Artículos de revistas sobre el tema "Health services utilisation"
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Xu, Jianqiang, Juan Zheng, Lingzhong Xu y Hongtao Wu. "Equity of Health Services Utilisation and Expenditure among Urban and Rural Residents under Universal Health Coverage". International Journal of Environmental Research and Public Health 18, n.º 2 (12 de enero de 2021): 593. http://dx.doi.org/10.3390/ijerph18020593.
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Worldwide countries are recognising the need for and significance of universal health coverage (UHC); however, health inequality continues to persist. This study evaluates the status and equity of residents’ demand for and utilisation of health services and expenditure by considering the three components of universal health coverage, urban-rural differences, and different income groups. Sample data from China’s Fifth Health Service Survey were analysed and the ‘five levels of income classification’ were used to classify people into income groups. This study used descriptive analysis and concentration index and concentration curve for equity evaluation. Statistically significant differences were found in the demand and utilisation of health services between urban and rural residents. Rural residents’ demand and utilisation of health services decreased with an increase in income and their health expenditure was higher than that of urban residents. Compared with middle- and high-income rural residents, middle- and lower-income rural residents faced higher hospitalisation expenses; and, compared with urban residents, equity in rural residents’ demand and utilisation of health services, and annual health and hospitalisation expenditures, were poorer. Thus, equity of health service utilisation and expenditure for urban and rural residents with different incomes remain problematic, requiring improved access and health policies.
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McCrone, Paul, Graham Thornicroft, Michael Phelan, Frank Holloway, Til Wykes y Sonia Johnson. "Utilisation and costs of community mental health services". British Journal of Psychiatry 173, n.º 5 (noviembre de 1998): 391–98. http://dx.doi.org/10.1192/bjp.173.5.391.
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BackgroundThe costs and the effectiveness of mental health services need to be evaluated if provision is to be efficient. Service use and costs are described for two geographical areas in south London.MethodService use was measured comprehensively for clients in both sectors for two six-month time periods using the Client Service Receipt Interview This information was combined with unit costs to calculate service costs. The ‘hidden’ costs of informal care and unsupported accommodation were also calculated.ResultsAt baseline significantly more intensive sector clients had in-patient stays but by the follow-up this difference had disappeared. There was significantly more use of supported accommodation in the intensive sector during both time periods. Baseline and follow-up total service costs were significantly higher for the intensive sector. Costs were spread disproportionately and a small number of services accounted for a large proportion of cost.ConclusionsWhile the cost at Time 2 was significantly greater in the intensive sector, this was largely due to the high use of supported accommodation. There was some convergence in cost between the sectors over time.
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Darma, Azri, Hidayati Hidayati y Fadil Oenzil. "Differences between dental health service quality and utilization of Community Health Centres in the City of Padang based on indicators of utilisation effectiveness". Padjadjaran Journal of Dentistry 30, n.º 2 (31 de julio de 2018): 140. http://dx.doi.org/10.24198/pjd.vol30no2.18330.
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Introduction: The high prevalence of oral disease have not been followed by the availability of oral healthcare, especially at the community-based level. This study was aimed to determine the differences between dental health service quality and utilisation of community health centres in the city of Padang based on indicators of utilisation effectiveness. Methods: A cross-sectional survey was conducted towards two Community Health Services (Puskesmas) as the samples selected using random sampling technique. One Community Health Service was representing a rarely visited Community Health Service with ≤ 9 patients visit per day, and another Community Health Service was representing oppositely. As much as 131 respondents were included in this study, selected using the purposive sampling method. Dimensional satisfaction of service quality including tangibility, reliability, responsiveness, assurance, and empathy, were collected by interviewing the respondents based on a self-reported questionnaire. All data were analysed using the chi-square test. Results: The majority of respondents agreed that dimensional satisfaction such as tangibility, reliability, responsiveness, assurance, and empathy at both Community Health Services were at a good level. There was a significant relationship (p < 0.05) between several dimensional satisfaction of service quality variables (the wide and clean parking area; intense involvement of dentists on every oral examination; friendly service by the front-office; and empathetic affection of dentists towards the patient’s complain) and the utilisation of oral health services. Conclusion: No service differences found from relationship analysis between dental health service quality and utilisation of community health centres in the city of Padang based on indicators of utilisation effectiveness.Keywords: Service quality, dimensional satisfaction, oral health service, service utilisation, Community Health Centre.
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Nolan, Brian. "Economic incentives, health status and health services utilisation". Journal of Health Economics 12, n.º 2 (julio de 1993): 151–69. http://dx.doi.org/10.1016/0167-6296(93)90025-a.
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Alkhawaldeh, Abdullah. "Factors associated with utilisation of university health centre services by students". International Journal Of Community Medicine And Public Health 4, n.º 6 (22 de mayo de 2017): 1858. http://dx.doi.org/10.18203/2394-6040.ijcmph20172145.
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Background: Little is known about the factors that are associated with students’ utilisation of university health centre services. The current study examines factors associated with utilisation of university health centre services by students.Methods: Data were collected from 440 university students using a cross-sectional study design and self-reported questionnaire.Results: University health centre services were utilised by 147 (39.5%) of the students in the past 6 months. Utilisation of university health centre services was associated with gender, faculty, tobacco use and chronic illnesses. The main predictor of university health centre services utilisation at 6 months was chronic illnesses (OR=4.205).Conclusions: Although several factors were associated with university health centre services utilisation, chronic illness was the most important predictor.
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Skinner, Elizabeth H., Michele Foster, Geoffrey Mitchell, Michele Haynes, Martin O'Flaherty y Terry P. Haines. "Effect of health insurance on the utilisation of allied health services by people with chronic disease: a systematic review and meta-analysis". Australian Journal of Primary Health 20, n.º 1 (2014): 9. http://dx.doi.org/10.1071/py13092.
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Allied health services benefit the management of many chronic diseases. The effects of health insurance on the utilisation of allied health services has not yet been established despite health insurance frequently being identified as a factor promoting utilisation of medical and hospital services among people with chronic disease. The objective of this systematic review and meta-analysis was to establish the effects of health insurance on the utilisation of allied health services by people with chronic disease. Medline (Ovid Medline 1948 to Present with Daily Update), EMBASE (1980 to 1 April 2011), CINAHL, PsychINFO and the Cochrane Central Register of Controlled Trials were searched to 12 April 2011 inclusive. Studies were eligible for inclusion if they were published in English, randomised controlled trials, quasi-experimental trials, quantitative observational studies and included people with one or more chronic diseases using allied health services and health insurance. A full-text review was performed independently by two reviewers. Meta-analyses were conducted. One hundred and fifty-eight citations were retrieved and seven articles were included in the meta-analyses. The pooled odds ratio (95% CI) of having insurance (versus no insurance) on the utilisation of allied health services among people with chronic disease was 1.33 (1.16−1.52; P < 0.001). There was a significant effect of insurance on the utilisation of non-physiotherapy services, pooled odds ratio (95% CI) 4.80 (1.46−15.79; P = 0.01) but having insurance compared with insurance of a lesser coverage was not significantly associated with an increase in physiotherapy utilisation, pooled odds ratio (95% CI) 1.53 (0.81−2.91; P = 0.19). The presence of co-morbidity or functional limitation and higher levels of education increased utilisation whereas gender, race, marital status and income had a limited and variable effect, according to the study population. The review was limited by the considerable heterogeneity in the research questions being asked, sample sizes, study methodology (including allied health service), insurance type and dependent variables analysed. The presence of health insurance was generally associated with increased utilisation of allied health services; however, this varied depending on the population, provider type and insurance product.
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Haddison, Eposi C., Chia E. Julius y Benjamin M. Kagina. "Health Services Utilisation before and during an Armed Conflict; Experiences from the Southwest Region of Cameroon". Open Public Health Journal 13, n.º 1 (26 de octubre de 2020): 547–54. http://dx.doi.org/10.2174/1874944502013010547.
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Introduction: Armed conflicts are a threat to the health of populations in affected areas. The threat can have several forms, such as direct injury or disruption of health service delivery and utilisation. There has been an armed conflict (Anglophone crisis) in the English-speaking regions of Cameroon since 2017. We assessed the utilisation of health services before and during the armed conflict s in the Southwest region of Cameroon. Methods: A retrospective study of surveillance data was carried out between 2016 and 2018. Regional data for selected routine immunisation, reproductive health, disease surveillance and HIV/AIDS indicators were retrieved. The data were presented as frequencies and described narratively. Results: In general, there was a difference in the utilisation of health services before and during the armed conflict. Specifically, there was an improvement in health service utilisation indicators from 2016 to 2017, followed by a decline in 2018. The DPT3 vaccination coverage dropped from 90% in 2017 to 55% in 2018; deliveries attended by qualified personnel dropped from 46% in 2017 to 26% in 2018; the absolute number of people tested for HIV dropped from 20,3987 in 2017 to 18,3654 in 2018. Conclusion: The utilisation of health services by the population of the Southwest region declined during the armed conflict. This decline could have a significant impact on the population’s health and potentially affect the set global health targets such as improved vaccination coverage in all districts. Due to the armed conflict, there were challenges with regard to accessing health services. Local, national, regional and global authorities must work together to develop risk mitigating interventions in settings with armed conflicts to preserve the delivery and utilisation of health services.
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Chen, Jiaqi, Song Xu y Jing Gao. "The Mixed Effect of China’s New Health Care Reform on Health Insurance Coverage and the Efficiency of Health Service Utilisation: A Longitudinal Approach". International Journal of Environmental Research and Public Health 17, n.º 5 (9 de marzo de 2020): 1782. http://dx.doi.org/10.3390/ijerph17051782.
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In 2009, China launched a new health care reform as it endeavoured to develop a tiered system of disease diagnosis and treatment to promote the integration of medical resources. This was important for improving service capacity and building medical alliances that would eventually lead to improved health service utilisation efficiency. However, while the 2009 reform aimed to provide universal health insurance coverage to all citizens, its overall effect on health service utilisation efficiency remains unclear. We aimed to examine the new health care reform’s mixed effect by applying a longitudinal study using China Health and Nutrition Survey (CHNS) data and the difference-in-difference (DID) method to estimate the health reform’s impact on health insurance coverage rate. Then, we studied whether the increase in health insurance coverage rate affected health service utilisation efficiency in China. Our results showed that the increase in insurance coverage rate has indeed made expensive medical services available to low-income individuals. However, it also increased the likelihood of use of hospitals rather than primary care facilities, since there is more insurance cover for outpatient visits, which has led to an increased demand for quality services. This effect has generated a negative impact on health care utilisation which directly pertains to systemic inefficiency. This study thus indicates that China’s latest health reform requires further policies to improve its overall efficiency.
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Mahmood, M. Afzal, Anna E. Bauze, Justin T. Lokhorst, Peng Bi y Arthur Saniotis. "Influence of living arrangements on health services utilisation in Australia". Australian Health Review 36, n.º 1 (2012): 34. http://dx.doi.org/10.1071/ah10920.
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Background. The number of people living alone is increasing markedly. Others live as couples only, couples with child(ren) and single adult with child(ren). Health service utilisation could differ for people in different living arrangements as a result of varying levels of risk factors, health status, access to informal care and decision-making for accessing care. Objective. To identify the association between living arrangements and health service use. Methods. The Australian Bureau of Statistics’ National Health Survey 2001 data for people 18–65 years old were analysed for household composition and service use. Results. People in various household types differ in terms of their overall use of health services and their use of services by general practitioners. Sex, rurality, socioeconomic status and status of heart condition significantly influenced the use of health services. Conclusion. There are implications for health services provision and planning within the context of rapid changes in living arrangements. Additional research is required to explore the reasons to such differences, level of access to informal care, healthcare decision-making processes and consequences of under- or over-utilisation of services. What is known about the topic? Health service use is influenced by the disease burden and pattern, demography, economic factors, access to social support, quality of care and satisfaction with standards of care. These factors may influence access to and use of care. What does this paper add? This research points to the potential role of living arrangements on health services use. Many people now live alone and may not have access to informal care, and access to health information and education. People in different living arrangements appear to have different health service use. What are the implications for practitioners? Practitioners, in both primary care and acute care sectors, need to consider that patients, including younger people, may not have access to informal care, may present with delays and may not have the needed adequate support during convalescence. Health education needs to consider that people in different living arrangements may be exposed to different levels of risk factors in terms of their healthcare use.
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Buckley, Dermot y Tony Lower. "Factors influencing the utilisation of health services by rural men". Australian Health Review 25, n.º 2 (2002): 11. http://dx.doi.org/10.1071/ah020011.
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This research identified the barriers and enablers that influence the utilisation of health services by rural men in the Midwest region of Western Australia. The methodology was based on participatory action research, including qualitative assessments to determine the issues for a larger quantitative study. Four variables were identified as predictors for the use of health services: those who attended for preventive reasons; those not affected by seasonal work;men who thought a medical telephone line was not important; and those who did not consider privacy an important issue. Modification of health service delivery to men could potentially enhance appropriate utilisation of health services in rural areas.
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Gibson, David A. J., Rachael E. Moorin, David B. Preen, Jon D. Emery y C. D'Arcy J. Holman. "Effects of the Medicare enhanced primary care program on primary care physician contact in the population of older Western Australians with chronic diseases". Australian Health Review 35, n.º 3 (2011): 334. http://dx.doi.org/10.1071/ah09852.
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Objective. Assess uptake of Medicare’s enhanced primary care (EPC) services in Western Australia (WA) in 2001 to 2006, evaluating effect of EPC services on the regularity of contact with general practitioners (GPs) in patients aged 65+ years. Method. Whole-population cohort study using linked routinely collected health service data from State and Federal health databases. Analyses include age-standardised rate of EPC services, odds of EPC utilisation relative to other GP services using logistic regression, and total GP service regularity pre- and post-implementation of the EPC program. Results. EPC services provided to WA seniors increased 345% 2001 to 2006, comprising an increasing proportion of the total GP services (1.1 to 3.6%). Uptake of EPC services accelerated abruptly after 2004 due to greater use of ‘care plans’. EPC services were associated with a history of chronic disease, especially type 2 diabetes (OR = 1.74, 95% CI 1.66–1.82). Regularity of total GP services was improved with any EPC service exposure, with greater improvement occurring in the presence of annual EPC service exposure. Conclusions. EPC item uptake responded favourably to item changes from Medicare Australia. Prior exposure to EPC items increased the regularity of GP services, an outcome inversely associated with chronic disease progression. What is known about the topic? The Australian Federal government has invested substantial funds (over $200 million in 2007–08 alone) in the enhanced primary care (EPC) program with the intention of improving patient outcomes, specifically aged patients and those suffering from chronic disease. The EPC program uses high value Medicare items to incentivise GPs to engage in long-term planned care. However, limited research has examined the effect of this program on patient service utilisation and outcomes. What does this paper add? This paper provides a whole-population perspective on the EPC utilisation trends from 2001 to 2006 for Western Australian residents over 65 years of age. The paper then examines the likelihood of using the EPC program on the basis of calendar year, sex, age and chronic disease history. A comparison of the regularity of GP service utilisation for those exposed to the EPC program is also made. What are the implications for practitioners? The adjustments made to the EPC program in 2004, after feedback from GPs, appears to have substantially increased the utilisation of the program. Additionally, patients suffering from several different chronic diseases are more likely to be exposed to the EPC program. Exposure to the EPC program also appears to provide an improvement in regularity of service utilisation which has been associated with improved outcomes in the literature.
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Khoo, Joanna, Helen Hasan y Kathy Eagar. "Utilisation patterns of privately funded mental health services in Australia". Journal of Health Organization and Management 33, n.º 1 (18 de marzo de 2019): 5–17. http://dx.doi.org/10.1108/jhom-02-2018-0062.
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Purpose The purpose of this paper is twofold: first, to present patient-level utilisation patterns of hospital-based mental health services funded by private health insurers; and second, to examine the implications of the findings for planning and delivering private mental health services in Australia. Design/methodology/approach Analysing private health insurance claims data, this study compares differences in demographic and hospital utilisation characteristics of 3,209 patients from 13 private health insurance funds with claims for mental health-related hospitalisations and 233,701 patients with claims for other types of hospitalisations for the period May 2014 to April 2016. Average number of overnight admissions, length of stay and per patient insurer costs are presented for each group, along with overnight admissions vs same-day visits and repeat services within a 28-day period following hospitalisation. Challenges in analysing and interpreting insurance claims data to better understand private mental health service utilisation are discussed. Findings Patients with claims for mental health-related hospitalisations are more likely to be female (62.0 per cent compared to 55.8 per cent), and are significantly younger than patients with claims for other types of hospitalisations (32.6 per cent of patients aged 55 years and over compared to 57.1 per cent). Patients with claims for mental health-related hospitalisations have significantly higher levels of service utilisation than the group with claims for other types of hospitalisations with a mean length of stay per overnight admission of 15.0 days (SD=14.1), a mean of 1.3 overnight admissions annually (SD=1.2) and mean hospital costs paid by the insurer of $13,192 per patient (SD=13,457) compared to 4.6 days (SD=7.3), 0.8 admissions (SD=0.6) and $2,065 per patient (SD=4,346), respectively, for patients with claims for other types of hospitalisations. More than half of patients with claims for mental health-related hospitalisations only claim for overnight admissions. However, the findings are difficult to interpret due to the limited information collected in insurance claims data. Practical implications This study shows the challenges of understanding utilisation patterns with one data source. Analysing insurance claims reveals information on mental health-related hospitalisations but information on community-based care is lacking due to the regulated role of the private health insurance sector in Australia. For mental health conditions, and other chronic health conditions, multiple data sources need to be integrated to build a comprehensive picture of health service use as care tends to be provided in multiple settings by different medical and allied health professionals. Originality/value This study contributes in two areas: patient-level trends in hospital-based mental health service utilisation claimed on private health insurance in Australia have not been previously reported. Additionally, as the amount of data routinely collected in health care settings increases, the study findings demonstrate that it is important to assess the quality of these data sources for understanding service utilisation.
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Phaiyarom, Mathudara, Nareerut Pudpong, Rapeepong Suphanchaimat, Watinee Kunpeuk, Sataporn Julchoo y Pigunkaew Sinam. "Outcomes of the Health Insurance Card Scheme on Migrants’ Use of Health Services in Ranong Province, Thailand". International Journal of Environmental Research and Public Health 17, n.º 12 (19 de junio de 2020): 4431. http://dx.doi.org/10.3390/ijerph17124431.
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In 2002, Thailand achieved Universal Health Coverage for all citizens; however, it remains the case that undocumented migrants are not fully covered. The Health Insurance Card Scheme (HICS) of the Ministry of Public Health is the key policy aiming to cover undocumented migrants. This study examined the impact of this policy on the utilisation rate of public health facilities among HICS beneficiaries including undocumented migrants. Facility-based individual records between 2011 and 2015 were purposively retrieved from one provincial hospital, one district hospital, and two health centres in one of the most densely migrant-populated provinces in Thailand. Poisson regression was conducted on inpatient (IP) utilisation, while negative binomial regression was conducted on outpatient (OP) utilisation. Of 74,722 admissions, 19.0% were insured by HICS. About 14.0% of the outpatient records were for HICS beneficiaries. Overall, the HICS utilisation rate in migrants was lower than in Thai patients. Being insured with the HICS significantly increased OP utilisation by 1.7%, and IP utilisation by 11.1% (relative to uninsured). Disease status was the most important factor that positively influenced the utilisation rate. Further studies that explore the differences in health service utilisation among HICS beneficiaries with diverse economic backgrounds are recommended
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Simpson, Grahame K., Mark Sabaz, Maysaa Daher, Robert Gordon y Barbara Strettles. "Challenging Behaviours, Co-morbidities, Service Utilisation and Service Access among Community-dwelling Adults with Severe Traumatic Brain Injury: A Multicentre Study". Brain Impairment 15, n.º 1 (mayo de 2014): 28–42. http://dx.doi.org/10.1017/brimp.2014.7.
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Objective: To examine patterns, predictors and unmet needs of service utilisation and access to mental health and/or drug and alcohol services among community-dwelling adults with severe traumatic brain injury, and compare those who displayed challenging behaviours with those not displaying challenging behaviour.Design: Retrospective multicentre study.Subjects: All active clients (n= 507) of the New South Wales (NSW) Brain Injury Rehabilitation Program (BIRP) community rehabilitation teams.Methods: Clinician-rated data were collected on client challenging behaviours, mental health and functional status, service utilisation and unmet needs. Between-groups analyses (challenging behaviour versus no challenging behaviours) were conducted to examine patterns of service utilisation and unmet needs. Predictors for service utilisation were tested by multiple linear regression.Results: Challenging behaviours were associated with higher use of BIRP and non-BIRP services and greater levels of unmet needs. Challenging behaviour was an independent predictor of higher levels of service utilisation, in conjunction with pre- and post-injury mental health and drug and alcohol co-morbidities and geographic location. Only 15.3% of the 111 clients with challenging behaviours and co-morbid drug and alcohol problems accessed a drug and alcohol service, while another 32.4% had unmet needs for such services.Conclusion: Challenging behaviours make an independent contribution to increased levels of service utilisation after severe traumatic brain injury.
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Hendrickx, David, Ingrid Amgarth-Duff, Asha C Bowen, Jonathan R Carapetis, Robby Chibawe, Margaret Samson y Roz Walker. "Barriers and Enablers of Health Service Utilisation for Childhood Skin Infections in Remote Aboriginal Communities of Western Australia". International Journal of Environmental Research and Public Health 17, n.º 3 (28 de enero de 2020): 808. http://dx.doi.org/10.3390/ijerph17030808.
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In Australia, children living in remote Aboriginal communities experience high rates of skin infections and associated complications. Prompt presentation to primary care health services is crucial for early diagnosis and treatment. We performed a qualitative study in four remote Aboriginal communities in the Pilbara region of Western Australia to explore factors that affected health service utilisation for childhood skin infections in this setting. The study consisted of semistructured interviews and focus group discussions with parents and carers (n = 16), healthcare practitioners (n = 15) and other community service providers (n = 25). We used Andersen’s health service utilisation model as an analytical framework. Our analysis captured a wide range of barriers that may undermine timely use of health services for childhood skin infections. These included general factors that illustrate the importance of cultural competency amongst healthcare providers, patient-centred care and community engagement. Relating specifically to health service utilisation for childhood skin infections, we identified their apparent normalisation and the common use of painful benzathine penicillin G injections for their treatment as important barriers. Health service utilisation in this setting may be enhanced by improving general awareness of the significance of childhood skin infections, actively engaging parents and carers in consultation and treatment processes and strengthening community involvement in health service activities.
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Pershouse, Kiley, Pim Kuipers, Delena Amsters y Glenda Price. "Responding to the Health and Disability Service Needs of People Ageing with Spinal Cord Injury: Implications from an Australian Study". Australian Journal of Primary Health 12, n.º 1 (2006): 65. http://dx.doi.org/10.1071/py06010.
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In the course of a large retrospective research study exploring implications of ageing with a spinal cord injury (SCI), 84 participants were asked to provide responses to a brief telephone questionnaire regarding the nature and quality of their utilisation of various health and disability services. The aim of this study was to explore service utilisation, level of satisfaction with the services utilised, and the nature of the support received from these services for a sample of people ageing with spinal cord injury (SCI). Findings highlighted that people ageing with SCI have need of a range of health and disability services predominantly focusing on achieving instrumental assistance. Satisfaction with service was generally high and demonstrated the importance of interpersonal communication skills, technical competence and responsiveness in the delivery of outcomes.
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Gulliford, Martin, Jose Figueroa-Munoz, Myfanwy Morgan, David Hughes, Barry Gibson, Roger Beech y Meryl Hudson. "What does 'access to health care' mean?" Journal of Health Services Research & Policy 7, n.º 3 (1 de julio de 2002): 186–88. http://dx.doi.org/10.1258/135581902760082517.
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Facilitating access is concerned with helping people to command appropriate health care resources in order to preserve or improve their health. Access is a complex concept and at least four aspects require evaluation. If services are available and there is an adequate supply of services, then the opportunity to obtain health care exists, and a population may 'have access' to services. The extent to which a population 'gains access' also depends on financial, organisational and social or cultural barriers that limit the utilisation of services. Thus access measured in terms of utilisation is dependent on the affordability, physical accessibility and acceptability of services and not merely adequacy of supply. Services available must be relevant and effective if the population is to 'gain access to satisfactory health outcomes'. The availability of services, and barriers to access, have to be considered in the context of the differing perspectives, health needs and material and cultural settings of diverse groups in society. Equity of access may be measured in terms of the availability, utilisation or outcomes of services. Both horizontal and vertical dimensions of equity require consideration.
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Poudel-Tandukar, Kalpana, Krishina C. Poudel y Conlin Macdougall. "Factors influencing women's use of health services for Sexually Transmitted Infections in eastern Nepal". Australian Health Review 26, n.º 1 (2003): 116. http://dx.doi.org/10.1071/ah030116.
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This paper explores low levels of women's health service utilization for Sexually Transmitted Infections (STIs)in Nepal. We interviewed 120 women individually and 53 in focus groups. Predictors of lower utilisation were self-medication, consultation with faith healers, inadequate knowledge of STIs, beliefs about causes, fear, social taboos and stigmatisation, women's secondary status, and presence of male health professionals. Results indicate the importance of people's beliefs in their decisions about health care. Strategies to improve access to health services in Nepal should systematically investigate the role of all these factors to improve access to and utilisation of health services for STIs.
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Kurebwa, Jeffrey. "Adolescent Sexual Reproductive Health Services in Bindura Urban of Zimbabwe". International Journal of Patient-Centered Healthcare 9, n.º 2 (julio de 2019): 1–20. http://dx.doi.org/10.4018/ijpch.2019070101.
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This study seeks to understand the capacity of adolescent-friendly reproductive health services (AFRHS) in promoting sexual reproductive health (SRP) among adolescents in Bindura Urban of Zimbabwe. The data collection methods used allowed the researcher to get insight on adolescents' experience and the factors associated with their accessing SRH services from AFRHS, the meaning of AFRHS for adolescents, healthcare providers' attitudes towards adolescents seeking SRH services, and community perceptions and readiness to accept AFRHS. The findings showed that both socio-cultural and health facility factors influence utilisation of SRH services. Many of these factors stem from the moral framework encapsulated in socio-cultural norms and values related to the sexual health of adolescents and healthcare providers' poor value clarification. This study provides an empirical understanding of the reasons and factors associated with SRH service utilisation, which goes much deeper than program provision of AFRHS in Zimbabwe.
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Brandstetter, Susanne, David Rothfuß, Birgit Seelbach-Göbel, Michael Melter, Michael Kabesch y Christian Apfelbacher. "Information on, knowledge and utilisation of support services during pregnancy and after childbirth: cross-sectional analyses of predictors using data from the KUNO-Kids health study". BMJ Open 10, n.º 10 (octubre de 2020): e037745. http://dx.doi.org/10.1136/bmjopen-2020-037745.
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ObjectivesTo investigate mothers’ knowledge and utilisation of antenatal and perinatal support services as well as predictors of knowledge and service utilisation.DesignCross-sectional study.SettingProspective birth cohort in Regensburg, Eastern Bavaria, Germany.Participants2455 mothers after delivery.Outcome measuresParticipants’ knowledge of distinct antenatal and perinatal support services (poor vs good, defined by median split). Participants’ use of antenatal services provided by midwife (yes, no) and of any other antenatal support services (yes, no).ResultsThe vast majority of mothers knew at least some support services. Two-thirds of women (68.4%) reported to have used the services provided by midwives. 23.6% of women reported to have used at least one of the other antenatal services. Good knowledge of services was associated with higher education (OR 1.37, 95% CI 1.13 to 1.67), no migration background (OR 2.26, 95% CI 1.76 to 2.90), better health literacy (OR 1.04, 95% CI 1.03 to 1.06), while being primiparous (OR 0.72, 95% CI 0.60 to 0.86) and being unmarried/living with a partner (OR 0.71, 95% CI 0.57 to 0.89) reduced the chance. Predictors of service utilisation differed with regard to the services considered.ConclusionsOverall, mothers had a good level of knowledge of antenatal and perinatal support services. However, we found that some groups of women were less well informed. This inequality in social predictors of knowledge of services was also partly reflected in differences in service utilisation during pregnancy.
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Seers, Kara, Lynley Cook, Gillian Abel, Philip Schluter y Paul Bridgford. "Is it time to talk? Interpreter services use in general practice within Canterbury". Journal of Primary Health Care 5, n.º 2 (2013): 129. http://dx.doi.org/10.1071/hc13129.
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INTRODUCTION: Effective communication is fundamental to successful health care service delivery, and has a positive impact on access, quality of care, health outcomes, and patient satisfaction. Although there are a growing number of New Zealanders who do not speak English proficiently, underutilisation of trained interpreter services appears to be common in primary health care settings. AIMS: To describe the pattern of interpreter service need and utilisation by general practice services, and to identify key barriers and enabling factors to the use of trained interpreters. METHODS: A mixed methods study was employed. Census and Partnership Health Canterbury Te Kei o Te Waka (PHC) databases were combined, and quantitative analysis used to derive interpreter service need and utilisation patterns. Transcripts of focus groups and interviews from general practitioners, practice nurses and practice administration staff within the PHC were analysed, using qualitative methods to identify barriers and enablers to interpreter service use. RESULTS: For the years 20082010, approximately 10 742 consultations per year involved a non-English-speaking patient, yet in only approximately 74.8 (0.7%) consultations per year were interpreter services utilised. Analysis of focus groups and interviews identified four global themes that represented barriers for interpreter service utilisation; namely, practicalities, expectations, knowledge of service, and systems. DISCUSSION: The current use of interpreter services in PHC general practice appears to be significantly less than the need. In order to maximise health outcomes and reduce risk, strategies must be initiated to counter the barriers currently inhibiting interpreter service use, including adopting best practice policies. KEYWORDS: Communication; communication barriers; general practice; primary health care
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Dolan, Carrie B. "Health aid projects have both expanded and constrained the capacity of health facilities to deliver malaria services to under-five children in Malawi". BMJ Global Health 3, n.º 6 (diciembre de 2018): e001051. http://dx.doi.org/10.1136/bmjgh-2018-001051.
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ObjectiveThis article examines the potential pathways health aid may use to influence the availability of malaria services at a facility level and the utilisation of malaria services for children under five in Malawi.MethodsThis work is grounded in a health services research theoretical model and combines a subnational census of health services available at Malawi health facilities with individual-level data on health service utilisation and the Government of Malawi’s official source of data about health aid allocation at a child-level (n=2171). Logistic and multinomial logistic models were used to assess the relationship between health aid, malaria service readiness and malaria service utilisation. Models were adjusted for predisposing, enabling and need factors and accounted for the complex relationship using a mediation approach.ResultsThe evidence presented suggests that health aid translates into increased diagnostic capacity, but not overall or training readiness. Results indicate that increasing aid projects in a region boost its facilities’ diagnostic readiness, increasing each facility’s relative likelihood of having a medium level of diagnostic readiness by 12% (relative risk (RR)=1.118; 95% CI 1.060 to 1.179) and its likelihood of having a high level of readiness by 23% (RR=1.230; 95% CI 1.161 to 1.303), but decreasing its readiness to provide training by 8% (RR=0.925; 95% CI 0.879 to 0.974).ConclusionThe results of this research highlight the fact that health aid is working to increase malaria diagnostic capacity at a facility level, but that increasing facility readiness to implement the diagnostic tests has been neglected.
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COOPER, HELEN, CHRIS SMAJE y SARA ARBER. "Equity in Health Service Use by Children: Examining the Ethnic Paradox". Journal of Social Policy 28, n.º 3 (junio de 1999): 457–78. http://dx.doi.org/10.1017/s0047279499005656.
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This article investigates whether equity is achieved in health service utilisation by children and young people aged 0–19 years. Data from the British General Household Survey 1991–4 is used to examine the influence of ethnicity, along with social class, housing tenure, family structure and employment of parents on the use of general practitioner, outpatient and inpatient services. Health status is the most powerful predictor of use for each health service and there is no evidence of socioeconomic inequalities. However, a clear ‘ethnic paradox’ persists after controlling for socioeconomic and demographic factors. South Asian children have a higher utilisation of GP services than any other ethnic group, but the use of hospital services is lower for children in all minority ethnic groups relative to the white population. Possible explanations for this paradox are examined in relation to indirect indicators of service quality. There is no evidence to suggest that South Asian children visit the doctor more frequently for a given illness episode than white children, but having a non-UK- born mother is associated with increased consultation and reduced use of outpatient services relative to UK-born South Asian parents.
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Parajuli, Jamuna y Dell Horey. "Barriers to and facilitators of health services utilisation by refugees in resettlement countries: an overview of systematic reviews". Australian Health Review 44, n.º 1 (2020): 132. http://dx.doi.org/10.1071/ah18108.
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Objective The aim of this study was to provide an overview of the previously reviewed research literature to identify barriers and facilitators to health service utilisation by refugees in resettlement countries. Methods An overview of systematic reviews was conducted. Seven electronic databases (Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, ProQuest Central, Scopus, EBSCO and Google Scholar) were searched for systematic reviews of barriers and facilitators to health-seeking behaviour and utilisation of health services by refugees following resettlement. The two authors independently undertook data selection, data extraction and quality assessment using a validated tool. Results Nine systematic reviews covered a range of study areas and refugee populations. Barriers to health service utilisation fell into three broad areas: (1) issues related to refugees, including refugee characteristics, sociocultural factors and the effects of previous experiences; (2) issues related to health services, including practice issues and the knowledge and skills of health professionals; and (3) issues related to the resettlement context, including policies and practical issues. Few facilitators were identified or evaluated, but these included approaches to care, health service responses and behaviours of health professionals. Conclusions Barriers to accessing health care include refugee characteristics, practice issues in health services, including the knowledge and skills of health professionals, and the resettlement context. Health services need to identify barriers to culturally sensitive care. Improvements in service delivery are needed that meet the needs of refugees. More research is needed to evaluate facilitators to improving health care accessibility for these vulnerable groups. What is known about the topic? Refugee health after resettlement is poor, yet health service use is low. What does this paper add? Barriers to accessing health services in resettlement countries are related not only to refugees, but also to issues regarding health service practices and health professionals’ knowledge and skill, as well as the context of resettlement. Few facilitators to improving refugee access to health services have been identified. What are the implications for practitioners? The barriers associated with health professionals and health services have been linked to trust building, and these need to be addressed to improve accessibility of care for refugees.
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Lederle, Mareike, Jana Tempes y Eva M. Bitzer. "Application of Andersen’s behavioural model of health services use: a scoping review with a focus on qualitative health services research". BMJ Open 11, n.º 5 (mayo de 2021): e045018. http://dx.doi.org/10.1136/bmjopen-2020-045018.
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IntroductionQualitative methods have become integral in health services research, and Andersen’s behavioural model of health services use (BMHSU) is one of the most commonly employed models of health service utilisation. The model focuses on three core factors to explain healthcare utilisation: predisposing, enabling and need factors. A recent overview of the application of the BMHSU is lacking, particularly regarding its application in qualitative research. Therefore, we provide (1) a descriptive overview of the application of the BMHSU in health services research in general and (2) a qualitative synthesis on the (un)suitability of the model in qualitative health services research.MethodsWe searched five databases from March to April 2019, and in April 2020. For inclusion, each study had to focus on individuals ≥18 years of age and to cite the BMHSU, a modified version of the model, or the three core factors that constitute the model, regardless of study design, or publication type. We used MS Excel to perform descriptive statistics, and applied MAXQDA 2020 as part of a qualitative content analysis.ResultsFrom a total of 6319 results, we identified 1879 publications dealing with the BMSHU. The main methodological approach was quantitative (89%). More than half of the studies are based on the BMHSU from 1995. 77 studies employed a qualitative design, the BMHSU was applied to justify the theoretical background (62%), structure the data collection (40%) and perform data coding (78%). Various publications highlight the usefulness of the BMHSU for qualitative data, while others criticise the model for several reasons (eg, its lack of cultural or psychosocial factors).ConclusionsThe application of different and older models of healthcare utilisation hinders comparative health services research. Future research should consider quantitative or qualitative study designs and account for the most current and comprehensive model of the BMHSU.
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Howarth, Ana, Morag Munro, Alf Theodorou y Peter R. Mills. "Trends in healthcare utilisation during COVID-19: a longitudinal study from the UK". BMJ Open 11, n.º 7 (julio de 2021): e048151. http://dx.doi.org/10.1136/bmjopen-2020-048151.
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ObjectiveThe first wave of the COVID-19 pandemic had a major impact on healthcare utilisation. The aim of this retrospective review was to quantify how utilisation of non-COVID care changed during this time so as to gain insight and inform planning of future services during potential second and subsequent waves.Methods and analysisA longitudinal design was used to analyse anonymous private UK health insurer datasets covering the period of January 2018 to August 2020. Taken as a measure of healthcare utilisation in the UK, incidence rates of claims broken down by service area and condition were calculated alongside overall monthly totals and costs. Pre-COVID-19 years were compared with the current year.ResultsHealthcare utilisation during the first wave of COVID-19 decreased by as much as 70% immediately after lockdown measures were implemented. After 2 months, the trend reversed and claims steadily began to increase, but did not reach rates seen from previous years by the end of August 2020. Assessment by service and diagnostic category showed that most areas, especially those highly reliant on in-person treatment, reflected the same pattern (ie, rapid drop followed by a steady recovery). The provision of mental health services differed from this observed trend, where utilisation increased by 20% during the first wave of COVID-19, in comparison to pre-COVID-19 years. The utilisation of maternity services and the treatment of existing cancers also stayed stable, or increased slightly, during this time.ConclusionsHealthcare utilisation in a UK-based privately insured population decreased dramatically during the first wave of the COVID-19 pandemic, being over 70% lower at its height. However, mental health services remained resilient during this time, possibly due to greater virtualisation of diagnostics and care.
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Mac-Seing, Muriel, Kate Zinszer, Charity Oga Omenka, Pierre de Beaudrap, Fereshteh Mehrabi y Christina Zarowsky. "Pro-equity legislation, health policy and utilisation of sexual and reproductive health services by vulnerable populations in sub-Saharan Africa: a systematic review". Global Health Promotion 27, n.º 4 (4 de agosto de 2020): 97–106. http://dx.doi.org/10.1177/1757975920941435.
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Twenty-five years ago, the International Conference on Population and Development highlighted the need to address sexual and reproductive health (SRH) rights on a global scale. The sub-Saharan Africa region continues to have the highest levels of maternal mortality and HIV, primarily affecting the most vulnerable populations. Recognising the critical role of policy in understanding population health, we conducted a systematic review of original primary research which examined the relationships between equity-focused legislation and policy and the utilisation of SRH services by vulnerable populations in sub-Saharan Africa. We searched nine bibliographic databases for relevant articles published between 1994 and 2019. Thirty-two studies, conducted in 14 sub-Saharan African countries, met the inclusion criteria. They focused on maternal health service utilisation, either through specific fee reduction/removal policies, or through healthcare reforms and insurance schemes to increase SRH service utilisation. Findings across most of the studies showed that health-related legislation and policy promoted an increase in service utilisation, over time, especially for antenatal care, skilled birth attendance and facility-based delivery. However, social health inequalities persisted among subgroups of women. Neither the reviewed studies nor the policies specifically addressed youth, people living with HIV and people with disabilities. In the era of the sustainable development goals, addressing health inequities in the context of social determinants of health becomes unavoidable. Systematic and rigorous quantitative and qualitative research, including longitudinal policy evaluation, is required to understand the complex relationships between policy addressing upstream social determinants of health and health service utilisation.
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Bwalya, Barbara N. y Thankian Kusanthan. "Gender Differential in Access to and Utilisation of Reproductive Health Services among Adolescents in Lusaka". International Journal of Contemporary Research and Review 9, n.º 04 (7 de abril de 2018): 20416–29. http://dx.doi.org/10.15520/ijcrr/2018/9/04/492.
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Adolescent sexuality and reproductive health has become a global concern in the recent past. Many adolescents face sexual health risks of early sexual debut like sexually transmitted infections including HIV/AIDS, unplanned pregnancies and illegal abortions. The present study was undertaken to examine gender differential in access to and utilization of reproductive health services among adolescents in Lusaka, Zambia. Data was collected by carrying out structured face-to-face interviews with 180 adolescents. Interview guides were used to collect data from 3 focus group discussions comprising 6 adolescents each and 2 key informants (health service providers). This study has established that there are gender gaps in knowledge and utilisation of RHS among the adolescents. The study discovered that more girls than boys were aware of specific types of RHS including family planning methods. It was further discovered that more (23.9%) males than females (21.7%) had utilised family planning methods. The findings further revealed that more (26.4%) female than male (25.3%) adolescents had received RHS. At the same time, the study noted that despite the gender gaps, the level of access and utilisation of RHS among adolescents was low for both sexes. Reasons for low utilisation of RHS included shortage of health services providers, and lack of adolescent-friendly services, adolescents’ preference for service providers of the same sex, age difference between adolescents and the service providers, and distance to the health facility. The study recommended scaling up of adolescent-friendly services; use of brochures and youth magazines to increase awareness of available services for adolescents and sensitisation of health providers, parents, guardians, communities and key stakeholders about RHS for adolescents.
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Gibbs, Lisa y Daniel Reidpath. "What about the men? General differences in utilisation of arthritis self-management services". Australian Journal of Primary Health 11, n.º 1 (2005): 63. http://dx.doi.org/10.1071/py05009.
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As self-management programs for chronic illness increasingly become the domain of primary health care providers, it is important to consider gender inequities in access to these services and gender differences in patterns of use to inform the development and delivery of services. This study explores gender differences in levels and patterns of access to arthritis self-management services by analyzing data collected from the Telephone Information Service of Arthritis Victoria. Contingency tables were analyzed and odds-ratios calculated to confirm gender differences in levels and patterns of service utilisation. Men were found to be significantly under-represented as users of the service, even after taking into account gender differences in prevalence of arthritis in the population. Women were more likely than men to contact the service on their own behalf. Men were more likely to have a family member or friend contact the service for them. Women showed more interest in learning about their condition while men focused more on symptom management. These gender differences in rates and patterns of service use indicate that service providers of self-management services for conditions such as arthritis need to take into account the interaction between gender and service utilisation.
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Chavane, Leonardo, Martinho Dgedge, Patricia Bailey, Osvaldo Loquiha, Marc Aerts y Marleen Temmerman. "Assessing women's satisfaction with family planning services in Mozambique". Journal of Family Planning and Reproductive Health Care 43, n.º 3 (8 de septiembre de 2016): 222–28. http://dx.doi.org/10.1136/jfprhc-2015-101190.
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BackgroundThe contraceptive prevalence rate in Mozambique was estimated as 11.3% in the last Demographic and Health Survey. The impact of family planning (FP) on women's health and on the reduction of maternal mortality is well known.MethodsAcknowledging the importance of user satisfaction in the utilisation of health services, exit interviews were used to assess women's satisfaction with FP services in Mozambique. The survey, conducted in 174 health facilities, was representative at the national level, covered all provinces, and both urban and rural areas.ResultsOverall, 86% of respondents were satisfied with FP services, but issues such as insufficient supplies of oral contraceptives and the low quality of healthcare provider/client interactions were given as reasons for women's dissatisfaction.ConclusionDefined actions at the level of health service provision are needed to tackle the identified issues and ensure improved satisfaction with, and better utilisation of, FP services in Mozambique.
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Nshakira-Rukundo, Emmanuel, Essa Chanie Mussa, Nathan Nshakira, Nicolas Gerber y Joachim von Braun. "Impact of community-based health insurance on utilisation of preventive health services in rural Uganda: a propensity score matching approach". International Journal of Health Economics and Management 21, n.º 2 (10 de febrero de 2021): 203–27. http://dx.doi.org/10.1007/s10754-021-09294-6.
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AbstractThe effect of voluntary health insurance on preventive health has received limited research attention in developing countries, even when they suffer immensely from easily preventable illnesses. This paper surveys households in rural south-western Uganda, which are geographically serviced by a voluntary Community-based health insurance scheme, and applied propensity score matching to assess the effect of enrolment on using mosquito nets and deworming under-five children. We find that enrolment in the scheme increased the probability of using a mosquito net by 26% and deworming by 18%. We postulate that these findings are partly mediated by information diffusion and social networks, financial protection, which gives households the capacity to save and use service more, especially curative services that are delivered alongside preventive services. This paper provides more insight into the broader effects of health insurance in developing countries, beyond financial protection and utilisation of hospital-based services.
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Singh, Neha S., Sarindi Aryasinghe, James Smith, Rajat Khosla, Lale Say y Karl Blanchet. "A long way to go: a systematic review to assess the utilisation of sexual and reproductive health services during humanitarian crises". BMJ Global Health 3, n.º 2 (mayo de 2018): e000682. http://dx.doi.org/10.1136/bmjgh-2017-000682.
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IntroductionWomen and girls are affected significantly in both sudden and slow-onset emergencies, and face multiple sexual and reproductive health (SRH) challenges in humanitarian crises contexts. There are an estimated 26 million women and girls of reproductive age living in humanitarian crises settings, all of whom need access to SRH information and services. This systematic review aimed to assess the utilisation of services of SRH interventions from the onset of emergencies in low- and middle-income countries.MethodsWe searched for both quantitative and qualitative studies in peer-reviewed journals across the following four databases: EMBASE, Global Health, MEDLINE and PsychINFO from 1 January 1980 to 10 April 2017. Primary outcomes of interest included self-reported use and/or confirmed use of the Minimum Initial Service Package services and abortion services. Two authors independently extracted and analysed data from published papers on the effect of SRH interventions on a range of SRH care utilisation outcomes from the onset of emergencies, and used a narrative synthesis approach.ResultsOf the 2404 identified citations, 23 studies met the inclusion criteria. 52.1% of the studies (n=12) used quasi-experimental study designs, which provided some statistical measure of difference between intervention and outcome. 39.1% of the studies (n=9) selected were graded as high quality, 39.1% moderate quality (n=9) and 17.4% low quality (n=4). Evidence of effectiveness in increasing service utilisation was available for the following interventions: peer-led and interpersonal education and mass media campaigns, community-based programming and three-tiered network of community-based reproductive and maternal health providers.ConclusionsDespite increased attention to SRH service provision in humanitarian crises settings, the evidence base is still very limited. More implementation research is required to identify interventions to increase utilisation of SRH services in diverse humanitarian crises settings and populations.
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Stuart, Geoffrey W., I. Harry Minas, Steven Klimidis y Siobhan O'connell. "English Language Ability and Mental Health Service Utilisation: A Census". Australian & New Zealand Journal of Psychiatry 30, n.º 2 (abril de 1996): 270–77. http://dx.doi.org/10.3109/00048679609076105.
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Objective: To explore the relationship between English language proficiency and mental health service utilisation. Methods: In September 1993, a sample census was conducted of all mental health services in the State of Victoria, including public and private hospital wards, outpatient consultations provided by psychiatrists and clinical psychologists, and primary mental health care provided by general practitioners. Response rates ranged from 37% for monolingual general practitioners (GPs) to 96% for inpatient units. Particular emphasis was placed on patients' English language proficiency and the role played by bilingual clinicians. Results: Over 80% of inpatients received a diagnosis of either dementia or psychosis. This proportion was even greater in the case of patients with English language difficulties. The latter group of patients underutilised specialist outpatient services, and those using these services were less likely to receive psychotherapy than fluent English speakers. They utilised GPs for mental disorder at at least the same rate as other patients. There was a marked preference for bilingual GPs, with 80% of patients with poor English language skills consulting GPs who spoke their native language. Conclusion: There appears to be considerable underutilisation of specialist mental health services by patients who are not fluent in English. The liaison-consultation model of psychiatric care may be an effective way of addressing this problem, given the important role already played by bilingual GPs in the psychiatric care of those whose native language is not English.
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Fun Chan, Yuk y Susan Quine. "Utilisation of Australian health care services by ethnic Chinese". Australian Health Review 20, n.º 1 (1997): 64. http://dx.doi.org/10.1071/ah970064.
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Australia is a multicultural society in which migrants from non-English-speakingbackgrounds may be more vulnerable to illness after their new settlement, andlanguage difficulties and cultural differences may affect their use of health services.The present qualitative study used focus group interviews to explore the health servicesused by Chinese migrants from Hong Kong and China. The general findings includedstrong preference for Chinese-speaking general practitioners, insufficient interpreterservices, low use of preventive services, and lack of knowledge about the existence androle of ethnic health workers. The paper reports specific differences between migrantsfrom China and Hong Kong, and by age group. It discusses reasons for these findingsand notes the implications.
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Phillips, Christine B., Mahomed S. Patel y Yolanda Cabaron. "Utilisation of health services by Aboriginal Australians with diabetes". Diabetes Research and Clinical Practice 20, n.º 3 (junio de 1993): 231–39. http://dx.doi.org/10.1016/0168-8227(93)90083-h.
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Liu, Lingrui, Hannah H. Leslie, Martias Joshua y Margaret E. Kruk. "Exploring the association between sick child healthcare utilisation and health facility quality in Malawi: a cross-sectional study". BMJ Open 9, n.º 7 (julio de 2019): e029631. http://dx.doi.org/10.1136/bmjopen-2019-029631.
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ObjectiveIncreasing the availability of basic healthcare services in low-and middle-income countries is not sufficient to meet the Sustainable Development Goal target for child survival in high-mortality settings, where healthcare utilisation is often inconsistent and quality of care can be poor. We assessed whether poor quality of sick child healthcare in Malawi is associated with low utilisation of sick child healthcare.DesignWe measured two elements of quality of sick child healthcare: facility structural readiness and process of care using data from the 2013 Malawi Service Provision Assessment. Overall quality was defined as the average of these metrics. We extracted demographic data from the 2013–2014 Malawi Multiple Indicator Cluster Survey and linked households to nearby facilities using geocodes. We used logistic regression to examine the association of facility quality with utilisation of formal health services for children under 5 years of age suffering diarrhoea, fever or cough/acute respiratory illness, controlling for demographic and socioeconomic characteristics. We conducted sensitivity analyses (SAs), modifying the travel distance and population—facility matching criteria.Setting and population568 facilities were linked with 9701 children with recent illness symptoms in Malawi, of whom 69% had been brought to a health facility.ResultsOverall, facilities showed gaps in structural quality (62% readiness) and major deficiencies in process quality (33%), for an overall quality score of 48%. Better facility quality was associated with higher odds of utilisation of sick child healthcare services (adjusted ORs (AOR): 1.66, 95% CI: 1.04 to 2.63), as was structural quality alone (AOR: 1.33, 95% CI: 0.95 to 1.87). SAs supported the main finding.ConclusionAlthough Malawi’s health facilities for curative child care are widely available, quality and utilisation of sick child healthcare services are in short supply. Improving facility quality may provide a way to encourage higher utilisation of healthcare, thereby decreasing preventable childhood morbidity and mortality.
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Coid, Donald R. "Measurement for Management: Report of a Pilot Project to Quantify Ambulance Misuse for Managers of a Fife Hospital". Health Services Management Research 2, n.º 3 (noviembre de 1989): 213–16. http://dx.doi.org/10.1177/095148488900200305.
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Ambulance services appear to be under increasing pressure to provide a full range of services to the Community. It is important, therefore, that the service is appropriately utilised by patients. Health Service Managers, however, have little readily available information which identifies ‘appropriate’ utilisation. A simple technique is suggested to measure ‘appropriateness’ of utilisation of ambulances and a pilot survey of ambulance use by patients attending Dunfermline and West Fife Hospital Out-Patient clinics is described. In each case of ambulance use a panel of health professionals evaluated the ‘appropriateness’ of the patient having utilised this service. In the clinics surveyed, 91% of the sample of 328 patients did not use an ambulance to travel to clinics; in only two cases was use of the ambulance considered to be ‘probably inappropriate’. Misuse of the ambulance service was minimal during this study. Health Service Managers have been provided with some evidence to refute suggestions of substantial, inappropriate use of the ambulance service.
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Galvão, Maria Helena Rodrigues, Arthur de Almeida Medeiros y Angelo Giuseppe Roncalli. "Contextual and individual factors associated with public dental services utilisation in Brazil: A multilevel analysis". PLOS ONE 16, n.º 7 (9 de julio de 2021): e0254310. http://dx.doi.org/10.1371/journal.pone.0254310.
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Background This study verified the association between contextual and individual factors and public dental services utilisation in Brazil. Methods The study was conducted based on a cross-sectional population-based household survey performed in Brazil (National Health Survey– 2019)). Data was collected between August 2019 and March 2020. Total sample included 43,167 individuals aged ≥15 years who had at least one dental appointment in the last 12 months before interview. Study outcome was ‘public dental service utilisation’, and Andersen’s behavioral model was adopted for selecting independent variables. A multilevel analysis was performed using individual factors as first level and federation units as second level. Results The highest prevalence of public dental service utilisation on an individual level was observed among unable to read or write people (PR: 3.31; p<0.001), indigenous (PR: 1.40; p<0.001), black or brown (PR: 1.16; p<0.001), with per capita household income of up to U$124 (PR: 2.40; p<0.001), living in the rural area (PR: 1.28; p<0.001), and who self-rated oral health as regular (PR: 1.15; p<0.001) or very bad/bad (PR: 1.26; p<0.001). On the contextual level, highest PR of public dental service utilisation was observed among those living in federal units with increased oral health coverage in primary health care. Conclusions Public dental service utilisation is associated with individual and contextual factors. These results can guide decision-making based on evidence from policymakers, demonstrating the potential for mitigating oral health inequalities and increasing service coverage in a public and universal health system.
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Amsters, Delena, Sarita Schuurs, Melissa Kendall, Kiley Pershouse, Ruth Barker y Pim Kuipers. "General practice visits by people with traumatic spinal cord injury: a Queensland longitudinal study". Australian Journal of Primary Health 20, n.º 2 (2014): 167. http://dx.doi.org/10.1071/py12105.
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People with traumatic spinal cord injury (SCI), although proportionally fewer in number, are known to be high users of primary health care services; however, details of their visits to GPs are unclear. This study presents information about GP utilisation patterns of 193 people with SCI over a 5-year period. Results demonstrate substantially greater GP service utilisation, particularly for young men with SCI, compared with their counterparts in the general population. Interestingly, people with paraplegia were proportionally higher users of GP services than those with tetraplegia. Results indicate the need for specialist support for GPs to meet the SCI-specific needs of this patient group. Specialist SCI outreach teams may be a useful resource to primary health care practitioners.
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Borotkanics, Robert, Cassandra Rowe, Andrew Georgiou, Heather Douglas, Meredith Makeham y Johanna Westbrook. "Changes in the profile of Australians in 77 residential aged care facilities across New South Wales and the Australian Capital Territory". Australian Health Review 41, n.º 6 (2017): 613. http://dx.doi.org/10.1071/ah16125.
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Objective Government expenditure on and the number of aged care facilities in Australia have increased consistently since 1995. As a result, a range of aged care policy changes have been implemented. Data on demographics and utilisation are important in determining the effects of policy on residential aged care services. Yet, there are surprisingly few statistical summaries in the peer-reviewed literature on the profile of Australian aged care residents or trends in service utilisation. Therefore, the aim of the present study was to characterise the demographic profile and utilisation of a large cohort of residential aged care residents, including trends over a 3-year period. Methods We collected 3 years of data (2011–14) from 77 residential aged care facilities and assessed trends and differences across five demographic and three service utilisation variables. Results The median age at admission over the 3-year period remained constant at 86 years. There were statistically significant decreases in separations to home (z = 2.62, P = 0.009) and a 1.35% increase in low care admissions. Widowed females made up the majority (44.75%) of permanent residents, were the oldest and had the longest lengths of stay. One-third of permanent residents had resided in aged care for 3 years or longer. Approximately 30% of residents were not born in Australia. Aboriginal residents made up less than 1% of the studied population, were younger and had shorter stays than non-Aboriginal residents. Conclusion The analyses revealed a clear demographic profile and consistent pattern of utilisation of aged care facilities. There have been several changes in aged care policy over the decades. The analyses outlined herein illustrate how community, health services and public health data can be used to inform policy, monitor progress and assess whether intended policy has had the desired effects on aged care services. What is known about the topic? Characterisation of permanent residents and their utilisation of residential aged care facilities is poorly described in the peer-reviewed literature. Further, publicly available government reports are incomplete or characterised using incomplete methods. What does this paper add? The analyses in the present study revealed a clear demographic profile and consistent pattern of utilisation of aged care facilities. The most significant finding of the study is that one-third of permanent residents had resided in an aged care facility for ≥3 years. These findings add to the overall picture of residential aged care utilisation in Australia. What are the implications for practitioners? The analyses outlined herein illustrate how community, health services and public health data can be utilised to inform policy, monitor progress and assess whether or not intended policy has had the desired effects on aged care services.
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Ebener, Steeve, Karin Stenberg, Michel Brun, Jean-Pierre Monet, Nicolas Ray, Howard Lawrence Sobel, Nathalie Roos et al. "Proposing standardised geographical indicators of physical access to emergency obstetric and newborn care in low-income and middle-income countries". BMJ Global Health 4, Suppl 5 (junio de 2019): e000778. http://dx.doi.org/10.1136/bmjgh-2018-000778.
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Emergency obstetric and newborn care (EmONC) can be life-saving in managing well-known complications during childbirth. However, suboptimal availability, accessibility, quality and utilisation of EmONC services hampered meeting Millennium Development Goal target 5A. Evaluation and modelling tools of health system performance and future potential can help countries to optimise their strategies towards reaching Sustainable Development Goal (SDG) 3: ensure healthy lives and promote well-being for all at all ages. The standard set of indicators for monitoring EmONC has been found useful for assessing quality and utilisation but does not account for travel time required to physically access health services. The increased use of geographical information systems, availability of free geographical modelling tools such as AccessMod and the quality of geographical data provide opportunities to complement the existing EmONC indicators by adding geographically explicit measurements. This paper proposes three additional EmONC indicators to the standard set for monitoring EmONC; two consider physical accessibility and a third addresses referral time from basic to comprehensive EmONC services. We provide examples to illustrate how the AccessMod tool can be used to measure these indicators, analyse service utilisation and propose options for the scaling-up of EmONC services. The additional indicators and analysis methods can supplement traditional EmONC assessments by informing approaches to improve timely access to achieve Universal Health Coverage and reach SDG 3.
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Edu, Betta, Thomas U. Agan, Emmanuel Monjok y Krystyna Makoweicka. "Effect of Free Maternal Health Care Program on Health-seeking Behavior of Women during Pregnancy, Intra-partum and Postpartum Periods in Cross River State of Nigeria: A Mixed Method Study". Open Access Macedonian Journal of Medical Sciences 5, n.º 3 (11 de junio de 2017): 370–82. http://dx.doi.org/10.3889/oamjms.2017.075.
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BACKGROUND: Increasing the percentage of maternal health service utilization in health facilities, through cost-removal policy is important in reducing maternal deaths. The Cross River State Government of Nigeria introduced a cost-removal policy in 2009, under the umbrella of “PROJECT HOPE†where free maternal health services are provided. Since its inception, there has been no formal evaluation of its effectiveness. AIM: This study aims to evaluate the effect of the free maternal health care program on the health care-seeking behaviours of pregnant women in Cross River State, Nigeria.METHOD: A mixed method approach (quantitative and qualitative methods) was used to describe the effect of free maternal health care intervention. The quantitative component uses data on maternal health service utilisation obtained from PROJECT HOPE and Nigeria Demographic Health Survey. The qualitative part uses Focus Group Discussions to examine women's perception of the program.RESULTS: Results suggest weak evidence of change in maternal health care service utilization, as 95% Confidence Intervals overlap even though point estimate suggest increase in utilization. Results of quantitative data show increase in the percentage of women accessing maternal health services. This increase is greater than the population growth rate of Cross River State which is 2.9%, from 2010 to 2013. This increase is likely to be a genuine increase in maternal health care utilisation. Qualitative results showed that women perceived that there have been increases in the number of women who utilize Antenatal care, delivery and Post Partum Care at health facilities, following the removal of direct cost of maternal health services. There is urban and rural differences as well as between communities closer to health facility and those further off. Perceived barriers to utilization are indirect cost of service utilization, poor information dissemination especially in rural areas, perceived poor quality of care at facilities including drug and consumables stock-outs, geographical barriers, inadequate health work force, and poor attitude of skilled health workers and lack of trust in the health system.CONCLUSION: Reasons for Maternal health care utilisation even under a cost-removal policy is multi-factorial. Therefore, in addition to fee-removal, the government must be committed to addressing other deterrents so as to significantly increase maternal health care service utilisation.
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Sundaresan, Puma, Martin R. Stockler y Christopher G. Milross. "What is access to radiation therapy? A conceptual framework and review of influencing factors". Australian Health Review 40, n.º 1 (2016): 11. http://dx.doi.org/10.1071/ah14262.
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Objectives Optimal radiation therapy (RT) utilisation rates (RURs) have been defined for various cancer indications through extensive work in Australia and overseas. These benchmarks remain unrealised. The gap between optimal RUR and actual RUR has been attributed to inadequacies in ‘RT access’. We aimed to develop a conceptual framework for the consideration of ‘RT access’ by examining the literature for existing constructs and translating it to the context of RT services. We further aimed to use this framework to identify and examine factors influencing ‘RT access’. Methods Existing models of health care access were reviewed and used to develop a multi-dimensional conceptual framework for ‘RT access’. A review of the literature was then conducted to identify factors reported to affect RT access and utilisation. The electronic databases searched, the host platform and date range of the databases searched were Ovid MEDLINE, 1946 to October 2014 and PsycINFOvia OvidSP,1806 to October 2014. Results The framework developed demonstrates that ‘RT access’ encompasses opportunity for RT as well as the translation of this opportunity to RT utilisation. Opportunity for RT includes availability, affordability, adequacy (quality) and acceptability of RT services. Several factors at the consumer, referrer and RT service levels affect the translation of this opportunity for RT to actual RT utilisation. Conclusion ‘Access’ is a term that is widely used in the context of health service related research, planning and political discussions. It is a multi-faceted concept with many descriptions. We propose a conceptual framework for the consideration of ‘RT access’ so that factors affecting RT access and utilisation may be identified and examined. Understanding these factors, and quantifying them where possible, will allow objective evaluation of their impact on RT utilisation and guide implementation of strategies to modify their effects. What is known about the topic? It is well documented that the use of RT in Australia is well below evidence-based benchmarks. The shortfall in the use of RT has been attributed to problems with access to treatment services. Although considerable attention has been directed (rightly) towards addressing infrastructure needs, access to RT is more than just supply of services. There is currently no specific framework for RT access to comprehensively consider and examine other factors influencing the use of RT. The existing international literature addresses some of the influencing factors. However, there is a need for a detailed review of all actual and potential influencers of RT utilisation. What does this paper add? This paper presents a conceptual framework for the specific consideration of access to RT. A detailed review of various factors affecting access and utilisation of RT has been performed using the aforementioned conceptual framework. To our knowledge this is the first such review and hence we are confident that it adds to the existing international literature on this subject. What are the implications for practitioners? The topic of improving consumers’ access to RT is of relevance locally, in Australia, as well as internationally. We feel that the RT access framework proposed herein will be of interest and use to those involved in health services research, delivery and policy, especially those involved with the planning and delivering of cancer services. In addition to compiling evidence on the subject, the review of factors influencing RT utilisation highlights and proposes areas for future translational and implementation research in the areas of health services and treatment-related decision making.
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Parslow, Ruth A. y Anthony F. Jorm. "Who Uses Mental Health Services in Australia? An Analysis of Data from the National Survey of Mental Health and Wellbeing". Australian & New Zealand Journal of Psychiatry 34, n.º 6 (diciembre de 2000): 997–1008. http://dx.doi.org/10.1080/000486700276.
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Objective: This study sought to identify sociodemographic and psychological measures associated with utilisation of mental health services in Australia, using information collected through the 1997 National Survey of Mental Health and Wellbeing. Method: Twenty-one potential predictor variables were selected from the National Survey. Predisposing and enabling factors included age, sex, marital status, labour force status, geographical location and level of education. Predictor variables measuring need for services included the General Health Questionnaire score, a neuroticism scale, diagnoses of affective, anxiety and substance-abuse disorders from the Composite International Diagnostic Interview, and self-identified depression, anxiety and substance abuse. Simple and multiple logistic regressions were undertaken to identify predictor variables associated with use of mental health services from general practitioners, psychiatrists, psychologists and other health professionals. Results: General practitioners were the most commonly reported providers of mental health services with 76% of those receiving any mental health care reporting using this type of service. Using multiple logistic regression, the predictor variables most associated with use of mental health services were measures of the need for such services, such as psychological distress and mental disorder. After controlling for need variables, the sociodemographic variables associated with using services provided by any health professional were being female, level of education and being separated. Living in a remote area was associated with lower use of specialist services, but not with general practitioner services. Older age was associated with less use of psychologists and other health professionals. Income and having a usual language other than English did not affect service use. Conclusions: The factors most strongly related to Australians' use of mental health services are their having a diagnosed affective, anxiety or substance-abuse disorder and their self-identifying as having depression or anxiety. Although there are regional inequalities in levels of utilisation of mental health services, these are seen more with specialist services than with those provided by general practitioners.
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Tang, Kwok Cho. "Utilisation of Medical Services—Difficulties and Solutions". Journal of Multicultural Social Work 4, n.º 2 (9 de marzo de 1996): 47–58. http://dx.doi.org/10.1300/j285v04n02_04.
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Farahbakhsh, Mostafa, Homayoun Sadeghi Bazargani, Mohammad Saadati, Jafar Sadegh Tabrizi, Mina Golestani y Akram Zakery. "Health services utilisation and responsiveness profiles in Iran: a provincial household study". Family Medicine and Community Health 7, n.º 1 (enero de 2019): e000007. http://dx.doi.org/10.1136/fmch-2018-000007.
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ObjectiveThe aim of this study was to describe health services utilisation and responsiveness in East Azerbaijan province, Iran.DesignA cross-sectional household study as part of a larger research on primary healthcare system.SettingWe carried out the study in East Azerbaijan Province, northwest Iran from July to September 2015.ParticipantsA total of 1318 households were included.ResultsMost of the participating households had social security health insurance. Heart failure or hypertension care, general outpatient care and arthritis care were the most used services. High services cost and inadequate medicine and medical equipment were introduced to be the main barriers to health services utilisation in Tabriz and province representative sample (PRS), respectively. Health system responsiveness mean score (the maximum is 100) was 33.71±16.15 (95% CI 32.45 to 34.97) in Tabriz and 32.02±14.3 (95% CI 30.9 to 33.13) in PRS, which showed significant difference (p≤0.02).ConclusionsDifferences in the utilisation and responsiveness of health services and distribution of health resources were observed between Tabriz and PRS. Evidently, health system responsiveness in both Tabriz and PRS was at low level. The results demonstrate the need for changing resource distribution policies and employing reactive health policies to response the public health.
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Farlina, Avlien y Diah Ayu Maharani. "Barriers of utilisation of dental services among children and adolescent: A systematic review". Padjadjaran Journal of Dentistry 30, n.º 3 (30 de noviembre de 2018): 150. http://dx.doi.org/10.24198/pjd.vol30no3.15001.
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Introduction: Underutilisation of dental services among children and adolescent is a worldwide problem that increases caries prevalence. Younger children are less likely to receive dental care and, thus, experience oral diseases more often. This systematic review was aimed to explore the barriers of utilisation of dental services among children and adolescent. Methods: The literature search was conducted in the electronic database of Pubmed©/Medline©. The literature exclusion criteria were adults and qualitative study. Keywords were verified in MeSH. Boolean “AND” and “NOT” was used to specify the search. Twenty-four literature were filtered from Pubmed©, and twenty-three literature fit the inclusion criteria. Result: The result revealed that low-income families, minority ethnic, and disability condition have lower dental care utilisation. Conclusion: The identified potential determinants of oral health and dental care utilisation among children and adolescent are economic barriers, uninsurance, and availability of dental service providers.Keywords: Dental care, dental services, utilisation, barrier, children, adolescent.
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Mekonnen, Tensae, Tinashe Dune, Janette Perz y Felix Akpojene Ogbo. "Trends and Determinants of Antenatal Care Service Use in Ethiopia between 2000 and 2016". International Journal of Environmental Research and Public Health 16, n.º 5 (1 de marzo de 2019): 748. http://dx.doi.org/10.3390/ijerph16050748.
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: Antenatal care (ANC) services are an essential intervention for improving maternal and child health worldwide. In Ethiopia, however, ANC service use has been suboptimal, and examining the trends and factors associated with ANC service use is needed to inform targeted maternal health care interventions. This study aimed to investigate the trends and determinants of ANC service utilisation in Ethiopia for the period ranging from 2000 to 2016. This study draws on the Ethiopia Demographic and Health Survey data for the years 2000 (n = 7928), 2005 (n = 7276), 2011 (n = 7881) and 2016 (n = 7558) to estimate the trends in ANC service utilisation. Multivariate logistic regression models with adjustment for clustering and sampling weights were used to investigate the association between the study factors and ANC service utilisation. Over the sixteen-year period, the proportion of Ethiopian women who received the recommended four or more ANC visits increased from 10.0% (95% confidence interval (95% CI: 8.7–12.5%) in 2000 to 32.0% (95% CI: 29.4–34.3%) in 2016. Similarly, the proportion of women who received one to three ANC visits increased from 27.0% (95% CI: 23.6–30.7%) in 2000 to 62.0% in 2016 (95% CI: 60.4–67.3%). Multivariate analyses showed that higher maternal and paternal education, higher household wealth status, urban residency and previous use of a contraceptive were associated with ANC service use (1–3 and 4+ ANC visits). The study suggests that while Ethiopian pregnant women’s engagement with ANC services improved during the millennium development goal era (2000–2015), recommended ANC use remains suboptimal. Improving the utilisation of ANC services among pregnant women is essential in Ethiopia, and efforts should focus on vulnerable women.
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Ruggeri, Mirella. "Service utilisation: a pivotal measure in assessing service needs and service outcome". Epidemiologia e psichiatria sociale. Monograph Supplement 6, S1 (abril de 1997): 105–12. http://dx.doi.org/10.1017/s1827433100000873.
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In past years the study of service utilization has given a great contribution to the evaluation of mental health services. Nowadays, the challenge that must be faced is to obtain from service utilization research useful knowledge for clinical practice and service planning.Psychiatric care organization should be based on coherent and comprehensive assessments of the population's morbidity and needs for care, and take into account costs and benefits of different forms of treatments in relieving mental disorders and meeting mental health needs. While the former issue has been widely studied, the last two are mostly unexplored. Specifically, there is limited amount of information available on the significance that certain patterns of service utilization, or changes in service utilization, may have for the patient, his/her relatives and the community, and on the correlation between certain characteristics of service utilization and the overall quality of care.In this perspective, service utilization must not be considered an isolated step in the patient's career; the causal link between needs, use, and outcome of services should be identified. A full understanding of the role of service utilization in psychiatry thus necessitates taking into consideration events occurring at various steps of a person's history:step 1: a person develops a mental disorder;step 2: in certain cases this will determine a mental health service need;step 3: in certain cases the service need will determine mental health service utilization;step 4: use of mental health services will have a certain outcome.
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Krishnaswamy, Saroja, Kavitha Subramaniam, Wah Yun Low, Jemain Abdul Aziz, Tishya Indran, Padma Ramachandran, Abdul Rahman Abdul Hamid y Vikram Patel. "Factors Contributing to Utilization of Health Care Services in Malaysia: A Population-Based Study". Asia Pacific Journal of Public Health 21, n.º 4 (25 de septiembre de 2009): 442–50. http://dx.doi.org/10.1177/1010539509345862.
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Objective. This paper examines the factors contributing to the under utilisation of health care services in the Malaysian population. Methodology. Using data derived from Malaysian Mental Health Survey (MMHS) information on utilisation of four basic health services in the previous three months, namely contact with health care professionals, ward admissions, having diagnostic or laboratory tests done and being on any medications were obtained. Results. A total of 2202 out of 3666 or 60% of the MMHS participants were included in this study. Thirty percent of the subjects (n = 664) had contacts with health care professionals. Those with health complications, disabilities and those aged 50 years and above utilised health services more significantly as compared to those who lacked health facilities near their homes, had little family support during illnesses and were from the Chinese ethnic group. Conclusion. Factors leading to the under utilisation of health care services need to be further studied and needs in certain groups in the population should be addressed. Healthcare providers must be prepared to fulfil these needs.