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1.
BMC Health Serv Res ; 24(1): 517, 2024 Apr 24.
Article in English | MEDLINE | ID: mdl-38658925

ABSTRACT

OBJECTIVE: This study aimed to assess the service quality (SQ) for Type 2 diabetes mellitus (T2DM) and hypertension in primary healthcare settings from the perspective of service users in Iran. METHODS: The Cross-sectional study was conducted from January to March 2020 in urban and rural public health centers in the East Azerbaijan province of Iran. A total of 561 individuals aged 18 or above with either or both conditions of T2DM and hypertension were eligible to participate in the study. The study employed a two-step stratified sampling method in East Azerbaijan province, Iran. A validated questionnaire assessed SQ. Data were analyzed using One-way ANOVA and multiple linear regression statistical models in STATA-17. RESULTS: Among the 561 individuals who participated in the study 176 (31.3%) were individuals with hypertension, 165 (29.4%) with T2DM, and 220 (39.2%) with both hypertension and T2DM mutually. The participants' anthropometric indicators and biochemical characteristics showed that the mean Fasting Blood Glucose (FBG) in individuals with T2DM was 174.4 (Standard deviation (SD) = 73.57) in patients with T2DM without hypertension and 159.4 (SD = 65.46) in patients with both T2DM and hypertension. The total SQ scores were 82.37 (SD = 12.19), 82.48 (SD = 12.45), and 81.69 (SD = 11.75) for hypertension, T2DM, and both conditions, respectively. Among people with hypertension and without diabetes, those who had specific service providers had higher SQ scores (b = 7.03; p = 0.001) compared to their peers who did not have specific service providers. Those who resided in rural areas had lower SQ scores (b = -6.07; p = 0.020) compared to their counterparts in urban areas. In the group of patients with T2DM and without hypertension, those who were living in non-metropolitan cities reported greater SQ scores compared to patients in metropolitan areas (b = 5.09; p = 0.038). Additionally, a one-point increase in self-management total score was related with a 0.13-point decrease in SQ score (P = 0.018). In the group of people with both hypertension and T2DM, those who had specific service providers had higher SQ scores (b = 8.32; p < 0.001) compared to the group without specific service providers. CONCLUSION: Study reveals gaps in T2DM and hypertension care quality despite routine check-ups. Higher SQ correlates with better self-care. Improving service quality in primary healthcare settings necessitates a comprehensive approach that prioritizes patient empowerment, continuity of care, and equitable access to services, particularly for vulnerable populations in rural areas.


Subject(s)
Diabetes Mellitus, Type 2 , Hypertension , Primary Health Care , Quality of Health Care , Humans , Diabetes Mellitus, Type 2/therapy , Hypertension/therapy , Hypertension/epidemiology , Iran , Cross-Sectional Studies , Male , Female , Middle Aged , Primary Health Care/standards , Primary Health Care/statistics & numerical data , Quality of Health Care/statistics & numerical data , Quality of Health Care/standards , Adult , Aged , Surveys and Questionnaires , Rural Health Services/standards , Rural Health Services/statistics & numerical data , Urban Health Services/standards , Urban Health Services/statistics & numerical data , Rural Population/statistics & numerical data , Urban Population/statistics & numerical data
2.
J Stroke Cerebrovasc Dis ; 33(6): 107702, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38556068

ABSTRACT

OBJECTIVE: To examine the relationship between stroke care infrastructure and stroke quality-of-care outcomes at 29 spoke hospitals participating in the Medical University of South Carolina (MUSC) hub-and-spoke telestroke network. MATERIALS AND METHODS: Encounter-level data from MUSC's telestroke patient registry were filtered to include encounters during 2015-2022 for patients aged 18 and above with a clinical diagnosis of acute ischemic stroke, and who received intravenous tissue plasminogen activator. Unadjusted and adjusted generalized estimating equations assessed associations between time-related stroke quality-of-care metrics captured during the encounter and the existence of the two components of stroke care infrastructure-stroke coordinators and stroke center certifications-across all hospitals and within hospital subgroups defined by size and rurality. RESULTS: Telestroke encounters at spoke hospitals with stroke coordinators and stroke center certifications were associated with shorter door-to-needle (DTN) times (60.9 min for hospitals with both components and 57.3 min for hospitals with one, vs. 81.2 min for hospitals with neither component, p <.001). Similar patterns were observed for the percentage of encounters with DTN time of ≤60 min (63.8% and 68.9% vs. 32.0%, p <.001) and ≤45 min (34.0% and 38.4% vs. 8.42%, p <.001). Associations were similar for other metrics (e.g., door-to-registration time), and were stronger for smaller (vs. larger) hospitals and rural (vs. urban) hospitals. CONCLUSIONS: Stroke coordinators or stroke center certifications may be important for stroke quality of care, especially at spoke hospitals with limited resources or in rural areas.


Subject(s)
Delivery of Health Care, Integrated , Fibrinolytic Agents , Ischemic Stroke , Quality Indicators, Health Care , Registries , Telemedicine , Thrombolytic Therapy , Time-to-Treatment , Tissue Plasminogen Activator , Humans , South Carolina , Male , Female , Time Factors , Aged , Treatment Outcome , Delivery of Health Care, Integrated/organization & administration , Middle Aged , Quality Indicators, Health Care/standards , Tissue Plasminogen Activator/administration & dosage , Fibrinolytic Agents/administration & dosage , Ischemic Stroke/therapy , Ischemic Stroke/diagnosis , Aged, 80 and over , Models, Organizational , Rural Health Services/organization & administration , Rural Health Services/standards , Hospital Bed Capacity , Outcome and Process Assessment, Health Care/standards , Hospitals, Rural/standards , Urban Health Services/standards , Urban Health Services/organization & administration , Stroke/therapy , Stroke/diagnosis
3.
Pan Afr Med J ; 38: 320, 2021.
Article in English | MEDLINE | ID: mdl-34285743

ABSTRACT

INTRODUCTION: all pregnant women are at potential risk of obstetric complications; majority of which can be treated if appropriate care is accessed promptly. A shift in focus to quality of care has the potential to unlock significant returns for every mother and newborn to end preventable maternal and infant deaths. The study aimed to assess the quality of maternal health services in primary health facilities in urban and rural communities of Kano State. METHODS: using a comparative cross-sectional study design that utilized mixed method of data collection, interviewer administered questionnaire were used to collect information from 438 women (219) each attending health facilities for maternal health services in rural and urban areas of Kano using multistage sampling technique from June to November, 2019. Six Key Informant Interviews with the heads of units/ facilities were purposively conducted. Quality of care was assessed using perspectives and system models based on the components of antenatal care received, postnatal care and perception of care received. A statistical significance was set at p-value < 0.05. Thematic framework analysis was used to analyze verbatim transcript from qualitative interviews. RESULTS: the age of the respondents ranged from 18-48 years with majority having secondary education in both communities. In both urban and rural communities, majority of the respondents had only 1-3 antenatal care visits making up 63.5% and 70.3% respectively. Almost similar proportions of the urban (58.4%) and rural (50.2%) respondents were delivered by a skilled birth attendant. About two-third of the respondents, 67.6% and 65.3% in the urban and rural communities respectively were completely satisfied with the quality of care received. Qualitative interviews pointed ignorance as the major factor that prevent mothers from accessing quality care and reported that satisfactory services were provided in all facilities. CONCLUSION: considerable disparity exists between urban and rural communities in quality of maternal health services with better provision of most services in the urban communities. There is need for improvement in the desirable and minimum acceptable quality of maternal health services in Kano State.


Subject(s)
Maternal Health Services/standards , Quality of Health Care , Rural Health Services/standards , Urban Health Services/standards , Adolescent , Adult , Cross-Sectional Studies , Female , Humans , Infant, Newborn , Maternal Health Services/statistics & numerical data , Middle Aged , Nigeria , Patient Satisfaction , Pregnancy , Prenatal Care/standards , Prenatal Care/statistics & numerical data , Rural Health Services/statistics & numerical data , Urban Health Services/statistics & numerical data , Young Adult
4.
J Am Heart Assoc ; 10(15): e019305, 2021 08 03.
Article in English | MEDLINE | ID: mdl-34323113

ABSTRACT

Background Timely emergency medical services (EMS) response, management, and transport of patients with suspected acute coronary syndrome (ACS) significantly reduce delays to emergency treatment and improve outcomes. We evaluated EMS response, scene, and transport times and adherence to proposed time benchmarks for patients with suspected ACS in North Carolina from 2011 to 2017. Methods and Results We conducted a population-based, retrospective study with the North Carolina Prehospital Medical Information System, a statewide electronic database of all EMS patient care reports. We analyzed 2011 to 2017 data on patient demographics, incident characteristics, EMS care, and county population density for EMS-suspected patients with ACS, defined as a complaint of chest pain or suspected cardiac event and documentation of myocardial ischemia on prehospital ECG or prehospital activation of the cardiac care team. Descriptive statistics for each EMS time interval were computed. Multivariable logistic regression was used to quantify relationships between meeting response and scene time benchmarks (11 and 15 minutes, respectively) and prespecified covariates. Among 4667 patients meeting eligibility criteria, median response time (8 minutes) was shorter than median scene (16 minutes) and transport (17 minutes) time. While scene times were comparable by population density, patients in rural (versus urban) counties experienced longer response and transport times. Overall, 62% of EMS encounters met the 11-minute response time benchmark and 49% met the 15-minute scene time benchmark. In adjusted regression analyses, EMS encounters of older and female patients and obtaining a 12-lead ECG and venous access were independently associated with lower adherence to the scene time benchmark. Conclusions Our statewide study identified urban-rural differences in response and transport times for suspected ACS as well as patient demographic and EMS care characteristics related to lower adherence to scene time benchmark. Strategies to reduce EMS scene times among patients with ACS need to be developed and evaluated.


Subject(s)
Acute Coronary Syndrome/therapy , Emergency Medical Services/standards , Healthcare Disparities/standards , Time-to-Treatment , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/physiopathology , Adult , Aged , Aged, 80 and over , Benchmarking/standards , Databases, Factual , Emergency Service, Hospital/standards , Female , Guideline Adherence/standards , Humans , Male , Middle Aged , North Carolina , Practice Guidelines as Topic/standards , Quality Improvement/standards , Quality Indicators, Health Care/standards , Retrospective Studies , Rural Health Services/standards , Time Factors , Transportation of Patients/standards , Urban Health Services/standards
5.
Pan Afr Med J ; 38: 35, 2021.
Article in English | MEDLINE | ID: mdl-33777303

ABSTRACT

INTRODUCTION: unsafe injection practices are commonplace in low-income countries, and place health care workers at risk of blood-borne infections. A safe injection strategy requires a synchronized approach to deal with change in behavior of users and service providers towards safer practice. There is general lack of data on injection safety practices in Cross River State. This was a baseline study to compare the knowledge and practice of safe injection practices among primary health care (PHC) workers in urban and rural health facilities in Cross River State, Nigeria. METHODS: this was a cross-sectional comparative study among PHC workers in randomly selected rural and urban Local Government Areas (LGAs). Using multistage sampling technique, a total of 320 respondents: 160 from the urban LGAs and 160 from the rural LGAs were interviewed. Semi-structured interviewer administered questionnaires were used to obtain data. Data analysis was done using STATATM version 14.0. Associations were tested using Chi square, and multivariate logistic regression analysis. RESULTS: in this study, there was no difference in the baseline knowledge (58.8% vs. 55.0%, P=0.499) and practice (33.1% vs. 34.4%, P=0.813) of injection safety between PHC workers in the urban and rural locations. In the multivariate logistic regression model, the senior health workers had a two-fold increased odds of practicing safe injection compared to their junior counterparts [OR=2.21 (95% CI: 1.28,3.84)]. CONCLUSION: in both the urban and rural locations, there was good knowledge but poor practice of injection safety among respondents in the LGAs; hence, the need to organize periodic injection safety training and retraining of PHC workers targeting junior workers to improve on the practices of injection safety.


Subject(s)
Health Knowledge, Attitudes, Practice , Health Personnel/statistics & numerical data , Injections/standards , Primary Health Care/standards , Adult , Cross-Sectional Studies , Female , Health Personnel/standards , Humans , Male , Middle Aged , Nigeria , Rural Health Services/standards , Surveys and Questionnaires , Urban Health Services/standards , Young Adult
6.
Pan Afr Med J ; 37(Suppl 1): 18, 2020.
Article in English | MEDLINE | ID: mdl-33343797

ABSTRACT

INTRODUCTION: the increased demands of health facilities and workers due to coronavirus overwhelm the already burdened Tanzanian health systems. This study evaluates the current capacity of facilities and providers for HIV care and treatment services and their preparedness to adhere to the national and global precaution guidelines for HIV service providers and patients. METHODS: data for this study come from the latest available, Tanzania Service Provision Assessment survey 2014-15. Frequencies and percentages described the readiness and availability of HIV services and providers. Chi-square test compared the distribution of services by facility location and availability and readiness of precaution commodities and HIV services by managing authorities. RESULTS: availability of latex gloves was high (83% at OPD and 95.3% laboratory). Availability of medical masks, alcohol-based hand rub and disinfectants was low. Availability of medical mask at outpatient department (OPD) was 28.7% urban (23.5% public; 33.8% private, p=0.02) and 13.5% rural (10.1% public; 25.4% private, p=0.001) and lower at laboratories. Fewer facilities in rural area (68.4%) had running water in OPD than urban (86.3%). Higher proportions of providers at public than private facilities in urban (82.8% versus 73.1%) and rural (88.2% versus 81.6%) areas provided HIV test counseling and at least two other HIV services. CONCLUSION: availability of commodities such as medical masks, alcohol-based hand rub, and disinfectant was low while the readiness of providers to multitask HIV related services was high. Urgent distribution and re-assessment of these supplies are necessary, to protect HIV patients, their caregivers, and health providers from COVID-19.


Subject(s)
COVID-19/prevention & control , Delivery of Health Care/statistics & numerical data , HIV Infections/therapy , Health Facilities/statistics & numerical data , Delivery of Health Care/standards , Disinfectants/supply & distribution , Guideline Adherence/statistics & numerical data , Hand Sanitizers/supply & distribution , Health Care Surveys , Health Facilities/standards , Humans , Masks/supply & distribution , Private Facilities/standards , Private Facilities/statistics & numerical data , Public Facilities/standards , Public Facilities/statistics & numerical data , Rural Health Services/standards , Rural Health Services/statistics & numerical data , Tanzania , Urban Health Services/standards , Urban Health Services/statistics & numerical data
7.
Obstet Gynecol ; 136(4): 739-744, 2020 10.
Article in English | MEDLINE | ID: mdl-32925622

ABSTRACT

Since 1970, the American College of Obstetricians and Gynecologists' Committee on American Indian and Alaska Native Women's Health has partnered with the Indian Health Service and health care facilities serving Native American women to improve quality of care in both rural and urban settings. Needs assessments have included formal surveys, expert panels, consensus conferences, and onsite program reviews. Improved care has been achieved through continuing professional education, recruitment of volunteer obstetrician-gynecologists, advocacy, and close collaboration at the local and national levels. The inclusive and multifaceted approach of this program should provide an effective model for collaborations between specialty societies and health care professionals providing primary care services that can reduce health disparities in underserved populations.


Subject(s)
Gynecology , Health Services Accessibility , Obstetrics , Quality Improvement/organization & administration , Women's Health Services , Female , Health Services Accessibility/organization & administration , Health Services Accessibility/standards , Health Services Accessibility/trends , Healthcare Disparities/ethnology , Humans , Indians, North American , Intersectoral Collaboration , Program Evaluation , Rural Health Services/standards , Surveys and Questionnaires , United States/epidemiology , Urban Health Services/standards , Vulnerable Populations/ethnology , Women's Health Services/organization & administration , Women's Health Services/standards , Women's Health Services/trends
8.
BMC Health Serv Res ; 20(1): 372, 2020 May 04.
Article in English | MEDLINE | ID: mdl-32366235

ABSTRACT

BACKGROUND: Despite improvement in health outcomes over the past few decades, China still experiences striking rural-urban health inequalities. There is limited research on the rural-urban differences in health system performance in China. METHOD: We conducted a cross-sectional analysis to compare health system performance between rural and urban areas in five key domains of the health system: effectiveness, cost, access, patient-centredness and equity, using data from the WHO Study on Global AGEing and adult health (SAGE), China. Multiple logistic and linear regression models were used to assess the first four domains, adjusting for individual characteristics, and a relative index of inequality (RII) was used to measure the equity domain. FINDINGS: Compared to urban areas, rural areas had poorer performance in the management and control of hypertension and diabetes, with more than 50% lower odds of having breast (AOR = 0.44; 95% CI: 0.30, 0.64) and cervical cancer screening (AOR = 0.49; 95% CI: 0.29, 0.83). There was better performance in rural areas in the patient-centredness domain, with more than twice higher odds of getting prompt attention, respect, clarity of the communication with health provider and involvement in decision making of the treatment in inpatient care (AOR = 2.56, 2.15, 2.28, 2.28). Although rural residents incurred relatively less out-of-pocket expenditures (OOPE) for outpatient and inpatient services than urban residents, they were more likely to incur catastrophic expenditures on health (AOR = 1.30; 95% CI 1.16, 1.44). Wealth inequality was found in many indicators related to the effectiveness, costs and access domains in both rural and urban areas. Rural areas had greater inequalities in the management of hypertension and coverage of cervical cancer (RII = 7.45 vs 1.64). CONCLUSION: Our findings suggest that urban areas have achieved better prevention and management of non-communicable disease than rural areas, but access to healthcare was equivalent. A better understanding of the causes of the observed variations is needed to develop appropriate policy interventions which address these disparities.


Subject(s)
Quality Indicators, Health Care/statistics & numerical data , Rural Health Services/standards , Urban Health Services/standards , Aged , China , Cross-Sectional Studies , Female , Health Services Research , Health Status Disparities , Humans , Male , Middle Aged , Rural Population/statistics & numerical data , Urban Population/statistics & numerical data
9.
BMJ Open Qual ; 9(2)2020 04.
Article in English | MEDLINE | ID: mdl-32269056

ABSTRACT

In 2017, almost 4000 Canadians died from opioid-related causes. Coadministration of opioids and benzodiazepines is a risk factor for overdose. Few studies have evaluated leveraging pharmacists to address opioid-benzodiazepine coprescribing. Our aim was to develop and test a role for pharmacists as opioid stewards, to reduce opioid and benzodiazepine doses in coprescribed patients. We conducted Plan-Do-Study-Act cycles between November 2017 and May 2018 across two primary care centre clinics. A third clinic acted as a control. Our intervention included a pharmacist: (1) identifying patients through medical record queries; (2) developing care plans; (3) discussing recommendations with physicians and (4) discussing implementing recommendations. We refined the intervention according to patient and physician feedback. At the intervention clinics, the number of patients with pharmacist developed care plans increased from less than 20% at baseline to over 60% postintervention. There was also a fourfold increase in the number of patients with an active opioid taper. At the control clinic, the number of patients with pharmacist developed care plans remained relatively stable at less than 20%. The number of patients with active opioid tapers remained zero. At the intervention clinics, mean daily opioid dose decreased 11% from 50.5 milligrams morphine equivalent (MME) to 44.7 MME. At the control clinic, it increased 15% from 62.3 MME to 71.4 MME. The number of patients with a benzodiazepine taper remained relatively stable at both the intervention and control clinics at less than 20%. At the intervention clinics, mean daily benzodiazepine dose decreased 8% from 9.9 milligrams diazepam equivalent (MDE) to 9.3 MDE. At the control clinic, it decreased 4% from 10.8 MDE to 10.4 MDE. A proactive, pharmacist-led intervention for coprescribed patients increased opioid tapers and decreased opioid and benzodiazepine doses. Future work will help us understand whether sustaining the intervention ultimately reduces rates of opioid-benzodiazepine coprescribing.


Subject(s)
Analgesics, Opioid/therapeutic use , Benzodiazepines/therapeutic use , Medical Overuse/prevention & control , Academic Medical Centers/organization & administration , Academic Medical Centers/statistics & numerical data , Aged , Analgesics, Opioid/standards , Canada , Female , Humans , Male , Medical Overuse/statistics & numerical data , Middle Aged , Practice Patterns, Physicians'/standards , Practice Patterns, Physicians'/statistics & numerical data , Primary Health Care/methods , Urban Health Services/standards , Urban Health Services/statistics & numerical data
10.
Pan Afr Med J ; 37: 313, 2020.
Article in English | MEDLINE | ID: mdl-33654532

ABSTRACT

INTRODUCTION: inspite of the demonstrable evidence of the preventive and protective ability of vaccines to reduce the outbreak of vaccine-preventable diseases, there are still some significant disease outbreaks recorded in our communities. In some settings, these outbreaks have been linked with poor vaccine management. Therefore, this study was conducted to compare the cold chain practices in Oyo State, Nigeria. METHODS: we conducted a cross-sectional survey among health workers in the local government areas of Oyo State between October and November 2019. Using purposive sampling, we recruited all the 84 routine immunization focal persons for the study. A self-administered questionnaire was used to collect data on cold chain management. Data were analyzed using SPSS version 24 and bivariate analysis was done using Chi-square. Statistical significance was set at p < 0.05. RESULTS: the mean age of the respondents was 46.4 ± 6.7 years. Most prevalent cadre in the rural facilities was health assistants (87.5%) while Community Extension Health Workers (54.8%) were prevalent in the urban (p = 0.002). The proportion of respondents with adequate cold chain equipment was significantly higher in the urban compared with the rural area. The cold boxes were the only adequate cold chain equipment found in the rural health facilities compared with the urban (p = 0.036). CONCLUSION: there was a low proportion of qualified health workers and inadequate cold chain equipment in the rural area compared with the urban facilities. Engagement of skilled health workers and supply of the cold chain equipment are recommended.


Subject(s)
Poliomyelitis/prevention & control , Poliovirus Vaccines/administration & dosage , Poliovirus/immunology , Refrigeration/standards , Adult , Cross-Sectional Studies , Disease Outbreaks , Drug Storage/standards , Female , Health Personnel/standards , Health Personnel/statistics & numerical data , Humans , Male , Middle Aged , Nigeria/epidemiology , Poliomyelitis/epidemiology , Poliovirus Vaccines/immunology , Rural Health Services/standards , Surveys and Questionnaires , Urban Health Services/standards , Vaccination/standards
11.
J Intensive Care Med ; 35(1): 82-90, 2020 Jan.
Article in English | MEDLINE | ID: mdl-28931361

ABSTRACT

BACKGROUND: In the new era of decreasing hospital bed availability, there is an increasing rate of direct discharge to home (DDH) from intensive care units (ICUs), despite sparse literature informing this practice. OBJECTIVES: To evaluate patient, family, and ICU attending physician satisfaction with planning for DDH from the ICU and intensivists' current DDH practices and perceptions. METHODS: Prospective cohort study, using convenience sampling, of adult patients undergoing DDH from an ICU between February 2016 and February 2017 using a modified FS-ICU 24 satisfaction survey completed by patients, family members, and attending physicians at the time of patient discharge to home from the ICU. RESULTS: Seventy-two percent of patients, 37% of family members, and 100% of ICU physicians recruited completed the survey. A majority of patients (89%) and families (78%) were satisfied or very satisfied with DDH. Only 6% of patients and 8% of families were dissatisfied to very dissatisfied with DDH. Conversely, ICU physician satisfaction varied, with only 5% being very comfortable with DDH and the majority (50%) only somewhat comfortable. Twenty percent of staff consultants were uncomfortable to very uncomfortable with the practice of DDH. Thirty-one percent of staff physician respondents felt that patient and family discomfort would be barriers to DDH. Compared to physicians and other allied health professionals, nurses were identified as the most helpful members of the health-care team in preparation for DDH by 98% of patients and 92% of family members. The DDH rates have increased for the past 12 years in our ICUs but declined during the study period (February 2016 to February 2017). CONCLUSIONS: Patients and family members are satisfied with the practice of DDH from ICU, although ICU physician satisfaction is more variable. Physician comfort may be improved by data informing which patients may be safely DDH from the ICU.


Subject(s)
Attitude of Health Personnel , Intensive Care Units/statistics & numerical data , Patient Discharge/standards , Patient Satisfaction , Adult , Aged , Canada , Family , Female , Humans , Male , Middle Aged , Prospective Studies , Urban Health Services/standards
12.
Surgery ; 167(1): 211-215, 2020 01.
Article in English | MEDLINE | ID: mdl-31564486

ABSTRACT

BACKGROUND: Primary aldosteronism is a common cause of secondary hypertension. Treatment with adrenalectomy or mineralocorticoid receptor-blockers can prevent long-term adverse outcomes. This study aimed to determine primary aldosteronism screening rats in patients with hypertension in an underserved urban healthcare system. METHODS: We reviewed records of outpatient adults in an urban healthcare system from 2013 to 2017. Chart review along with International Statistical Classification of Diseases, 9th and 10th editions, diagnosis codes were used to identify patients meeting inclusion criteria for screening according to the 2016 Endocrine Society guidelines. The corresponding aldosterone, plasma renin activity, and 24-hour urine aldosterone values were identified. Multivariate logistic regression was performed to determine positive predictors of screening. RESULTS: Of 15,511 hypertensive patients seen, 6,809 (43.8%) met criteria for screening. Blacks were the most common racial group, and Medicare and Medicaid were the most frequent insurers. The aldosterone-to-renin ratio level was checked in 86 (1.3%) patients; 22 (25.6%) had an aldosterone-to-renin ratio >20. Of the 77 patients with hypertension and incidentaloma, 14 (18.2%) had an aldosterone-to-renin ratio checked. Additional positive predictors for being screened were hypertension and hypokalemia and sustained hypertension. CONCLUSION: Screening rates for primary aldosteronism in an underserved population are low. Proper identification of primary aldosteronism in those at risk could help ameliorate long-term effects of disease.


Subject(s)
Guideline Adherence/statistics & numerical data , Hyperaldosteronism/diagnosis , Hypertension/etiology , Mass Screening/statistics & numerical data , Urban Health Services/statistics & numerical data , Aged , Aldosterone/blood , Aldosterone/urine , Animals , Consensus , Female , Humans , Hyperaldosteronism/blood , Hyperaldosteronism/complications , Hyperaldosteronism/urine , Hypertension/blood , Hypertension/urine , Male , Mass Screening/standards , Medicaid/statistics & numerical data , Medicare/statistics & numerical data , Middle Aged , New York , Practice Guidelines as Topic , Rats , Renin/blood , Retrospective Studies , United States , Urban Health Services/standards , Vulnerable Populations/statistics & numerical data
13.
Pan Afr Med J ; 33: 10, 2019.
Article in English | MEDLINE | ID: mdl-31303955

ABSTRACT

Epilepsy in Sudan accounts for 1.6 annual mortality rates and 238.7 disability adjusted life years per 100 000. These figures are higher among females; children and young adults. It is associated with notable stigma and social burdens. Patients of epilepsy are subjected to various forms of social discrimination that affect their quality of life. They are isolated, neglected and deprived of their education and employments rights and not able to achieve normal social and family life. Aiming at highlighting social implications of epilepsy among Sudanese patients, this study found that social encumbrances due to epilepsy in Sudan are more prevalent among highly vulnerable groups like women, children and poor populations living in remote areas. Lack of trained medical personnel in neurology and the medical equipment's required for proper diagnosis and treatment of epilepsy in Sudan are key reasons aggravating social and health burden of epilepsy both among patients and their caregivers.


Subject(s)
Epilepsy/therapy , Healthcare Disparities/statistics & numerical data , Quality of Life , Urban Health Services/standards , Child , Epilepsy/economics , Epilepsy/epidemiology , Female , Healthcare Disparities/economics , Humans , Male , Poverty , Social Discrimination , Sudan/epidemiology , Urban Health Services/economics , Urban Population/statistics & numerical data , Vulnerable Populations/statistics & numerical data , Young Adult
14.
Public Health Rep ; 134(4): 395-403, 2019.
Article in English | MEDLINE | ID: mdl-31158319

ABSTRACT

OBJECTIVES: The objectives of our study were to (1) illustrate a public health workforce assessment process in a medium-sized city or county health department and (2) demonstrate the insights gained by moving from the use of aggregate department-level and competency domain-level training needs results to more granular division-level and skills-level results when creating a workforce development plan. METHODS: We used a 130-question needs assessment to guide the creation of a workforce development plan for the Lincoln Lancaster County Health Department (LLCHD) in Nebraska and its 7 divisions. Using SurveyMonkey, we administered the survey to 128 (of the 129) LLCHD public health staff members in June 2015. Using a Likert scale, respondents indicated (1) the importance of the skill to their work and (2) their capacity to carry out 57 skills in 8 domains of the core competencies for public health professionals. We identified training needs as those for which the percentage of respondents who perceived moderate-to-high importance was at least 15 percentage points higher than the percentage of respondents who perceived moderate-to-high capacity. RESULTS: LLCHD as a department had training needs in only 2 competency domains: financial planning and management (importance-capacity difference, 15 percentage points) and policy development and program planning (importance-capacity difference, 19 percentage points). The Health Promotion and Outreach division had training needs in all 8 domains (importance-capacity difference range, 15-45 percentage points). Of the 57 skills, 41 were identified by at least 1 of the LLCHD divisions as having training needs. In 24 instances, a division did not qualify as having training needs in the overall domain yet did have training needs for specific skills within a domain. CONCLUSIONS: When performing public health workforce assessments, medium-to-large public health departments can obtain detailed workforce training needs results that pertain to individual skills and that are tailored to each of their divisions. These results may help customize and improve workforce development plans, ensuring that the workforce has the necessary skills to do its job.


Subject(s)
Health Planning Guidelines , Health Policy , Health Workforce/standards , Models, Organizational , Public Health Administration/standards , Urban Health Services/standards , Humans , Nebraska , Social Planning , United States
15.
West J Emerg Med ; 20(3): 477-484, 2019 May.
Article in English | MEDLINE | ID: mdl-31123549

ABSTRACT

INTRODUCTION: Attempts to reduce low-value hospital care often focus on emergency department (ED) hospitalizations. We compared rural and urban EDs in Michigan on resources designed to reduce avoidable admissions. METHODS: A cross-sectional, web-based survey was emailed to medical directors and/or nurse managers of the 135 hospital-based EDs in Michigan. Questions included presence of clinical pathways, services to reduce admissions, and barriers to connecting patients to outpatient services. We performed chi-squared comparisons, regression modeling, and predictive margins. RESULTS: Of 135 EDs, 64 (47%) responded with 33 in urban and 31 in rural counties. Clinical pathways were equally present in urban and rural EDs (67% vs 74%, p=0.5). Compared with urban EDs, rural EDs reported greater access to extended care facilities (21% vs 52%, p=0.02) but less access to observation units (52% vs 35%, p=0.04). Common barriers to connecting ED patients to outpatient services exist in both settings, including lack of social support (88% and 76%, p=0.20), and patient/family preference (68% and 68%, p=1.0). However, rural EDs were more likely to report time required for care coordination (88% vs 66%, p=0.05) and less likely to report limitations to home care (21% vs 48%, p=0.05) as barriers. In regression modeling, ED volume was predictive of the presence of clinical pathways rather than rurality. CONCLUSION: While rural-urban differences in resources and barriers exist, ED size rather than rurality may be a more important indicator of ability to reduce avoidable hospitalizations.


Subject(s)
Emergency Service, Hospital/statistics & numerical data , Medical Overuse/prevention & control , Rural Health Services/standards , Urban Health Services/standards , Ambulatory Care/methods , Ambulatory Care/standards , Continuity of Patient Care/standards , Critical Pathways/standards , Hospitals, High-Volume/statistics & numerical data , Hospitals, Low-Volume/statistics & numerical data , Humans , Michigan , Quality Assurance, Health Care
16.
Lancet Glob Health ; 7(5): e633-e643, 2019 05.
Article in English | MEDLINE | ID: mdl-30928341

ABSTRACT

BACKGROUND: In India, men are more likely than women to have active tuberculosis but are less likely to be diagnosed and notified to national tuberculosis programmes. We used data from standardised patient visits to assess whether these gender differences occur because of provider practice. METHODS: We sent standardised patients (people recruited from local populations and trained to portray a scripted medical condition to health-care providers) to present four tuberculosis case scenarios to private health-care providers in the cities of Mumbai and Patna. Sampling and weighting allowed for city representative interpretation. Because standardised patients were assigned to providers by a field team blinded to this study, we did balance and placebo regression tests to confirm standardised patients were assigned by gender as good as randomly. Then, by use of linear and logistic regression, we assessed correct case management, our primary outcome, and other dimensions of care by standardised patient gender. FINDINGS: Between Nov 21, 2014, and Aug 21, 2015, 2602 clinical interactions at 1203 private facilities were completed by 24 standardised patients (16 men, eight women). We found standardised patients were assigned to providers as good as randomly. We found no differences in correct management by patient gender (odds ratio 1·05; 95% CI 0·76-1·45; p=0·77) and no differences across gender within any case scenario, setting, provider gender, or provider qualification. INTERPRETATION: Systematic differences in quality of care are unlikely to be a cause of the observed under-representation of men in tuberculosis notifications in the private sector in urban India. FUNDING: Grand Challenges Canada, Bill & Melinda Gates Foundation, World Bank Knowledge for Change Program.


Subject(s)
Healthcare Disparities , Quality Assurance, Health Care/methods , Tuberculosis, Pulmonary/therapy , Urban Health Services/standards , Adolescent , Adult , Cross-Sectional Studies , Female , Humans , India , Male , Middle Aged , Quality Assurance, Health Care/standards , Quality of Health Care/standards , Sex Factors , Tuberculosis, Pulmonary/diagnosis , Young Adult
17.
JAMA Netw Open ; 2(3): e190138, 2019 03 01.
Article in English | MEDLINE | ID: mdl-30848804

ABSTRACT

Importance: Little is known about the distribution of life-saving trauma resources by racial/ethnic composition in US cities, and if racial/ethnic minority populations disproportionately live in US urban trauma deserts. Objective: To examine racial/ethnic differences in geographic access to trauma care in the 3 largest US cities, considering the role of residential segregation and neighborhood poverty. Design, Setting, and Participants: A cross-sectional, multiple-methods study evaluated census tract data from the 2015 American Community Survey in Chicago, Illinois; Los Angeles (LA), California; and New York City (NYC), New York (N = 3932). These data were paired to geographic coordinates of all adult level I and II trauma centers within an 8.0-km buffer of each city. Between February and September 2018, small-area analyses were conducted to assess trauma desert status as a function of neighborhood racial/ethnic composition, and geospatial analyses were conducted to examine statistically significant trauma desert hot spots. Main Outcomes and Measures: In small-area analyses, a trauma desert was defined as travel distance greater than 8.0 km to the nearest adult level I or level II trauma center. In geospatial analyses, relative trauma deserts were identified using travel distance as a continuous measure. Census tracts were classified into (1) racial/ethnic composition categories, based on patterns of residential segregation, including white majority, black majority, Hispanic/Latino majority, and other or integrated; and (2) poverty categories, including nonpoor and poor. Results: Chicago, LA, and NYC contained 798, 1006, and 2128 census tracts, respectively. A large proportion comprised a black majority population in Chicago (35.1%) and NYC (21.4%), compared with LA (2.7%). In primary analyses, black majority census tracts were more likely than white majority census tracts to be located in a trauma desert in Chicago (odds ratio [OR], 8.48; 95% CI, 5.71-12.59) and LA (OR, 5.11; 95% CI, 1.50-17.39). In NYC, racial/ethnic disparities were not significant in unadjusted models, but were significant in models adjusting for poverty and race-poverty interaction effects (adjusted OR, 1.87; 95% CI, 1.27-2.74). In comparison, Hispanic/Latino majority census tracts were less likely to be located in a trauma desert in NYC (OR, 0.03; 95% CI, 0.01-0.11) and LA (OR, 0.30; 95% CI, 0.22-0.40), but slightly more likely in Chicago (OR, 2.38; 95% CI, 1.56-3.64). Conclusions and Relevance: In this study, black majority census tracts were the only racial/ethnic group that appeared to be associated with disparities in geographic access to trauma centers.


Subject(s)
Health Services Accessibility/statistics & numerical data , Healthcare Disparities/ethnology , Trauma Centers , Urban Health Services , Adult , Cross-Sectional Studies , Ethnicity/statistics & numerical data , Female , Humans , Male , Residence Characteristics , Socioeconomic Factors , Trauma Centers/organization & administration , Trauma Centers/standards , United States/epidemiology , Urban Health Services/organization & administration , Urban Health Services/standards
18.
PLoS One ; 14(2): e0211984, 2019.
Article in English | MEDLINE | ID: mdl-30730967

ABSTRACT

OBJECTIVE: To explore influential factors contributing to the choice of primary care facilities (PCFs) for the initial treatment among rural and urban residents in Southwestern China. METHODS: A face-to-face survey was conducted on a multistage stratified random sample of 456 rural and 459 urban residents in Sichuan Province from January to August in 2014. A structured questionnaire was used to collect data on residents' characteristics, provider of initial treatment and principal reason for the choice. Multivariate logistic regression was performed to identify factors associated with choosing PCFs for the initial treatment. RESULTS: The result showed that 65.4% of the rural residents and 50.5% of the urban residents chose PCFs as their initial contact for medical care. Among both rural and urban residents, the principal reason for choosing medical institutions for the initial treatment was convenience (42.3% versus 40.5%, respectively), followed by high quality of medical care (26.5% versus 29.4%, respectively). Compared to rural residents, urban residents were more likely to value trust in doctors and high quality of medical care but were less likely to value the insurance designation status of the facilities. Logistic regression analysis showed that both rural and urban residents were less likely to choose PCFs for the initial treatment if they lived more than 15 minutes (by walk) from the nearest facilities (rural: OR = 0.15, 95%CI = 0.09-0.26; urban: OR = 0.19, 95%CI = 0.10-0.36), had fair (rural: OR = 0.49, 95%CI = 0.26-0.92; urban: OR = 0.31, 95%CI = 0.15-0.64) or poor (rural: OR = 0.14, 95%CI = 0.07-0.30; urban: OR = 0.22, 95%CI = 0.11-0.44) self-reported health status. Among rural residents, attending college or higher education (OR = 0.21, 95%CI = 0.08-0.59), being retired (OR = 0.90, 95%CI = 0.44-1.84) and earning a per capita annual income of household of 10,000-29,999 (OR = 0.24, 95%CI = 0.11-0.52) and 30,000-49,999 (OR = 0.26, 95%CI = 0.07-0.92) were associated with lower rates of seeking care at PCFs. CONCLUSION: Efforts should be made to improve the accessibility of PCFs and to upgrade the services capability of PCFs both in rural and urban areas in China. At the same time, resources should be prioritized to residents with poorer self-reported health status, and rural residents who retire or have better education and higher income levels should be taken into account.


Subject(s)
Decision Making , Primary Health Care/standards , Adult , Aged , Ambulatory Care Facilities , China , Cross-Sectional Studies , Female , Humans , Logistic Models , Male , Middle Aged , Quality of Health Care , Rural Health Services/standards , Surveys and Questionnaires , Urban Health Services/standards , Young Adult
19.
J Rural Health ; 35(1): 97-107, 2019 01.
Article in English | MEDLINE | ID: mdl-29664203

ABSTRACT

PURPOSE: Increased opioid analgesic prescribing (OAP) has been associated with increased risk of prescription opioid diversion, misuse, and abuse. We studied regional and rural-urban variations in OAP trends in Kentucky, from 2012 to 2015, and examined potential county-level risk and protective factors. METHODS: This study used prescription drug monitoring data. Marginal models employing generalized estimating equations were used to model repeated counts of residents with opioid analgesic prescriptions within county-quarter, 2012-2015, with offset for resident population, by rural-urban classification exposure, and adjusting for time-varying socioeconomic and relevant health status measures. FINDINGS: There were significant downward trends in rates of residents receiving dispensed opioid analgesic prescriptions, with no regional or rural/urban differences in the degree of decline over time. The adjusted models showed the Kentucky Appalachian region retained a significantly higher rate of residents with opioid analgesic prescriptions per 1,000 residents (30% higher than Central Kentucky and 19% higher than Kentucky Delta regions). Residents of nonmetropolitan not adjacent-to-metropolitan counties had significantly higher adjusted rates of OAP (33% higher than metropolitan counties and 17% higher compared to nonmetropolitan adjacent-to-metropolitan counties). The rate of OAP was significantly positively associated with emergency department visit injury rates and negatively associated with buprenorphine/naloxone prescribing rates. CONCLUSIONS: Information on OAP trends and patterns will be used by Kentucky stakeholders to inform targeted interventions. Further research is needed to evaluate the availability and accessibility of nonopioid pain treatment in rural counties and the role of geography and time/distance traveled as risk factors for increased OAP.


Subject(s)
Analgesics, Opioid/therapeutic use , Drug Prescriptions/statistics & numerical data , Geographic Mapping , Rural Health Services/standards , Urban Health Services/standards , Humans , Kentucky , Longitudinal Studies , Rural Health Services/statistics & numerical data , Urban Health Services/statistics & numerical data
20.
Rev Salud Publica (Bogota) ; 21(1): 128-134, 2019 01 01.
Article in Spanish | MEDLINE | ID: mdl-33206920

ABSTRACT

OBJECTIVE: To know the user satisfaction level in relation to the services provided by the Bogotá Health Department and its affiliated institutions. MATERIALS AND METHODS: A descriptive, cross-sectional study was performed, in which 12 573 users and patients at 196 care points of the health services sub-networks, the benefits plan administration entity (Capital Salud EPS) and the governing entity of the Bogotá Health System were asked about aspects related to perceived quality and satisfaction. RESULTS: Five categories are presented: 1. overall performance result, understood as the confidence generated; 2. management improvements compared to the previous year; 3. level of adherence to treatments; 4. intention to cooperate with the system; and 5. comprehensive experience as the sum of the interactions during the care process. Although acceptable levels of satisfaction were found, improvement opportunities were also identified. DISCUSSION: The importance and validity of the study was analyzed. Some improvement actions are proposed, and the systematic implementation of this type of studies is recommended.


OBJETIVO: Conocer el nivel de satisfacción de los usuarios en relación con los servicios prestados por las entidades del sector público de salud de Bogotá. MÉTODO: Estudio descriptivo de corte trasversal, en el cual se indagó a 12 573 usuarios y pacientes de 196 puntos de atención de las subredes de servicios de salud, la entidad administradora de planes de beneficios (Capital Salud EPS) y la entidad rectora del sistema de salud en Bogotá, acerca de aspectos relacionados con la calidad y satisfacción percibidas. Se diseñaron tres instrumentos con calificación entre 1 y 5, en los que puntajes de 4 y 5 representaron satisfacción. RESULTADOS: Se presentan en cinco categorías: 1. El resultado global de desempeño del sistema, entendido como la confianza que genera y el posicionamiento del mismo; 2. Si hay mejoras en la gestión en relación con el año anterior; 3. El nivel de adherencia a los tratamientos; 4. La intención de colaborar con el sistema, y; 5. La experiencia vivencial integral, como la suma de las interacciones durante el proceso de atención. Aunque se encuentran niveles de satisfacción aceptables, se identifican diversas oportunidades de mejoramiento. DISCUSIÓN: Se analiza la importancia y validez del estudio, se postulan algunas acciones de mejora y se recomienda la implementación sistemática de este tipo de estudios.


Subject(s)
Patient Satisfaction/statistics & numerical data , Urban Health Services/standards , Adolescent , Adult , Aged , Aged, 80 and over , Child , Colombia , Cross-Sectional Studies , Female , Health Care Surveys , Health Services Accessibility/standards , Health Services Accessibility/statistics & numerical data , Humans , Male , Middle Aged , Patient Acceptance of Health Care/statistics & numerical data , Social Perception , Urban Health Services/statistics & numerical data , Young Adult
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