Health services use for ambulatory care sensitive conditions in the developing country of Barbados

Objective: This research examined hospitalization for ambulatory care sensitive conditions (ACSH) for the population of Barbados during 2003-2008. I examined differences in ACSH rates for females and males at the parish and population levels over the six year period. This study compared hospitalization rates across years and geographic locations for the six most prevalent ambulatory care sensitive conditions in the adult population, ages 20 and over, and for five individual ambulatory care sensitive conditions in the population ages 19 years and younger. I also compared ACSH rates in Barbados to published rates for other developed and developing countries. Methods: ACSHs were identified using data from the Queen Elizabeth Hospital in Barbados for 2003-2008. For the adult population, ages 20 and over, International Classification of Diseases, Tenth Revision Australian Modification (ICD-10-AM) codes and categories were used to identify ACSH rates based on the codes used to define potentially avoidable hospitalizations by the Victorian Government Department of Human Services (VGDHS, 2004), codes that are used by the government of Australia that have been validated through extensive research and publication. The United States Agency for Healthcare Research and Quality (AHRQ) area level pediatric quality indicators (PDIs) were used to identify ACSHs for the population ages 19 years and younger, using an ICD-10 cross-walk developed for this research. Cross-sectional and time series analyses of ACSH rates were performed for the period 2003-2008. Poisson analysis estimated relative rates and provided 95% confidence intervals and p-values, enabling comparisons of differences in hospitalization rates between women and men, among years of the study, and across parishes. Results: For the adult population, the gender analysis showed that women age 50+ had the highest percent of hospitalizations that were ACSH, nearly half of all hospitalizations (47.4%). Across years studied, the highest ACSH population-based rates were observed for men age 50+ (31.36 per 1000). Considerable variation in ACSH rates was observed among parishes for both men and women for all age groups. The analysis by gender found that, compared with men, women ages 20-49 had higher rates of hospitalization across the study period 2003-2008 and for each year. For women and men ages 50+, ACSH rates were higher for men than for women. For men and women ages 20-49 years, those who lived in St. Michael had the highest rates of ACSH of the eleven parishes. Among adults ages 20-49 and 50+, the top six ambulatory care sensitive conditions were influenza and pneumonia, congestive heart failure, diabetes, angina, dehydration, and hypertension. Among all ACSHs, the rate of hospitalization for influenza and pneumonia was highest for both women and men ages 20-49 and 50+. In the age 19 and younger population, ACSH rates differed considerably for girls and boys, and were generally higher for boys than girls across parishes and across the years 2003-2008. The most prevalent ACSH in the 19 and younger group was asthma. Trends for ACSH rates in Barbados were consistent with countries such as Taiwan and Australia, with considerable variability across the study years; however, there was notable evidence that ACSH rates may have increased considerably in the latter study years. Discussion: There were significant differences in ACSH rates across the parishes in Barbados for females and males. The substantial variation in ACSH rates among parishes suggests evidence of potential problems in access to primary care, particularly for residents of St. Michael, and the adult populations in St. Thomas, St. Andrew, and St. James. This study provides relevant base line informationaboutACSHratesandsuggeststheneedforfutureresearchinthisarea. Itis possible that the higher ACSH rates in these parishes are attributable to area factors other than primary care, factors such as disease prevalence or differences in education; further research should investigate this possibility

IMPROVING PATIENT SATISFACTION WITH ELECTIVE SURGERY WAITING: AN EMPOWERMENT PERSPECTIVE

Waiting for elective surgery has been causing severe patient dissatisfaction and is becoming a major concern in most countries with publicly funded healthcare systems. While waitlists, which are used to rationalize the balances between healthcare service demand and supply, are almost impossible to avoid currently, healthcare policy makers could try to remove the tension through providing more satisfactory elective surgery waitlist information to patients on the waitlist. This work-in-progress paper seeks to build a framework towards improving elective surgery patients’ information satisfaction. We propose that an effective waitlist information system (which can meet the information needs of waiting patients) empowers patients, creating a sense of autonomy and control for their own health situation, reducing their stress and uncertainty, improving their sense of perceived equity and power (relative to the healthcare authorities who manage the waitlist) and eventually improves patient satisfaction towards waiting

Generalist telephone counselling and referral call data as a social indicator : a lifeline to social support?

The aim of this Australian Research Council Linkage doctoral project with industry partners UnitingCare-Lifeline Ballarat and Lifeline Australia was to investigate whether calls to Lifeline – a generalist telephone counselling and referral service – could be used as valid and reliable social indicators of health. The Lifeline Australia service receives approximately 1,000 calls a day and key details of each call are recorded on its Client Services Management Information System (CSMIS). A number of research questions directed this study: (1) What are the characteristics or attributes of callers to Lifeline?; (2) How do the patterns of calls to Lifeline vary spatially?; and (3) What is the statistical relationship between calls to Lifeline and other measures of community health? This thesis presents a detailed descriptive summary and analysis of Lifeline’s national CSMIS call data (N = 90,128 cases) from 01-04-2003 to 29-06-2003. It explores this and other sources of call data, such as the Telstra Exchange data, for their potential to be used as social indicators. The project created a model of generalist telephone counselling and referral use (MGTCRU). The MGTCRU was used as a theoretical base to a call rate indicator, named the Lifeline Indicator of Social Need (LISN), which reflects the community’s capacity to provide social support to its most socially isolated residents. The LISN was found to have useful attributes and a potential for use as a social indicator of community strength. The call rate indicator showed a statistically significant relationship with the Accessibility/Remoteness Index of Australia, measures of socio-economic disadvantage, and suicide rates. However, the CSMIS database was found to have certain limitations. The thesis presents recommendations for this situation to be addressed. While acknowledging that there are limitations to telephone counselling call data it is clear that these call data can be used to create cost effective, rapid, reliable, and potentially valid social indicators. This thesis has made a number of significant empirical and theoretical contributions to knowledge on telephone counselling and referral. The descriptive summary of the CSMIS data provided in this thesis might be used in innovative ways by social researchers. The LISN could be used on its own or included in other social indices. The MGTCRU provides a theoretical framework for understanding telephone counselling and referral services use and may assist these services to organise their operations and meet the needs of their callers. This project may have particular application to a current upgrade of Lifeline Australia’s telephony and call data systems.Doctor of Philosoph

A method to include in lca road traffic noise and its health effects

Background, Aims and Scope: Transport noise represents an environmental problem that is perceived by humans more directly than the usual chemical emissions or resource uses. In spite of this, traditional LCA applications still exclude noise — probably due to the unavailability of an appropriate assessment method. In order to fill the gap, this article presents a study proposing a new computational procedure for the determination of health impairment resulting from noise emissions of road vehicles. Main Features: The magnitude of health impairment due to noise is determined separately for each vehicle class (cars, trucks,..) and is calculated per vehicle-kilometre driven during the day or at nighttime on the Swiss road network. This health impairment is expressed in cases of sleep disturbance or communication disturbance, and furthermore aggregated in DALY (Disability Adjusted Life Years) units representing the number, duration and severity of the health cases. The method is modelling the full cause-effect chain from the noise emissions of a single vehicle up to the health damage. As in some other modern concepts of environmental damage assessment, the analysis is subdivided into the four modules of fate analysis, exposure analysis, effect analysis and damage analysis. The fate analysis yielding the noise level increment due to an additional road transport over a given distance is conducted for transports with known or with unknown routing, the latter case being more important in LCA practice. The current number of persons subject to specific background levels of noise is determined on the basis of the road traffic noise model, LUK, developed by the Swiss canton of Zurich. The number of additional cases of health impairment due to incremental noise is calculated with data out of the Swiss Noise Study 90. An assessment of the severity of sleep disturbance and communication disturbance, in comparison to other types of health impairment, was performed by a panel consisting of physicians experienced in the field of severity weighting of disabilities. Results and Discussion: The quantities of health cases and of DALY units are given per 1′000 truck or car kilometres on Swiss roads, and the range of the confidence interval is estimated. A plausibility check is made by a quantitative comparison of the results with health damage due to traffic accidents in Switzerland, and with health damage due to traffic noise in the Netherlands. Conclusions and Oudook: The method is ready for use in LCA practice. However, the temporary solution for transports outside of Switzerland should be replaced by feeding country specific data into the fate and exposure model. Further, a comparable assessment for rail transport would facilitate decisions on road or rail transport. A decisive element of transport noise assessment is the availability of robust links between noise level and medical conditions. Whilst the number of the corresponding studies is sufficiendy large, a design for better pooling of study results is desirabl

A rural perspective of telephone counselling and referral

A telephone survey was used to examine rural residents' (n=102) perceptions and knowledge of a well-established national telephone counselling and referral service-Lifeline. Residents in rural Australia experience generally poorer access and availability to health-related services than their metropolitan counterparts. They may also have problems with confidentiality and stigmatisation in using what services are available in their area. Although this was a non-comparative study, it was reasoned that these barriers to help-seeking in rural areas would mean their population would know and value a service such as Lifeline, which provides equitable and anonymous support and referrals to all Australians. The results showed that the service was known, valued, and supported strongly by the respondents. The findings supported the belief that telephone counselling and referral has an important and unique place in rural health support and referral.C