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Providing pharmaceutical care for indigent patients: A roundtable discussion

AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY 2001年第10期58卷 867-878页

作者： Wilson, AL McAllister, JC Miller, DE Hatwig, CA Parkland Hlth & Hosp Syst Ambulatory Pharm Serv Dallas TX 75235 USA Univ N Carolina Hosp & Clin Dept Pharm Chapel Hill NC USA Grady Hlth Syst Atlanta GA USA Med Coll Virginia Hosp & Physicians Dept Pharm Serv Richmond VA USA

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Prospective surveillance applying the National Nosocomial Infection Surveillance methods in a Brazilian pediatric public hospital

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AMERICAN JOURNAL OF INFECTION CONTROL 2002年第1期30卷 1-7页

作者： Lopes, JMM Tonelli, E Lamounier, JA Couto, BRGM Siqueira, AL Komatsuzaki, F Champs, AP Starling, CEF Univ Ctr Belo Horizonte City Sch Med Dept Pediat Belo Horizonte MG Brazil Univ Fed Minas Gerais Dept Stat Belo Horizonte MG Brazil Hosp Fdn Minas Gerais Gen Ctr Pediat Belo Horizonte MG Brazil

Background: A hospital-wide, traditional prospective surveillance for nosocomial infections was commenced in 1992 in Centro Geral de Pediatria in Minas Gerais, Brazil, to describe the epidemiology of nosocomial infection in this pediatric hospital and to implement cross-infection prevention and control policies. Methods: we performed a prospective cohort nosocomial infection surveillance of all patients receiving acute care according to the hospital-wide and intensive care unit components of the National Nosocomial Infections Surveillance System from January 1993 to December 1997 (14,892 discharges;131,764 patient-days). The Centers for Disease Control and Prevention (Atlanta) 1988-definitions and the Brazilian Ministry of Health-Legislation 930 (1992) were used. Results: The average overall nosocomial infection rate per 1000 patient-days was 8.9 in units 2 and 3 and 16.4 in the pediatric intensive care unit, Over time, the overall hospital infection rate decreased from 16.6 nosocomial infections per 1000 patient-days in 1993 to 7.0 in 1997 (P <.05). We believe this can be attributed to interventions and data reporting during the period, The five most frequent sites of infections were eye-ear-nose-throat (38%), skin (22%), pneumonia (12%), soft tissue (5%) and laboratory-confirmed bloodstream infection (4%). in the pediatric intensive care unit, the most frequent nosocomial infection sites were pneumonia related to mechanical ventilators (22%), with rates ranging from 0 to 42 per 1000 ventilator-days and sepsis related to central lines (11%), with rates ranging from 0 to 32 per 1000 central line-days. Conclusions: Describing the epidemiology of nosocomial infections in this hospital enabled us to establish infection occurrence, distribution, and expected incidence, as well as to recognize trends and keep track of possible outbreaks. The knowledge acquired through this surveillance allowed us to target more specific and continuous quality improvement projects, to upg

关键词：巴西/流行病学队列研究交叉感染/流行病学交叉感染/预防和控制医院儿科/标准医院儿科/统计学和数值数据医院公立/标准医院公立/统计学和数值数据感染控制/方法重症监护病房儿科/标准重症监护病房儿科/统计学和数值数据组织方针前瞻性研究哨点监测美国儿童人类

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Researching the public/private mix in health care in a Thai urban area: methodological approaches

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HEALTH POLICY AND PLANNING 1998年第3期13卷 234-248页

作者： Pannarunothai, S Mills, A Univ London London Sch Hyg & Trop Med Hlth Policy Unit London WC1E 7HT England Buddhachinaraj Hosp Phitsanulok Thailand

The private health sector has been growing rapidly in many low and middle income countries, yet not enough is known about its sources of finance or characteristics of its users. Moreover, health care reform measures are leading to alterations in the mix of public and private finance and provision, increasing further the need for information. This paper presents and evaluates some research methods which can be used to collect information relevant to considering policies on the public/private mix. They comprise a household survey, a health diary and interview survey, a bed census, and a health resource survey. Each method is described as it was used in a study in a large urban setting in Thailand, and strengths and weaknesses of the methods are identified. The use of data to estimate the shares of public and private finance and provision, and particularly private sources of finance of public hospitals and public sources of finance for private hospitals, is demonstrated. Policy issues highlighted by the data are identified.

关键词：卫生保健改革卫生保健调查/方法卫生经费支出/统计学和数值数据医院私立/经济学医院私立/统计学和数值数据医院私立/利用医院公立/经济学医院公立/统计学和数值数据医院公立/利用收入/统计学和数值数据模型经济计量学私营部门/经济学私营部门/统计学和数值数据公共卫生管理/经济学公共卫生管理/统计学和数值数据社会经济因素泰国

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Appropriateness of emergency department visits in a Portuguese University Hospital

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ANNALS OF EMERGENCY MEDICINE 2001年第6期37卷 580-586页

作者： Pereira, S Silva, AOE Quintas, M Almeida, J Marujo, C Pizarro, M Angélico, V Fonseca, L Loureiro, E Barroso, S Machado, A Soares, M de Costa, AB de Freitas, AF Hosp Sao Joao Serv Med 2 P-4200 Porto Portugal

Study objective: There are no studies in Portugal supporting a common claim that most emergency department visits are inappropriate. The aim of this study was to determine the prevalence of and to evaluate factors associated with an appropriate ED visit in a major public hospital. Methods: A cross-sectional prospective study was performed at a public university hospital ED. Data for demographic variables, duration of complaint, transfer from other medical sources, and previous medical care for the same complaints were collected by interviewing all patients who arrived at the ED within a consecutive period of at least 24 hours. Data for diagnostic tests, treatment performed, and final patient destination were collected by triage records review. An appropriate ED visit was defined by explicit criteria: interhospital transfer, patient death at the ED, hospitalization, and diagnostic tests or treatments performed. Results: The study included 5,818 adult patients. The prevalence of an appropriate ED visit, by use of our criteria, was 68.7%. Sex was an effect modifier, According to this study, determinants of an appropriate visit for men and women were age 60 years or older and complaints of 24 hours or less and in women but not in men, retired from work and with arrival between midnight and 8 AM. Conclusions: In a university hospital in Oporto, the majority of ED visits were appropriate according to explicit criteria. Some variables may be associated with appropriateness of ED visits. A duration of the complaint 24 hours or less along with an arrival between midnight and 8 AM in women and age 60 years or older in men were the most important determinants.

关键词：年龄因素方差分析横断面研究教育程度急诊室医院/统计学和数值数据就业/统计学和数值数据卫生服务滥用/统计学和数值数据卫生服务研究医院公立/统计学和数值数据医院大学/统计学和数值数据 Logistic模型病人接受卫生保健的程度/心理学病人接受卫生保健的程度/统计学和数值数据葡萄牙/流行病学患病率前瞻性研究危险因素性别因素时间因素利用情况审核成年人老年人女(雌)性人类男(雄)性中年人

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The paradox of the cost and affordability of traditional and government health services in Tanzania

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HEALTH POLICY AND PLANNING 2000年第3期15卷 296-302页

作者： Muela, SH Mushi, AK Ribera, JM Swiss Trop Inst Dept Epidemiol & Publ Hlth CH-4002 Basel Switzerland Ifakara Hlth Res & Dev Ctr Ifakara Tanzania Univ Autonoma Barcelona Dept Antropol Social E-08193 Barcelona Spain

Since the introduction of user fee systems in the government health facilities of most African countries, which shifted part of the burden of financing health care onto the community, affordability of basic health care has been a much discussed topic. It is sometimes assumed that in areas where high levels of spending for traditional treatments are common, people would be able to pay for basic health care at governmental facilities, but may not be willing to do so. However, examining willingness to pay and ability to pay in the broader context of different types of illness and their treatment leads us to a very different conclusion. in the course of a medical-ethnographic study in south-eastern Tanzania, we found evidence that people may indeed be willing, but may nevertheless not be able, to pay for biomedical health care - even when they can afford costly traditional medicine. In this article, we suggest that the ability to pay for traditional treatment can differ from ability to pay for hospital attendance for two main reasons. First, many healers - in contrast to the hospital - offer alternatives to cash payments, such as compensation in kind or in work, or payment on a credit basis. Secondly, and more importantly, the activation of social networks for financial help is different for the two sectors. For the poor in particular, ability to pay for health care depends a great deal on contributions from relatives, neighbours and friends. The treatment of the 'personalistic' type of illness, which is carried out by a traditional healer, involves an extended kin-group, and there is high social pressure to comply with the requirements of the family elders, which may include providing financial support. In contrast, the costs for the treatment of 'normal' illnesses at the hospital are usually covered by the patient him/herself, or a small circle of relatives and friends.

关键词：社区卫生服务/经济学费用分担卫生保健费用卫生服务易得程度/经济学医院公立/经济学医院公立/统计学和数值数据医学传统病人接受卫生保健的程度/心理学社会支持坦桑尼亚人类

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Patient satisfaction with quality of care in a hospital system in Qatar.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 1999年第1期21卷 28-29,32-36,41页

作者： McGivern, S.A. CIGNA Healthcare Seattle WA United States

This article presents the results of a patient satisfaction survey carried out in an acute care hospital complex in Doha, Qatar, in the Middle East. The objectives were to determine the level of patient satisfaction as follows: in general, in 18 different patient areas and services, for Qatar citizens and noncitizens, among patients with different sociodemographic characteristics, and in technical and interpersonal areas of care. The quantitative, descriptive survey design involved two 73-item questionnaires, one in English and one in Arabic. It was given to medical, surgical, and obstetric and gynecologic patients. Satisfaction was rated on a 5-point scale, and univariate statistics and chi-square analysis were used to determine frequencies and statistical differences. The response rate was 77%;84% rated the overall quality of care excellent or very good. Respondents gave nursing services the highest ratings and slightly favored technical over interpersonal care. The results show that patients are willing to participate in the survey process and that the questionnaire is a valuable tool for measuring satisfaction and for obtaining feedback and continuous evaluation of services.

关键词：规范反馈卫生保健调查卫生服务研究医院公立/标准医院公立/统计学和数值数据病人满意度/统计学和数值数据卡塔尔质量指标卫生保健卫生保健质量/分类卫生保健质量/统计学和数值数据问卷调查社会经济因素成年人人类

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Open heart surgery in public and private practice

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Journal of Health Services Research and Policy 1999年第2期4卷 73-78页

作者： Pons, J. Moreno, V. Borras, J. Espinas, J. Almazan, C. Granados, A. Catalan Agency Hth. Technol. Assess. Catalan Health Service Pavello Ave Maria 08028 Barcelona Trav. de les Corts 131-159 Spain

Objectives: To compare open heart surgery services provided by public and private hospitals in Catalonia (Spain) according to case mix, procedures undergone and surgical mortality. Methods: Data on all adult patients undergoing open heart surgery procedures were collected prospectively in a sample of public and privately owned centres for a 6.5-month period in 1994. Sociodemographic, clinical and procedural variables were collected. A predictive model stratifying patients according to their surgical mortality risk was used to adjust for differences in case mix between providers. Results: Included were 1287 open heart surgery procedures. Public and private patients differed significantly in terms of gender, clinical history (e.g. hypertension, pulmonary disease, recent infarction) and procedural variables (e.g. reoperation, type of intervention). There were also statistically significant differences related to educational level, with better educated patients more likely to be treated in private centres. Crude surgical mortality rates differed between providers, although public centres operated on higher-risk patients. After adjusting for differences in case mix, the association between the type of provider and surgical mortality was not statistically significant (odds ratio 1.68;95% CI from 0.94 to 3.0). Conclusions: Although crude mortality rates differ between public and private providers, there is a significant trend towards higher surgical risk in public centres. After adjusting for surgical risk, differences between types of provider decreased and were no longer statistically significant. The importance of other social and health-related factors, such as educational level, may explain differences between providers in their patients' surgical risk and in their performance in open heart surgery.

关键词：心脏外科手术/死亡率心脏外科手术/利用诊断相关患者组教育程度医院死亡率医院私立/统计学和数值数据医院公立/统计学和数值数据前瞻性研究危险性评估西班牙/流行病学老年人女(雌)性人类男(雄)性中年人

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User fees and patient behaviour: Evidence from Niamey National Hospital

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HEALTH POLICY AND PLANNING 1995年第4期10卷 350-361页

作者： Weaver, M WASHINGTON UNIV DEPT HLTH SERVSEATTLEWA

Evidence is presented on the effects of price changes on the delay before seeking care and on referral status in a sample of hospital patients in Niger. Price changes are measured as differences across patients at one hospital in whether or not they pay for care, rather than as differences in prices across several hospitals. User fees are charged, but the fee system allows exemptions for some payor categories such as government employees, students, and indigent patients. Evidence is also presented on the effect of income on the delay before seeking care and referral status. The analysis demonstrates a technical point on whether household consumption or current income is a more appropriate measure of income. The analysis shows that user fees affect patient behaviour, but the effects are not the same for outpatients and inpatients. Outpatients who pay for care wait longer before seeking care, but inpatients do not. Inpatients who pay for care are more likely to be referred, but outpatients are not. Patients with more income wait less time to seek care and are less likely to be referred than other patients. Further, household consumption explains patient behaviour better than current income.

关键词：数据收集发展中国家卫生服务易得程度/经济学卫生服务易得程度/统计学和数值数据卫生服务研究/方法医院收费/统计学和数值数据医院公立/经济学医院公立/统计学和数值数据医院公立/利用住院病人/统计学和数值数据最小二乘法分析尼日尔门诊病人/统计学和数值数据病人参与/经济学病人参与/统计学和数值数据转诊和会诊时间因素人类

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A comparative study of admissions to two public sector regional secure units and one independent medium-secure psychiatric hospital

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MEDICINE SCIENCE AND THE LAW 2000年第3期40卷 216-222页

作者： Moss, KR Staffordshire Univ Sch Law Stoke On Trent ST4 2DF Staffs England

To date there has been no research carried out in respect of the contribution being made by the independent sector to medium-secure psychiatric care. There are also no published studies comparing the provision of the independent sector with that of the public sector. As such this is a neglected field of study. This paper examines the characteristics of patients admitted to one independent medium-secure psychiatric hospital and two regional secure units in terms of their demographic characteristics, source, detention under the Mental Health Act, 1983, psychiatric diagnosis, criminal history and discharge. The results of the study are tested for their significance using the chi-square distribution. There is discussion of how the independent sector may be providing a service either unavailable within the National Health Service or for which the National Health Service is unsuitable in terms of patients tither requiring medium- to long-term hospital care in conditions of security or those who cannot live independently and therefore require 'asylum', which is no longer an option within the National Health Service. In this sense, the independent sector could be seen as meeting a national need by acting as a 'safety valve' for National Health Service facilities.

关键词：英格兰医院私立/统计学和数值数据医院精神病/统计学和数值数据医院公立/统计学和数值数据病人入院/立法和法学病人入院/统计学和数值数据囚犯成年人女(雌)性人类男(雄)性中年人

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The libraries of the public hospitals in Spain. An economic analysis. The Research Group on Libraries

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Gaceta sanitaria / S.E.S.P.A.S 1999年第2期13卷 141-149页

作者： Sánchez Gómez, C. Lázaro y de Mercado, P. Poza Sanz, M.A. Estrada Lorenzo, J.M. Unidad de Investigación es Servicios de Salud España.

BACKGROUND: The continuous increase in scientific knowledge in the health field, the development of new technologies and the rising cost of publications means that libraries are essential for patient care, medical education and research. In Spain some deficiencies have been seen in hospital libraries, and their cost is unknown. OBJECTIVE: To analyze the cost of public hospital libraries in Spain and to estimate the cost of adapting them to international standards. METHODS: Cross-sectional survey of public hospitals larger than 100 beds, or smaller public hospitals with teaching accreditation. Information on the variables of interest was collected by questionnaire mailed to the libraries and followed up by telephone. Data collection was completed in 1996. The information on costs is for 1994. A sensitivity analysis was done to examine the effects of imprecise estimates and assumptions. RESULTS: Of the 314 hospitals identified, 211 (67.2%) had libraries. The 1994 cost of the of the 211 libraries was 3,060 million pesetas (mean cost: 14.5 million pesetas). Personnel costs were the most important item (38% of the total), followed by the cost of subscriptions (29%). The cost of hospital libraries represented 0.08% of national public expenditures on health. The cost of correcting inadequacies in accordance with international standards would increase spending by about 400 million pesetas the first year (0.01% of public spending on health). CONCLUSIONS: The cost of hospital libraries represents only a small fraction of public spending on health. Correction of the observed deficiencies and the importance of libraries in the health system would require increasing spending to about 0.1% of public spending on health.

关键词：成本及成本分析医院病床数医院公立/经济学医院公立/标准医院公立/统计学和数值数据图书馆医院/经济学图书馆医院/标准图书馆医院/统计学和数值数据西班牙人类

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