Telehealth to support referral management in a universal health system: a before-and-after study

Background Management of patient flow within a healthcare network, allowing equitable and qualified access to healthcare, is a major challenge for universal health systems. Implementation of telehealth strategies to support referral management has been shown to increase primary care resolution and to promote coordination of care. The objective of this study was to assess the impact of telehealth strategies on waiting lists and waiting times for specialized care in Brazil. Methods Before-and-after study with measures obtained between January 2019 and February 2020. Baseline measurements of waiting lists were obtained immediately before the implementation of a remotely operated referral management system. Post-interventional measurements were obtained monthly, up to six months after the beginning of operation. Data was extracted from the database of the project. General linear models were applied to assess interaction of locality and time over number of cases on waiting lists and waiting times. Results At baseline, the median number of cases on waiting lists ranged from 2961 to 12,305 cases. Reductions of the number of cases on waiting lists after six months of operation were observed in all localities. The magnitude of the reduction ranged from 54.67 to 88.97 %. Interaction of time measurements was statistically significant from the second month onward. Median waiting times ranged from 159 to 241 days at baseline. After six months, there was a decrease of 100 and 114 waiting days in two localities, respectively, with reduction of waiting times only for high-risk cases in the third locality. Conclusions Adoption of telehealth strategies resulted in the reduction of number of cases on waiting lists. Results were consistent across localities, suggesting that telehealth interventions are viable in diverse settings.

A multidisciplinary neuro-oncological triage panel reduces the time to referral and treatment for patients with a brain tumor

Background Regional collaboration and appropriate referral management are crucial in neuro-oncological care. Lack of electronic access to medical records across healthcare organisations impedes interhospital consultation and may lead to incomplete and delayed referrals. To improve referral management, we have established a multidisciplinary Neuro-Oncological Triage Panel (NOTP) with digital image exchange and determined the effects on lead times, costs and time investment. Methods A prospective cohort study was conducted from February 2019 to March 2020. All newly diagnosed patients referred to Brain Tumor Center Amsterdam were analyzed according referral pathway: 1) standard referral, 2) NOTP. The primary outcome was lead time, defined as time-to-referral, time-to-treatment, and total time (median days [interquartile range]). Secondary outcomes were costs and time investment. Results In total, 225 patients were included, of whom 153 had standard referral and 72 NOTP referral. Patients discussed in the NOTP were referred more frequently for first neurosurgical consultation (44.7% versus 28.8%) or combined neurological and neurosurgical consultation (12.8% versus 2.5%, p=0.002). Time-to-referral was reduced for NOTP referral compared to standard referral (1[0.25-4] versus 6[1.5-10] days, p<0.001). Total time decreased from 27[14-48] days for the standard group to 15[12-38.25] days for the NOTP group (p=0.040). Costs and time investment were comparable for both groups. Conclusion Implementation of digital referral to a multidisciplinary NOTP is feasible and leads to more swift patient-tailored referrals at comparable costs and time investment as standard referral. This quality improvement initiative has the potential to improve collaboration and coordination of multidisciplinary care in the field of neuro-oncology.

Perception and Willingness to Maintain Continuity of Care by Parents of Children with Asthma in Taiwan

To investigate caregivers’ attitudes toward continuity of care (COC) and their willingness to maintain continuity for their children with asthma under a national health insurance (NHI) system without strict referral management. We sampled 825 individuals from six pediatric outpatient departments in different parts of Taiwan from 2017 to 2018. We used a contingent valuation with a payment card method. Post-stratification weighting adjustment and coarsened exact matching were utilized. Multiple logistic regression was used to compare the willingness to pay and spend extra time maintaining continuity by parents. More than 80% of caregivers in the asthma group believed having a primary pediatrician was important for children’s health. Only 27.5% and 15.8% of caregivers in the asthma and control groups, respectively, believed changing pediatricians would negatively affect therapeutic outcomes. Regression analysis showed that the predicted willingness to pay for the asthma and non-asthma groups were NT$508 (SD = 196) and NT$402 (SD = 172), respectively, and there was a significant positive dose–response relationship between household income and willingness to pay for maintaining health care provider continuity. Caregivers’ free choices among health care providers may reduce willingness to spend extra effort to maintain high COC. Caregivers should be educated on the importance of COC.

Pre-referral management of patients with severe preeclampsia and eclampsia in a district hospital, Southeast Sulawesi, Indonesia

Objective: This study aims to determine the enforcement of diagnosis, management and description of the referral system of PEB and eclampsia patients at Level I Health Facilities and South Konawe Hospital in January-December 2017Materials and Methods: This study used an observational descriptive design, carried out in the Maternity Room of South Konawe Hospital on 1 January-31 December 2017. There were 47 cases of PEB/Eclampsia from 420 total cases. Most cases of PEB/Eclampsia in Konsel Hospital suffered by pregnant women aged> 35 years, as many as 27 cases (59%). age 21- 34 years, 15 (31%) and the lowest among women aged <20 years, as many as 5 cases (10%). Multigravida, which is 38 cases (81%) and 9 cases 19%) in primigravida. Pregnancy> 34 weeks is 46 cases (98%) and 1 case (2%) at <34 weeks gestation. There were 39 referral cases (83%) all of which were counseled and 8 non-referral cases (17%), where completeness of the tools, medicines and referral letters obtained 39 cases (100%) incomplete.Results: The administration of antihypertensive drugs was given to 89% of cases, and MgSO4 was not given to 100% of cases of PEB/Eclampsia referred to RSUD Konawe Selatan due to fear of officers in providing such therapy to PEB/Eclampsia patients. Examination of urine protein as a support for PEB/Eclampsia cases was recorded in 69% of referral cases at the Konawe Selatan General Hospital.Conclusion: From the whole data, it was found that the pre-requisite conditions had not been fulfilled properly. Referral should be well prepared in order to achieve patient safety and decrease in MMR.

Strategi Pengelolaan Taman Wisata Alam Gunung Meja melalui Penataan Kawasan

The purpose of this research is to formulate management strategies related to the condition and potential of the park. The results showed that land cover of Gunung Meja natural tourism park dominated by natural forest (77.5%), followed by plantations forest (11.7%), the former garden area (5.6%), gardens (3.4%) and open land, electricity network, tower and street with percent smaller extent. Potential natural forest vegetation is very high, includes 159 species of trees (186 individuals/ha, high diversity indeck), 149 species of poles (867 individuals / ha, medium diversity indeck), 164 species of saplings (3,904 individuals / ha, medium diversity indeck) and 177 species of seedlings (32,300 individuals / ha, medium diversity indeck) with the total of species is 223, as well as forest vegetation plants, medicinal plants and farm / plantation vegetation. The diversity of wildlife species include 15 species of mammals (2 species protected), 35 species of birds (12 species protected), 21 other species (8 lizards, 3 amphibia, 9 snakes and 1 turtles) and 14 species of insects (1 species protected). Potential support includes Japanese monument, caves, water and social communities. Utilization of the region has not done so well that affect the area as a result of the existence of agricultural activities, logging and utilities. Referral management includes policies (policies that embody accommodate all interests through the zoning system by protected zone, farm exploit zone and buffer zone).

Penerapan Manajemen Rujukan Kegawatdaruratan Obstetri Dengan Insiden Kegawatdaruratan Obstetri Di Pusat Pelayanan Primer

Latar belakang: Indonesia merupakan suatu negara berkembang dengan masalah kesehatan yang masih menjadi perhatian khusus yaitu AKI yang masih tinggi. Sebanyak 99% kematian ibu akibat masalah persalinan atau kelahiran terjadi di negara-negara berkembang. Berdasarkan SUPAS masih 305 per 100.000 per kelahiran hidup pada tahun 2030. Tujuan: Menganalisis pengaruh manajemen rujukan kegawatdaruratan obstetric dengan insiden kegawatdaruratan obstetric di Pusat Pelayanan Primer. Metode penelitian: Penelitian ini menggunakan pendekatan kualitatif desain diskriptif fenomenologi serta restropective. Penelitian dilakukan di wilayah kerja puskesmas jagir dari bulan April sampai Juli 2019 informan utama yaitu Bidan. Pengumpulan informan dengan teknik wawancara mendalam, studi dokumentasi serta observasi. Hasil penelitian: Hasil penelitian ini sesuai dengan pedoman system rujukan nasional menyebutkan bahwa evaluasi internal perlu dilakukan dalam rangka peningkatan mutu pelayanan, dan memperbaiki ketaatan pelaksanaan rujukan oleh fasilitas kesehatan, memperbaiki serta mengevaluasi sarana serta SDM dipelayanan Kesehatan. Semua informan dalam manajemen rujukan kegawatdaruratan obstetri dengan insiden kegawatdaruratan obstetri di pusat pelayanan primer sudah cukup baik. Kesimpulan: Semua informan dalam pengetahuan tentang manajemen rujukan kegawatdaruratan obstetri dengan insiden kegawatdaruratan obstetri di pusat pelayanan primer sudah cukup baik. Pengetahuan sistem rujukan kasus kegawatdaruratan obstetric informan sudah baik. Sarana dan Prasarana yang tersedia di puskesmas sudah tersedia lengkap sesuai standar minimal untuk kegawatdaruratan obstetric dan dalam kondisi yang baik. SOP sudah sesuai dengan protap yang ada. Surat pengantar rujukan, transportasi serta penyerahan tanggung jawab sudah sesuai dan baik. Semua informan telah melakukan pencatatan serta pelaporan terkait kasus rujukan yang dilakukan. Mayoritas informan telah melakukan evaluasi internal untuk menilai apakah prosedur rujukan yang telah dilakukan sudah cukup baik. Saran: Diharapkan hasil penelitian ini menjadi sumber referensi dalam pengembangan ilmu kebidanan untuk meningkatkan kualitas pemberian asuhan kebidanan khususnya pada layanan kebidanan. Background: Indonesia is a developing country with health problems that are still a special concern is the high maternal mortality rate. As many as 99% of maternal deaths due to childbirth or birth problems occur in developing countries. Based on the inter-census population survey it is still 305 per 100,000 per live birth in 2030. Aims: to analyze the involvement of obstetric emergency referral management by reporting on obstetric emergencies at the Primary Service Center. Research Methods: This research uses descriptive qualitative design of phenomenology and restropective. The study was conducted in the working area of the Jagir public health center from April to July 2019, the main informant was Midwife Information gathering with in-depth interview techniques, study collection and collection. Results: The results of this study are in accordance with the national referral system guidelines stating that internal evaluation needs to be done in order to improve the quality of services, and improve compliance with referral services by health facilities, improve and evaluate facilities and human resources in health services. All informants in obstetric emergency referral management with obstetric emergency incidents in primary care centers are good enough. Conclusion: All informants in knowledge of obstetric emergency referral management with obstetric emergency incidents in primary care centers are good enough. Knowledge of the obstetric emergency case referral system is good. Facilities and infrastructure available at the public health center are fully available according to the minimum standards for obstetric emergencies and in good condition. Standard operational procedures are in accordance with existing procedures. Letter of reference for referral, transportation and assignment of responsibilities are appropriate and good. All informants have recorded and reported related to the referral case. The majority of informants have conducted internal evaluations to assess whether the referral procedures that have been carried out are good enough. Suggestion: It is hoped that the results of this study will become a reference source in developing midwifery to improve the quality of special midwifery care assistance in midwifery services.