Pengaruh Efisiensi Waktu Tunggu, Biaya Pelayanan, Kebersihan, serta Kenyamanan Ruangan terhadap Kepuasan Pasien (Studi Pada Pelayanan Instalasi Rawat Jalan Rumah Sakit Medika Lestari)

Seeing the importance of patient adherence in a patient's therapeutic journey and several factors related to patient adherence, we tried to assess patient satisfaction with the outpatient unit of Medika Lestari Hospital in 2021. Therefore, we conducted a cross-sectional study of patients aged 18–59 years to assess their satisfaction with the services of the Medika Lestari Hospital outpatient unit on 28 July 2021. We evaluated 4 main dimensions, namely: (1) Efficiency, (2) Convenience; (3) Cleanliness; and (4) Financing. The survey instrument was prepared based on the consensus of the research team and has good validity and reliability based on the Pearson and Cronbach–alpha tests. All statistical analyzes were performed with SmartPLS software version 3.3.3. A total of 206 patients were recruited, with a composition of 102 (49.51%) males and 104 (50.49%) females. There were 43 (20.87%), 103 (50%), 46 (22.33%), and 14 (6.80%) patients, respectively, in the age categories 18-25 years, 26–35 years, 36–45 years, and 46–59 years, respectively. We found that the average patient satisfaction with outpatient services at Medika Lestari Hospital was 4.23 (84.6%). The average patient satisfaction score for the outpatient service at the Medika Lestari Hospital is 4.23±0.363. In addition, we also found that service efficiency, cost, cleanliness of the service room, and comfort of the service room had a positive effect on patient satisfaction in the outpatient unit at Medika Lestari Hospital.

Faktor - Faktor Pendukung Keputusan Rujukan Pasien pada Fasilitas Kesehatan Tingkat Pertama (FKTP) dengan metode Analytical Hierrarchy Process (AHP)

Pratama Bakti Timah Clinic is one of the First Level Health Facilities (FKTP) that provides health services to the community in the Pangkalpinang area and its surroundings. In these health service activities, when a patient requires special medical care in terms of medical services, medical personnel, medical support, outpatient services, and inpatient services, the patient will be referred to a higher health facility. Considering the various factors that cause patients to be referred and there are several hospitals that are referred to, this condition is a multi-criteria and multi-alternative condition. To overcome this, it is necessary to design a decision support system that will make it easier for medical administration service officers at the Primary Clinic. The decision support system is designed using the Analytical Hierarchy Process (AHP) method which is able to accommodate multi-criteria and multi-alternative decision making. The results of data processing showed that the most important factor in the referral of FKTP patients at the Pratama Clinic was the outpatient service factor with a weight of 30.7%, the second factor was medical services 24.4%, the third factor was medical personnel 17.5%, the fourth factor was supporting medical services 15.9%, and the last is inpatient services 11.4%. While the first referral hospital is RSUD Ir. Soekarno with a weight of 31.1%, then Depati Hamzah Hospital with a weight of 27.5%, then Bakti Timah Hospital with 27.3%, and Bakti Wara Hospital with 14.1%.

Prevalence of crack cocaine use and its associated factors in patients treated in a specialized outpatient service

Background Despite the advance in studies addressing the use of crack cocaine, knowledge about the characteristics of users that seek treatment in the different modalities of care for substance use disorders is important to plan the operationalization of these services. Objective To analyze the prevalence and factors associated with the use of crack cocaine in outpatients. Method Cross-sectional study consisting in the analysis of the medical records of outpatients of a chemical dependency clinic located in the south of Brazil from 1999 to 2015. The Fisher’s exact test and the Poisson regression model were used to analyze the data. Results Medical records from 1,253 patients were analyzed, and 1,196 (95.5%) of them contained information on the use of crack cocaine. Use of this substance was reported by 47% (95% CI [44, 50]) of the outpatients. The risk group was composed of adults aged 20-39 years, with no income, who had three or more children, did not consume alcohol or marijuana, had continuous family assistance, spontaneously looked for the service, and had already been hospitalized or assisted at a therapeutic community or psychosocial center. Conclusion There is great demand for the outpatient care of crack cocaine users. It is crucial that the risk factors guide treatment planning.

Effectiveness of Forensic Assertive Community Treatment on Forensic and Health Outcomes: A Systematic Review and Meta-Analysis

Given the increasing literature on forensic assertive community treatment (FACT), we conducted a systematic review and meta-analysis to explore the effectiveness of FACT among justice-involved individuals with severe mental illness. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Sixteen studies were included in the systematic review, six of which were included in the meta-analyses for a total of 1,246 participants. Mixed results regarding health-related outcomes were found. The pre-post FACT analysis and comparison with control groups did not yield significant results other than increased outpatient service use. Results on forensic outcomes were more compelling. Both the narrative review and the meta-analysis highlighted that FACT programs may improve justice outcomes such as the number of days spent in jail. More high quality and multisite randomized controlled trials are needed to consolidate findings. Further research is needed to examine other psychosocial factors related to FACT program success.

Trends in Health Care Use and Spending for Young Children With Neurologic Impairment

BACKGROUND AND OBJECTIVES: Children with neurologic impairment (NI) are a growing subset of children who frequently use health care. We examined health care use and spending trends across services for children with NI during their first 5 years of life. METHODS: This was a retrospective study of 13 947 children with NI in the multistate IBM Medicaid MarketScan Database (2009–2017). We established birth cohorts of children with NI and analyzed claims from birth to 5 years. NI, identified by using International Classification of Diseases, 9th Revision, diagnosis codes, was defined as ≥1 neurologic diagnosis that was associated with functional and/or intellectual impairment. We measured annual health care use and per-member-per-year spending by inpatient, emergency department (ED), and outpatient services. Population trends in use and spending were assessed with logistic and linear regression, respectively. RESULTS: During their first versus fifth year, 66.8% vs 5.8% of children with NI used inpatient services, and 67.8% vs 44.4% used ED services. Annual use in both categories decreased over 0–5 years (inpatient odds ratio: 0.35, 95% confidence interval: 0.34 to 0.36; ED odds ratio: 0.78, 95% confidence interval: 0.77 to 0.79). The use of outpatient services (primary care, specialty care, home health) decreased gradually. Per-member-per-year spending on inpatient services remained the largest spending category: $83 352 (90.2% of annual spending) in the first year and $1944 (25.5%) in the fifth year. CONCLUSIONS: For children with early-onset NI from 0–5 years, use and spending on inpatient services decreased dramatically; ED and outpatient service use decreased more gradually. These findings may help systems, clinicians, and families optimize care by anticipating and adjusting for shifting use of health care services.

Who Have a Higher Risk of Falling Into Catastrophic Health Expenditures?

Catastrophic health expenditure is one of the challenges Indonesia faces in achieving Universal Health Coverage. Aside from being a financial disaster, the incident caused by out-of-pocket health expenditure exceeding a fixed limit can drive people into poverty. Unfortunately, the availability of the data causes the limitation of the study in Indonesia. This study aims to analyze the association between catastrophic health expenditure and several social-economic factors by using the latest data of out-of-pocket expenditure collected at the individual level from the 2019 Susenas Module of Health and Housing. Using the Chi-square test, this study confirms a significant association between catastrophic health expenditures and the following social-economic factors: outpatient and inpatient service use, health insurance ownership, age, sex, marital status, educational level, work status, welfare status, type of area, and geographic location. From the logistic regression, the probability of the population to experience catastrophic health expenditure is higher for people in the following categories: use inpatient or outpatient services, do not have health insurance, are elderly, ever-married, not working, not poor, and live in the rural areas or Java island. Disaggregation by outpatient and inpatient service use shows the large gap in the probability of falling into catastrophic health expenditures. The probability for people who used inpatient service is more than four times people who never used the service. Meanwhile, for outpatient service, the probability is almost three times. Therefore, people can strengthen preventive care, especially those with low or no cost, to avoid falling into catastrophic health expenditure.

Accuracy and Safety of Ultrasound-Guided Core Needle Biopsy of Soft Tissue Tumors in an Outpatient Setting: A Sarcoma Center Analysis of 392 Consecutive Patients

Background: The aim of this study was to investigate diagnostic accuracy, safety and histologic results of ultrasound guided core needle biopsy (CNB) in patients with soft tissue lesions (STL) at a tertiary referral center. Methods: A retrospective analysis of all consecutive patients undergoing ultrasound guided CNB for STL at our sarcoma outpatient service between January 2015 and August 2020 was performed. Results: A total of 392 patients were identified. Main histologic entities were sarcomas, lipomas and desmoid tumors. Biopsy was performed in an outpatient setting in 87.6% of the cases. Conclusive biopsies were obtained in 88.5% of the cases. In patients who underwent surgical resection after CNB, the concordance of dignity, tumor entity and histopathological grading between biopsy and resection specimen were 97.2%, 92.7% and 92.5% respectively. The risk of inconclusive CNB was highest in intraabdominal or retroperitoneal tumors (19.5%) and lowest in lesions at the lower extremity (4.4%). Major complications after CNB occurred in three cases (0.8%). No case of biopsy tract seeding was observed during the study period. Conclusions: Ultrasound guided CNB for STL at first presentation in a dedicated surgical outpatient setting is a safe procedure and yields a high diagnostic accuracy.

Consideration factors of older adults seeking medical treatment at outpatient services in Taiwan

Background Taiwan will become a super-aged society by 2025, leading to the more frequent use of outpatient services by older adults for medical treatment compared with other age groups. Understanding the outpatient service consideration factors of older adults seeking medical treatment can improve health care quality. This study explored the selection factors and crucial considerations of older adults for outpatient services. Methods Qualitative study was conducted. Purposive sampling was used to recruit 16 older adults over 65 years of age with chronic disease who were patients of an internal medicine department and regularly returned for checkups. Data including reasons for receiving medical treatment, factors affecting their choice of hospitals, and health care and environmental considerations were collected through structured interviews. Results The older adults identified four factors. (1) The care of doctors: The doctors possessed professional skill, allocate sufficient consultation time, and undertake effective communication. (2) The care of other medical professionals: Other medical professionals provided services in a cordial manner. (3) The accessibility and convenience of outpatient services: Convenient transportation and registration as well as short consultation wait time. (4) Environment and equipment: The hospital had the novel facilities and satisfactory barrier-free equipment. Conclusions The older adults cared most about the adequacy of diagnosis and treatment by doctors and other medical professionals. In addition, they reported having higher satisfaction with hospitals that provide comprehensive medical facilities, fast and convenient medical procedures, and short wait times.

Healthcare Resource Utilization and Costs in US Patients with Newly Diagnosed Acute Myeloid Leukemia Treated with Intensive Induction Chemotherapy

INTRODUCTION: Acute myeloid leukemia (AML) is a heterogeneous hematologic malignancy. In the United States (US) in 2020, the incidence of AML was 4.3/100,000, with a death rate of ~2.8 per 100,000. Following diagnosis, for patients who are fit for high-dose therapy, standard of care consists of initial intensive remission-inducing chemotherapy followed by post-remission therapy comprising consolidation chemotherapy alone, hematopoietic stem cell transplantation (HSCT) alone, or consolidation chemotherapy followed by HSCT. Despite an initial response to treatment, most patients with AML progress, and relapse is common. Relapse in AML is associated with poor prognosis, substantial healthcare resource utilization (HCRU), and a cost burden. Maintenance therapy with newer agents may delay relapse and prolong survival. Understanding HCRU and costs of newly diagnosed AML may inform clinicians, policy makers, and payers on the burden of AML and the potential clinical and economic benefits of novel therapies. This retrospective study describes HCRU and costs for patients with newly diagnosed AML receiving intensive induction chemotherapy in the US. METHODS: The Premier Healthcare Database was used to identify patients aged ≥18 years with an inpatient hospitalization or hospital-based outpatient visit (01/01/2016-03/31/2019), an AML diagnosis (ICD-10-CM diagnosis codes: C92.00, C92.40, C92.50, C92.60, C92.A0), who received CPX-351 or 7+3 treatments, and had ≤280 days from the end of first induction treatment to remission. Patients with prior AML diagnosis or those receiving other treatments were excluded. Index date was the admission date for the first hospitalization or the first hospital-based outpatient visit with an AML diagnosis. Patients were followed until death, relapse or last known follow-up, whichever was first. Unadjusted descriptive analyses were performed for patient demographics, baseline clinical characteristics, outpatient days, inpatient hospitalizations, intensive care unit (ICU) admissions, and costs. RESULTS: Overall, 642 patients who received induction chemotherapy for newly diagnosed AML were identified. Mean (median) patient age was 53.7 (56.0) years, and 53.1% of patients were male. Patients had commercial (47.2%), Medicare (26.8%), Medicaid (17.6%), or other (8.4%) insurance. Mean (SD) Charlson Comorbidity Index was 3.5 (2.2), and the most common comorbidities were diabetes (20.3%), chronic pulmonary disease (15.4%), and congestive heart failure (9.4%). Most frequent adverse events were pyrexia (47.2%), neutropenia (39.9%), sepsis (28.0%), pneumonia (24.3%), and fungal infection (17.9%). Median (interquartile range [IQR]) time from the end of first induction chemotherapy to remission was 58 (40-90) days. Median (IQR) time from remission to relapse was 274 (141-389) days. A total of 385 (60.0%) patients had outpatient service days at a Premier facility; median (IQR) number of outpatient service days per patient was 3 (1-6), outpatient hospital cost per visit was $1,083 ($481-$2,189), and total outpatient hospital cost was $2,904 ($1,054-$7,217). All patients had an inpatient hospitalization; median (IQR) number of inpatient hospitalizations per patient was 2 (2-3), length of stay (LOS) per inpatient hospitalization was 16 (13-21) days, cost per inpatient hospitalization was $34,558 ($25,419-$49,460), and total inpatient hospital cost was $83,440 ($63,067-$113,985). A total of 144 (22.4%) patients had an ICU admission; median (IQR) number of ICU admissions per patient was 1 (1-1), LOS per ICU admission was 3 (2-8) days, cost per ICU visit was $15,771 ($7,209-$27,564), and ICU cost was $16,550 ($7,368-$36,968). CONCLUSIONS: In the US, healthcare costs for patients with newly diagnosed AML who receive induction chemotherapy are considerable, primarily due to high HCRU and lengthy inpatient stays. Patient response to induction therapy and duration of remission may also contribute to HCRU and costs. More tolerable therapies that improve remission rate and duration, and/or reduce hospitalization rates, may alleviate the economic burden of AML. Disclosures Huggar: Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company. Knoth: Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company. Copher: Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company. Cao: Premier, Inc.: Current Employment; BeiGene, Ltd.: Consultancy. Lipkin: Premier, Inc.: Current Employment. McBride: Bristol Myers Squibb: Current Employment. LeBlanc: Amgen: Consultancy, Other: travel; BMS/Celgene: Consultancy, Honoraria, Other: Travel fees, Research Funding, Speakers Bureau; Flatiron: Consultancy, Other: Advisory board; Astellas: Consultancy, Honoraria, Other: Advisory board; Duke University: Research Funding; American Cancer Society: Research Funding; Helsinn: Consultancy, Research Funding; AstraZeneca: Consultancy, Honoraria, Other: Advisory board, Research Funding; Heron: Consultancy, Honoraria, Other: advisory board; Agios: Consultancy, Honoraria, Other: Advisory board; Travel fees, Speakers Bureau; Pfizer: Consultancy, Other: Advisory Board; CareVive: Consultancy, Other, Research Funding; Seattle Genetics: Consultancy, Other: Advisory board, Research Funding; Jazz Pharmaceuticals: Research Funding; Otsuka: Consultancy, Honoraria, Other; Daiichi-Sankyo: Consultancy, Honoraria, Other: Advisory board; AbbVie: Consultancy, Honoraria, Other: Advisory board; Travel fees, Speakers Bureau; UpToDate: Patents & Royalties; NINR/NIH: Research Funding.

Factors Associated With Hypertension Awareness, Treatment, and Control Among Adults in Kerala, India

Background: Hypertension, the most significant risk factor for cardiovascular disease, is an increasing contributor to global health burden, particularly in low- and middle-income countries (LMICs) such as India. While the rates of hypertension awareness, treatment, and control in India have been reported in several studies, the factors associated with these rates are less well-understood. Existing studies are predominantly cross-sectional, and the factors examined are limited. Understanding the predictors associated with these rates, using more rigorous study designs, is crucial for the development of strategies to improve hypertension management.Aims: To examine a range of factors associated with hypertension awareness, treatment, and control using both cross-sectional and longitudinal analyses.Methods: Data was derived from a population-based sample of 1,710 participants from Kerala, aged 30–60 years. We examined a comprehensive range of factors, including demographic, behavioral factors, anthropometric, clinical measures, psychosocial factors and healthcare utilization. Multilevel mixed effects logistic regression was used for both cross-sectional and longitudinal analyses (repeated measures for all variables across 2 years) to determine the factors associated with awareness, treatment, and control of hypertension.Results: A total of 467 (27.3%) participants had hypertension at baseline. Among those, the rates of awareness, treatment, and control of hypertension were 54.4, 25.5, and 36.4%, respectively. Being male (OR 0.27, 95% CI 0.14–0.53) and consumption of alcohol (OR 0.49, 95% CI 0.31–0.80) were significant predictors of poorly controlled hypertension (longitudinal analysis). Depression (OR 2.04, 95% CI 1.15–3.61) and fair-to-poor self-perceived health status (OR 1.87, 95% CI 1.15–3.04) were associated with increased hypertension awareness, whereas anxiety (OR 1.97, 95% CI 1.04–3.71) was associated with increased hypertension treatment (cross-sectional analysis). Seeking outpatient service in the past 4 weeks was associated with higher awareness (OR 1.09, 95% CI 1.27–2.87), treatment (OR 1.73, 95% CI 1.20–2.50) and control (OR 1.96, 95% CI 1.37–2.80) (longitudinal analysis).Conclusion: Our findings suggest the importance of considering psychosocial factors and better engagement with health services in hypertension management, as well as giving more attention to body fat control and largely male-related behaviors such as alcohol consumption, taking into account of some Indian specific attributes.