RESUMEN
OBJECTIVE: To assess the impact of geographic access to surgical center on readmission risk and burden in children after congenital heart surgery. STUDY DESIGN: Children <6 years old at discharge after congenital heart surgery (Risk Adjustment for Congenital Heart Surgery-1 score 2-6) were identified using Pediatric Health Information System data (46 hospitals, 2004-2015). Residential distance from the surgery center, calculated using ZIP code centroids, was categorized as <15, 15-29, 30-59, 60-119, and ≥120 miles. Rurality was defined using rural-urban commuting area codes. Geographic risk factors for unplanned readmissions to the surgical center and associated burden (total hospital length of stay [LOS], costs, and complications) were analyzed using multivariable regression. RESULTS: Among 59 696 eligible children, 19 355 (32%) had ≥1 unplanned readmission. The median LOS was 9 days (IQR 22) across the entire cohort. In those readmitted, median total costs were $31 559 (IQR $90 176). Distance from the center was inversely related but rurality was positively related to readmission risk. Among those readmitted, increased distance was associated with longer LOS, more complications, and greater costs. Compared with urban patients, highly rural patients were more likely to have an unplanned readmission but had fewer average readmission days. CONCLUSIONS: Geographic measures of access differentially affect readmission to the surgery center. Increased distance from the center was associated with fewer unplanned readmissions but more complications. Among those readmitted, the most isolated patients had the greatest readmission costs. Understanding the contribution of geographic access will aid in developing strategies to improve care delivery to this population.
Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Cardiopatías Congénitas/cirugía , Hospitales Pediátricos/provisión & distribución , Readmisión del Paciente/estadística & datos numéricos , Centros de Atención Terciaria/provisión & distribución , Niño , Preescolar , Femenino , Costos de la Atención en Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/economía , Cardiopatías Congénitas/economía , Hospitales Pediátricos/economía , Humanos , Lactante , Recién Nacido , Estudios Longitudinales , Masculino , Readmisión del Paciente/economía , Análisis de Regresión , Estudios Retrospectivos , Salud Rural/economía , Salud Rural/estadística & datos numéricos , Servicios de Salud Rural/economía , Servicios de Salud Rural/provisión & distribución , Centros de Atención Terciaria/economía , Estados Unidos , Salud Urbana/economía , Salud Urbana/estadística & datos numéricos , Servicios Urbanos de Salud/economía , Servicios Urbanos de Salud/provisión & distribuciónRESUMEN
OBJECTIVE: To identify the sexual and reproductive profile and demand for gynecologic services by high school girls in the city of Rio de Janeiro. DESIGN: Cross-sectional study carried out by administration of a questionnaire filled in by the respondents on their own, given to students at 3 high schools with different socioeconomic profiles: private, state, and federal. The questions covered socio-demographic characteristics, sexual behavior, and demand for gynecologic services. The data were analyzed by the Yates chi-square test and Student t-test, with P < .05. SETTING: Three high schools in the city of Rio de Janeiro. INTERVENTIONS: None. PARTICIPANTS: Female high school students. MAIN OUTCOME MEASURE: Age, race, socioeconomic level, parents' schooling, and sexual activity. RESULTS: A total of 418 students participated, 122 from a private school, 165 from a state public school, and 131 from a federal public school. The state school students were predominantly black and had the lowest socioeconomic level, with their parents having the fewest average years of schooling. They also reported the most sexual partners, pregnancies, and abortions. Their characteristics differed significantly from those of the private and federal school students, which were similar to each other. The average age of first sexual activity was similar for all the respondents and the first visit to a gynecologist occurred significantly later among the state school students. CONCLUSIONS: The more frequent pregnancies and abortions by the state school students can be a consequence of the lower demand for or insufficient access to gynecologic services, depriving these students of the necessary care to promote sexual and reproductive health. This demonstrates the need for public policies that promote and facilitate access to routine preventive gynecologic care by low-income adolescent girls.
Asunto(s)
Conducta del Adolescente , Servicios de Salud del Adolescente/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Servicios de Salud Reproductiva/estadística & datos numéricos , Conducta Sexual , Servicios Urbanos de Salud/estadística & datos numéricos , Adolescente , Servicios de Salud del Adolescente/provisión & distribución , Brasil , Estudios Transversales , Femenino , Encuestas de Atención de la Salud , Accesibilidad a los Servicios de Salud , Humanos , Proyectos Piloto , Investigación Cualitativa , Servicios de Salud Reproductiva/provisión & distribución , Factores Socioeconómicos , Encuestas y Cuestionarios , Servicios Urbanos de Salud/provisión & distribución , Adulto JovenRESUMEN
OBJECTIVES: To assess the impact of direct pharmacy access to emergency contraception (EC) and availability of EC in Albuquerque and rural New Mexico and to compare availability of EC in Albuquerque with that estimated in a 2002 study. DESIGN: Investigational study. SETTING: Albuquerque and rural New Mexico, between March and September 2005. PARTICIPANTS: 121 community pharmacies (94 in Albuquerque and 27 in rural New Mexico). INTERVENTIONS: Research assistants visited pharmacies and followed a predetermined script during interviews with pharmacy staff. MAIN OUTCOME MEASURES: Availability of EC with and without an advance prescription; other factors related to EC access. RESULTS: EC was available in 50% of both Albuquerque and rural pharmacies. EC was available without an advance prescription in 13% of pharmacies. The medication was more likely to be in stock at pharmacies with an EC-certified pharmacist on staff (92%) than in those without an EC-certified pharmacist (39%) (P < 0.001). A study performed in 2002 reported that EC was in stock during 11% of visits to Albuquerque pharmacies, whereas the current study reported EC being available during 50% of visits. CONCLUSION: At the time of this study, EC availability was similar in both Albuquerque and rural New Mexico pharmacies, and pharmacies with trained pharmacists on staff were more likely to stock EC medications.
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Servicios Comunitarios de Farmacia/estadística & datos numéricos , Anticonceptivos Poscoito/provisión & distribución , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Certificación , Recolección de Datos , Femenino , Humanos , New Mexico , Farmacéuticos/organización & administración , Embarazo , Servicios de Salud Rural/provisión & distribución , Servicios Urbanos de Salud/provisión & distribuciónRESUMEN
OBJECTIVES: Although it is commonly accepted that rural healthcare providers face demands that are both qualitatively and quantitatively different from those faced by urban providers, this conclusion is based largely on data from healthcare consumers and relies on qualitative work with small sample sizes, surveys with small sample sizes, theoretical reviews and anecdotal reports. To enhance our knowledge of the demands faced by rural healthcare providers and to gain the perspectives of healthcare providers themselves, this study explored the caseloads of rural providers compared with those of urban providers. METHOD: An extensive survey of over 1500 licensed clinicians across eight physical and behavioural healthcare provider groups in Alaska and New Mexico was undertaken to explore differences in caseloads based on community size (small rural, rural, small urban, urban), state (Alaska, New Mexico) and discipline (health, behavioural). RESULTS: Findings indicated numerous caseload differences between community sizes that were consistent across both states, with complex case presentations being described most commonly by small rural and rural providers. Substance abuse, alcohol use, cultural diversity, economic disadvantage and age diversity were issues faced more often by providers in rural and small rural communities than by providers in small urban and urban communities. Rural, but not small rural, providers faced challenges around work with prisoners and individuals needing involuntary hospitalization. Although some state and discipline differences were noted, the most important findings were based on community size. CONCLUSIONS: The findings of this study have important implications for provider preparation and training, future research, tailored resource allocation, public health policy, and efforts to prevent 'burnout' of rural providers.
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Encuestas de Atención de la Salud , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Ubicación de la Práctica Profesional/estadística & datos numéricos , Servicios de Salud Rural/estadística & datos numéricos , Servicios Urbanos de Salud/estadística & datos numéricos , Carga de Trabajo/estadística & datos numéricos , Adolescente , Adulto , Anciano , Alaska/epidemiología , Análisis de Varianza , Niño , Preescolar , Diversidad Cultural , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , New Mexico/epidemiología , Características de la Residencia/clasificación , Características de la Residencia/estadística & datos numéricos , Servicios de Salud Rural/provisión & distribución , Factores Socioeconómicos , Servicios Urbanos de Salud/provisión & distribuciónRESUMEN
Recent studies such as the Commission on Macroeconomics and Health have highlighted the need for expanding the coverage of services for HIV/AIDS, malaria, tuberculosis, immunisations and other diseases. In order for policy makers to plan for these changes, they need to analyse the change in costs when interventions are 'scaled-up' to cover greater percentages of the population. Previous studies suggest that applying current unit costs to an entire population can misconstrue the true costs of an intervention. This study presents the methodology used in WHO-CHOICE's generalised cost effectiveness analysis, which includes non-linear cost functions for health centres, transportation and supervision costs, as well as the presence of fixed costs of establishing a health infrastructure. Results show changing marginal costs as predicted by economic theory.
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Costos de la Atención en Salud/estadística & datos numéricos , Promoción de la Salud/economía , Accesibilidad a los Servicios de Salud/economía , Modelos Econométricos , Regionalización , África , Asignación de Costos , Análisis Costo-Beneficio , Cuba , Sistemas de Información Geográfica , Investigación sobre Servicios de Salud , Humanos , Dinámicas no Lineales , América del Norte , Servicios de Salud Rural/economía , Servicios de Salud Rural/provisión & distribución , Transportes/economía , Servicios Urbanos de Salud/economía , Servicios Urbanos de Salud/provisión & distribución , Organización Mundial de la SaludRESUMEN
In 1994, the Federal Government of Brazil enacted legislation to share the costs with municipalities of establishing or remodelling up to 20 000 health clinics, covering a population of 69 million people. São José clinic was established with family physicians in 1993 in a community of 3000 in the City of Curitiba. The clinic was functioning by 1995 when the Canadian four principles of Family Medicine were introduced to clinic staff. The impact of the clinic's work has measured improvements in perinatal mortality and child nutrition, reduced hepatitis A infection and produced dramatic improvements in delivery of preventive services. The presence of the clinic has empowered a poor community to demand improved municipal services that have helped to improve overall health. The introduction of Family Health Clinics in Brazil, and assistance provided by Canada, has achieved the objectives of the national Government in one sample site.