Reorienting Health Services to People with Chronic Health Conditions: Diabetes and Stroke Services in Malaysia, Sri Lanka and Thailand

Yiengprugsawan, Vasoontara; Healy, Judith; Kendig, Hal; Neelamegam, Malinee; Karunapema, Palitha; Kasemsup, Vijj

doi:10.1080/23288604.2017.1356428

Cited by 9 publications

(8 citation statements)

References 18 publications

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“…Primary health care is a cornerstone of UHC and sustainable development in many countries [ 32 ]. Evidence from Thailand, Sri Lanka and Malaysia has shown that availability and proximity of access to primary health care could favour older persons [ 33 ]. Recent evidence in Mongolia has reported the transformation of FHC and SHC under way towards health promotion (219 FHC and 273 SHC, 41.8 % and 38.6 % for outpatient visits for preventive purposes).…”

Section: Discussionmentioning

confidence: 99%

Disparities in outpatient and inpatient utilization by rural-urban areas among older Mongolians based on a modified WHO-SAGE instrument

Yiengprugsawan

Dorj

Dracakis

et al. 2021

BMC Health Serv Res

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Background Mongolia has made significant progress towards achieving Universal Health Coverage (UHC), but there are still challenges ahead with population ageing and non-communicable diseases (NCDs). The purpose of this study was to investigate patterns and determinants of outpatient and inpatient health service use amongst older people in Mongolia. Methods Data were collected using a questionnaire developed for the World Health Organization’s Study on global AGEing and adult health (WHO SAGE). There were 478 participants from rural areas and 497 participants from Ulaanbaatar (further divided into 255 ger/yurt district and 242 apartment district residents). Multivariable logistic regression analyses were used to investigate determinants of outpatient and inpatient health service use with reported adjusted Odds Ratios (AORs) and 95 % Confidence Intervals (CIs). Results Participants were aged 60 to 93 years. About 55 % of respondents used outpatient services in the past 12 months and 51 % used inpatient services in the past three years. Hypertension was the most common reason for health service use. Rural residents had longer travel times and were more likely to incur out-of-pocket expenditure (OOP). Multivariable logistic regression revealed that women were more likely to use outpatient services (AOR 1.88; 1.34-2.63). Compared to apartment residents in urban areas, ger residents in urban areas were less likely to use outpatient services (AOR 0.54; 0.36-0.83). There was no statistically significant differences in inpatient service by location. Increasing numbers of chronic conditions (1 and 2+ compared to none) were associated with both outpatient (AORs 2.59 and 2.78) and inpatient (AORs 1.97 and 3.01) service use. Conclusions This study highlights the needs to address disparities in outpatient service use for rural and urban ger populations. Compared with other WHO-SAGE countries, older Mongolians have relatively higher use of inpatient health care services. With a high prevalence of hypertension and an ageing population, efforts to achieve UHC would benefit from reorienting care services towards prevention and primary care management of NCDs to reduce the costs from hospital-based care.

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Section: Discussionmentioning

confidence: 99%

Disparities in outpatient and inpatient utilization by rural-urban areas among older Mongolians based on a modified WHO-SAGE instrument

Yiengprugsawan

Dorj

Dracakis

et al. 2021

BMC Health Serv Res

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“…Extending the roles and responsibilities of district and commune health stations (with the appropriate support for these facilities to provide services), and investing in rural health infrastructure [7], could have a significant impact on improving breast cancer services. As stated by Yiengprugsawan (et.al) in their study on reorienting the delivery of NCD services in Malaysia, Sri Lanka, and Thailand, ‘NCD care requires integration across all levels of health care: primary care screening of risk factors; timely intervention at secondary and sometimes tertiary and rehabilitation levels, and hospital discharge referrals back for management by primary care’ [22].…”

Section: Discussionmentioning

confidence: 99%

Strengthening breast cancer services in Vietnam: a mixed-methods study

Jenkins

Ngan

Nguyen

et al. 2019

glob health res policy

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BackgroundIncidence of breast cancer has increased in Vietnam over the past two decades, but little data exists to inform policy and planning. This study examined the organisation and delivery of breast cancer services in Vietnam in order to address the lack of data on detection, diagnosis and treatment.MethodsWe gathered quantitative and qualitative data using an adapted survey-based Service Availability and Readiness Assessment (SARA) tool and semi-structured interviews from healthcare providers in 69 healthcare facilities about the experience and challenges of delivering breast cancer services. We conducted our study across four levels of the health system in three provinces in Vietnam.ResultsThe analysis of our data show that a number of areas require strengthening particularly in relation to service availability and service readiness. Firstly, healthcare providers across all levels of the health system reported that service provision was constrained by a lack of resources both in relation to health infrastructure and training for healthcare providers. Secondly, access to timely diagnosis and treatment is limited due to services only being available at the top two levels of the health system. Women living outside the immediate vicinity of such facilities tend to find access more costly and time-consuming, and there is a need to investigate the social, economic, geographic and cultural barriers that may prevent women from accessing services.ConclusionsOur study suggests that there is a need to strengthen lower levels of the Vietnamese health system in relation to the detection of breast cancer. Provision of some services such as clinical breast examination, advice on self-examination, and conducting ultrasound tests (supported with appropriate training and capacity-building of healthcare providers) at commune and district levels of the health system may reduce the overcrowding and service-delivery burden experienced in provincial and national-level hospitals. Empowering lower levels of the health system to conduct breast cancer screening, which is currently undertaken on an ad hoc basis through higher-level facilities, is likely to improve access to services for women.

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“…The Global Burden of Diseases 19 attributes the elevation of chronic diseases to the prevalence of risk factors (e.g., obesity) and aging. Health systems must be able to organize responses around prevention, early intervention, and adequate treatment 20 to cope with the rising levels of chronic diseases and population aging. This guidance requires PHC to be appropriately integrated with other levels of health care (curative, rehabilitative, continued) as it allows patients to be referred and monitored.…”

Section: Contracted Indicators and Phc Contribution To Sdg3mentioning

confidence: 99%

Indicadores de monitorização e desempenho nas unidades de saúde familiar e os Objetivos do Desenvolvimento Sustentável na saúde (ODS 3): uma análise comparada em Portugal no período de 2013-2018

Monteiro

2020

Ciênc. saúde coletiva

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Resumo É considerável a escala da transformação necessária para alcançar todos os Objetivos de Desenvolvimento Sustentável (ODS). O terceiro ODS (ODS3), explicitamente, está relacionado com a saúde, visando assegurar vidas saudáveis e bem-estar para todos, em todas as idades. Os Cuidados de Saúde Primários (CSP), neste contexto, constituem a espinha dorsal de um sistema de saúde que pode melhorar a saúde das pessoas, reduzir a despesa e diminuir as desigualdades. Uma forte orientação do sistema para os CSP deve ser temporalmente estável, desde a sua reformulação. Esta análise utiliza o estudo de caso instrumental. Este tipo de estudo de caso oferece a oportunidade de aprender sobre os acontecimentos. Analisamos e debatemos 13 indicadores, comparando ao longo do tempo, os resultados obtidos pela tipologia de unidades de saúde existentes em Portugal: USF-A, USF-B, UCSP, UCSP-M. Os resultados demonstrados são discrepantes, quando se comparam as USF e as UCSP e podem contribuir para o aprofundamento das desigualdades de acesso. Este é um problema que se relaciona com a governação clínica e não com o modelo de unidade de saúde. O empoderamento das coordenações e a melhoria de eficácia da gestão intermédia é aqui fundamental.

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Reorienting Health Services to People with Chronic Health Conditions: Diabetes and Stroke Services in Malaysia, Sri Lanka and Thailand

Cited by 9 publications

References 18 publications

Disparities in outpatient and inpatient utilization by rural-urban areas among older Mongolians based on a modified WHO-SAGE instrument

Disparities in outpatient and inpatient utilization by rural-urban areas among older Mongolians based on a modified WHO-SAGE instrument

Strengthening breast cancer services in Vietnam: a mixed-methods study

Indicadores de monitorização e desempenho nas unidades de saúde familiar e os Objetivos do Desenvolvimento Sustentável na saúde (ODS 3): uma análise comparada em Portugal no período de 2013-2018

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