Suchergebnisse

OBJECTIVES: Effective coverage of non‐communicable disease (NCD) care in sub‐Saharan Africa remains low, with the majority of services still largely restricted to central referral centres. Between 2015 and 2017, the Rwandan Ministry of Health implemented a strategy to decentralise outpatient care for severe chronic NCDs, including type 1 diabetes, heart failure and severe hypertension, to rural first‐level hospitals. This study describes the facility‐level implementation outcomes of this strategy. METHODS: In 2014, the Ministry of Health trained two nurses in each of the country's 42 first‐level hospitals to implement and deliver nurse‐led, integrated, outpatient NCD clinics, which focused on severe NCDs. Post‐intervention evaluation occurred via repeated cross‐sectional surveys, informal interviews and routinely collected clinical data over two rounds of visits in 2015 and 2017. Implementation outcomes included fidelity, feasibility and penetration. RESULTS: By 2017, all NCD clinics were staffed by at least one NCD‐trained nurse. Among the approximately 27 000 nationally enrolled patients, hypertension was the most common diagnosis (70%), followed by type 2 diabetes (19%), chronic respiratory disease (5%), type 1 diabetes (4%) and heart failure (2%). With the exception of warfarin and beta‐blockers, national essential medicines were available at more than 70% of facilities. Clinicians adhered to clinical protocols at approximately 70% agreement with evaluators. CONCLUSION: The government of Rwanda was able to scale a nurse‐led outpatient NCD programme to all first‐level hospitals with good fidelity, feasibility and penetration as to expand access to care for severe NCDs.

Health insurance is a guarantee in the health sector that is given to people who have paid contributions either by individuals or by the government. The issue that is developing in today's society is that there are complaints about the lack of quality health services to patients using health insurance cards or BPJS, especially services at the Puskesmas level. The purpose of this study was to determine the difference in the level of satisfaction of BPJS health patients and non BPJS patients with outpatient services at the Tanjung Nusa Tenggara Barat Health Center. The research method using a cross-sectional study was carried out on 32 patients using BPJS health and 32 non BPJS patients, the qualitative sample in this study used 10 informants selected according to research needs, 4 informants from patients, 4 informants from health workers on duty, 1 doctor, and 1 representative informant from the leadership of the Puskesmas. The statistical test used was Mann-Whitney. The results showed that there was no difference in the level of satisfaction of BPJS health patients and non BPJS patients in the outpatient services of the Tanjung Nusa Tenggara Barat Health Center (p = 0.215; = 0.05). Overall there is no difference in the level of satisfaction of BPJS and Non-BPJS patients. Researchers also suggest that people can use BPJS health services as one of their future health insurance. In addition, the service elements of responsiveness and tangibles should still be maximized.

Abstract Background The National Health Insurance Scheme (NHIS) was launched in Ghana in 2003 with the main objective of increasing utilisation to healthcare by making healthcare more affordable. Previous studies on the NHIS have repeatedly highlighted that cost of premiums is one of the major barriers for enrollment. However, despite introducing premium exemptions for pregnant women, older people, children and indigents, many Ghanaians are still not active members of the NHIS. In this paper we investigate why there is limited success of the NHIS in improving access to healthcare in Ghana and whether social exclusion could be one of the limiting barriers. The study explores this by looking at the Social, Political, Economic and Cultural (SPEC) dimensions of social exclusion. Methods Using logistic regression, the study investigates the determinants of health service utilisation using SPEC variables including other variables. Data was collected from 4050 representative households in five districts in Ghana covering the 3 ecological zones (coastal, forest and savannah) in Ghana. Results Among 16,200 individuals who responded to the survey, 54 % were insured. Out of the 1349 who sought health care, 64 % were insured and 65 % of them had basic education and 60 % were women. The results from the logistic regressions show health insurance status, education and gender to be the three main determinants of health care utilisation. Overall, a large proportion of the insured who reported ill, sought care from formal health care providers compared to those who had never insured in the scheme. Conclusion The paper demonstrates that the NHIS presents a workable policy tool for increasing access to healthcare through an emphasis on social health protection. However, affordability is not the only barrier for access to health services. Geographical, social, cultural, informational, political, and other barriers also come into play.

This book is part of a series of titles that are a spin-off of the Shingo Prize-winning book Leveraging Lean in Healthcare: Transforming Your Enterprise into a High Quality Patient Care Delivery System. Each book in the series focuses on a specific aspect of healthcare-including emergency departments, medical laboratories, outpatient clinics, ancillary services, and surgical services-that has demonstrated significant process and quality improvements after a Lean implementation.Because ambulatory care settings play a significant role in the healthcare delivery system, it is important to underst

This paper describes a state‐funded program providing dental services for community‐based mentally ill clients. Contrasts between outpatient services for persons with mental illness and similar programs serving the mentally retarded population are emphasized. Implications of client eligibility, communication, and compliance issues relative to limitations of care are discussed. Suggestions for improving similar programs are provided.

The utilization of telemedicine and telepsychiatry (TP) services in the outpatient department (OPD) has been increasing in recent years. The information about the technological, administrative, and clinical challenges is being addressed by the telemedicine and TP guidelines published by several individual nations. TP aims to address the treatment gaps, barriers for utilization, accessibility, diagnostic validity, financial implications, and individual client preferences. Utilization of TP in the OPD varies from country to country depending upon their healthcare delivery systems. It also varies in populations utilizing the TP services—urban, rural, child and adolescent, geriatric, and differently abled. TP services in the OPDs are being incorporated differentially by government organizations, insurance recognized psychiatric healthcare organizations, private psychiatric group practice deliverers, and individual, standalone psychiatric healthcare deliverers. TP may not replace the traditional in-person consultations completely. Covid-19 pandemic has hastened its utilization across several healthcare delivery systems. Healthcare organizations, clinicians, other healthcare deliverers, and end users are in the process of adapting to the new scenario. Incorporation of the big data, machine learning, artificial intelligence, virtual reality, and other technological advances in the psychiatric healthcare delivery systems into TP services in the OPDs would significantly contribute to the overall quality and efficacy of the psychiatric healthcare delivery systems in the future.

Holistic patient-centred care is the aim of health services in the United Kingdom delivered through the 6Cs. Chaplains can offer aspects of this through compassionate care of the patient, particularly when a person is facing a life- limiting prognosis. This study firstly evaluated patient awareness and use of chaplaincy services in two oncology settings; Inpatient and Outpatient. Outpatients had not previously been offered chaplaincy services. Secondly, the demand and needs for a chaplaincy intervention was investigated with patients who expressed a spiritual or religious belief and had received a chaplaincy visit. Results indicated that half of the patients seen in the first evaluation identified with a spiritual/religious belief and both Outpatients and inpatients had a similar demand for chaplaincy visits. Those receiving a chaplaincy visit before being evaluated generally requested further visits. Based on these results we have now established a chaplaincy visiting service in the Outpatient chemotherapy suites to try to match demands.

Testimony issued by the Government Accountability Office with an abstract that begins "In fiscal year 2003, the Department of Veterans Affairs (VA) estimated that about 157,000 veterans were legally blind, and about 44,000 of these veterans were enrolled in VA health care. The Chairman of the Subcommittee on Health, House Veterans' Affairs Committee, and the Ranking Minority Member, Senate Veterans' Affairs Committee expressed concerns about VA's rehabilitation services for blind veterans. GAO reviewed (1) the availability of VA outpatient blind rehabilitation services, (2) whether legally blind veterans benefit from VA and non-VA outpatient services, and (3) what factors affect VA's ability to increase veterans' access to blind rehabilitation outpatient services. GAO reviewed VA's blind rehabilitation policies; interviewed officials from VA, the Blinded Veterans Association, state and private nonprofit agencies, and visited five Blind Rehabilitation Centers (BRC)."

Minimum Service Standards were made to serve as guidance for regions in organizing hospitals. The standards were then used as working indicators by the hospital management. In the field of health, the Minimum Service Standards were regulated by Health Minister's Decree Nr. 43 of 2016. It was used as a tool to ensure even basic services access and quality to the community that was established and accountable to the Central Government. The Minimum Health Service Standards were very important for hospital's outpatients in relation with the services provided and were closely related to the outpatient's protection. This research applied socio-legal approach having analytical-descriptive specification. The data were gathered by having interviews to some resources, namely Head of Health Office of Bogor District, Director of Mary Hospital of Cileungsi Hijau, Unit Head of Sentosa Hospital of Parung.The results of the research showed that the Health Minister's Decree Nr. 43 of 2016 on Minimum Service Standards in Health Field had not well implemented. The absence of minimun service standards setting issued by the Local Government, namely Bogor District, had made the health services run the minimum service standards in accordance with the existing regulations that referred to Health Office's Strategic Planning (Renstra) and Health Minister's Regulation on Hospital Classification and Permit. Bogor District should refer to the Health Minister's Decree Nr. 43 of 2016 on Minimum Service Standards in Health Field so that the implementation of minimum services standards to outpatients could be well performed.

OBJECTIVE: To determine (1) the use of outpatient services for all surgical breast procedures for breast cancer and (2) the influence of payer and state on the use of outpatient services for complete mastectomy in light of state and federal length-of-stay managed care legislation. DATA SOURCES: Healthcare Cost and Utilization Project representing all discharges from hospitals and ambulatory surgery centers for five states (Colorado, Connecticut, Maryland, New Jersey, and New York) and seven years (1990-96). STUDY DESIGN: Longitudinal, cross-sectional analyses of all women undergoing inpatient and outpatient complete mastectomy (CMAS), subtotal mastectomy (STMAS), and lumpectomy (LUMP) for cancer were employed. Total age-adjusted rates and percentage of outpatient CMAS, STMAS, and LUMP were compared. Independent influence of state and HMO payer on likelihood of receiving an outpatient CMAS was determined from multivariate models, adjusting for clinical characteristics (age < 50 years, comorbidity, metastases, simple mastectomy, breast reconstruction) and hospital characteristics (teaching, ownership, urban). PRINCIPAL FINDINGS: In 1993, 1 to 2 percent of CMASs were outpatient in all states. By 1996, 8 percent of CMASs were outpatient in Connecticut, 13 percent were outpatient in Maryland, and 22 percent were outpatient in Colorado. In comparison, LUMPs were 78 to 88 percent outpatient, and by 1996, 43 to 72 percent of STMASs were outpatient. In 1996, women were 30 percent more likely to receive an outpatient CMAS in New York, 2.5 times more likely in Connecticut, 4.7 times more likely in Maryland, and 8.6 times more likely in Colorado compared to New Jersey. In addition, women with Medicare, Medicaid, or private commercial insurance were less likely to receive an outpatient CMAS compared to women with an HMO payer. CONCLUSIONS: LUMP is an outpatient procedure, and STMAS is becoming primarily outpatient. CMAS, while still primarily inpatient, is increasingly outpatient in some states. Although clinical ...