Profile of Patients Availing Marital and Psychosexual Clinic Services During the Pre-COVID and COVID Era: A Study From a Tertiary Care Center

Aim: To assess the profile of patients availing the marital and psychosexual clinic (MPC) services through the telemode at a tertiary care center after the imposition of lockdown and compare the same with the profile of the patients attending the outpatient services, in-person MPC services during the prelockdown period. Materials and Methods: It was a retrospective study in which comparisons were made between patients availing the MPC services from March 24, 2020 to March 23, 2021 with the profile of patients during the period of March 24, 2019 to March 23, 2020 (ie, COVID period—lockdown). Results: A total of 112 patients availed the MPC services during the COVID study period compared to 307 patients in the pre-COVID period. However, when the proportion of MPC cases among the total walk-ins was compared, during the COVID period the proportion of MPC cases increased by almost 1.75 times. During the COVID time period, there was an increase in the patients who were significantly younger ( P = .002), females ( P = .003), more from urban locality ( P = .035), and being referred by self or caregiver ( P = .001). In terms of specific diagnosis, as compared to the pre-COVID timeframe, significantly higher numbers of patients were diagnosed with premature ejaculation (PME) and PME + erectile dysfunction while the services were being provided through the telemode. Conclusion: The present study suggests an increase in the proportion of patients seeking help for marital and sexual issues while the services are being provided by telemode.

The Symptom Burden and Quality of Life in Cancer Patients in the Gaza Strip, Palestine: A Cross-Sectional Study

Objectives Cancer is the second leading cause of death in the Gaza Strip, Palestine, but there is an absence of evidence systematically assessing symptom burden and quality of life (QoL) using validated tools. Our objective was to assess associations between socio-demographic and disease-related characteristics, symptom burden and QoL in a sample of cancer patients accessing outpatient services in the Gaza Strip. Design A cross-sectional, descriptive survey using interviews and medical record review involving patients with cancer accessing oncology outpatient services at Al Rantisi Hospital and European Gaza Hospital (EGH) in the Gaza Strip was employed. Socio-demographic and disease-related data, the Lebanese version of the Memorial Symptom Assessment Scale (MSAS-Leb), and the Arabic version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) were collected. Multiple linear regression was used to judge the relative influence of determinants of QoL. Results Of 414 cancer patients approached, 385 patients consented to participation. The majority were women (64.7%) with a mean age of 52 years (SD = 16.7). Common cancer diagnoses were breast (32.2%), haematological (17.9%) and colorectal (9.1%). The median number of symptoms was 10 (IQR 1.5–18.5). Mean overall QoL was 70.5 (SD 19.9) with common physical and psychological symptoms identified. A higher burden of symptoms was associated with marital status, education and income. Limited access to both opioids and psychological support were reported. Conclusions A high symptom burden was identified in outpatients with cancer. Increasing provision and access to supportive care for physical and psychological symptoms should be prioritised alongside exploring routine assessment of symptom burden and QoL.

Determinants of Health Service Utilization Among Adults at High Risk of Developing Type 2 Diabetes in Kerala, India

The purpose of this study was to examine the determinants of health service utilization in a population at high risk of developing type 2 diabetes mellitus in India. Using Andersen’s behavioral model of healthcare utilization, multivariate logistic regression analysis was performed on baseline data of the Kerala Diabetes Prevention Program. We examined the association between predisposing, enabling, and need factors with outpatient health service use in the past four weeks and inpatient health service use in the past 12 months. More than a quarter (27.9%) and 12.9% of 1007 participants used outpatient services and inpatient services, respectively. Men were less likely to use outpatient services (odds ratio [OR] = 0.56; 95% confidence interval [CI] [0.39, 0.82]). Outpatient service utilization was positively associated with low social support (OR = 1.69; 95% CI [1.09, 2.62]), low general health status (OR = 5.71; 95% CI [2.42, 13.47]), and time off from work due to illness (OR = 8.01; 95% CI [5.32, 12.07]). Higher educational status (OR = 0.63; 95% CI [0.41, 0.95]), low general health status (OR = 3.59; 95% CI [1.54, 8.34]), and time off from work due to illness (OR = 1.21; 95% CI [0.76,1.93]) were associated with increased utilization of inpatient services. Although gender, educational status, and social support had important roles, health service utilization in this study population was largely dependent on general health status and presence of illness.

Delivering outpatient virtual clinics during the COVID-19 pandemic: early evaluation of clinicians’ experiences

BackgroundThe COVID-19 pandemic has put health systems across the world under significant pressure. In March 2020, a national directive was issued by the National Health Service (NHS) England instructing trusts to scale back face-to-face outpatient appointments, and rapidly implement virtual clinics.MethodsA multidisciplinary team of change managers, analysts and clinicians were assembled to evaluate initial implementation of virtual clinics at Guy’s and St Thomas’ NHS Foundation Trust. In-depth interviews were conducted with clinicians who have delivered virtual clinics during the pandemic. An inductive thematic approach was used to analyse clinicians’ early experiences and identify enablers for longer term sustainability.ResultsNinety-five clinicians from specialist services across the trust were interviewed between April and May 2020 to reflect on their experiences of delivering virtual clinics during Wave I COVID-19. Key reflections include the perceived benefits of virtual consultations to patients and clinicians; the limitations of virtual consultations compared with face-to-face consultations; and the key enablers that would optimise and sustain the delivery of virtual pathways longer term.ConclusionsIn response to the pandemic, outpatient services across the trust were rapidly redesigned and virtual clinics implemented. As a result, services have been able to sustain some level of service delivery. However, clinicians have identified challenges in delivering this model of care and highlighted enablers needed to sustaining the delivery of virtual clinics longer term, such as patient access to diagnostic tests and investigations closer to home.

Uptake of Cervical Cancer Screening and Associated Factors Among Women Attending Outpatient Services in Rwamagana Hospital, Rwanda

BackgroundCervical cancer is a global public health threat for women. Rwanda Ministry of Health recommends screening as preventive strategy. However, the screening remains low in Rwanda.ObjectiveTo determine the uptake level of cervical cancer screening and associated factors among Rwandan women.MethodsA quantitative analytical cross-sectional study design was used. We recruited 178 participants using convenience sampling from an estimated 320 women who attended outpatient department in the previous month. The sample size was calculated using the Yamane’s formula. We used chi-square test, t-test and multiple logistic regression analysis to analyse data.ResultsA total of 178 (100%) participants completed the survey. Forty-one (23%) participants had undertaken cervical cancer screening. Knowledge (OR: 1.26,95% CI:1.069-1.485, p=.006) and income were predictors of cervical cancer screening uptake. Participants earning RWF ≥ 63,751 were more likely to uptake cervical cancer screening (OR:11.141, 95% CI:3.136-39.571, p< .001) compared to those earning less than RWF 25,500 monthly.ConclusionCervical cancer screening uptake among study population was low. Participants with more knowledge and high-income were more likely to uptake cervical cancer screening. Improving women’s knowledge and socioeconomic situation would improve the uptake of cervical cancer screening.Rwanda J Med Health Sci 2021;4(3):387-397

Pengaruh Efisiensi Waktu Tunggu, Biaya Pelayanan, Kebersihan, serta Kenyamanan Ruangan terhadap Kepuasan Pasien (Studi Pada Pelayanan Instalasi Rawat Jalan Rumah Sakit Medika Lestari)

Seeing the importance of patient adherence in a patient's therapeutic journey and several factors related to patient adherence, we tried to assess patient satisfaction with the outpatient unit of Medika Lestari Hospital in 2021. Therefore, we conducted a cross-sectional study of patients aged 18–59 years to assess their satisfaction with the services of the Medika Lestari Hospital outpatient unit on 28 July 2021. We evaluated 4 main dimensions, namely: (1) Efficiency, (2) Convenience; (3) Cleanliness; and (4) Financing. The survey instrument was prepared based on the consensus of the research team and has good validity and reliability based on the Pearson and Cronbach–alpha tests. All statistical analyzes were performed with SmartPLS software version 3.3.3. A total of 206 patients were recruited, with a composition of 102 (49.51%) males and 104 (50.49%) females. There were 43 (20.87%), 103 (50%), 46 (22.33%), and 14 (6.80%) patients, respectively, in the age categories 18-25 years, 26–35 years, 36–45 years, and 46–59 years, respectively. We found that the average patient satisfaction with outpatient services at Medika Lestari Hospital was 4.23 (84.6%). The average patient satisfaction score for the outpatient service at the Medika Lestari Hospital is 4.23±0.363. In addition, we also found that service efficiency, cost, cleanliness of the service room, and comfort of the service room had a positive effect on patient satisfaction in the outpatient unit at Medika Lestari Hospital.

Analisis Tata Kelola Teknologi Informasi Untuk Mendefinisikan Arsitektur Informasi Dengan Framework COBIT 4.1 (Studi Kasus Instalasi Rawat Jalan RSUD Prov. NTB)

Treatment for outpatient installations (IRJA) NTB provincial hospitals have used hospital management information systems, but this is still not effective. The information system is not effective because registration centred in the main hall. The centralized registration caused the accumulation of patient queues that occurred in each IRJA polyclinic, and this was due to the absence of an integrated queue number between registrations carried out in the main hall and IRJA polyclinics. Therefore, the governance of information architecture processes needs to be applied to optimize information systems. We use COBIT 4.1 to conduct governance. The aim is to get existing and expected outpatients from Prov. NTB Hospital. So, it can help to manage information architecture to perform quality and competitive outpatient services. The results showed the IT processes selected in PO2 (Determine Information Architecture) and AI4 (Activate and Use). We reach the maturity level of all IT processes at level 3 (the specified process) for conditions as they are and 5 (optimized) for conditions that will occur. The level of maturity can help the NTB Provincial Hospital to improve its services.

Faktor - Faktor Pendukung Keputusan Rujukan Pasien pada Fasilitas Kesehatan Tingkat Pertama (FKTP) dengan metode Analytical Hierrarchy Process (AHP)

Pratama Bakti Timah Clinic is one of the First Level Health Facilities (FKTP) that provides health services to the community in the Pangkalpinang area and its surroundings. In these health service activities, when a patient requires special medical care in terms of medical services, medical personnel, medical support, outpatient services, and inpatient services, the patient will be referred to a higher health facility. Considering the various factors that cause patients to be referred and there are several hospitals that are referred to, this condition is a multi-criteria and multi-alternative condition. To overcome this, it is necessary to design a decision support system that will make it easier for medical administration service officers at the Primary Clinic. The decision support system is designed using the Analytical Hierarchy Process (AHP) method which is able to accommodate multi-criteria and multi-alternative decision making. The results of data processing showed that the most important factor in the referral of FKTP patients at the Pratama Clinic was the outpatient service factor with a weight of 30.7%, the second factor was medical services 24.4%, the third factor was medical personnel 17.5%, the fourth factor was supporting medical services 15.9%, and the last is inpatient services 11.4%. While the first referral hospital is RSUD Ir. Soekarno with a weight of 31.1%, then Depati Hamzah Hospital with a weight of 27.5%, then Bakti Timah Hospital with 27.3%, and Bakti Wara Hospital with 14.1%.

A Cascade of Care Model for Suicide Prevention

The rising rates of suicide in the United States, particularly among young people of color, requires urgent attention. While the healthcare system is a critical service sector for suicide prevention given high levels of utilization by people at risk of suicide, it is not sufficient. Only approximately 50% of those identified as at-risk in an Emergency Department, agree to be connected to outpatient services, with even small proportions engaging in these services. This “care cascade” parallels health services challenges in other domains, such as HIV. Corresponding Cascade of Care (COC) models have been galvanizing public health frameworks, as they can be utilized to track both patient-level outcomes and leveraged to form aspirational goals to improve systems of care for those in need. We aim to delineate a COC model specific to suicide prevention efforts, to help frame existing challenges and unify efforts to address these gaps. Given the complexity of suicidal thoughts and behaviors, solutions are needed that address care at multiple levels of the socio-ecological framework and build multisectoral networks into an integrated system of care. Defining and delineating this COC model can help structure local and national efforts to comprehensively address the suicide epidemic in the United States.

Change in the trend of long-term care service usage following COVID-19 pandemic in Japan: a survey using nationwide statistical summary in 2018-2021

Aim: Social restriction due to coronavirus disease 2019 (COVID-19) pandemic forced long-term care (LTC) service users to refrain from using services as before, of which degree of change we aim to evaluate in this study. Methods: We retrospectively analyzed publicly-distributed nationwide statistics summarizing the monthly number of public LTC insurance users in Japan in the period between April 2018 and March 2021. The degree of decline was quantified as odds ratio (OR), where the ratio of a certain month to the reference month was divided by the ratio in the previous year. Results: The use of LTC services showed unimodal serial change: it started to decline in March 2020 and reached its largest decline in May 2020, which had insufficiently recovered even as of late 2020. The degree of decline was specifically large in services provided in facilities for community-dwelling elderly individuals (adjusted OR 0.719 (95%CI: 0.664 ~ 0.777) in short-stay services and adjusted OR 0.876 (95%CI: 0.820 ~ 0.935) in outpatient services) but was non-significant in other types of service, including those provided for elderly individuals living in nursing homes. Conclusions: Current study showed that community-dwelling elderly individuals who had used outpatient or short-stay services were the segments which were specifically affected by the COVID-19 pandemic in 2020 Japan. It underlines the need for further investigation for the medium- or long-term influence on the mental and physical health of these LTC service users as well as their family caregivers.