual reports, were analysed. The number of National Health Laboratory Service and private laboratory posts were secured from the National Health Laboratory Service plan performance report. A comparison between the total number of South African medical technology (private and public) posts occupied versus the HPCSA practitioner 2016 register was completed, to determine the saturation status.Results: Annual student, intern, and practitioner registries indicated a mean growth of 6.8%, 28.9%, and 0.7% from 2008 to 2018. The transition of interns to practitioners is progressively dwindling (2015–2018). The practitioner register showed a 1.2% decline in registration from 2013 until 2018. In 2016, only 55.9% of the HPCSA registered medical technologists were employed (p 0.001).Conclusion: There are more medical technologists than available public and private sector posts. The progressively growing student register compared to the dwindling practitioner register indicates attrition in the profession. An investigation identifying the reasons why graduates neglect to register as practising medical technologists should be undertaken.

scholarly journals Financial Impact of Cancer Drug Wastage and Potential Cost Savings From Mitigation Strategies

2017 ◽  
Vol 13 (7) ◽  
pp. e646-e652 ◽  
Author(s):  
Caitlyn Y.W. Leung ◽  
Matthew C. Cheung ◽  
Lauren F. Charbonneau ◽  
Anca Prica ◽  
Pamela Ng ◽  
...  
Keyword(s):  
Cost Savings ◽  
Mitigation Strategies ◽  
Drug Costs ◽  
Financial Impact ◽  
Cancer Drug ◽  
Total Drug ◽  
Potential Cost ◽  
Cross Sectional ◽  
Drug Wastage ◽  
The Cost

Purpose: Cancer drug wastage occurs when a parenteral drug within a fixed vial is not administered fully to a patient. This study investigated the extent of drug wastage, the financial impact on the hospital budget, and the cost savings associated with current mitigation strategies. Methods: We conducted a cross-sectional study in three University of Toronto–affiliated hospitals of various sizes. We recorded the actual amount of drug wasted over a 2-week period while using current mitigation strategies. Single-dose vial cancer drugs with the highest wastage potentials were identified (14 drugs). To calculate the hypothetical drug wastage with no mitigation strategies, we determined how many vials of drugs would be needed to fill a single prescription. Results: The total drug costs over the 2 weeks ranged from $50,257 to $716,983 in the three institutions. With existing mitigation strategies, the actual drug wastage over the 2 weeks ranged from $928 to $5,472, which was approximately 1% to 2% of the total drug costs. In the hypothetical model with no mitigation strategies implemented, the projected drug cost wastage would have been $11,232 to $149,131, which accounted for 16% to 18% of the total drug costs. As a result, the potential annual savings while using current mitigation strategies range from 15% to 17%. Conclusion: The financial impact of drug wastage is substantial. Mitigation strategies lead to substantial cost savings, with the opportunity to reinvest those savings. More research is needed to determine the appropriate methods to minimize risk to patients while using the cost-saving mitigation strategies.

Novel Die-to-Wafer Interconnect Process for 3D-IC Utilizing a Thermo-Decomposable Adhesive and Cu-Cu Thermo-Compression Bonding

2011 ◽  
Vol 2011 (DPC) ◽  
pp. 000781-000796
Author(s):  
Daniel N. Pascual
Keyword(s):  
High Temperature ◽  
Cost Savings ◽  
Adhesive Layer ◽  
Decomposition Temperature ◽  
Potential Cost ◽  
Closed Chamber ◽  
Cross Sectional ◽  
3D Ic ◽  
Cu Bonding ◽  
Free Environment

Die-to-wafer interconnect offers key advantages for 3D-IC including heterogeneous die population using devices from different process lines, and higher yield by incorporating only known-good die. Attaching the dies to a wafer, however, typically involves serial processing whereby each die is aligned and bonded one at a time. This can be prohibitively time consuming particularly when using a slow, high-temperature process such as Cu-Cu thermo-compression for each die in succession. Also, the high temperatures applied locally can adversely affect neighboring sites by oxidizing the Cu bonding surface if not protected in an oxygen-free environment. We have developed a novel die-to-wafer interconnect process that circumvents these problems using a die-tacking and global-bonding approach. Using a high-accuracy die placement tool, individual dies are aligned and tacked onto a wafer that is coated with a thermo-decomposable adhesive layer. The low-temperature tacking process avoids oxidation of the Cu bonding surfaces, minimizes thermal cycling, and increases throughput significantly. Once the wafer is fully populated, it is then processed in a closed-chamber wafer-bonding tool, which provides an oxygen-free environment. All of the dies are bonded in parallel using a high-temperature Cu-Cu bonding process to globally apply the required heat and force. Once the adhesive is heated past its critical decomposition temperature, it cleanly vaporizes away and allows the Cu-Cu bonding to proceed. We have successfully demonstrated this process on a 300mm platform using custom-designed test dies and wafers containing through-silicon via (TSV) chains and Kelvin test structures providing 4-point resistance measurements. Experimental results including TSV chain yield, electrical resistance, alignment accuracy, and cross-sectional analysis will be presented. A discussion will also be given on the potential cost savings and future technical challenges of this approach.

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