35 research outputs found
El mercado de las farmacias en Chile: ¿competencia por localización?
Competition in the Chilean drugstore market has been recently disputed, based on a price-fixing case involving the three major drugstore chains. However, firms also compete in other dimensions such as geographical location of stores. Using an original dataset, this paper describes the geographical distribution of the three major pharmacy chains’ stores at national, regional and municipal level. The results show that: i) drugstores tend to agglomerate in certain geographical areas; ii) there are many municipalities in which the three main drugstore chains do not have a single store and; iii) one of the firms (Cruz Verde) has a location strategy different from its competitors. The goal of the paper is to describe the national drugstore market, understood as a first step to identify the way in which firms do (or do not) compete by location, as well as its implications for consumers.La competencia en el mercado de las farmacias en Chile ha sido cuestionada en el último tiempo a raÃz del caso de fijación de precios en que se vieron involucradas las tres cadenas de farmacias más importantes del paÃs. Sin embargo, también existen otras dimensiones sobre las que las empresas compiten, como la localización de los puntos de venta. A partir de una base de datos completamente novedosa, este trabajo caracteriza la distribución geográfica de puntos de venta de las tres principales cadenas de farmacias, entregando información a nivel nacional, regional y comunal. Se encuentra que: i) las farmacias tienden a concentrarse en determinadas zonas geográficas, ii) existe una importante cantidad de comunas sin presencia de locales de estas cadenas, y iii) una de las cadenas (Cruz Verde) tiene una estrategia de ubicación de locales distinta a la de sus competidores. El trabajo busca representar el mercado nacional de farmacias mediante un análisis descriptivo, entendido como el primer paso para comprender la forma en que las empresas compiten (o no) por localización, asà como las consecuencias que ejercen estos patrones en los consumidores
Improving Long-Term Care Facilities’ Crisis Response: Lessons From the COVID-19 in Chile
Context: The COVID-19 pandemic hit Chile hard and affected older people the most. Through its National Service for Older Adults, the country implemented a strategy to prevent and mitigate infection and spread in long-term care facilities (LTCF), reaching regulated and registered residences and, for the first time, informal and unregistered residences.
Objective: Identify the challenges and lessons from the COVID-19 response in LTCF with respect to the support received, the implementation of infection control measures, workforce challenges experienced and the measures adopted to promote residents’ wellbeing.
Methods: An online questionnaire was sent to all LTCF managers (N = 385, Response Rate = 32.4%). Statistical tests compare results to identify differences across LTCF characteristics: residence size, location and management type (private, public or subsidized, or informal).
Findings: Irrespective of their location, size or management, managers highlight common challenges during the crisis. They include limited personal protective equipment (PPE) availability, staff shortages, low quality of replacement staff, reduced staff mental health, and the difficulty to understand and implement protocols. Managers acknowledge receiving institutional support in the form of PPE provision and opportunities for staff training, but managers noted the need to expand this support to cover staffing surge needs, staff psychological needs, and ensure the continuity of clinical support for residents as well. Managers share a common demand for a more coordinated response from public institutions. Managers recognize that the pandemic and the measures implemented to mitigate it negatively affected staff morale and residents’ wellbeing. Many noted that peer-to-peer support was a mechanism to support staff.
Limitations: Results might be subject to selection bias. Data collection covered a limited period of time at the early stage of the pandemic.
Implications: Findings are relevant to assess the COVID-19 response and to better prepare for another COVID-19 wave or similar health or environmental threats in the future
Enablers and Barriers to Implement COVID-19 Measures in Long-Term Care Facilities: A Mixed Methods Implementation Science Assessment in Chile
Background: As elsewhere, in Chile the COVID-19 affected disproportionately older people, and particularly people living in long-term care facilities. Considering this problem, the Government issued a series of guidelines and protocols to prevent and manage COVID-19 outbreaks in these facilities.
Methods: This study aims to identify barriers and enablers that affect the implementation of these prevention and management measures. For the analysis, we used an implementation science approach and a mixed methods strategy — a survey among facilities’ managers and interviews among staff — classifying enablers and barriers into four categories: agreement with the intervention’s goals, financial resources to implement the measures, technical needs of the intervention, and cultural factors in the facilities.
Results: Results highlight the importance of the four factors above in the implementation of COVID-19 guidelines and protocols. Managers and staff differ in their view of the main enablers and barriers for implementation. However, they both identify the knowledge about the measures and availability of personal protective equipment as enablers and human resources as a potential barrier.
Conclusions: The identification of several factors related to goals and culture highlights the need to adopt a broad implementation approach when designing interventions for long-term care facilities, avoiding restricting the discussion to the availability of resources.
Highlight:
• Understanding implementation factors is key to design and assess successful interventions.
• The prevention and management measures implemented in the Chilean facilities found barriers (e.g., infrastructure, human capital and resistance to chance), and enablers (e.g., PPE availability and trust in technical staff) that could have impacted the effectiveness of the measures proposed.
• Tackling the identified implementation barriers using feasible and evidence based strategies could improve the effectiveness of the measures
Food Insecurity and Functional Disability Among Older Adults in Ghana: The Role of Sex and Physical Activity
Objectives: We examined the associations between food insecurity and functional disability among older adults in Ghana and, the roles of sex and physical activity on the relationship. Design: A cross-sectional study design was employed. Setting and participants: A total of 4446 older adults (50+ years of age) from the Study on Global Aging and Adult Health Ghana Wave 2, a countrywide study, was completed in 2015. Methods: Logistic regression models were used to examine the associations between measures of food insecurity and functional disability using data from Study on Global Aging and Adult Health Ghana Wave 2. Functional disability was assessed using World Health Organization Disability Assessment Schedule 2.0 composed of 12 items in 6 domains of cognition, mobility, self-care, getting along, life activities, and participation in society. Food insecurity was assessed from 12-month food sufficiency and experience of hunger over the last 12 months. Results: Approximately 11% were identified as having functional disability. The prevalence of food insecurity was 23.8% for insufficient food intake and 18.3% for hunger. Adjusting for all variables, older adults who reported consuming insufficient food (OR 2.27; 95% CI 1.57, 3.28), and those who experienced hunger (OR 2.35; 95% CI 1.59, 3.46) had higher odds of functional disability, compared with those not reporting these issues. Sex differences modified the association between hunger and functional disability. Physical activity served as a protective factor (OR 0.60; 95% CI 0.38, 0.95) on the association implying that older adults who engaged in physical activity were 40% less likely to experience food insecurity-induced functional disability. Conclusions and Implications: Food insecurity is associated with functional disability among older adults. Results highlight the usefulness of tackling the social determinants of health and promoting financial/social security in older age in a changing Ghanaian society
Physical activity and functional disability among older adults in Ghana: The moderating role of multi-morbidity
Knowledge about how physical activity levels relate to functional disability is essential for health promotion and planning older adults’ care or rehabilitation. The risk of living with one or more chronic health conditions increases with increasing age in lower and higher income countries–many of which are associated with physical inactivity. We conducted a cross-sectional study to examine the moderating role of multimorbidity on physical activity and its measures on functional disability among older adults in Ghana. Data from WHO’s Study on global AGEing and adult health Ghana Wave 2 with a sample of 4,446 people aged 50+ years was used for this study. Functional disability was assessed using the 12-item WHO Disability Assessment Schedule 2.0. Three categories of physical activity levels were used: vigorous intensity, moderate intensity, and walking. Past month diagnosis by a doctor was used to assess the presence of a chronic condition, and the presence of two or more conditions was used to define multi-morbidity. Logistic regressions with a post hoc interactional tests were used to examine the associations. Overall, physical activity had a significant association with functional disability (OR = 0.25, 95%CI; 0.12, 0.32). A similar relationship was found for vigorous-intensity (OR = 0.19, 95%CI: 0.12, 0.29), moderate-intensity (OR = 0.19, 95%CI: 0.15, 0.25) and walking (OR = 0.41, 95%CI: 0.33, 0.51). Older adults living with one condition and physically active were 47% less likely to experience functional disability compared with the less active counterparts living with at least two chronic conditions. Among the three measures of physical activity, multimorbidity moderated the relationship between walking and functional disability. Future strategies for meeting the health and long-term care needs of older adults, particularly those living with only one chronic condition in Ghana should consider encouraging walking. Policies, financial assistance, family, and community level interventions aimed to promote and sustain physical activity among older adults should be a priority for stakeholders in Ghana
Effectiveness of a Gamification Strategy to Prevent Childhood Obesity in Schools : A Cluster Controlled Trial
Objective The aim of this study was to examine the effectiveness of a school-based gamification strategy to prevent childhood obesity. Methods Schools were randomized in Santiago, Chile, between March and May 2018 to control or to receive a nutrition and physical activity intervention using a gamification strategy (i.e., the use of points, levels, and rewards) to achieve healthy challenges. The intervention was delivered for 7 months and participants were assessed at 4 and 7 months. Primary outcomes were mean difference in BMI z score and waist circumference (WC) between trial arms at 7 months. Secondary outcomes were mean difference in BMI and systolic and diastolic blood pressure between trial arms at 7 months. Results A total of 24 schools (5 controls) and 2,197 students (653 controls) were analyzed. Mean BMI z score was lower in the intervention arm compared with control (adjusted mean difference -0.133, 95% CI: -0.25 to -0.01), whereas no evidence of reduction in WC was found. Mean BMI and systolic blood pressure were lower in the intervention arm compared with control. No evidence of reduction in diastolic blood pressure was found. Conclusions The multicomponent intervention was effective in preventing obesity but not in reducing WC. Gamification is a potentially powerful tool to increase the effectiveness of school-based interventions to prevent obesity.Peer reviewe
Housing conditions and long-term care needs of older adults in Ghana: Evidence from the WHO SAGE Ghana Wave 1
Envejecimiento y cuidados a largo plazo en Chile: desafÃos en el contexto de la OCDE
RESUMEN Chile se encuentra en pleno proceso de transición demográfica y su población envejece rápidamente. Esta situación presenta múltiples desafÃos de polÃtica pública, incluidos los del área de la salud pública. En concreto, la relación entre el envejecimiento y la pérdida de la autonomÃa exige diseñar con urgencia una polÃtica de cuidados a largo plazo en el paÃs. El objetivo de este documento es describir el escenario actual de los cuidados a largo plazo en Chile usando la experiencia de los paÃses de la Organización para la Cooperación y el Desarrollo Económico, para poner de manifiesto la necesidad de avanzar en el diseño y el financiamiento de una polÃtica coordinada en el paÃs, que permita afrontar con antelación los desafÃos del envejecimiento en las próximas décadas
The Health Care System in Chile
This country report provides a description of the emergence of a health care system under public responsibility in Chile. The inception of the health care system refers to the first legislation stipulating entitlements to medical care. The report also includes a brief description of major health care reforms, and the current organization of the health care system in Chile. This report is part of the CRC 1342 Social Policy Country Briefs Series.Deutsche Forschungsgemeinschaft (DFG)2