Shared Care and Virtual Clinics for Glaucoma in a Hospital Setting

Glaucoma patients require lifelong management, and the prevalence of glaucoma is expected to increase, resulting in capacity problems in many hospital eye departments. New models of care delivery are needed to offer requisite capacity. This review evaluates two alternative schemes for glaucoma care within a hospital, i.e., shared care (SC) and virtual clinics (VCs), whereby non-medical staff are entrusted with more responsibilities, and compares these schemes with the “traditional” ophthalmologist-led outpatient service (standard care). A literature search was conducted in three large bibliographic databases (PubMed, Embase, and Trip), and the abstracts from the prior five annual meetings of the Association for Research in Vision and Ophthalmology were consulted. Twenty-nine were included in the review (14 on SC and 15 on VCs). Patients with low risk of vision loss were considered suitable for these approaches. Among the non-medical staff, optometrists were the most frequently involved. The quality of both schemes was good and improved with the non-medical staff being trained in glaucoma care. No evidence was found on patients feeling disadvantaged by the lack of a doctor visit. Both schemes increased the hospital’s efficiency. Both SC and VCs are promising approaches to tackle the upcoming capacity problems of hospital-based glaucoma care.

A Survey of Patients’ Opinions and Preferences on the Use of E-Prescriptions in Poland

E-prescription is already used in many countries, improving the standard of patient care. Officially, from 8 January 2020 e-prescribing has been obligated in Poland. Physicians’ and pharmacists’ opinions on e-prescribing have been widely researched and reported in the literature. In contrast, patients’ perception has, to date, received little attention. For this reason, the aim of this study was to find the features and functionalities of e-prescribing that are desired by the public and influence the positive evaluation of this tool, according to patient opinion. In order to obtain data, a questionnaire was completed by 456 randomly selected adults. The obtained results indicated that only eight people (1.8%) did not know what e-prescription is. Of the remaining 448 individuals, 72.1% prefer e-prescription because it is more convenient for them. Most patients (62.1%) also recognize that e-prescribing makes it easier to purchase medications on behalf of another patient. Based on the study, it can be concluded that e-prescription is well evaluated by Polish patients. A large percentage of respondents were positive about obtaining prescriptions for continued treatment, without a personal doctor visit. Therefore, it is reasonable to maintain the possibility of such contact with a physician. The most popular, and preferred, method of receiving e-prescriptions is via SMS. However, it is necessary to offer different options for obtaining prescriptions, to meet the needs of different populations.

Health-seeking and diagnosis delay and its associated factors: a case study on COVID-19 infections in Shaanxi Province, China

This time-to-event study examines social factors associated with health-seeking and diagnosis of 165 COVID-19 cases in response to the pandemic spread in Shaanxi Province, China. In particular, we investigate the differential access to healthcare in terms of delayed time from symptom onset to first medical visit and subsequently to diagnosis by factors such as sex, age, travel history, and type of healthcare utilization. We show that it takes more time for patients older than 60 (against those under 30) to seek healthcare after developing symptoms (+ 2.5 days, $$p<0.01$$ p < 0.01 ), surveillance on people with living or travel history to Wuhan helps shorten the time to the first doctor visit (− 0.8 days) and diagnosis (− 2.2 days, $$p<0.01$$ p < 0.01 ). A delay cut is associated with the adoption of intermediary and large hospitals rather than community-based care as primary care choices (− 1.6 days, $$p<0.1$$ p < 0.1 and − 2.2 days, $$p<0.05$$ p < 0.05 ). One unit increase of healthcare workers per 1000 people saves patients 0.5 days ($$p<0.1$$ p < 0.1 ) for diagnosis from the first doctor visit and 0.6 days ($$p<0.05$$ p < 0.05 ) in total. Our analysis of factors associated with the time delay for diagnosis may provide a better understanding of the health-seeking behaviors of patients and the diagnosis capacity of healthcare providers during the COVID-19 pandemic.

Assessment of asthma control in users of oral anti-asthma medications

BACKGROUND: Despite guidelines recommending inhalation therapy as the preferred choice, oral therapy is still widely used in the treatment of asthma in India. However, data about the level of asthma control and healthcare use in patients on oral anti-asthma medications are scarce.METHODS: A retrospective study was conducted to assess the level of asthma control and healthcare use in patients taking oral anti-asthma medications.RESULTS: The study population consisted of 381 adults randomly selected from health screening programmes. All subjects were already receiving oral anti-asthma medications; however, up to 72% had not been diagnosed with asthma by their treating doctors prior to the screening programmes. The cohort had a mean age of 48.26 ± 13.83 years (70% males) and mean peak expiratory flow of 245 ± 78.93 mL/sec. The mean Asthma Control Questionnaire 5 (ACQ-5) score was 2.53 ± 1.15, with respectively 33%, 49.3% and 32.6% reporting at least one episode of breathlessness, one emergency doctor visit and one hospitalisation due to asthma or its symptoms in the past year.CONCLUSION: Underdiagnosis and inappropriate management, as indicated by the poor asthma control and increased hospitalisations seen in this study, is probably a key contributor to the increased burden of the disease in India.

Impacts of health insurance on healthcare in the poor and near-poor households in Vietnam

Improving health and reducing catastrophic healthcare expenditure for the poor and near-poor are the major concerns of the Vietnam Government. This research analyses the impacts of health insurance schemes for the poor and near-poor households in Vietnam on two aspects, including healthcare utilization and out-of-pocket expenditure. The study applies the zero-inflated model and pooled OLS regression on the data that is extracted from the Vietnam Household Living Standard Surveys in two years 2014 and 2016. The findings show that health insurance significantly increases the probability of having a doctor visit and the number of doctor visits for a health check or outpatient treatment. For inpatient treatment, insurance does not increase the probability of having a doctor visit or the number of doctor visits. Having insurance significantly reduces out-of-pocket expenditures for both inpatients and outpatients.

Incidence of the Apparent Active Problems of Chronic Kidney Disease Patients in CKD Clinic of the Outpatient Department at Thammasat Hospital

Background: Chronic kidney disease (CKD) is a common disease. Patients with CKD usually have many other diseases, and complications are more common than general patients. The nephrologist must deal with these problems. It may take a long time to advise these patients in CKD clinic. Objective: To identify the number of apparent problems in CKD patients, the duration of the nephrologist visits for these patients, and the relationship between the number of problems and the duration of doctor visit. Materials and Methods: The study was a descriptive observational cohort study. Patients with CKD aged 18 years and over were enrolled at the CKD clinic of Thammasat University Hospital. The patient’s information including any current active problems and the time spent during each visit were recorded by data collectors. The data was collected for a period of six months between September 1, 2015 and February 28, 2016. Results: Five hundred forty-eight patients were included. Nine physicians were observed by the data collectors in each patient visit. The average number of problems was 2.10. The three most common problems were hypoalbuminemia, proteinuria, and edema. The average time spent in each visit was 8.4 minutes, 14.56 minutes for new cases, and 7.81 minutes for old cases. Physicians spent 5.39 minutes for each visit to CKD patients with no apparent problems and spent more time for additional problems. Conclusion: CKD patients had at least two problems, and each visit lasted an average of 8.40 minutes. When the number of problems increased, the physician required longer time to solve the problems. Keywords: Active problem, Chronic kidney disease, Outpatient department, Spending time, Nephrology

Analysis of Factors Affecting the Quality of Service Toward Inpatient Patient Satisfaction BPJS DIRSU Bandung

Quality problems arise when there is a gap between the services provided and the expectations that the patient wants. In general, patients who feel dissatisfied with the service file complaints to the hospital, the complaints most often heard in hospitals are about uncertain doctor visit schedules, lack of responsiveness medical personnel in the hospital, lack of empathy, and uncomfortable waiting rooms. This study aims to determine the effect of service quality which includes reliability, responsiveness, assurance, empathy, facilities, and infrastructure on BPJS patient satisfaction in Bandung general hospital. This type of research is cross-sectional. The sample of this study was all BPJS patient who was hospitalized in class 1,2, and 3 rooms at the Bandung general hospital, totalling 60 people with a purposive sampling method with data analysis techniques using multiple linear regression. The results of this study indicate that the variable reliability (p=0.007) has a statistically significant relationship to the satisfaction of BPJS inpatients at the Bandung general hospital, while the responsiveness variable (p=0.125), the empathy variable (p=0.067) and the infrastructure and facilities variable (p=0.235) does not have a significant relationship with the satisfaction of BPJS participants at RSU Bandung.

Ayurveda Treatment Protocol in the Management of Galagraha (Pharyngitis)- A Case Study

Pharyngitis is inflammation of the pharynx, which affects in back of the throat. It is most often referred to simply as sore throat; it is one of the most common reasons for doctor visit. The condition is the usual phenomenon in paediatric population due to intake of cold drinks, junk food etc. This disease is more recurrent now a days than earlier As per ayurvedic classics the condition has close similarity with the disease Galagraha. Aim: In this article management of pharyngitis with ayurvedic modalities were discussed. Material & Method: A 32 years male patient visited ENT OPD of Shalakya Tantra, I.P.G.T&R.A Hospital on 16/12/2019 with complaints of pain and foreign body sensation of throat, Recurrent moderate cough, mild fever and head ache, difficulty in swallowing along with congestion in posterior pharyngeal wall aggravate since 10 days. He consulted a local hospital near his house but didn’t get a satisfactory relief. History reveals the reccurents of disease since 3 years. We started Triphala + Darvi kwatha kawala thrice/Day, Haritaki Kwatha pana Twice BD with honey (20 ml Before food), Khadiradi vati (2 Tab -4 times/ day) for Chushanartha, Sitopaladi churna -3gm +Yastimadhu 1 gm, Naradiya Lakshmi vilasa rasa-125 mg-2 times a day for 14 days Followed by Virechana and Nasya. Marked relief was found in signs and symptoms within 7 days and cured completly within 21 days of treatment. Conclusion: Study concluded that the above Ayurvedic treatment can prove to be an effective alternate management in Chronic Catarrhal Pharyngitis with proper diet and regimen.

Self-Control and Demand for Preventive Health: Evidence from Hypertension in India

Self-control problems constitute a potential explanation for the under-investment in preventive health in low-income countries. Behavioral economics offers a tool to solve such problems: commitment devices. We conduct a field experiment to evaluate the effectiveness of different types of theoretically-motivated commitment contracts in increasing preventive doctor visits by hypertensive patients in rural India. Despite achieving high take-up of such contracts in some treatment arms, we find no effects on actual doctor visits or individual health outcomes. A substantial number of individuals pay for commitment but fail to follow through on the doctor visit, losing money without experiencing health benefits. We develop and structurally estimate a pre-specified model of consumer behavior under present bias with varying levels of naivete. The results are consistent with a large share of individuals being partially naive about their own self-control problems: sophisticated enough to demand some commitment, but overly optimistic about whether a given level of commitment is sufficiently strong to be effective. The results suggest that commitment devices may in practice be welfare diminishing, at least in some contexts, and serve as a cautionary tale about their role in health care.