referral and consultation

转诊和咨询
  • 文章类型: Journal Article
    背景:产后抑郁症(PPD)已受到广泛关注。自2013年以来,深圳一直在开展一项大规模的PPD计划。该计划要求母亲在2021年开始将信息技术应用于PPD筛查时进行自我评估。这项研究的目的是对mHealth应用程序对PPD患者寻求健康行为的影响进行纵向分析。
    方法:本研究采用深圳市妇幼保健管理信息系统(MCHMIS)10年的纵向数据。转诊成功率(RSR,成功转诊到指定医院占所需转诊的百分比)用于评估寻求健康的行为。采用趋势χ2检验评估深圳市十区实施mHealth后总体变化趋势。中断时间序列分析(ITSA)用于评估mHealth应用程序在改变患者寻求健康行为中的作用。
    结果:对于趋势χ2检验的结果,深圳十个区呈上升趋势。对于ITSA结果,不同地区之间显示了不同的结果。南山区,龙华区,和龙岗区都显示了在第一年应用mHealth应用程序的上升趋势。南山区和龙岗区的持续效应均呈上升趋势。
    结论:mHealth应用程序在十个地区的性能存在差异。结果表明,卫生资源配置较好的三个区,南山,龙岗,和龙华区,展示了更显著的mHealth应用程序改进。mHealth应用程序的功能,管理系统,和卫生资源分配可能是结果中的潜在因素。这表明,在利用mHealth应用程序时,第一步是注重宏观层面的区域资源分配措施。其次,应有有效的流程设计和严格的监管措施。最后,也应该有适当的宣传手段。
    BACKGROUND: Postpartum depression (PPD) has received widespread attention. Shenzhen has been running a large-scale program for PPD since 2013. The program requires mothers to self-assess when applying information technology to PPD screening beginning in 2021. The purpose of this study was to conduct a longitudinal analysis of the impact of mHealth apps on the health-seeking behaviors of PPD patients.
    METHODS: Longitudinal data from districts in the Shenzhen Maternal and Child Health Management Information System (MCHMIS) for ten years was used in this study. Referral success rate (RSR, successful referrals to designated hospitals as a percentage of needed referrals) was used to assess health-seeking behavior. Trend χ2 tests were used to assess the overall trend of change after the implementation of mHealth in ten districts in Shenzhen. Interrupted Time Series Analysis (ITSA) was employed to assess the role of the mHealth app in changing patient health-seeking behaviors.
    RESULTS: For the results of the trend χ2 tests, the ten districts of Shenzhen showed an upward trend. For the ITSA results, different results were shown between districts. Nanshan district, Longhua district, and Longgang district all demonstrated an upward trend in the first-year application of the mHealth app. Nanshan district and Longgang district both exhibited an upward trend in terms of sustained effects.
    CONCLUSIONS: There is a difference in the performance of the mHealth app across the ten districts. The results show that the three districts with better health resource allocation, Nanshan, Longgang, and Longhua districts, demonstrated more significant mHealth app improvements. The mHealth app\'s functions, management systems, and health resource allocation may be potential factors in the results. This suggests that when leveraging mHealth applications, the first step is to focus on macro-level area resource allocation measures. Secondly, there should be effective process design and strict regulatory measures. Finally, there should also be appropriate means of publicity.
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  • 文章类型: Journal Article
    背景:总的来说,在德国,关于门诊病人获得和质量的社会决定因素的研究很少。因此,社会差距(根据性别,年龄,收入,迁移背景,和健康保险)在这项研究中探讨了德国门诊护理(初级保健医生和专家)的感知访问和咨询质量。
    方法:使用横断面在线调查进行分析。从离线招募的小组中随机抽取成年人口样本(N=2,201)。通过预约的等待时间(以天为单位)和练习的旅行时间(以分钟为单位)来评估感知的访问权限。咨询质量是通过咨询时间(分钟)和沟通质量(四个项目的规模,克朗巴赫的阿尔法0.89)。
    结果:就初级保健而言,与男性相比,女性的咨询机会和质量较差。与私人保险受访者相比,拥有法定健康保险的人的估计咨询时间较短。关于专科护理,60岁及以上的人报告等待时间更短,沟通质量更高。低收入群体报告沟通质量较低,而在有法定健康保险的受访者中,咨询的可达性和质量较差。社会特征所解释的差异在感知访问的范围内介于1%至4%之间,在咨询质量方面介于3%至7%之间。
    结论:我们发现,在德国门诊护理中,人们对咨询的可得性和质量存在社会差异。这种获取上的差异可能表明结构性歧视,而咨询质量的差异可能表明医疗保健中的人际歧视。
    BACKGROUND: Overall, research on social determinants of access and quality of outpatient care in Germany is scarce. Therefore, social disparities (according to sex, age, income, migration background, and health insurance) in perceived access and quality of consultation in outpatient care (primary care physicians and specialists) in Germany were explored in this study.
    METHODS: Analyses made use of a cross-sectional online survey. An adult population sample was randomly drawn from a panel which was recruited offline (N = 2,201). Perceived access was assessed by waiting time for an appointment (in days) and travel time to the practice (in minutes), while quality of consultation was measured by consultation time (in minutes) and quality of communication (scale of four items, Cronbach\'s Alpha 0.89).
    RESULTS: In terms of primary care, perceived access and quality of consultation was worse among women compared to men. Estimated consultation time was shorter among people with statutory health insurance compared to privately insured respondents. Regarding specialist care, people aged 60 years and older reported shorter waiting times and better quality of communication. Lower income groups reported lower quality of communication, while perceived access and quality of consultation was worse among respondents with a statutory health insurance. Variances explained by the social characteristics ranged between 1% and 4% for perceived access and between 3% and 7% for quality of consultation.
    CONCLUSIONS: We found social disparities in perceived access and quality of consultation in outpatient care in Germany. Such disparities in access may indicate structural discrimination, while disparities in quality of consultation may point to interpersonal discrimination in health care.
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  • 文章类型: Journal Article
    背景:从2020年3月7日至4月7日,马德里社区(CoM),西班牙,针对COVID-19疫情发布干预措施,包括长期护理机构(LTCF)居民的医院转诊分诊方案(3月18日至25日)。中度至重度身体残疾和认知障碍的患者被排除在医院转诊之外。这项研究评估了由于分诊方案而导致的每日医院转诊与LTCF居民死亡之间的关联变化。
    方法:获得2020年1月至6月LTCF居民和65岁以上CoM人群的每日医院转诊和全因死亡率。LTCF住院医师每日医院转诊时间序列的显著变化,以及LTCF和医院内的每日死亡,通过时间序列中的休息和制度测试进行了检查。进行了多变量时间序列分析,以测试LTCF住院病人医院转诊与住院和LTCF中每日死亡之间的相关性变化。以及实施分诊方案时65岁以上的CoM人群。
    结果:在LTCF居民中,2020年3月6日至3月23日,医院转诊率急剧下降。从3月7日至4月1日,LTCF居民的每日死亡人数增加,随后在4月28日之后下降到流行前的水平。从2020年3月9日至4月19日,住院死亡人数与LTCF死亡人数的每日比率达到最低值。分诊协议的四个版本,3月18日至3月25日发表的文章对医院转诊与LTCF居民住院或LTCF中每日死亡的关系的进一步变化没有影响.
    结论:虽然LTCF居民的死亡增加,3月7日,随着CoM政府干预措施的实施,LTCF居民的医院转诊减少。它们是在制定分诊协议之前实施的,保护医院免于崩溃,同时忽视了LTCF中对护理标准的需求。CoM分诊协议批准了对LTCF居民医院转诊的现有限制。
    BACKGROUND: From March 7 to April 7, 2020, the Community of Madrid (CoM), Spain, issued interventions in response to the COVID-19 epidemic, including hospital referral triage protocols for long-term care facility (LTCF) residents (March 18-25). Those with moderate to severe physical disability and cognitive impairment were excluded from hospital referral. This research assesses changes in the association between daily hospital referrals and the deaths of LTCF residents attributable to the triage protocols.
    METHODS: Daily hospital referrals and all-cause mortality from January to June 2020 among LTCF residents and the CoM population aged 65 + were obtained. Significant changes in LTCF resident daily hospital referrals time series, and in-LTCF and in-hospital daily deaths, were examined with tests for breaks and regimes in time series. Multivariate time series analyses were conducted to test changes in the associations between LTCF resident hospital referrals with daily deaths in-hospital and in-LTCF, and in the CoM population aged 65 + when the triage protocols were implemented.
    RESULTS: Among LTCF residents, hospital referrals declined sharply from March 6 to March 23, 2020. Increases in LTCF residents\' daily deaths occurred from March 7 to April 1, followed by a decrease reaching pre-epidemic levels after April 28. The daily ratio of in-hospital deaths to in-LTCF deaths reached its lowest values from March 9 to April 19, 2020. The four versions of the triage protocol, published from March 18 to March 25 had no impact on further changes in the association of hospital referrals with daily deaths of LTCF residents in-hospital or in-LTCF.
    CONCLUSIONS: While LTCF residents\' deaths increased, hospital referrals of LTCF residents decreased with the introduction of the CoM governmental interventions on March 7. They were implemented before the enactment of the triage protocols, protecting hospitals from collapse while overlooking the need for standards of care within LTCFs. The CoM triage protocols sanctioned the existing restrictions on hospital referrals of LTCF residents.
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  • 文章类型: Journal Article
    背景:耐甲氧西林金黄色葡萄球菌(MRSA)的定植增加了医院和社区获得性MRSA之间MRSA菌株复合物的随后感染的风险,这增加了耐药性的机会和疾病的严重程度。
    目的:从坦桑尼亚地区转诊医院患者中分离出的金黄色葡萄球菌菌株的基因组特征。
    方法:使用基于短读数的测序技术的基于实验室的横断面研究,(Nextseq550,Illumina,Inc.SanDiego,加州,美国)。所使用的样本是从在SeqAfrica项目下在坦桑尼亚选定的地区转诊医院就诊的患者那里收集的。使用基因组和流行病学服务器中心可用的工具分析序列,在ITOL6.0中进行了系统发育树的可视化。采用SPSS28.0进行统计分析。
    结果:在金黄色葡萄球菌的103个序列中,48.5%(50/103)携带MRSA的mecA基因。在18至34岁的参与者中观察到高比例的MRSA(52.4%)。女性(54.3%),门诊病人(60.5%)。大多数观察到的MRSA携带质粒rep5a(92.0%),rep16(90.0%),rep7c(90.0%),回购15(82.0%),rep19(80.0%)和rep10(72.0%)。在所有观察到的质粒rep5a中,rep16、rep20和repUS70携带blaZ基因,rep10携带erm(C)基因,rep7a携带tet(K)基因。MLST和系统发育分析揭示了MRSA之间的高度多样性。在选定的区域医院中观察到六个不同的克隆在循环,以ST8为主的MRSA。
    结论:该研究表明,来自坦桑尼亚地区医院的金黄色葡萄球菌菌株中存在大量MRSA,近一半携带mecA基因。MRSA在年轻人中尤为普遍,女性,和门诊病人,表现出较高的遗传多样性和ST8优势。携带抗性基因的各种质粒表明了复杂的抗性特征,强调需要有针对性的干预措施来管理坦桑尼亚的MRSA感染。
    BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) colonization increases the risk of subsequent infection by MRSA strain complex interlinking between hospital and community-acquired MRSA which increases the chance of drug resistance and severity of the disease.
    OBJECTIVE: Genomic characterization of Staphylococcus aures strains isolated from patients attending regional referral hospitals in Tanzania.
    METHODS: A laboratory-based cross-sectional study using short read-based sequencing technology, (Nextseq550,Illumina, Inc. San diego, California, USA). The samples used were collected from patients attending selected regional referral hospitals in Tanzania under the SeqAfrica project. Sequences were analyzed using tools available in the center for genomic and epidemiology server, and visualization of the phylogenetic tree was performed in ITOL 6.0. SPSS 28.0 was used for statistical analysis.
    RESULTS: Among 103 sequences of S. aureus, 48.5% (50/103) carry the mecA gene for MRSA. High proportions of MRSA were observed among participants aged between 18 and 34 years (52.4%), in females (54.3%), and among outpatients (60.5%). The majority of observed MRSA carried plasmids rep5a (92.0%), rep16 (90.0%), rep7c (90.0%), rep15 (82.0%), rep19 (80.0%) and rep10 (72.0%). Among all plasmids observed rep5a, rep16, rep20, and repUS70 carried the blaZ gene, rep10 carried the erm(C) gene and rep7a carried the tet(K) gene. MLST and phylogeny analysis reveal high diversity among MRSA. Six different clones were observed circulating at selected regional hospitals and MRSA with ST8 was dominant.
    CONCLUSIONS: The study reveals a significant presence of MRSA in Staphylococcus aureus strains from Tanzanian regional hospitals, with nearly half carrying the mecA gene. MRSA is notably prevalent among young adults, females, and outpatients, showing high genetic diversity and dominance of ST8. Various plasmids carrying resistance genes indicate a complex resistance profile, highlighting the need for targeted interventions to manage MRSA infections in Tanzania.
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  • 文章类型: Journal Article
    背景:精神疾病在儿童中很常见,对儿童和以后生活的健康产生负面影响。然而,许多患有这些疾病的儿童无法获得所需的精神保健。威斯康星州儿童精神病学咨询计划(WICPCP)旨在通过向初级保健提供者提供转诊资源来减少获得护理的差距,获得行为健康咨询,和心理健康主题培训。
    目的:本研究的目的是1)评估密尔沃基县WICPCP的有效性,提供对提供者照顾儿童心理健康的能力的具体见解,and2)identifychallengesMilwaukeePCPfacedinprovidingmentalhealthcaretochildpatientsandcontactualizethesechallengesinaconceptualframeworkofaccesstohealthcare.
    方法:使用从2014年至2022年在密尔沃基县参与该计划的提供者完成的在线基线和9个月随访调查中收集的数据进行了横断面混合方法二次数据分析。使用双样本Wilcoxon秩和(Mann-Whitney)检验(基线与后续调查回复)和描述性统计(仅限后续调查)。使用主题分析研究方法对提供者提供精神卫生保健的挑战进行了定性分析。
    结果:定量分析结果表明,从基线到随访,提供者在治疗儿童焦虑和抑郁方面的信心和技能得到了改善。定性分析的结果按WICPCP范围内外的因素进行分类。在WICPCP的范围内,提供者报告缺乏转诊选择的知识,缺乏精神保健方面的培训,以及缺乏评估和治疗精神障碍的知识。尽管如此,许多障碍仍然存在,超出了WICPCP的范围,例如漫长的等待时间和缺乏保险。
    结论:这项研究支持改善儿童获得护理的计划的有效性。然而,需要其他解决方案,例如为精神卫生专业人员提供更好的报销和扩大保险范围。
    BACKGROUND: Mental illnesses are common among children and negatively impact wellbeing during childhood as well as later in life. However, many children with these conditions are not able to access needed mental health care. The Wisconsin Child Psychiatry Consultation Program (WI CPCP) was created to reduce gaps in access to care by providing primary care providers with referral resources, access to behavioral health consultations, and training on mental health topics.
    OBJECTIVE: The purpose of this study was 1) to assess the effectiveness of the WI CPCP in Milwaukee County, providing specific insights into provider\'s ability to care for child mental health, and 2) identify challenges Milwaukee PCPs faced in providing mental health care to child patients and contextualize these challenges in a conceptual framework of access to health care.
    METHODS: A cross-sectional mixed-methods secondary data analysis was conducted using data collected from online baseline and nine-month follow-up surveys completed by providers participating in the program practicing in Milwaukee County from 2014 to 2022. Provider confidence and skill in providing mental health care was analyzed quantitatively using Two-sample Wilcoxon rank-sum (Mann-Whitney) tests (baseline vs. follow-up survey responses) and descriptive statistics (follow-up survey only). Provider challenges to providing mental health care were analyzed qualitatively using a thematic analysis research approach.
    RESULTS: Results from quantitative analyses showed that provider confidence and skill in treating childhood anxiety and depression improved from baseline to follow-up. Results from qualitative analyses were categorized by factors within and beyond the scope of WI CPCP. Within the scope of WI CPCP, providers reported a lack of knowledge of referral options and a lack of training in mental health care as well as a lack of knowledge in assessing and treating mental disorders. Still, many barriers to mental healthcare access persist that are beyond the scope of WI CPCP, such as long wait times and a lack of insurance coverage.
    CONCLUSIONS: This study supports the effectiveness of the program to improve access to care for children. However, there is a need for additional solutions such as better reimbursement for mental health professionals and expanded insurance coverage.
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  • 文章类型: Journal Article
    背景:英国国家卫生服务有多个与癌症诊断和治疗相关的等待时间标准。目标可能会产生意想不到的影响,例如基于目标而不是临床需要的优先级。在这种情况下,在刚刚达到目标的医院中,“阈值效应”将出现峰值。
    方法:我们对公开的癌症等待时间数据进行了回顾性研究,包括2周等待专家预约,31天的首次治疗决定和62天的治疗标准转诊,导致经济处罚。我们按财政年度检查了医院信托对这些目标的表现,以寻找门槛效应,使用Cattaneo等人。操纵密度试验。
    结果:对癌症等待目标的信任表现随着时间的推移而下降,自新冠肺炎大流行开始以来,这一趋势加速了。2周和31天标准的阈值效应的统计证据仅在几年内出现。然而,有强有力的统计证据表明,所有财政年度的62天标准都有阈值效应(p<0.01).
    结论:数据表明,阈值目标的影响改变了目标水平的医院行为,但并非所有标准都一样。62天标准的阈值效应证据特别强,可能是由于少量合格患者的某种组合,更大的惩罚,医院可以介入的多个航路点,相对于目标和目标设置的基准性能(即有多少净空可用)。将来使用阈值目标和针对此类目标的不同设计的RCT将提供极大的信息。
    BACKGROUND: The English National Health Service has multiple waiting time standards relating to cancer diagnosis and treatment. Targets can have unintended effects, such as prioritisation based on targets instead of clinical need. In this case, a `threshold effect\' will appear as a spike in hospitals just meeting the target.
    METHODS: We conducted a retrospective study of publicly available cancer waiting time data, including a 2-week wait for a specialist appointment, a 31-day decision to first treatment and a 62-day referral to treatment standard that attracted a financial penalty. We examined the performance of hospital trusts against these targets by financial year to look for threshold effects, using Cattaneo et al. manipulation density test.
    RESULTS: Trust performance against cancer waiting targets declined over time, and this trend accelerated since the start of the Covid-19 pandemic. Statistical evidence of a threshold effect for the 2-week and 31-day standard was only present in a few years. However, there was strong statistical evidence of a threshold effect for the 62-day standard across all financial years (p < 0.01).
    CONCLUSIONS: The data suggests that the effect of threshold targets alters hospital behaviour at target levels but does not do so equally for all standards. Evidence of threshold effects for the 62-day standard was particularly strong, possibly due to some combination of a smaller volume of eligible patients, a larger penalty, multiple waypoints where hospitals can intervene, baseline performance against the target and where the target is set (i.e. how much headroom is available). RCTs of the use of threshold targets and of different designs for such targets in the future would be extremely informative.
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  • 文章类型: Journal Article
    背景:乳腺癌在撒哈拉以南非洲构成了重大的健康挑战,尤其是在加纳,晚期诊断和有限的医疗保健服务导致死亡率上升。这项研究的重点是病理学和实验室医学(PALM)服务在加纳乳腺癌的及时诊断中的关键作用。
    方法:2020年11月至2021年10月完成了对医院的横断面调查,94.8%的国内医院参与了调查。评估的病理服务相关参数包括病理是否可用于现场或通过外部转诊诊断乳腺癌,病理学人员的数量,额外的乳腺癌诊断能力,包括雌激素和孕激素和/或HER2检测,以及从活检到患者接受检查结果的时间。地理空间制图用于识别访问受限的区域。
    结果:在参与的328家医院中,136(41%)报告乳腺癌病理服务,只有6个有现场能力。病理学人员,由15名顾问和15名专家组成,集中在主要的转诊中心,特别是在大阿克拉和库马西。对转诊模式的评估表明,75%的人口居住在乳腺癌病理服务的一个小时内。在获得乳腺癌病理学的136家医院中,只有有限数量的报告结果包括ER/PR(38%)和HER2检测(33%).
    结论:加纳已经能够通过集中实验室的强大转诊途径确保显著的病理学服务可用性。尽管如此,困难仍然存在,大多数病理结果不包括激素受体测试,这对提供肿瘤特异性治疗很重要。
    BACKGROUND: Breast cancer poses a significant health challenge in Sub-Saharan Africa, particularly in Ghana, where late-stage diagnoses and limited healthcare access contribute to elevated mortality rates. This study focuses on the crucial role of pathology and laboratory medical (PALM) services in the timely diagnosis of breast cancer within Ghana.
    METHODS: A cross-sectional survey of hospitals was completed from November 2020 to October 2021, with 94.8% of identified in-country hospitals participating. Pathology service-related parameters assessed included whether pathology was available for the diagnosis of breast cancer on-site or via external referral, the number of pathology personnel, additional breast cancer diagnostic capabilities including estrogen and progesterone and/or HER2 testing, and the time from biopsy to patients receiving their results. Geospatial mapping was used to identify areas of limited access.
    RESULTS: Of the 328 participating hospitals, 136 (41%) reported breast cancer pathology services, with only 6 having on-site capabilities. Pathology personnel, comprising 15 consultants and 15 specialists, were concentrated in major referral centers, particularly in Greater Accra and Kumasi. An assessment of referral patterns suggested that 75% of the population reside within an hour of breast cancer pathology services. Among the 136 hospitals with access to breast cancer pathology, only a limited number reported that results included ER/PR (38%) and HER2 testing (33%).
    CONCLUSIONS: Ghana has been able to ensure significant pathology service availability through robust referral pathways with centralized labs. Despite this, difficulties persist with the majority of pathology results not including hormone receptor testing which is important in providing tumor specific treatment.
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  • 文章类型: Journal Article
    2017年,布基纳法索卫生和公共卫生部(MoH)在4个地区使用国家快递服务(LaPosteBF)设计并试行了标本运输系统。基于令人满意的绩效指标,卫生部设定了一个愿景,旨在扩大这一系统,以加强对全国易流行疾病的疾病检测和监测。这项工作描述了实施过程,表演,和吸取的教训。
    这项工作描述了实现过程,表演,和吸取的教训。在卫生部人口健康保护局的领导下,采用了逐步的方法,将各个部门的多个合作伙伴召集在一起,以开发第一批所需的文件,包括指南,实施计划,标准操作程序,和数据收集工具。然后,执行阶段包括设备采购,培训,并就融资机制达成共识。定义了关键指标以进行绩效监测。
    综合生物标本转诊系统(SITEB)于2020年1月正式启动,将包括COVID-19在内的优先疾病的人类生物标本从地区级运送到全国的参考实验室。截至2022年12月31日,LaPosteBF从所有13个地区运送了168,856个包裹,其中包含206,314个样本。99.66%的包裹按要求在<24小时内交付,99.68%的标本在接收时状况良好。COVID-19标本分别占2020年和2021年运输样品的18%和63%。
    政治意愿与在试点阶段获得的经验以及所有利益相关者的承诺和支持相结合,为有效实施该系统奠定了基础。两个政府实体(卫生部和交通部长,城市流动性,和道路安全),以使公共卫生受益,从而为可持续性制定了合理的定价。尽管所有文档都集成了“一个健康”方法,该系统确保目前仅运输人类样本。尽管有安全限制,布基纳法索已成功建立了一个使用国家邮政服务的系统,以确保在实验室监测下的所有疾病的标本的常规运输,包括从地区一级到全国参考实验室的艾滋病毒和结核病实验室检测。该系统也被证明在管理公共卫生紧急情况方面是有用和有效的。
    UNASSIGNED: In 2017, the Ministry of Health and Public Hygiene (MoH) of Burkina Faso designed and piloted a specimen transport system using the national courier services (La Poste BF) in 4 districts. Based on satisfactory performance indicators, the MoH set a vision aimed at scaling up this system to strengthen disease detection and surveillance of epidemic prone diseases across the country. This work describes the implementation process, performances, and lessons learned.
    UNASSIGNED: This work describes the implementation process, performances, and lessons learned. Under the leadership of the Directorate of Population Health Protection within the MoH, a stepwise approach was used to bring together multiple partners across sectors to develop the first needed documents including a guide, an implementation plan, Standard Operating Procedures, and data collection tools. Then, the execution phase included equipment purchase, trainings, and consensus on a financing mechanism. Key indicators were defined to allow performance monitoring.
    UNASSIGNED: The integrated biological specimen referral system (SITEB) was officially launched in January 2020 to transport human biological specimens of priority diseases including COVID-19 from district level to reference laboratories nationwide. As of December 31, 2022, La Poste BF transported 168,856 packages containing 206,314 specimens from all 13 regions. 99.66% of packages were delivered in <24 h as required, and 99.68% of specimens were in good condition at reception. COVID-19 specimens represented respectively 18% and 63% of samples transported in 2020 and 2021.
    UNASSIGNED: The political will combined with the experience gained during the pilot phase and the commitment and support from all stakeholders laid to the foundation of the effective implementation of this system. Collaboration between two government entities (MoH and Minister of Transport, Urban Mobility, and Road Safety) to benefit public health has led to reasonable pricing for sustainability. Although all documents integrate the \"One Health\" approach, the system ensures the transport of only human samples for now. Despite security constraints, Burkina Faso has successfully set up a system using the national postal service to ensure the routine transport of specimens for all diseases under laboratory surveillance including laboratory tests for HIV and TB from the district level to reference laboratories nationwide. This system has also proved to be useful and efficient in managing public health emergency.
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  • 文章类型: Journal Article
    目标:由于医疗保健系统的复杂性日益增加,住院医师(院内医师)和初级保健医师(PCP)之间的有效沟通和数据交换既是核心又具有挑战性.在瑞士,关于住院医生对他们与PCP沟通的看法知之甚少。主要目的是评估住院医师对与PCP沟通的满意度。次要目标解决了有关转诊过程以及在医院相遇期间和之后与PCP沟通的所有信息。最后,我们并置了PCP中先前调查的结果,以比较它们对类似问题的回答.
    方法:这项研究调查了瑞士中部地区六家医院的住院医师。该调查于2021年11月至2022年2月通过电子邮件发送给住院医生。问卷包含17个问题,带有单选题和多选题答案以及自由文本输入选项。使用探索性多变量逻辑回归分析独立关联。
    结果:总计,1134名住院医师中有276名做出了回应(回应率24.3%):(1)大多数住院医师对一般沟通(n=162,58.7%)以及推荐信(n=145,52.5%)感到满意,(2)推荐信的首选信息渠道是电子邮件(n=212,76.8%)和电子门户(n=181,65.5%),(3)转诊中最重要的三个信息项目是:用药清单,诊断和转诊的原因。在多变量回归中,与其他临床医生相比,内科医生倾向于及时告知PCP患者的急诊入院情况(OR2.04;95CI1.21-3.49).比较PCP的响应(n=109),最突出的差异是67%(n=184)的住院医生声称在遭遇后“总是”通知,而只有7%(n=8)的PCP同意。
    结论:大多数住院医师对与PCP的沟通感到满意,更喜欢电子沟通渠道。在医院相遇前后及时传达患者信息,发现了改善的空间。
    OBJECTIVE: Due to the increasing complexity of the healthcare system, effective communication and data exchange between hospitalists (in-hospital physicians) and primary care physicians (PCPs) is both central and challenging. In Switzerland, little is known about hospitalists\' perception of their communication with PCPs. The primary objective was to assess hospitalists\' satisfaction with their communication with PCPs. Secondary objectives addressed all information about the referral process and communication with PCPs during and after the hospital encounter. Lastly, the results of a previous survey among PCPs were juxtaposed to compare their responses to similar questions.
    METHODS: This study surveyed hospitalists in six hospitals in the Central Switzerland region. The survey was sent via email to hospitalists from November 2021 to February 2022. The questionnaire contained 17 questions with single- and multiple-choice answers and the option of free-text entry. Exploratory multivariable logistic regression was used to analyse independent associations.
    RESULTS: In total, 276 of 1134 hospitalists responded (response rate 24.3%): (1) the majority of hospitalists are satisfied with the general communication (n = 162, 58.7%) as well as with referral letters (n = 145, 52.5%), (2) preferred information channels for referral letters are email (n = 212, 76.8%) and electronic portals (n = 181, 65.5%), (3) the three most important items of information in referrals are: medication list, diagnoses and reason for referral. In multivariable regression, compared to other clinicians, internists independently favoured informing PCPs of emergency admissions of their patients in a timely manner (OR 2.04; 95%CI 1.21-3.49). Comparing responses from PCPs (n = 109), the most prominent discrepancy was that 67% (n = 184) of hospitalists claimed to \"always\" inform after an encounter, whereas only 7% (n = 8) of PCPs agreed.
    CONCLUSIONS: Most hospitalists are satisfied with the communication with PCPs and prefer electronic communication channels. Room for improvement was found around timely transmission of patient information before and after hospital encounters.
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  • 文章类型: Journal Article
    背景:在资源有限的环境中,对高级医疗机构的不当利用和转诊流程的无效管理正日益成为发展中国家卫生保健管理中的一个问题。其特点是自我转诊和经常绕过最近的保健设施,加上正规转诊机制较低。这种情况适用于在高成本的医疗机构中不必要地管理简单的医疗条件的情况。2021年7月1日,肯雅塔国家医院(KNH)执行了《肯尼亚卫生部门转诊实施指南》。2014年,要求患者获得KNH转诊办公室的批准,并在KNH接受正式的转诊信,以减少步入者的数量,并允许KNH作为肯尼亚2010年宪法和1987年KNH法律雕像所设想的转诊设施。
    目的:确定执行国家转诊指南对KNH骨科入院模式的影响。这是一项干预前研究。在执行国家推荐指南之前和之后,对459和446个图表进行了数据提取,分别。
    结果:国家转诊指南的实施将步入式入院的比例从54.9%降至45.1%,而设施转介的比例从46.6%增加到53.4%(p=0.013)。非创伤骨科入院的百分比从12.0%增加到22.4%(p<0.001)。门诊诊所和企业门诊诊所的入院人数也有所增加。急诊入院比例下降,而选修录取人数增加。选修个案的增加主要是由于有现役保险的女性入院人数增加,高等教育,非创伤相关疾病和老年群体。然而,尽管执行了国家转介指南,但官方正式书面转介信的使用并未改变。
    结论:国家转诊指南的实施降低了KNH入院的比例。虽然国家转介准则的执行对正式书面转介信的使用没有影响,这确实限制了没有有效保险且需要紧急骨科护理的年轻男性患者获得和利用住院骨科服务。
    BACKGROUND: Inappropriate utilization of higher-level health facilities and ineffective management of referral processes in resource-limited settings are becoming increasingly a concern in health care management in developing countries. This is characterized by self-referral and frequent bypassing of the nearest health facilities coupled with low formal referral mechanisms. This scenario lends itself to a situation where uncomplicated medical conditions are unnecessarily managed in a high-cost health facility. On July 1, 2021, Kenyatta National Hospital (KNH) enforced the Kenya Health Sector Referral Implementation Guidelines, 2014, which required patients to receive approval from the KNH referral office and a formal referral letter to be admitted at KNH to reduce the number of walk-ins and allow KNH to function as a referral facility as envisioned by the Kenya 2010 Constitution and KNH legal statue of 1987.
    OBJECTIVE: To determine the effect of enforcing the national referral guidelines on patterns of orthopaedic admissions to the KNH. This was a pre-post intervention study. Data abstraction was done for 459 and 446 charts before and after the enforcement of the national referral guidelines, respectively.
    RESULTS: Enforcement of the national referral guidelines reduced the proportion of walk-in admissions from 54.9% to 45.1%, while the proportion of facility referrals increased from 46.6% to 53.4% (p = 0.013). The percentage of non-trauma orthopaedic admissions doubled from 12.0% to 22.4% (p<0.001). There was also an increase in admissions through the Outpatient Clinic and Corporate Outpatient Clinic. The proportion of emergency admissions declined, while that of elective admissions increased. The increase in elective cases was mainly driven by the increase in female admissions with active insurance cover, tertiary education, non-trauma-related conditions and older age groups. However, the use of official formal written referral letters did not change despite the enforcement of the national referral guidelines.
    CONCLUSIONS: The enforcement of the national referral guidelines reduced the proportion of walk-ins\' admissions to KNH. While the enforcement of the national referral guidelines had no effect on the use of official formal written referral letters, it did limit access and utilization of inpatient orthopedic services for young male patients with no active insurance cover and in need of emergency orthopedic care.
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