Importance of health system context for evaluating utilization patterns across systems

2011 ◽  
Vol 20 (2) ◽  
pp. 239-251 ◽  
Author(s):  
James F. Burgess ◽  
Matthew L. Maciejewski ◽  
Chris L. Bryson ◽  
Michael Chapko ◽  
John C. Fortney ◽  
...  
Keyword(s):  
Health System ◽  
Utilization Patterns ◽  
System Context

Utilization Patterns and Trends in The Use of Medications for Asthma Control in a Cohort of Colombian Patients, 2017-2019. v1

2021 ◽  
Author(s):  
Jorge Machado Alba
Keyword(s):  
Retrospective Study ◽  
General Practitioner ◽  
Health System ◽  
Triple Therapy ◽  
Inhaled Corticosteroids ◽  
Prescription Patterns ◽  
Utilization Patterns ◽  
Control Therapy ◽  
Long Acting

Objective:To determine the trend in the use of medications used to treat asthma in a group of patients affiliated to the Colombian health system. Methods:A retrospective study on prescription patterns of medications used to treat asthma in patients over 5 years of age between 2017 and 2019. Sociodemographic variables, medications used and combinations, persistence of use and prescribing physician were considered. Results:10,706 people with a diagnosis of asthma were identified, with predominance in female sex (56.8 %), median age 32.2 ± 26.1 years. At the start of follow-up, 53.2% of patients aged 5-11 years were receiving monotherapy, mean 1.5 ± 0.6 drugs/patient, especially inhaled corticosteroids (ICS; 55.9%) and short-acting β-agonists (SABA; 55.6%). Moreover, in patients older than 12 years, 53.5% were treated in monotherapy, mean 1.6 ± 0.7 drugs/patient, of which 45.9% were on SABA, and 37.1 % on ICS.Between 63.0% and 83.6% of patients were treated by a general practitioner. The proportion of patients on the ICS/ long-acting β-agonists (LABA) combination grew at 24 months follow-up by 411% and 177%, respectively. 12.5% of patients (495) received triple therapy (ICS/LABA+LAMA [long-acting anticholinergics]), particularly with fluticasone/salmeterol+tiotropium. Conclusions:Patients with a diagnosis of asthma older than 5 years in Colombia are mainly receiving control therapy with ICS, alone or combined with SAMA and, to a lesser extent, with LABA.

Not just about machines: Analysis of MRI quality determinants in the Turkish health system context

2021 ◽  
Author(s):  
İlhan Can Özen ◽  
Dilek Başar ◽  
Selcen Öztürk ◽  
Ekim Gümeler ◽  
Deniz Akata ◽  
...  
Keyword(s):  
Health System ◽  
System Context

Patterns of Healthcare Access and Utilization among Nonurban Transgender and Nonbinary Patients at a Large Safety Net Health System in Colorado

2020 ◽  
Vol 1 (3) ◽  
pp. 186-199
Author(s):  
Corey F. Walsh ◽  
Ryan P. O'Connell ◽  
Elizabeth Kvach
Keyword(s):  
Gender Identity ◽  
Health System ◽  
Healthcare Access ◽  
Insurance Coverage ◽  
Marijuana Use ◽  
Safety Net ◽  
Urban Centers ◽  
Utilization Patterns ◽  
And Gender ◽  
Distance To Care

Current research characterizing transgender and nonbinary (TNB) communities focuses on coastal, urban centers and inadequately recognizes intersections of geography and gender identity. This study evaluates demographics, health insurance, mental health, one-way distance to care, and types of care accessed for a cohort of nonurban TNB patients seeking care at a large, safety net health system in Denver, Colorado. Electronic medical record (EMR) data were used to identify this TNB patient cohort (n = 1,230) Characteristics of age, race/ethnicity, sex assigned at birth, gender identity, insurance, residence ZIP code, alcohol use disorder, tobacco use, marijuana use, depression, and anxiety were extracted. Chart review characterized utilization patterns among non-Denver TNB patients (n = 232). Denver TNB patients were more likely to have the following characteristics: black or Hispanic identity, marijuana use, commercial insurance, depression, anxiety; comparatively, non-Denver TNB patients were more likely to be white and have public insurance coverage. The non-Denver cohort traveled an average of 82.52 miles one-way. A majority of non-Denver patients accessed gender-affirming (99%), hormone-related (81%), primary (78%), and preventive (69%) care. A minority of these patients (23%) accessed surgical transition care. Proximity to care is one of many important factors for TNB patients seeking care. The number of non-Denver TNB traveling for healthcare likely reflects a lack of accessibility to local gender-affirming care, which should prompt nonurban medical providers to seek training that meets this need. Medical educators should improve teaching on gender-affirming healthcare, particularly for rural educational tracks.

OP108 From Essential Medicines List To Health Technology Assessment, And From Reimbursement To Pricing Decision-Making

2018 ◽  
Vol 34 (S1) ◽  
pp. 40-41
Author(s):  
Hector Castro Jaramillo
Keyword(s):  
Health System ◽  
Priority Setting ◽  
Technology Assessment ◽  
Financial Support ◽  
Institutional Development ◽  
Health Technology ◽  
Essential Medicines ◽  
Cultural Aspects ◽  
Stakeholder Pressure ◽  
System Context

Introduction:All health systems are challenged by finite resources to address unlimited demand for services. In many countries priority-setting and resource-allocation decision-making has been inconsistent and unstructured. In these cases, the lack of coherence between limitless promise and limited resources leads to implicit and covert rationing through waiting lines, low quality, inequities, and other mechanisms. Over the past decades, different countries have established specialized health technology assessment (HTA) organizations aimed at better informing health care policies and clinical practice. Although the first technology assessment institution, although not exclusively health related, was the Office for Technology Assessment (OTA) in the U.S. in the 1970s, HTA is not yet current nationwide practice. Nevertheless, there are more than fifty agencies in operation in over thirty countries to assist systematic priority setting, especially in high income countries. The cases of Ukraine, Colombia and U.S. represent different features of the need for systematic priority setting. Ukraine is moving from National essential medicines lists (EML) to more dynamic HTA use to update its publicly funded benefits package; Colombia established a few years ago nationwide HTA, but is currently attempting to use HTA for Pricing and Reimbursement since healthcare coverage is so heavily contested by judicialization. Nevertheless, even in countries where formal HTA activities are ongoing, and in most low and middle income countries, rationing still occurs as an ad hoc, haphazard series of non-transparent choices that reflect the competing interests of governments, payers and other stakeholders. Henceforth, there is the opportunity to closely review why the state of development for HTA varies so much according to setting.Methods:Retrospective policy analysis considering common motivators for the implementation of HTA; the agenda setting model of the three streams (problems, policy and politics) for policy action ; and qualitative approaches for the inception of HTA are being used in these three cases.Results:Through a qualitative approach, ten “drivers” previously emerged with the ability to help or hinder HTA development in Colombia were used to assess the difference of HTA development in the USA and Ukraine (i.e. availability and quality of data, implementation strategy, cultural aspects, local capacity, financial support, policy/political support, globalization, stakeholder pressure, health system context, and usefulness perception). Policy/political and financial support, stakeholder pressure, cultural aspects and health system context were the most prominent drivers to induce or prevent institutional development of HTA in different countries.Conclusions:Common motivators, similar drivers and context specific characteristics are all influential for the implementation of HTA at the national level. Policy/political and financial support, stakeholder pressure, cultural aspects and health system context preliminarily seemed the most prominent drivers to induce or prevent institutional development of HTA in different countries. Henceforth, methods and processes matter, as well as the political economy for HTA. Further research is needed to test these preliminary findings.

scholarly journals Health extension workers’ perceived health system context and health post preparedness to provide services: a cross-sectional study in four Ethiopian regions

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e048517
Author(s):  
Theodros Getachew ◽  
Solomon Mekonnen Abebe ◽  
Mezgebu Yitayal ◽  
Anna Bergström ◽  
Lars-Ake Persson ◽  
...  
Keyword(s):  
Health System ◽  
Local Community ◽  
Essential Medicines ◽  
Potential Contribution ◽  
Work Culture ◽  
Health Post ◽  
Health Extension Workers ◽  
Informal Payments ◽  
System Context

ObjectiveThe health system context influences the implementation of evidence-based practices and quality of healthcare services. Ethiopia aims at reaching universal health coverage but faces low primary care utilisation and substandard quality of care. We assessed the health extension workers’ perceived context and the preparedness of health posts to provide services.SettingThis study was part of evaluating a complex intervention in 52 districts of four regions of Ethiopia. This paper used the endline data collected from December 2018 to February 2019.ParticipantsA total of 152 health posts and health extension workers serving selected enumeration areas were included.Outcome measuresWe used the Context Assessment for Community Health (COACH) tool and the Service Availability and Readiness Assessment tool.ResultsInternal reliability of COACH was satisfactory. The dimensions community engagement, work culture, commitment to work and leadership all scored high (mean 3.75–4.01 on a 1–5 scale), while organisational resources, sources of knowledge and informal payments scored low (1.78–2.71). The general service readiness index was 59%. On average, 67% of the health posts had basic amenities to provide services, 81% had basic equipment, 42% had standard precautions for infection prevention, 47% had test capacity for malaria and 58% had essential medicines.ConclusionThe health extension workers had a good relationship with the local community, used data for planning, were highly committed to their work with positive perceptions of their work culture, a relatively positive attitude regarding their leaders, and reported no corruption or informal payments. In contrast, they had insufficient sources of information and a severe lack of resources. The health post preparedness confirmed the low level of resources and preparedness for services. These findings suggest a significant potential contribution by health extension workers to Ethiopia’s primary healthcare, provided that they receive improved support, including new information and essential resources.

scholarly journals Health system utilization before age 1 among children later diagnosed with autism or ADHD

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Matthew M. Engelhard ◽  
Samuel I. Berchuck ◽  
Jyotsna Garg ◽  
Ricardo Henao ◽  
Andrew Olson ◽  
...  
Keyword(s):  
Health System ◽  
Hospital Admissions ◽  
Autism Spectrum ◽  
Upper Respiratory Infection ◽  
Logistic Regression Models ◽  
System Utilization ◽  
Patterns Of Utilization ◽  
Utilization Patterns ◽  
Early Health ◽  
Ed Visits

Abstract Children with autism spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD) have 2–3 times increased healthcare utilization and annual costs once diagnosed, but little is known about their utilization patterns early in life. Quantifying their early health system utilization could uncover condition-specific health trajectories to facilitate earlier detection and intervention. Patients born 10/1/2006–10/1/2016 with ≥ 2 well-child visits within the Duke University Health System before age 1 were grouped as ASD, ADHD, ASD + ADHD, or No Diagnosis using retrospective billing codes. An additional comparison group was defined by later upper respiratory infection diagnosis. Adjusted odds ratios (AOR) for hospital admissions, procedures, emergency department (ED) visits, and outpatient clinic encounters before age 1 were compared between groups via logistic regression models. Length of hospital encounters were compared between groups via Mann–Whitney U test. In total, 29,929 patients met study criteria (ASD N = 343; ADHD N = 1175; ASD + ADHD N = 140). ASD was associated with increased procedures (AOR = 1.5, p < 0.001), including intubation and ventilation (AOR = 2.4, p < 0.001); and outpatient specialty care, including physical therapy (AOR = 3.5, p < 0.001) and ophthalmology (AOR = 3.1, p < 0.001). ADHD was associated with increased procedures (AOR = 1.41, p < 0.001), including blood transfusion (AOR = 4.7, p < 0.001); hospital admission (AOR = 1.60, p < 0.001); and ED visits (AOR = 1.58, p < 0.001). Median length of stay was increased after birth in ASD (+ 6.5 h, p < 0.001) and ADHD (+ 3.8 h, p < 0.001), and after non-birth admission in ADHD (+ 1.1 d, p < 0.001) and ASD + ADHD (+ 2.4 d, p = 0.003). Each condition was associated with increased health system utilization and distinctive patterns of utilization before age 1. Recognizing these patterns may contribute to earlier detection and intervention.

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