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ABSTRAKIndonesia has entered an aging population as showed by the number of elderly population which has reached more than 7% of the population. Basically, the increase in the elderly population will also increase the number of illnesses, because the more a person ages, the physical condition will decrease and be more susceptible to disease. This research is a quantitative study that aims to determine the determinants of outpatient health service use for Indonesian elderly in 2017. This research used secondary data from the 2017 National Socio-Economic Survey (Susenas) results with the unit of analysis is people aged ≥ 60 years who had health complaints. The analytical method used is logit regression analysis. The results showed that gender, education, employment status, residential area, health insurance ownership, economic status, and disruption of activity due to illness had a p-value of 0,000 < 0,05 which means that it was significantly associated with the utilization of outpatient health services. The most dominant variable is the disruption of activity due to illness. The government can issue policies related to efforts to register each elderly person into health insurance through optimizing a healthy Indonesian program with a family approach. The government is expected to be more assertive in monitoring and evaluating elderly health services by considering factors that support the elderly in utilizing health services to achieve healthy aging and active aging. ABSTRAKIndonesia telah memasuki populasi menua yang ditunjukkan dengan angka populasi lansia yang sudah mencapai angka lebih dari 7% jumlah penduduk. Pada dasarnya kenaikan populasi lansia juga akan meningkatkan angka keluhan kesehatan dan kesakitan, karena semakin bertambah usia seseorang maka kondisi fisiknya akan menurun dan lebih rentan terhadap penyakit. Penelitian ini merupakan penelitian kuantitatif yang bertujuan untuk mengetahui determinan pemanfaatan pelayanan kesehatan rawat jalan pada lansia sakit di Indonesia tahun 2017. Data yang digunakan adalah data sekunder dari hasil Survei Sosial Ekonomi Nasional (Susenas) tahun 2017 dengan unit analisis yaitu individu dengan usia ≥ 60 tahun yang mempunyai keluhan kesehatan. Metode analisis yang digunakan adalah analisis regresi logit. Hasil penelitian menunjukkan bahwa jenis kelamin, pendidikan, status pekerjaan, wilayah tinggal, kepemilikan jaminan kesehatan, status ekonomi, dan gangguan aktivitas akibat sakit mempunyai nilai P-value 0,000 < 0,05 yang berarti berhubungan secara signifikan dengan pemanfaatan pelayanan kesehatan rawat jalan. Pemerintah diharapkan dapat lebih tegas dalam memonitoring serta mengevaluasi pelayanan kesehatan lansia dengan mempertimbangkan faktor yang mendukung lansia dalam memanfaatkan pelayanan kesehatan agar tercapainya healthy ageing dan active ageing.

Ziel des Beitrags ist die Untersuchung und Bewertung der Erreichbarkeit der Bevölkerung durch ambulante Pflegedienste in Unterfranken unter Einbeziehung der räumlich differenzierten Bevölkerungsstruktur für das Jahr 2017 sowie der voraussichtlichen demographischen Entwicklung bis 2025. Die Erreichbarkeiten werden sowohl rasterbasiert als auch vektorbasiert in einer GIS-Software modelliert. Darüber hinaus werden demographische Entwicklungen in der Altersgruppe "80 Jahre und älter" eingebunden. Die Ergebnisse der rasterbasierten Fahrzeitenmodellierung zeigen flächenhaft relativ gute Erreichbarkeiten, mit Ausnahme weniger peripherer Gebiete. Mittels vektorbasierter Fahrzeitenmodellierung werden Einzugsgebiete, welche auf Personalkosten und Anfahrtspauschalen nach SGB V und SGB XI als Berechnungsgrundlagen basieren, für ambulante Pflegedienste berechnet. Es zeigt sich, dass in Teilen Unterfrankens keine ausreichende Kostendeckung gegeben ist. Hinsichtlich der skizzierten Bevölkerungsentwicklung sowie unzureichender Fahrtkostendeckung im Bereich der Mittelgebirge und abseits der Verdichtungsräume wird eine Flexibilisierung der Anfahrtsvergütung sowie eine Aufstockung des Pflegepersonals empfohlen.

The support of professional interpreters is an essential component of adequate mental health care for migrants with limited language proficiency. Nevertheless, for varied reasons, only a small proportion of outpatient psychotherapists provide interpreter-mediated psychotherapy for migrants. This study explored the perspectives of psychotherapists who have not worked with professional interpreters in outpatient mental health care to identify factors that may prevent the use of interpreters in outpatient care and explore possible incentives to provide interpreter-mediated psychotherapy for migrants with limited language proficiency. Semi-structured interviews were conducted with 13 outpatient psychotherapists in Northern Germany who had not yet worked with professional interpreters in outpatient care. The interviews were audio recorded, transcribed and analysed using a structured content analysis approach. The psychotherapists named structural as well as subjective barriers and concerns. Findings suggest that improving structural factors, such as secure funding, minimal additional work, better preparation and training could facilitate the integration of professional interpreters into everyday treatment. Psychotherapists also mentioned concerns about their own confidence (e.g., insecurities regarding the triadic situation), the patient (e.g., reduced openness), the interpreter (e.g., doubts about suitability, motivation and empathy), as well as the therapeutic process (e.g., unclear allocation of roles). However, positive aspects and opportunities of interpreter-mediated psychotherapy were also described. These could be enhanced by the presence of conducive factors, such as existing trust between all parties and professional cooperation between interpreter and psychotherapist.

BACKGROUND: Non-arthritic hip disorders are defined as abnormalities of the articulating surfaces of the acetabulum and femur before the onset of osteoarthritis, including intra-articular structures such as the acetabular labrum and chondral surfaces. Abnormal femoroacetabular morphology is commonly seen in young men who constitute much of the UK military population. Residential multidisciplinary team (MDT) rehabilitation for patients with musculoskeletal injuries has a long tradition in the UK military, however, there are no studies presenting empirical data on the efficacy of a residential MDT approach compared with individualised conventional outpatient treatment. With no available data, the sustainability of this care pathway has been questioned. The purpose of this randomised controlled trial is to compare the effects of a residential multidisciplinary intervention, to usual outpatient care, on the clinical outcomes of young active adults undergoing treatment for non-arthritic intra-articular hip pain. METHODS/DESIGN: The trial will be conducted at the Defence Medical Rehabilitation Centre, Headley Court, UK. One hundred military male participants with clinical indicators of non-arthritic intra-articular hip pain will be randomly allocated to either: (1) 7-day residential multidisciplinary team intervention, n = 50; (2) 6-week physiotherapist-led outpatient intervention (conventional care), n = 50. Measurements will be taken at baseline, post-treatment (1-week MDT group; 6-weeks physiotherapy group), and 12-weeks. The primary outcome measures are the function in daily living sub-scale of the Copenhagen Hip and Groin Outcome Score (HAGOS), the physical function subscale of the Non-arthritic Hip Score (NAHS), and VAS pain scale. Secondary outcomes include objective measures of physical capacity and general health. An intention-to-treat analysis will be performed using linear and mixed models. DISCUSSION: This study will be the first to assess the efficacy of intensive MDT rehabilitation, versus conventional ...

Background: Currently, palliative care is widely discussed. The aim of this study is to explore different aspects of the ambulatory treatment environment of palliative care patients and its structure in Germany from the viewpoint of caring physicians. Methods: A structured questionnaire was developed and sent to 1,003 office-based physicians in Germany. Topics were the delivery and effort of care, cooperation among health care providers, the subjective assessment of existing health care structures, the reimbursement system, as well as an assessment of future developments. Sub-group analyses were conducted. Results: Three hundred fourteen questionnaires were included in the statistical analyses. Fifty percent of physicians estimate the additional time and effort for palliative care patients compared to non-palliative care patients to be 50% and more. The best cooperation is seen with caregivers; however, cooperation with psycho-social care providers should be improved. Fifty percent describe the outpatient health care situation as (very) insufficient, but improvements are expected in the future. Ninety percent assess German reimbursement structures as (very) insufficient. Conclusions: This study gives an insight into the German outpatient health care setting for palliative care patients. Palliative care patients have higher and more complex needs with respect to health care than other patients. Further studies should focus on the collection of longitudinal patient data for more comprehensive insight.

The authors present the first nationally representative data on managed care penetration in the outpatient substance abuse treatment (OSAT) sector. Thirty-eight percent of all OSAT units were involved in some form of managed care in 1995, with 22 percent of their client base covered by managed care. There is also variation in managed care penetration and activity across different types of treatment units. Private for-profit units are involved in managed care to a greater extent than are public and private, not-for-profit organizations. Units affiliated with a hospital have greater participation and penetration than other units. Smaller OSAT facilities have a disproportionately large percentage of their client base in managed care arrangements. Finally, private managed care arrangements are more prevalent, more evenly distributed across organizational types, and represented in larger numbers than are public sources of managed care.

IntroductionBusiness process management has gained importance in organizations for providing improved productivity and cost reduction, with process modeling being the central role. Usually, with reduced resources, the health area can benefit from good management of its processes.ObjectiveTo identify proposals for improvements in the process of outpatient care of children and adolescents in a tertiary‐level—the most specialized and complex—pediatric hospital.MethodsA bibliographic survey on the subject and a case study with in loco observation of the processes with semistructured interviews with the professionals involved were carried out. Alpha Hospital was chosen for this study, and the modeling of the process was performed using Business Process Model and Notation.ResultsTwelve relevant articles were identified. The "AS‐IS" model of the process was obtained as a result and presents the existing 4 subprocesses (patient reception, preconsultation, consultation, and postconsultation). Specifically, the following improvement opportunities were identified: (a) process monitoring through indicators; (b) adequacy of the information system; (c) creation of service evaluation mechanisms; and (d) definition and application of training sessions for whenever a new professional begins working in a specific sector. The problem with the waiting time for patient care was also identified, but with no obvious solution; further studies should be carried to solve the problem.ConclusionThe use of the business process modeling approach and process analysis allowed the hospital team awareness of the process and the identification of an improved set that can be helpful to Alpha Hospital or be used by other hospitals.

Abstract Background As a part of nationwide healthcare reforms, the Chinese government launched web-based appointment systems (WAS) to provide a solution to problems around outpatient appointments and services. These have been in place in all Chinese public tertiary hospitals since 2009. Methods Questionnaires were collected from both patients and doctors in one large tertiary public hospital in Shanghai, China.Data were analyzed to measure their satisfaction and views about the WAS. Results The 1000 outpatients randomly selected for the survey were least satisfied about the waiting time to see a doctor. Even though the WAS provided a much more convenient booking method, only 17% of patients used it. Of the 197 doctors surveyed, over 90% thought it was necessary to provide alternative forms of appointment booking systems for outpatients. However, about 80% of those doctors who were not associated professors would like to provide an 'on-the-spot' appointment option, which would lead to longer waits for patients. Conclusions Patients were least satisfied about the waiting times. To effectively reduce appointment-waiting times is therefore an urgent issue. Despite the benefits of using the WAS, most patients still registered via the usual method of queuing, suggesting that hospitals and health service providers should promote and encourage the use of the WAS. Furthermore, Chinese health providers need to help doctors to take others' opinions or feedback into consideration when treating patients to minimize the gap between patients' and doctors' opinions. These findings may provide useful information for both practitioners and regulators, and improve recognition of this efficient and useful booking system, which may have far-reaching and positive implications for China's ongoing reforms.

BACKGROUND: Waiting time for outpatient specialist care is an ever-present problem for all Countries with a universal healthcare system. In Italy, information about waiting times must be available on all websites belonging to public health agencies and healthcare structures. The aim of the present descriptive study is to evaluate the accessibility and quality of such information on websites of all public health agencies and healthcare structures in Lombardy Region. METHODS: All websites belonging to 8 health agencies (ATS), 27 public hospitals (ASST), 4 research and teaching hospitals (IRCCS) were analyzed using a newly designed 30-item checklist. The items were scored 0/1 and grouped in five categories: Accessibility, Architecture, Content, Interactivity, Utility. RESULTS: In all, 76.3% of websites reported their waiting times directly, but three did not update data at least monthly as required by current legislation. Less than half of websites provided information aimed at raising awareness and tackling no-shows, and only 10.5% explained the role of private practice in public structures when maximum waiting times are exceeded. CONCLUSIONS: The lack of exposition of waiting times on some websites belonging to ATS, ASST and IRCCS appears to be a relevant issue. There is also little empowering information that may help tackle waiting times themselves. These results warrant further efforts to improve accessibility, quality and transparency of information for all citizens.

AbstractIn an integrated system of care for persons with chronic mental illness, the emergency and outpatient department can control access to the system, expedite patient transfers, and help ensure continuity of care.

The British Columbia (BC) mental health roadmap prioritizes equitable access to care. This study investigates the equity of care pathways experienced by BC residents accessing outpatient psychiatric care for the first time. Community-based care pathways are paramount as they indicate timely access to care and are less expensive for the health system.
We analyzed linked administrative BC health data spanning April 1st 2013, to March 31st 2022, to study how sociodemographic factors relate to accessing psychiatric care pathways. Pathways to outpatient psychiatric care include a community-based pathway, hospitalization to primary care to outpatient psychiatry, and hospitalization directly to outpatient psychiatry. Sociodemographic factors considered were administrative sex, immigration recency and status, neighbourhood income quintile and being a recipient of a low-income drug plan. These relationships were analyzed using multinomial logistic regression, adjusting for age, location, fiscal year, and stratifying by mental disorder diagnoses.
Being male, a low-income drug plan recipient, living in a lower income neighbourhood, or being a recent economic immigrant or permit holder was associated with increased odds of accessing outpatient psychiatric care via either hospitalization pathway. Having a diagnosis of schizophrenia/bipolar disorder was independently associated with both hospitalization pathways, and this diagnosis exacerbated the magnitude of the estimates for the sociodemographic characteristics.
We find clear disparities in pathways to accessing outpatient psychiatric care. These disparities indicate health system failures in addressing specific population needs, highlighting the importance of targeted interventions, such as increasing the number of community health workers, to achieve equitable mental health care in BC.