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BACKGROUND: The costs associated with healthcare are of critical importance to both decision-makers and users, given the limited resources allocated to the health sector. However, the available scientific evidence on healthcare costs in low- and middle-income countries, such as Peru, is scarce. In the Peruvian context, the health system is fragmented, and the private health insurance and its financing models have received less research attention. We aimed to analyse user cost-sharing and associated factors within the private healthcare system. METHODS: Our study was cross-sectional, using open data from the Electronic Transaction Model of Standardized Billing Data-TEDEF-SUSALUD, between 2021-2022. Our unit of analysis is the user's medical bills. We considered the total amount of cost-sharing, proportion of total payments as cost-sharing, and cost-sharing as a proportion of minimum salaries. We use a multiple regression model to perform the analyses. RESULTS: Our study included 5,286,556 health services provided to users of the private health insurance in Peru. We found a significant difference was observed in the cost-sharing for hospitalization-related services, with an average of 419.64 soles per day (95% CI: 413.44 to 425.85). Also, we identified that for hospitalization-related services per day is, on average, 0.41 (95% CI: 0.41 to 0.41) minimum salaries more expensive than outpatient care, although cost-sharing per day of hospitalization represent on average only 14% of the total amount submitted. CONCLUSIONS: Our study provides a detailed overview of cost-sharing in the private healthcare system in Peru and the factors associated with them. Policymakers can use the study's finding that higher cost-sharing for inpatient hospitalization compared to outpatient care in private insurance can create inequities in access to healthcare to design policies aimed at reducing these costs and promoting a more equitable and accessible healthcare system in Peru.
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Custo Compartilhado de Seguro , Atenção à Saúde , Seguro Saúde , Peru , Humanos , Custo Compartilhado de Seguro/economia , Estudos Transversais , Seguro Saúde/economia , Atenção à Saúde/economia , Setor Privado/economia , Custos de Cuidados de Saúde , Hospitalização/economia , Gastos em Saúde/estatística & dados numéricosRESUMO
Family violence is a critical public health problem in Latin America. In Peru, family violence continues to be difficult to detect and prevent, with child-to-parent violence (CPV) arising as a key issue. This study aimed to do a psychometric adaptation of a brief scale of evaluation of CPV and intrafamily violence in a sample of Peruvian adolescents. Our study analyzed internal structure, internal consistency (with depression, family satisfaction, and anxiety), convergent validity, and measurement invariance. The study population included 570 adolescents living with both parents (50.2% women). Adequate goodness-of-fit indices were found for the full version of CPV and intrafamily violence of nine items (CFI = 0.991; RMSEA = 0.053) and the version with only CPV of six items (CFI = 0.995; RMSEA = 0.074). The latent correlations between CPV with depressive symptoms and anxiety symptoms were greater than 0.40. Our study found that the full version of CPV and intrafamily violence (nine items) and the CPV-only version (six items) were invariant by sex. Reliability was adequate in all cases (ω > 0.70). The scale presents evidence of validity and reliability in Peruvian adolescents. It is suitable for epidemiological research on family violence.
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Violência Doméstica , Humanos , Feminino , Adolescente , Masculino , Peru/epidemiologia , Psicometria , Reprodutibilidade dos Testes , PaisRESUMO
Background Profiles of depressive symptoms have been described due to heterogeneity in symptomatology and presentation. In our study, we estimate depressive symptom profiles and relate these symptom profiles to risk factors in the Peruvian population. Methods We carried out an observational study based on the Peruvian Demographic and Health Survey (2014-2022). Men and women aged 15 years and older living in urban and rural areas in all regions of Peru were included. The Patient Health Questionnaire-9 was used to define depressive symptom profiles. We estimated latent class models to define the profiles and performed a Poisson regression analysis to determine the associated factors. Results A total of 259,655 participants were included. The three-class model was found to be the most appropriate, and the classes were defined according to the severity of depressive symptoms (moderate-severe symptoms, mild symptoms, and without depressive symptoms). Also, it was found that the three classes identified have not changed during the years of evaluations, presenting very similar prevalence over the years. In addition, women are more likely than men to belong to a class with more severe depressive symptoms; and the older the age, the higher the probability of belonging to a class with greater severity of depressive symptoms. Conclusions Our study found that at the population level in Peru, depressive symptoms are grouped into three classes according to the intensity of the symptomatology present (no symptoms, mild symptoms and moderate-severe symptoms).
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Depressão , Humanos , Depressão/epidemiologia , Peru/epidemiologia , Inquéritos e Questionários , PrevalênciaRESUMO
PURPOSE: The COVID-19 pandemic increased the burden of mental disorders worldwide. Peru has been one of the countries most affected by COVID-19, however, studies evaluating the medium and long-term consequences of the pandemic on Peruvians' mental health are recent and represent a new field of study in proliferation. We aimed to estimate the impact of the COVID-19 pandemic on the prevalence and treatment of depressive symptoms using nationally representative surveys in Peru. METHODS: Our study is an analysis of secondary data. We carried out a time series cross-sectional analysis based on the National Demographic and Health Survey of Peru, collected using a complex sampling design. The Patient Health Questionnaire-9 was used to measure mild (5-9 points), moderate (10-14 points), and severe (15 points or more) depressive symptoms. The participants were men and women aged 15 years and older, living in urban and rural areas of all regions of Peru. The main statistical analysis used segmented regression with Newey-West standard errors, taking into account that each year of the evaluation was divided into four measures (quarter measure). RESULTS: We included 259,516 participants. An average quarterly increase of 0.17% (95% CI 0.03-0.32%) in the prevalence of moderate depressive symptoms was identified after the onset of the COVID-19 pandemic (approximately an increase of 1583 new cases of moderate depressive symptoms by each quarter). The percentage of cases treated for mild depressive symptoms increased quarterly by an average of 0.46% (95% CI 0.20-0.71%) after the onset of the COVID-19 pandemic (approximately an increase of 1242 new cases treated for mild depressive symptoms by each quarter). CONCLUSION: In Peru, increases in the prevalence of moderate depressive symptoms and the proportion of cases treated with mild depressive symptoms were found after the COVID-19 pandemic. Therefore, this study is a precedent for future research assessing the prevalence of depressive symptoms and the proportion of cases receiving treatment during the pandemic and post-pandemic years.
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COVID-19 , Masculino , Humanos , Feminino , COVID-19/epidemiologia , Peru/epidemiologia , Análise de Séries Temporais Interrompida , Prevalência , Pandemias , Estudos Transversais , Depressão/epidemiologiaRESUMO
BACKGROUND: The use of technologies has served to reduce gaps in access to treatment, and digital health interventions show promise in the care of mental health problems. However, to understand what and how these interventions work, it is imperative to document the aspects related to their challenging implementation. OBJECTIVE: The aim of this study was to determine what evidence is available for synchronous digital mental health implementation and to develop a framework, informed by a realist review, to explain what makes digital mental health interventions work for people with mental health problems. METHODS: The SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, and Research type) framework was used to develop the following review question: What makes digital mental health interventions with a synchronous component work on people with mental health problems, including depression, anxiety, or stress, based on implementation, economic, quantitative, qualitative, and mixed methods studies? The MEDLINE, EBM Reviews, PsycINFO, EMBASE, SCOPUS, CINAHL Complete, and Web of Science databases were searched from January 1, 2015, to September 2020 with no language restriction. A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR-2) was used to assess the risk of bias and Confidence in Evidence from Reviews of Qualitative Research (CERQual) was used to assess the confidence in cumulative evidence. Realist synthesis analysis allowed for developing a framework on the implementation of synchronous digital mental health using a grounded-theory approach with an emergent approach. RESULTS: A total of 21 systematic reviews were included in the study. Among these, 90% (n=19) presented a critically low confidence level as assessed with AMSTAR-2. The realist synthesis allowed for the development of three hypotheses to identify the context and mechanisms in which these interventions achieve these outcomes: (1) these interventions reach populations otherwise unable to have access because they do not require the physical presence of the therapist nor the patient, thereby tackling geographic barriers posed by in-person therapy; (2) these interventions reach populations otherwise unable to have access because they can be successfully delivered by nonspecialists, which makes them more cost-effective to implement in health services; and (3) these interventions are acceptable and show good results in satisfaction because they require less need of disclosure and provide more privacy, comfortability, and participation, enabling the establishment of rapport with the therapist. CONCLUSIONS: We developed a framework with three hypotheses that explain what makes digital mental health interventions with a synchronous component work on people with mental health problems. Each hypothesis represents essential outcomes in the implementation process. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42020203811; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020203811. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.12688/f1000research.27150.2.
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Background: The pandemic caused by Sars-cov-2 has generated multiple sustained efforts for its identification, characteristics and mobility of the disease that to date has repercussions worldwide. Given this need, it is necessary to have updated information considering transparent research processes. Method: A critical review of the current literature on COVID-19 research. Conclusions: It is essential to have ethical procedures in the different phases of research that can go beyond personal interests and that guarantee the preservation of people's welfare in the reduction of possible damage to health globally, adequate procedures in the collection of information that is not built to the measure of the researchers, to avoid involuntary segregation of the participants and that this leads to a reduction of significant damage due to implicit biases that are generated by poor planning that pursues the scoop instead of social good.
Introducción: La pandemia ocasionada por el Sars-cov-2 ha genero múltiples esfuerzos sostenidos para su identificación, características y movilidad de la enfermedad que hasta la fecha tiene repercusión a nivel mundial y ante esta necesidad es necesario contar con información de actualiza teniendo en cuento procesos claros de investigación. Método: revisión crítica del cuerpo actual de literatura sobre investigación en COVID-19. Conclusiones: Es imprescindible contar con procedimientos éticos en las diferentes fases de investigación que puedan ir más allá de los intereses personales y que garanticen la preservación del bienestar de las personas en la reducción de posibles daños en la salud de manera global, adecuados procedimientos en la recolección de información que no se encuentren construidos a la medida de los investigadores, para evitar una segregación involuntaria de los participantes y que esto conlleve en una reducción de daños significativos por sesgos implícitos que son generados por una mala planificación que persigue la primicia en lugar de un bien social.
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Background: During the COVID-19 pandemic, it has been necessary to incorporate technologies in the care of mental health problems. But there have been difficulties in the application of technology-based interventions in mental health. Some quantitative systematic reviews don't allow us to fully identify and properly describe this subject. In order to answer the question "how do electronic interventions apply in mental health and what makes the application of any of these interventions work", this study will carry out an overview of systematic reviews, which will make it possible to develop a theoretical framework on the implementation of electronic care in mental health problems. Methods: We will search MEDLINE, EBM Reviews, PsycINFO, EMBASE, SCOPUS, CINAHL Complete, and Web of Science databases from 1st January 2015 to September 2020, with no language restriction. We will follow a qualitative method approach and include systematic reviews that assess primary studies relating to adults with common mental health problems using any type of mobile mental health intervention that includes a synchronic component and communication with a mental health professional. For the analysis, we will make a meta-synthesis of the systematic reviews, using an emergent grounded theory approach to synthesize the information, prioritizing the systematic reviews with the lowest risk of bias in the AMSTAR-2 tool. The meta-synthesis will be based on interpreting, integrating, and inferring the evaluation elements to understand better the e-health implementation process for patients with mental health problems. Finally, we will present the overall assessment in a Summary of Qualitative Findings table. Conclusion: Our results will allow a better understanding of the facilitator and limitations in implementing e-health interventions for mental health problems.
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COVID-19 , Saúde Mental , Adulto , Humanos , Metanálise como Assunto , Pandemias , SARS-CoV-2 , Revisões Sistemáticas como AssuntoRESUMO
OBJECTIVE: Analyze the measurement invariance and the factor structure of the Patient Health Questionnaire-9 (PHQ-9) in the Peruvian population. METHOD: Secondary data analysis performed using cross-sectional data from the Health Questionnaire of the Demographic and Health Survey in Peru. Variables of interest were the PHQ-9 and demographic characteristics (sex, age group, level of education, socioeconomic status, marital status, and area of residence). Factor structure was evaluated by standard confirmatory factor analysis (CFA), and measurement invariance by multi-group CFA, using standard goodness-of-fit indices criteria for interpreting results from both CFAs. Analysis of the internal consistency (α and ω) was also pursued. RESULTS: Data from 30,449 study participants were analyzed, 56.7% were women, average age was 40.5 years (standard deviation (SD) = 16.3), 65.9% lived in urban areas, 74.6% were married, and had 9 years of education on average (SD = 4.6). From standard CFA, a one-dimensional model presented the best fit (CFI = 0.936; RMSEA = 0.089; SRMR = 0.039). From multi-group CFA, all progressively restricted models had ΔCFI<0.01 across almost all groups by demographic characteristics. PHQ-9 reliability was optimal (α = ω = 0.87). CONCLUSIONS: The evidence presents support for the one-dimensional model and measurement invariance of the PHQ-9 measure, allowing for reliable comparisons between sex, age groups, education level, socioeconomic status, marital status, and residence area, and recommends its use within the Peruvian population.