All children left behind: drug adherence and the COVID-19 pandemic

We study the effect of the COVID-19 pandemic on chronic disease drug adherence. Focusing on asthma, we use a database that tracks the vast majority of prescription drug claims in the U.S. from 2018 to 2020. Using a difference-in-differences empirical specification, we compare monthly drug adherence in 2019 and 2020 for the set of chronic patients taking asthma medication before the onset of the pandemic. We find that the pandemic increased adherence for asthmatic adults by 10 percent. However, we find a sustained decrease in pediatric drug adherence that is most severe for the youngest children. By the end of 2020, drug adherence fell by 30 percent for children aged 0 to 5, by 12 percent for children aged 6 to 12, and 5 percent for children aged 13 to 18. These negative effects are persistent regardless of changes in medical need, socioeconomic factors, insurance coverage and access to health services. We provide suggestive evidence that the observed pediatric changes are likely driven by parental inattention.

Telemedicine Management in Public Health Education at Bitung City Health Office

Objective:This study seeks to examine the planning, implementation, and assessment of Telemedicine Services in Public HealthEducation in the city of Bitung. Method(s): This study is qualitative in nature. This research was conducted at the Bitung City Health Office. This study's data source comprises of two types of sources: primary and secondary data sources. Result(s):The results indicated that the Planning of Telemedicine Services in Public Health Education in Bitung City begins with the preparation of human resources, including both resource individuals (Medical/Paramedic) and IT personnel, facilities, infrastructure, and equipment. In addition to developing health materials that will be distributed to the community, planning includes the creation of budget postings that will be utilized in telemedicine services. During the Covid-19 pandemic, the installation of telemedicine services in the form of teleconsultation went smoothly in the city of Bitung via the PSC 119 hotline number, which grew in popularity. In addition, the Bitung Digital Medical application includes a telemedicine service. In addition to utilizing existing social media such as websites, Facebook, and Instagram, the delivery of products and healthcare services also makes use of these platforms. Conclusion(s): The planning of telemedicine services as a health education attempt at the Bitung City Health Office has been carried out well, but the implementation is still not well programmed, as well as the evaluation which has not been comprehensive. The implementation of good telemedicine management can improve public health education. Hence, cross-sectoral cooperation is needed such as cooperation with the information and telecommunications service, education office and other sectors and there is a need for government regulations that can regulate the mechanism of this telemedicine service so that this telemedicine service can improve public health education.Copyright © 2023, Anka Publishers. All rights reserved.

Knowledge, Attitude and Apparent Job Stress Among Clinical Research Associates working at Contract Research Organizations (CRO)in MENA Region during Covid-19

The SARS-CoV-2 unique human coronavirus that causes coronavirus disease 2019 (COVID-19) was initially discovered in Wuhan, China, in December 2019 and the disease soon spread to every continent, on March 11, 2020, the World Health Organization declared it to be a global pandemic(Kamacooko et al., 2021). Around the world, the COVID-19 epidemic has had a disastrous effect on the economy, social environment, and healthcare system. High levels of posttraumatic stress disorder, anxiety, sadness, and other distressing symptoms have been brought on by COVID-19. Additionally, the quantity and quality of social ties have decreased, as have people's impressions of others' feelings of empathy. The demand for health services has significantly increased in the healthcare sector as a result of Covid 19. Anxiety, depression, and sleep disturbance are just a few of the psychiatric problems that Covid-19 harms(Ramdan & Sari, 2022).Copyright © 2022, Anka Publishers. All rights reserved.

Care trajectories of COVID-19 patients: from preventive measures to rehabilitation

This study aims to analyze the care trajectories of patients diagnosed with COVID-19 who were hospitalized and are currently undergoing rehabilitation regarding their use of and access to the healthcare network (HN). An evaluative, qualitative study was carried out based on interviews with patients in the city of Niteroi, Rio de Janeiro State, Brazil. The care trajectories were reconstructed at three different occasions that express their experiences with the healthcare and support network during the pandemic: prevention, support and diagnosis measures;hospitalization;postCOVID-19 care, rehabilitation and support. The results indicate that the main source of information about COVID-19 was TV newscasts. Preventive hygiene measures were the most widely adopted. The family was the main support network. There was no waiting time for admission to the municipal referral hospital. Hospitalization was very well evaluated in terms of user embracement, multidisciplinary care, virtual visits and daily contact between doctor and family members. A post-discharge "care vacuum" was identified, with no follow-up by primary health care (PHC) and other public services. Low-cost health insurance plans and private specialized post-COVID-19 services were frequently and spontaneously sought until the implementation of the rehabilitation service. In summary, solitary and discontinuous care trajectories of individuals and families shed light on several challenges to the health system, including guaranteed access to coordinated PHC and expanded offer of specialized public services and rehabilitation, aligned with the principles of humanized care, in addition to the maintenance of social support measures.

National keynote lecture: Establishing primary care, Turkey and Azerbaijan primary care organization

Health systems built based on primary health care are fundamental to succeeding universal health coverage. Well-organised primary healthcare services can play a basic role in improving population health as well as the well-being of the population. Although significant improvements in the health outcomes of the global population during the era of the Millennium Development Goals, nearly half of the population cannot access the health services, they need. Health is central to the 2030 Agenda for Sustainable Development as it relates to many of the Sustainable Development Goals and is the specific focus of Goal 3. Outbreaks of global pandemics or emergencies like COVID-19 are the biggest challenges to the 'resilience' of primary care systems. Therefore, countries need to establish a regular system of facility assessments to provide objective measures for evaluating the health services' availability, readiness, quality, including measures to evaluate preparedness and response capacities. Barbara Starfield was the first author to explore the context of primary care organisation (PCO). She mentioned that organisation of primary care includes four main primary care domains: first-contact care, comprehensiveness, continuity, and coordination. In 2008 Hogg et al., proposed that the conceptual framework for PCO consists of structural and performance domains and this domain classification influenced new authors on the subject until today. The structural domain includes three components;the health care system, the practice context and the organisation of the practice;and the performance domain includes two components;healthcare service delivery and technical quality of clinical care. According to Kringos et al., the structure of primary care consists of three dimensions: primary care governance, financing of primary care and primary care workforce development. They determined the primary care process by four dimensions: accessibility of primary care, comprehensiveness of primary care;continuity of primary care;and coordination of primary care. Senn et al., proposed a consolidated framework, which is particularly beneficial for primary care organisations designing and implementing well-defined monitoring activities. With the addition socio-cultural, economic and biological contexts, the framework became multidimensional and in-depth. Inclusion of needs and outcomes of patients and the population has the potential to cover the productivity of the given organisation. Strong primary care requires well-developed organisational planning between levels of care. Primary care-oriented health systems are required to effectively handle the unmet health needs of the population. An efficient primary care organisation is very important for achieving a primary care-oriented health system. In this keynote, PCO's key aspects and benchmarks will be explored based on previously mentioned frameworks and domains. As an example of health systems in transition, Turkey and Azerbaijan are reforming their health systems, including primary care services. Turkey has completed the implementation of several interventions in the structural component of primary care, however, there is still room for development in the process components. Azerbaijan has established a state health insurance scheme and set up family health centres as primary care facilities serving a defined population. However, serious structural reforms are still needed for a functional primary care service accessible to the whole nation. This keynote will also cover more information on recent primary care reforms in both countries. The frameworks provided above will serve as tools for analysing primary care in these countries.

The 2023 CPT Coding and Medicare Payment Update

There are a host of changes that will affect family physicians, including new vaccine codes and bundled Medicare payments for chronic pain management.

In‐person MH service decline during pandemic offset by telehealth increases

Although the pandemic disrupted in‐person mental health care, that disruption was counteracted by a rapid expansion of telehealth service use by adults with such disorders as depression, anxiety and post‐traumatic stress disorder, according to new research by the RAND Corporation.

Editor's picks on ModernHealthcare.com

This section offers news briefs in the U.S. healthcare industry as of January 2, 2023. Topics include a slowdown in healthcare spending growth in 2021 based on data from the Centers for Medicare and Medicaid Services, the proposal from MEDICARE CMS to raise Medicare Advantage marketing, rating stakes, and the value-based arrangements made by Blue Cross Blue Shield of Massachusetts with four health systems that offer financial incentives for eliminating health disparities in outpatient care.

Eastern Mediterranean Health Journal [2022;Vol.28, Issue 6]

Eastern Mediterranean Health Journal is the official health journal published by the Eastern Mediterranean Regional Office of the World Health Organization. It is a forum for the presentation and promotion of new policies and initiatives in health services;and for the exchange of ideas concepts epidemiological data research findings and other information with special reference to the Eastern Mediterranean Region. It addresses all members of the health profession medical and other health educational institutes interested NGOs WHO Collaborating Centres and individuals within and outside the Region. المجلة الصحية لشرق المتوسط هى المجلة الرسمية التى تصدرعن المكتب الاقليمى لشرق المتوسط بمنظمة الصحة العالمية. وهى منبر لتقديم السياسات والمبادرات الجديدة فى الصحة العامة والخدمات الصحية والترويج لها، و لتبادل الاراء و المفاهيم والمعطيات الوبائية ونتائج الابحاث وغير ذلك من المعلومات، و خاصة ما يتعلق منها باقليم شرق المتوسط. وهى موجهة الى كل اعضاء المهن الصحية، والكليات الطبية وسائر المعاهد التعليمية، و كذا المنظمات غير الحكومية المعنية، والمراكز المتعاونة مع منظمة الصحة العالمية والافراد المهتمين بالصحة فى الاقليم و خارجه La Revue de Santé de la Méditerranée Orientale est une revue de santé officielle publiée par le Bureau régional de l’Organisation mondiale de la Santé pour la Méditerranée orientale. Elle offre une tribune pour la présentation et la promotion de nouvelles politiques et initiatives dans le domaine de la santé publique et des services de santé ainsi qu’à l’échange d’idées de concepts de données épidémiologiques de résultats de recherches et d’autres informations se rapportant plus particulièrement à la Région de la Méditerranée orientale. Elle s’adresse à tous les professionnels de la santé aux membres des instituts médicaux et autres instituts de formation médico-sanitaire aux ONG Centres collaborateurs de l’OMS et personnes concernés au sein et hors de la Région.

Rehabilitations- und Vorsorgeeinrichtungen in der Corona-Krise: Situation und postpandemische Perspektive

Background During the early phase of the Corona pandemic (March to July 2020) rehab clinics were supposed to stop offering rehab treatment in order to be ready for admitting low-care patients from acute hospitals. On the other hand, acute care hospitals postponed elective interventions for the benefit of Corona patients and rehab patients denied treatment due to the fear of becoming infected. As a consequence a loss in revenue turns out while additional costs for infection protection management arose simultaneously. Methodology Aim of the study was to specify the economic risks of rehab facilities caused by the pandemic as well as the increasing medical requirements. Based on a structured questionnaire 97 rehab providers were polled referring to e. g. the „medical treatment situation", the „revenue development", the „cost pressure" and the „effects of supporting activities of the government". Results The revenue of rehab clinics collapsed intermittently up to 70 % compared to the previous year. Simultaneously, additional costs of 349 € per patient and employee per treatment cycle (21 days) accumulated due to decreed infection prevention arrangements. This unplanned cost burden corresponds roughly to 13 % of the revenue per case. The decline of rehab treatments under the pandemic will lead on to an exaggerated demand of medically necessary treatments in future. This congestion of non-performed rehab treatments is prognosed to exceed 20 % to 25 % of the rehab treatments performed in 2019. In 29 % of the facilities the shortage of personal protective equipment was associated with dysfunctional workflows and endangerment of patients suffering an infection. 71 % of the rehab facilities stated not to have benefitted from the procurement initiative of the German Ministry of Health. Discussion The Corona pandemic has reinforced the economic vulnerability of many rehab providers. This, due to additional costs for infection prevention activities, revenue losses owing to reduced occupancy and because of an investment bottleneck accumulated over years. Furthermore, the reimbursement system is complained not to cover the total costs of treatment in an economically sufficient way. Necessary investments in infection protection are a cost-driver but also lead to a factual impairment of treatment capacity. As a consequence, a piling up of medically essential rehab treatment is assumed to happen and will effect an increasing disease burden in the health system. Core Message The risk of insolvency has enhanced for rehab facilities due to the pandemic. Simultaneously, medical requirements have arisen and cost pressure has become more intensive. Because rehabilitation to play a pivotal role in public services the reimbursement system of the rehab sector is urged to be changed. One strong opinion requires to finance the costs of keeping rehab facilities. Indeed, this financing approach should be based on an assessment of the rehab demand. Furthermore, the operating costs are advised to be paid depended on medical quality, physical condition of the patient and the complexity of treatment. Zusammenfassung: Hintergrund Bereits in den ersten 6 Monaten der Pandemie erlitten die Rehabilitations- und Vorsorgeeinrichtungen massive Erlöseinbußen. Dies einerseits durch die Aussetzung von Heilverfahren und Nachsorgeangeboten sowie die Verpflichtung, im Bedarfsfall verlegbare Patienten aus Akutkrankenhäusern zu übernehmen;andererseits führte die Verschiebung elektiver Eingriffe zugunsten der prioritären Behandlung von Covid-19-Patienten in den Akuthäusern sowie die Angst von Reha-Patienten vor einer Infektion zu einem Nachfragerückgang. Demgegenüber entstanden erhebliche Zusatzkosten durch die Organisation infektionssicherer Arbeitsabläufe sowie die Beschaffung von Produkten der persönlichen Schutzausrüstung (PSA) auf einem überhitzten freien Markt. Das Insolvenzrisiko für die Reha-Einrichtungen erhöhte sich. Methoden Ziel der Studie war es, die ökonomischen und ablauforganisatorischen Konsequenzen sowie die Infektionsrisiken für Personal und Patienten einer Unterversorgung mit PSA-Produkten im Bereich der Rehabilitation zu ermitteln sowie die Effektivität staatlicher Eingriffe bei der Beschaffung von PSA-Produkten zu reflektieren. Durchgeführt wurde im Zeitraum 25. bis 28. Woche 2020 eine Online-Befragung unter 79 Einrichtungen mittels strukturiertem Fragebogen, u. a. spezifiziert nach den Erhebungsbereichen „Versorgungssituation bei PSA-Produkten", „Umgang mit PSA-Versorgungsengpässen", „Ertragssituation", „Zusatzkosten" und „Wirksamkeit staatlicher Hilfsmaßnahmen". In weiteren 18 Einrichtungen wurden Einzelinterviews zur Praxis des Pandemie-Managements vor Ort geführt. Die Erhebung wurde auf orthopädische, kardiologische und neurologische Einrichtungen konzentriert. Ergebnisse Der Umsatz der Einrichtungen ging um zeitweise bis zu 70 % gegenüber dem Vorjahr zurück, gleichzeitig erhöhten sich die Kosten für Infektionsprophylaxe um durchschnittlich 349 € pro Patient und Mitarbeiter pro Behandlungszyklus (21 Tage), was etwa 13 % des Fall-Erlöses bedeutete. Durch den Rückgang bei Patientenbehandlungen während der Pandemie baute sich ein Behandlungsstau auf, der zwischen 20 und 25 % der Reha-Leistungen des Jahres 2019 entspricht und die Krankheitslast im Gesundheitssystem zukünftig erhöhen wird. Der Mangel an Schutzausrüstung führte in 29 % der Einrichtungen zu erschwerten Arbeitsabläufen mit Infektionsgefährdung für Patienten und Mitarbeitende. Von der Beschaffungsinitiative des Bundesministeriums für Gesundheit fühlten sich 71 % der Einrichtungen nicht versorgt. Diskussion Die Corona-Pandemie hat die Anfälligkeit zahlreicher Reha-Einrichtungen für eine wirtschaftliche Schieflage verstärkt. Ursache dafür sind pandemiebedingte Zusatzkosten, Erlösausfälle aufgrund von Belegungsrückgängen und ein Investitionsstau in zahlreichen Einrichtungen. Notwendige Maßnahmen des Infektionsschutzes erhöhen nicht nur die Kostenbelastung, sondern vermindern faktisch die verfügbare Behandlungskapazität. Als Konsequenz ist ein Behandlungsstau zu erwarten, der mit erhöhter Krankheitslast im Gesundheitssystem verbunden sein wird. Kernbotschaft Das Insolvenzrisiko hat sich für Rehabilitations- und Vorsorgeeinrichtungen durch die Corona-Krise erhöht, gleichzeitig sind die Anforderungen an medizinische Qualität und Infektionsschutz ebenso wie die Vorhalte- und Behandlungskosten gestiegen. Eine Reform der Refinanzierung von Reha-Leistungen ist notwendig: Dies betrifft die Finanzierung von Vorhaltekosten von Reha-Einrichtungen als Teil der Daseinsvorsorge. Hier ist allerdings eine versorgungsstrukturelle und institutionenorientierte Bedarfsermittlung vorzuschalten, um Mitnahmeeffekten vorzubeugen. Weiterhin ist die Vergütung der Betriebskosten qualitäts- und aufwandorientiert am Krankheitsbild und am Patientenzustand vorzunehmen.