Integrated community case management: quality of care and adherence to medication in Beneshangul-Gumuz Region, Ethiopia.
Robinah NajjembaLilian KiapiShiferaw Dechasa DemissieTadesse GossayeMezgebu EngidaRuwan RatnayakeTedbabe DegefieHailemariam LegesseAtaklti Fisseha LemmaHiwot GetachewMuluken Gebrie
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The International Rescue Committee (IRC) supports implementation of integrated Community Case Management (iCCM) in all 20 woredas (districts) of Benishangul Gumuz Region (BSG) in Ethiopia.To identify the gaps in the provision of quality iCCM services provided by Health Extension Workers (HEWs) and to assess caregivers' adherence to prescribed medicines for children under five years of age.We conducted a cross-sectional descriptive study with both quantitative and qualitative study methods. We interviewed 233 HEWs and 384 caregivers, reviewed HEW records of 1,082 cases, and organized eight focus groups.Most cases (98%) seen by HEWs were children 2-59 months old, and 85% of the HEWs did not see any sick young infant. The HEWs' knowledge on assessments and classification and need for referral of cases was above 80%. However; some reported challenges, especially in carrying out assessment correctly and not checking for danger signs. Over 90% of caretakers reported compliance with HEWs' prescription.Partners have successfully deployed trained HEWs who can deliver iCCM according to protocol; however, additional support is needed to assure a supply of medicines and to mobilize demand for services, especially for young infants.Cite
Objective: To study the phenomenon that the community residents fail to make up a prescription in community health service centre and the change of their referral rates before and after implementing the essential drugs system in Shanghai so as to provide the reference for the government to adjust the essential drugs catalogues in future. Method: The patient referral data registered in the community health service center and outpatient information in its information section from 2009-2011 were counted up and analyzed for their referral rate and reasons before and after implementation of the essential drugs system. Result: The average referral rate of the patients with residents’ medical insurance was 3.63‰ and the average referral time was 2.18 per person within 3 years. There were no significant statistical differences in the referral rates of the patient with residents’ medical insurance before and after implementation of essential drugs system. The referral rate of the patients who failed to make up a prescription in the community health service center was 17.4%. Conclusion: The catalogues of 688 essential drugs implemented in the community health service centers can meet the basic clinical requirement of community residents.
Community Health
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Primary care physicians in Germany are potentially in a pivotal position to provide physical activity counselling and exercise referral for their patients. The preventative prescription scheme dates back to the late 1970s. This scheme called “green prescription” (Grünes Rezept), however, could not be established as exercise referral scheme in primary care on a regular and systematic basis. After the German Medical Association (Bundesärztekammer), the German Association for Sports Medicine and Prevention (Deutsche Gesellschaft für Sportmedizin und Prävention) and the German Olympic Sports Federation (Deutscher Olympischer Sportbund) had developed the standardized national quality criteria of Physical Activity on Prescription in a joint effort, the German Medical Association has adopted them in 2011 and now recommends them to the Medical Associations of the Federal States for implementation. These national criteria establish a framework, but given the federal structure of Germany, schemes are not implemented in a uniform or centralized way. The federal states rather develop their own delivery methods according to local possibilities and needs. Exercise as a therapeutic means in the rehabilitation phase of a large number of chronic conditions as well as for people with disabilities is a legally established part of health care. The current legal and financial bases as well as the level of institutionalised support for the prescription of physical activity and exercise within health care are markedly different in the areas of prevention and therapy, respectively. While patients with chronic conditions are entitled to receive free exercise as a means of therapy (within certain limitations), no such “right” exists in the area of prevention. Exercise referrals rely on group offers with defined high standards in organised sports, making use of easily accessible sport clubs which are a traditional part of community life. Rigorous scientific evaluations are needed to provide guidance on how to further develop Germany´s exercise referral schemes.
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Introduction: Patients with confirmed idiopathic pulmonary fibrosis (IPF) are prescribed antifibrotics if they fulfill NICE criteria to reduce symptoms and progression of disease. It is unclear whether delay in beginning treatment will result in poorer outcomes. Methods: Outcome data for patients with eventual IPF diagnosis initiated on antifibrotics were included from Jan 2012 to Jan 2019. Time between date of first radiological finding of interstitial lung disease (ILD) and treatment initiation were identified. FVC and DLCO% were collected at treatment commencement. Inpatient admission events and all-cause mortality were recorded. Cohorts were divided between those who began treatment >12months (+12m) and <12months (-12m) from ILD finding. Student t-test measured differences of FVC and DLCO% between the groups. Logisitic regression models comparing odds of inpatient admission events and mortality were fitted. Results: 34 patients were included in this study. Mean time from first ILD finding to treatment initiation was 20 months. Mean FVC was 2.40 (+12m) vs 2.14 (-12m) (diff 0.26 95% Cl 1.91, 2.53). Mean DLCO% was 41.8% (+12m) vs 40.6% (-12m) (diff 1.2 95% Cl 36.6, 47.2). Odds ratio of inpatient admission events and mortality between the +12m and -12m cohorts was 1.39 (95% Cl 0.343, 5.66, p=0.643). Mean follow-up was 45.4 months. Conclusion: Patients with longer delay in starting antifibrotics actually presented with superior lung function with no significant increase in morbidity or mortality. This suggests different clinical phenotypes of IPF. Further characterisation of these phenotypes may allow targeting antifibrotics to high risk groups.
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Rates of consultations and prescriptions for patients referred to clinical psychologists, and for these patients' immediate families, were investigated for three-year periods both before and after referral. Patients and their children consulted more and had more medication prescribed before referral than control groups, this tendency being particularly prevalent in the year before referral. After the contact with the psychologist there was a decrease in all these indices in the short term, and there were long-term decreases in psychotropic drug prescriptions for patients and in both consultations and prescriptions for their children.
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Abstract : Despite evidence in favor of breast cancer screening with mammograms and that screening has increased in the last years, mammogram compliance among low-income, minority and women over 50 years of age has been slow. This three-year project contemplates a study of women's compliance with 1997 NIH screening mammogram guidelines and physicians' observance of NIH guidelines in Puerto Rico. Two-hundred low-income women age 40 to 64 in Puerto Rico will be interviewed to assess factors that affect compliance with screening mammogram in order to determine self- assessment cancer risks. Fifty clinicians will be interviewed to obtain data about mammogram referral patterns. Physicians will be asked permission to examine a random number of records to document referral patterns and select potential survey participants. The first stage of the project was directed to obtain qualitative data to develop the instruments to be administered to the physicians and the women. Focus groups were conducted for this purpose. The women's focus groups served to incorporate pertinent issues and appropriate vocabulary. The physicians' focus group was directed to assess an instrument developed by the research team consisting of case-studies by which to probe if physicians were familiar with 1997 NIH screening mammogram guidelines.
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One form of self-medication is sharing of medications, defined as borrowing or lending medications in situations where the receiver of these drugs is not the individual to whom the medications were allocated.To explore experiences and opinions of patients about sharing prescription analgesics, reasons for sharing prescription analgesics, the way in which patients choose to share those medications, their awareness of risk regarding sharing prescription analgesics, and how they estimated the potential risk.This qualitative study was conducted by focus group discussions with 40 participants led by a moderator trained in focus group methodology using a semi-structured moderator guide. Adults aged ≥18 years who had received a prescription for an analgesic at least once in a lifetime were included. Six separate focus groups were conducted to discuss participants' perception of risks associated with sharing of prescription analgesics among patients. Additionally, participants filled out two questionnaires on demographic data, their own behavior regarding sharing analgesics, and their attitudes about risks associated with sharing prescription analgesics.In a questionnaire, 55% of the participants indicated that they personally shared prescription analgesics, while subsequently in the focus group discussions, 76% confessed to such behavior. Participants recognized certain risks related to sharing of prescription analgesics, mentioned a number of reasons for engaging in such behavior, and indicated certain positive aspects of such behavior. Forty-five percent of the participants indicated that sharing prescription analgesics is riskier than sharing nonprescription analgesics.There is a prevalent attitude among participants that sharing prescription analgesics is a positive behavior, where potential benefits outweigh risks.
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Background: Increased number of Askes insurance members with type 2 diabetes mellitus (DM) may have an impact of cost of health care. Since 2010, PT Askes (Persero) implemented the Chronic Disease Management Programme (Prolanis), especially for type 2 DM disease. However, back referral from internal medicine specialist to primary care physician was not well implemented. Aim: This study aims to identify perceptions of internal medicine specialist and patients affecting implementation of back referral for patients with type 2 DM from the hospital to primary care physician. Method: A qualitative study was employed, using in-depth interviews, observation and focus group discussions. In-depth interviews were conducted with eight internal medicine spesialists in three hospitals in Kudus district and two primary care physicians. Focus group discussions were conducted with four groups of patients with type 2 DM, and observation was made to describe the working environment at the hospital. Result: This study found that implementation of back referrals were influenced by physicians’ workload at the hospital, perceived competence of primary care physician, lack of communication and coordination between the specialists and primary care physicians, as well as patient demands toward specialist doctor. Patients felt that access to a specialist doctor was limited due to referrals made by the primary physicians. Conclusion: Both the internal medicine specialists and patients factors affect poor implementation of back referrals, despite their perceived understanding of the importance. Keywords: back referral, Askes insurance members, type 2 diabetes mellitus, qualitative study
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Objective The aim of this study was to explore and understand women's experience with cervical cancer screening and with the referral pathways for abnormal Papanicolau (Pap) smears. Design and setting Focus group discussions were conducted with first time colposcopy clinic attendees at a tertiary hospital colposcopy clinic in Cape Town, South Africa during November 2014. A thematic analysis was conducted to identify key themes. Initial coding categories were drawn from the interview guide. Participants 27 women participated in 4 focus group discussions. Results Participants mean age was 34 years, most did not complete secondary level education and were unemployed. Negative community opinions relating to Pap smears and colposcopy referral might deter women from seeking treatment. Having a gynaecological symptom was the most commonly cited reason for having a Pap smear. Fear of having a HIV test performed at the same time as Pap smear and low encouragement from peers, were factors identified as potential access barriers. Participants commented on insufficient or lack of information from primary providers on referral to the colposcopy clinic and concerns and apprehension during waiting periods between receiving results and the colposcopy appointment were discussed. Conclusions There is a strong and urgent need to improve current knowledge about cervical cancer and Pap smears and the necessity and benefits of timely access to screening programmes, results and treatment. Strategies such as community health education programmes and mass media interventions could be employed to disseminate cervical cancer information and address negative community perceptions. Better training and support mechanisms to equip healthcare providers with the skills to convey cervical cancer information to women are needed. The use of short message service (SMS) to deliver Pap smear results and provide patients with more information should be considered to improve waiting times for results and alleviate apprehension during waiting periods.
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