2,484 research outputs found

    Breaking the Barriers to Specialty Care: Practical Ideas to Improve Health Equity and Reduce Cost - Increasing Specialty Care Availability

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    Tremendous health outcome inequities remain in the U.S. across race and ethnicity, gender and sexual orientation, socio-economic status, and geography—particularly for those with serious conditions such as lung or skin cancer, HIV/AIDS, or cardiovascular disease.These inequities are driven by a complex set of factors—including distance to a specialist, insurance coverage, provider bias, and a patient's housing and healthy food access. These inequities not only harm patients, resulting in avoidable illness and death, they also drive unnecessary health systems costs.This 5-part series highlights the urgent need to address these issues, providing resources such as case studies, data, and recommendations to help the health care sector make meaningful strides toward achieving equity in specialty care.Top TakeawaysThere are vast inequalities in access to and outcomes from specialty health care in the U.S. These inequalities are worst for minority patients, low-income patients, patients with limited English language proficiency, and patients in rural areas.A number of solutions have emerged to improve health outcomes for minority and medically underserved patients. These solutions fall into three main categories: increasing specialty care availability, ensuring high-quality care, and helping patients engage in care.As these inequities are also significant drivers of health costs, payers, health care provider organizations, and policy makers have a strong incentive to invest in solutions that will both improve outcomes and reduce unnecessary costs. These actors play a critical role in ensuring that equity is embedded into core care delivery at scale.Part 2: "Increasing Specialty Care Availability"Solutions such as telemedicine, innovative partnerships between specialists and primary care physicians, and centralized local referral networks improve access to specialty care

    Internet of Things in Emergency Medical Care and Services

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    Emergency care is a critical area of medicine whose outcomes are influenced by the time, availability, and accuracy of contextual information. In addition, the success of emergency care depends on the quality and accuracy of the information received during the emergency call and data collected during the emergency transportation. The success of a follow medical treatment at an emergency care unit depends too on data collected during the two phases: emergency call and transport. However, most information received during an emergency-call is inaccurate and the process of information collection, storage, processing, and retrieval, during an emergency-transportation, is remaining manual and time-consuming. Emergency doctors mostly lack patient’s health records and base the medical treatment on a set of collected information including information provided by the patient or his relatives. Hence, the emergency care delivery is more patient-centered than patient-centric information. Wireless body area network and Internet of Technology (IoT) enable accurate collection of data and are increasingly used in medical applications. This chapter discusses the challenges facing the emergency medical care services delivery, especially in the developing countries. It presents and discusses an IoT platform for a patient-centric-information-based emergency care services delivery. The study is focused on a case of road traffic injury. Results of conducted experiments are discussed

    Challenges of Continuum of HIV/AIDS Care and Treatment in Tanzania: The Effects of Parasites Co-Infections, HIV Clinical Manifestations, and Adherence to Antiretroviral Therapy

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    In Tanzania, the National AIDS Control Program with the support of Non-Government Organizations is scaling-up Antiretroviral Therapy (ART) services to peripheral (rural) health facilities. The aim of scaling-up is to improve availability, access and adherence to ART by all HIV-infected population. HIV-infected persons in peripheral (rural) areas are at increased risk for several medical co-morbidities including tuberculosis, bacterial and parasitic infections. As ART is successfully made universally available, non-AIDS co-morbidities caused by helminths and malaria will emerge as leading problems that will complicate care, adherence to ART and retention. These challenges can be improved by comprehensive and multidisciplinary management strategies. In addition a range of interventions such as counselling, use of treatment assistants and integrated health services delivery need to be enhanced to improve adherence and treatment of co-morbidities. However, concerns are raised regarding proper HIV/AIDS management in the peripheral (rural) settings which focuses on clinical monitoring and treatment of opportunistic infections. Clinical monitoring is based on WHO clinical stages and CD4+ T-lymphocyte counts. Clinicians in the peripheral (rural) settings faces challenges in accessing CD4+ T-lymphocyte counts, HIV and AIDS clinical features not corresponding with WHO clinical stages, co-infections and co-morbidity. The aim of the work reported in this thesis was to conduct research to investigate effects of concurrent parasites infections and challenges of HIV/AIDS case management on peripheral (rural) patients in order to contribute information towards better care for HIV/AIDS patients in Tanzania. The studies were conducted at Tumbi Hospital and Chalinze Health Centre in Tanzania between April 2008 and June 2009. The research consisted of three sub-studies carried out consecutively utilizing different study designs and populations. The first study examined the effects of parasite co-infection on CD4+ T-lymphocyte counts, WHO clinical staging and haemoglobin. In addition, the study attempted to develop a simplified clinical staging by utilizing local experiences HIV/AIDS clinical manifestation. Adult patients registering for the first time at HIV-clinic were clinically examined for malaria parasites and helminths. CD4 counts and haemoglobin were also analyzed. Patients were initiated on treatments according to their respective diagnosis and followed up for six months. At 6 months, clinical procedures were performed similar to first contact assessment. The second study utilized a case-control design to elucidate factors associated with non-adherence to ART. Adult patients attending care and treatment at the study clinics and being on ART for at least three months were studied. Patients with ART adherence of less than 95%; and those with more than 95% were defined as cases and controls respectively. The third study was an observation study which documented experiences and lessons generated in the process of implementing ART services at Chalinze health centre. Clinical procedures were evaluated and document review was carried out to solicit patients’ characteristics and enrolment rates

    ROLE OF INFORMATION AND COMMUNICATION TECHNOLOGY (ICT) IN HIV/AIDS HEALTH COMMUNICATION IN SLUMS (A Case of Kawangware Division, Nairobi Kenya)

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    Purpose: Information and Communication Technologies are key elements of a civil society response to the HIV/AIDS epidemic, enabling advocacy, mobilization, and empowerment of People Living with HIV (PLWHA), women, and other vulnerable groups. This study sought to investigate the role of Information and Communication Technology (ICT) in HIV/AIDS Health Communication in slums through a case study of a project sponsored by AfriAfya in Kawangware division, Nairobi Kenya. AfriAfya, also known as the African Network for Health Knowledge Management and Communication, is a consortium of health NGOs namely: Aga Khan Health Services; African Medical and Research Foundation (AMREF); CARE Kenya; Christian Health Association of Kenya; HealthNet Kenya; the Ministry of Health, Kenya; PLAN International; and World Vision International, Kenya. AfriAfya was set up in April 2000 to explore the ways of harnessing ICTs for community health in rural and marginalized communities.  The study was guided by the following specific objectives: (i) to analyze the ICT interventions and tools used in the fight against HIV/AIDS in Kenya; to examine the benefits derived from adoption of ICTs in the fight against HIV/AIDS in Kenyan slums; to assess the challenges faced in the adoption of ICTs in the fight against HIV/AIDS in the slums in Kenya; and to recommend strategies on how best to employ ICTs in the fight against HIV/AIDS in Kenyan slums. Methods: The data collected by this study was analyzed by descriptive statistics such as percentages, frequencies and tables. In addition, standard deviations and mean scores were used to present information pertaining to the study objectives. The information was presented and discussed as per the objectives and research questions of the study. Findings: Findings of the study indicate that all the four objectives were met as follows:- The tools used in the fight against HIV/AIDS in Kenya were established as being e-mail discussion groups, Internet, Dissemination of information on World Wide Web (www), Radio, Television, and  Distance learning systems. The interventions used in the fight against HIV/AIDS in Kenya were established as being Prevention:-Dissemination of prevention messages as well as prevention services to target groups such as commercial sex workers; School Based Education:- Education and life skills training in the schools for effecting appropriate behavioral changes among youth; and Education of Health Care Workers :- ICTs are being used to improve access to information, education, and communication for health workers using, Internet, email discussion groups, and distance learning systems. The benefits derived from adoption of ICTs in the fight against HIV/AIDS in Kenyan slums were determined as being Social change; empowerment and reduction of vulnerability; advocacy, mobilization, networking and capacity building; Remote consultations and diagnosis; Information sharing; Remote mentoring; Facilitation of Distance learning teaching; and Online Counseling. The challenges of adoption of the ICTs in HIV/AIDS Health Communication were established as being: - Limited connectivity; Poor ICT infrastructure status; High costs of accessing the Internet; and Language barrier. Key Words: Information & Communication Technology, HIV/AIDS, Community Based Organizations

    M-health review: joining up healthcare in a wireless world

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    In recent years, there has been a huge increase in the use of information and communication technologies (ICT) to deliver health and social care. This trend is bound to continue as providers (whether public or private) strive to deliver better care to more people under conditions of severe budgetary constraint

    Audit of Antenatal Testing of Sexually Transmissible Infections and Blood Borne Viruses at Western Australian Hospitals

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    In August 2007, the Western Australian Department of Health (DOH) released updated recommendations for testing of sexually transmissible infections (STI) and blood-borne viruses (BBV) in antenates. Prior to this, the Royal Australian & New Zealand College of Obstetricians & Gynaecologists (RANZCOG) antenatal testing recommendations had been accepted practice in most antenatal settings. The RANZCOG recommends that testing for HIV, syphilis, hepatitis B and C be offered at the first antenatal visit. The DOH recommends that in addition, chlamydia testing be offered. We conducted a baseline audit of antenatal STI/BBV testing in women who delivered at selected public hospitals before the DOH recommendations. We examined the medical records of 200 women who had delivered before 1st July 2007 from each of the sevenWAhospitals included in the audit. STI and BBV testing information and demographic data were collected. Of the 1,409 women included, 1,205 (86%) were non-Aboriginal and 200 (14%) were Aboriginal. High proportions of women had been tested for HIV (76%), syphilis (86%), hepatitis C (87%) and hepatitis B (88%). Overall, 72% of women had undergone STI/BBV testing in accordance with RANZCOG recommendations. However, chlamydia testing was evident in only 18% of records. STI/BBV prevalence ranged from 3.9% (CI 1.5– 6.3%) for chlamydia, to 1.7% (CI 1–2.4%) for hepatitis C, 0.7% (CI 0.3–1.2) for hepatitis B and 0.6% (CI 0.2–1) for syphilis. Prior to the DOH recommendations, nearly three-quarters of antenates had undergone STI/BBV testing in accordance with RANZCOG recommendations, but less than one fifth had been tested for chlamydia. The DOH recommendations will be further promoted with the assistance of hospitals and other stakeholders. A future audit will be conducted to determine the proportion of women tested according to the DOH recommendations. The hand book from this conference is available for download Published in 2008 by the Australasian Society for HIV Medicine Inc © Australasian Society for HIV Medicine Inc 2008 ISBN: 978-1-920773-59-

    SIDATRAT: informatics to improve HIV/AIDS care

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    Diabetic retinopathy in sub-Saharan Africa: meeting the challenges of an emerging epidemic

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    BACKGROUND: Sub-Saharan Africa faces an epidemic of diabetes. Diabetes causes significant morbidity including visual loss from diabetic retinopathy, which is largely preventable. In this resource-poor setting, health systems are poorly organized to deliver chronic care with multiple system involvement. The specific skills and resources needed to manage diabetic retinopathy are scarce. The costs of inaction for individuals, communities and countries are likely to be high. DISCUSSION: Screening for and treatment of diabetic retinopathy have been shown to be effective, and cost-effective, in resource-rich settings. In sub-Saharan Africa, clinical services for diabetes need to be expanded with the provision of effective, integrated care, including case-finding and management of diabetic retinopathy. This should be underpinned by a high quality evidence base accounting for differences in diabetes types, resources, patients and society in Africa. Research must address the epidemiology of diabetic retinopathy in Africa, strategies for disease detection and management with laser treatment, and include health economic analyses. Models of care tailored to the local geographic and social context are most likely to be cost effective, and should draw on experience and expertise from other continents. Research into diabetic retinopathy in Africa can drive the political agenda for service development and enable informed prioritization of available health funding at a national level. Effective interventions need to be implemented in the near future to avert a large burden of visual loss from diabetic retinopathy in the continent. SUMMARY: An increase in visual loss from diabetic retinopathy is inevitable as the diabetes epidemic emerges in sub-Saharan Africa. This could be minimized by the provision of case-finding and laser treatment, but how to do this most effectively in the regional context is not known. Research into the epidemiology, case-finding and laser treatment of diabetic retinopathy in sub-Saharan Africa will highlight a poorly met need, as well as guide the development of services for that need as it expands

    A Critical Scan of Four Key Topics for the Philanthropic Sector: A study by the Rockefeller Foundation and Accenture Development Partnerships

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    The study aims to identify problem areas in the developing and developed world, as well as areas of dynamism and convergence that will, over the next five to 10 years, present opportunities to make a greater impact in the development sector. The study, which made use of a consultative process, investigates four key topics central to human wellbeing. These are: natural ecosystems, health, livelihoods, and urban environments. In each of the four identified topic areas there is a greater need to foster innovation and shift paradigms in order to expand opportunity for the vulnerable and those living in poverty, and strengthen their resilience
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