ABSTRACT
OBJECTIVES: To measure the quality of the clinical Genitourinary (G-U) Medicine and Sexually Transmitted Infection (GUM/STI) management process at a primary care polyclinic and establish a baseline for future monitoring and evaluation. METHODS: This was a prospective cohort study on 220 data abstracted clinical notes randomly selected and stratified by gender, age and first point of contact from 2131 GU/STI patients of the GUM/STI clinic seen from 2003-5. Data were also obtained by tele-interview of a subset of 27 individuals. Measurements were incidence (95% CI) as proportions of successful level of activity and outcome indicators for diagnosis, treatment and prognosis. RESULTS:Among 220 patients, the incidence (95% CI) of accurate clinical diagnosis and treatment was 40.5% (33%, 46%) before laboratory results boosted it to 96% (93%, 99%). Successful prognosis at 1st, 2nd and 3rd follow-up was 23.2%, 56.6% and 86.2%. The risk at follow-up for 1, 2 and >2 GU/STI episodes was 28.9%, 45.8% and 25.3%. Follow-up of partners was low, 4.7%. Adequate health promotion and preventive services were reported in 86.5% (78%, 88%) of 220 patients' records and by 84.5% (71%, 98%) of 26 who were tele-interviewed. In 88.5% (76%, 100%) of those (27) tele-interviewed, there was satisfaction with the service, but 73.8% (56%, 90%) would have preferred appointments and 29.6% (12%, 47%) preferred extended hours. Per capita ideal cost of medication could have been BB$6.30 (± 1.56) instead of actual BB$13.05 (± 1.84); (BB$2 = US$1). CONCLUSION: GU/STI quality performance improvement in Barbados requires rapid laboratory diag-nosis, standardized data formats with prompt expedited partner notification and treatment appointments and use of recommended algorithm that can half the cost of medication. Genitourinary medicine should be strategized instead of STI to better encapsulate the spectrum diversity of presentations and points of service.
OBJETIVO: Medir la calidad de la medicina genitourinaria clínica y el proceso del tratamiento de las infecciones de transmisión sexual (MGU/ITS) en un policlínico de atención primaria, y establecer una línea de base para el monitoreo y la evaluación futuros. MÉTODOS: Se trató de un estudio de cohorte prospectivo realizados sobre 220 notas clínicas extraídas de datos, seleccionadas aleatoriamente y estratificadas por género, edad y primer punto de contacto, de 2131 pacientes MGU/ITS de la clínica MGU/ITS atendidos en 2003-2005, y por tele-entrevista de un subconjunto de 27 individuos. Las mediciones fueron incidencias (95% IC) como proporciones del nivel de éxito de la actividad e indicadores de los resultados para el diagnóstico, el tratamiento y la prognosis. RESULTADOS: Entre 220 pacientes, la incidencia (95% IC) del diagnóstico clínico exacto y el tratamiento fue 40.5% (33%, 46%) antes de que los resultados de laboratorio la elevaran a 96% (93%, 99%). La prognosis exitosa en el primer, segundo y tercer seguimiento fue 23.2%, 56.6% y 86.2%. El riesgo en el seguimiento para los episodios GU/ITS 1, 2, y > 2 fue 28.9%, 45.8% y 25.3%. El seguimiento de parejas fue bajo, 4.7%. La promoción adecuada de la salud y los servicios de prevención fueron reportados en 86.5% (78%, 88%) de las historias de 220 pacientes y por 84.5% (71%, 98%) de 26 que fueron tele-entrevistados. En 88.5% (76%, 100%) de los (27) tele-entrevistados, hubo satisfacción con el servicio, pero 73.8% (56%, 90%) hubiera preferido citas y 29.6% (12%, 47%) extensión del horario. El costo ideal per capita de la medicación podría haber sido 6.30 BBD (± 1.56) en lugar de 13.05 BBD (± 1.84); (2 BBD = 1 USD). CONCLUSIONES: El mejoramiento en cuanto a resultados de calidad en GU/ITS en Barbados, requiere diagnósticos de laboratorio rápidos, formatos estandarizados de datos con pronta notificación a las parejas, citas para el tratamiento, y uso del algoritmo recomendado que puede reducir a la mitad el costo de la medicación. MUG debe ser estrategizada en lugar del TIS, a fin de encapsular mejor el espectro de la diversidad en las presentaciones y puntos de servicio.
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Clinical Audit , Female Urogenital Diseases/diagnosis , Female Urogenital Diseases/therapy , Male Urogenital Diseases/diagnosis , Male Urogenital Diseases/therapy , Primary Health Care/standards , Ambulatory Care Facilities , Barbados , Female Urogenital Diseases/economics , Interviews as Topic , Male Urogenital Diseases/economics , Outcome and Process Assessment, Health Care , Patient Care Team , Patient Satisfaction , Prescription Fees , Prospective StudiesABSTRACT
Longitudinal data from a case series indicated that clearance rates (95% CIs) of anogenital warts (AGW) by silver nitrate (n = 14) and podophyllin (n = 34) were 93% (79.35, 100) and 14.7% (3, 27) respectively; and RR, 6.31 (95% CI 2.77, 14.37, p = 0.0(5)2), relative benefit increase, 532% (410, 654), and NNT, 1 (1, 2). The total effort needed US$28(BB$56) vs US$598 in 1-3 vs 1-37 visits to achieve one successfully treated patient respectively. While subject to the errors of an open, non-randomized case series, silver nitrate was highly efficacious and cost-effective and should replace podophyllin at the Winston Scot Polyclinic.
Datos longitudinales de una serie de casos indicaron que las tasas de eliminación (95% CI) de verrugas anogenitales (VAG) mediante nitrato de plata (n = 14) y podofilina (n = 34) fueron 93% (79.35, 100); y 14.7% (3, 27) respectivamente; y RR, 6.31 (95% CI 2.77, 14.37, p = 0.0(5)2), aumento relativo de beneficios, 532% (410, 654), y NNT, 1 (1, 2). El esfuerzo total necesitó $28 USD (BB$56) vs $598 USD en 1-3 vs 1-37 visitas para lograr un paciente tratado con éxito respectivamente. Aunque sujeto a los errores de una serie de casos abierta no aleatorizada, el nitrato de plato fue altamente eficaz y costo-efectivo y debe reemplazar la podofilina en Winston Scot Polyclinic.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Antiviral Agents/therapeutic use , Condylomata Acuminata/drug therapy , Podophyllin/therapeutic use , Silver Nitrate/therapeutic use , Antiviral Agents/economics , Cost-Benefit Analysis , Podophyllin/economics , Retrospective Studies , Silver Nitrate/economics , Treatment OutcomeABSTRACT
To evaluate methods of preventing young children from experimenting with tobacco and to determine cost effectiveness, students (n = 1005) in 31 primary schools, from randomly selected higher grade-levels were recruited into a partially randomized, single blinded controlled trial in which seven groups of schools were randomly assigned to a combination of teaching, leaflet, and drama, in order to modify students' knowledge, attitudes, beliefs and behaviour (KAB). The eighth group (n = 346) with ten schools, distantly separated from the former, was assigned to be the control, but was dropped from comparison analysis for lack of randomness at baseline. The mean, standard deviation and median age of the intervention groups was 9.94 years (0.81), 10.0 years, (n = 669) at baseline; and 10.62 years (0.66), 11.0 years, (n = 397), at 12 months follow-up. In all, 6.6had ever used tobacco at least once at a median age of seven years. Teaching health education at school when combined with other methods was significantly better at improving KAB. In 2003, after a year post-intervention, the occurrence of experimentation smoking in the last 30 days, dropped from 9.2to 1.2(p = 0.00), equivalent to 87(95CI 78, 93) reduction in the group exposed to health education compared to none in the leaflet-only group and Numbers Needed to Treat (NNT) = 12.5. Due to its cost-effectiveness (comparable to child immunizations) at BDS dollars 1.89 to 2.89 or US dollars 1 to 1.5 per child contacted and BDS dollars 100 to 140 (US dollars 50 to 70) capital investment in other resources per school, the experience could be utilized routinely in elementary schools.
A fin de evaluar los métodos usados para impedir que los niños en edad escolar experimenten con tabaco, y determinar la efectividad del costo, estudiantes (n = 1005) en 31 escuelas primarias de los grados más altos seleccionados aleatoriamente fueron enrolados en una prueba parcialmente aleatoria controlada, de simple ciego. En este ensayo, a siete grupos de escuelas se les asignó aleatoriamente una combinación de instrucción, folletos, y drama, con el propósito de modificar sus conocimientos, actitudes, creencias y comportamiento (CAC). El octavo grupo (n = 346) con diez escuelas, separado a distancia de los anteriores, fue escogido como control, pero fue dejado fuera del análisis comparativo debido a falta de aleatoriedad en la línea de base. La media, la desviación estándar, y la mediana de la edad de los grupos de intervención fue de 9.94 años (0.81), 10.0 años, (n = 669) en la línea de base; y 10.62 años (0.66), 11.0 años, (n = 397), a los 12 meses de seguimiento. En total, 6.6% habían usado por lo menos una vez tabaco a la edad mediana de siete años.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Health Education/organization & administration , Primary Prevention/methods , Nicotiana/adverse effects , Tobacco Use Disorder/prevention & control , Cluster Analysis , Attitude to Health , Program Evaluation , Barbados/epidemiology , Schools , Single-Blind Method , Developing Countries , Probability , School Health Services , Tobacco Use Disorder/epidemiology , Reference ValuesABSTRACT
Policy makers need justification for smoking prevention. Barbados has debated but not enacted policies on tobacco control. This study estimated tobacco-associated morbidity and hospital care costs in order to justify prevention in a developing country with a low smoking prevalence of 9. Hospital files of patients of index diseases and other chronic diseases with recorded status of smoking were followed on their outpatient, inpatient, elective and emergency attendance up to last discharge and analyzed as a nested case-control in a cohort of smokers and non-smokers. Outcome measure was excess healthcare financial burden per person per year derived from morbidity incidence density, risk ratios, preventive fractions and excess hospital services consumed per person per year. Of 258 hospital patients, 84 were smokers. The mean follow up was 5.2 years. Eighty-four smokers had 463 excess outpatient appointments, 43 excess admissions, and 2651.6 excess hospital days. There were 44.8 fewer elective admissions and 62.24 more emergency admissions among smokers who suffered frequent and severer complications, (odds ratio = 3.78 for > or = 3 complications, p for Chi square trend, 0.0223), and had poorer prognosis translating into higher care costs, personnel effort, time, and human suffering. The excess hospital care cost was BDS$2,267 per smoker per year. Despite a low prevalence of smoking, tobacco caused a substantial public health burden. Hospital care cost for patients who smoked was 1.86 times higher than for non-smokers, and five times more than the government per capita health allocation. The annual excess hospital care costs in 1556 similar smokers would have exceeded the annual tobacco revenue