Patients' views on the quality of transitional care at a health insurance hospital in Alexandria, Egypt

Persons with continuous complex care frequently require care in multiple settings. During transitions between settings, there is evidence that the quality of care is jeopardized for these patients. The present study aims to measure the quality of transitional care at one of the Health Insurance Hospitals in Alexandria using the Care Transition Measure [CTM] and to explore the association between the quality of care transition and patients' characteristics. The CTM was administered to 314 patients diagnosed with four chronic conditions. The measure included the following sections: [a] demographic and medicoadministrative characteristics of the patients age, sex, education, the number of comorbid conditions, the type of admission, length of stay [LOS], the discharge diagnosis, and hospital admissions for the same condition as for the index hospitalization in the past 3 months. [b] The CTM is composed of 15 items designated to patients after discharge from the hospital. The measure comprises four subdimensions: critical understanding, importance of preferences, management preparation, and the existence of a written and understandable care plan. The score in the CTM ranges from 0 to 100, with lower scores indicating a lower quality of transitional care. The total mean score was 42.2, with a wide range [from 0.0 to 100.0]. The highest scores were attributed to the factor critical understanding, whereas the lowest scores were attributed to the factor care plan [52.1 vs. 20.9]. The factors level of communication with the medical staff, management preparation, and importance of preferences had an average score of about 39.0 [38.5, 41.4, and 33.5, respectively]. Patients admitted from the emergency department had significantly higher CTM scores than those admitted from the outpatient department [P=0.023]. Patients with an LOS of more than 6 days had significantly higher CTM scores compared with patients with an LOS of less than 6 days [P=0.006]. Patients admitted for the same diagnoses as for the index hospitalization more than three times within the previous 3 months had a significantly higher CTM score than those admitted less than three times [P=0.017]. The quality of transitional care at Health Insurance Organization hospitals is suboptimal. An adequate plan for preparing patient discharge and follow-up after discharge should be designed

Responsiveness of the health insurance and private systems in Alexandria, Egyptah, Saudi Arabia

Background: Responsiveness to patients is a key indicator for measuring the health system performance with respect to nonhealth aspects. This study aimed to compare responsiveness of the Health Insurance Organization [HIO] with the private healthcare system and also to assess the importance of the different responsiveness domains according to the study population's perspective

Participants and methods: Patients attending both inpatient and outpatient settings of both organizations were interviewed [200 outpatients and 200 inpatients from each selected hospital] using the WHO questionnaire. The questionnaire elicits the ratings of the respondents on their experiences with the healthcare system over the past 12 months in terms of responsiveness domains, respondents' inability to access medical care because of financial barriers, and their ranking of the relative importance of responsiveness domains

Results: Almost twice the number of HIO participants reported poor responsiveness compared with the private organization participants [27.8 vs. 56.8%, respectively]. The outpatient setting scored much favorably compared with the inpatient setting at the HIO [52.3% of respondents reported poor responsiveness in the outpatient setting compared with 76.3% in the inpatient setting]; however, they were comparable in the private setting. Communication, prompt attention, and dignity were the domains most frequently rated as the most important [36.0, 32.0, and 14.7%, respectively]. The type of organization [HIO vs. private organization] and setting of care [inpatient vs. outpatient] were significant predictors of responsiveness score [P<0.001]

Conclusion and recommendations: The overall rating of the patients on responsiveness of the HIO system is low, especially when compared with the private sector. The results emphasize the importance of establishment of systems for monitoring the performance of the providers and discontinuation of the services for the nonperformers

Does low dose of suxamethonium with propofol induction provide adequate intubation condition and prevent post-operative myalgia?

The present study has demonstrated that the incidence of myalgia and fasciculations has decreased significantly in patients given low dose suxamethonium [0.25 mg/kg] with propofol than the average dose [1 mg/kg] used with thiopentone and a similar degree of clinical neuromuscular block with no difference in the intubating conditions was achieved in both groups. The concentration of creatine kinase increased in both groups, but the increase was significantly higher with larger dose of suxamethonium. So, the findings support that there is a good subjective correlation between muscle pain and biochemical indices of muscle damage