Patient journey

During the coronavirus disease 2019 (COVID-19) pandemic, cancer patients were vulnerable to both severe COVID-19 and, owing to interruptions in health care services, cancer progression. Here, the impact of the COVID-19 pandemic on cancer care was examined specifically among patients in low-resource settings in Kenya. Survey data show that patients experienced significant economic and logistical challenges during the pandemic. Patients reported declines in income, worries about affordability of care, interruptions in access to medications, and losses in access to specialized care due to travel restrictions. The findings emphasize the importance of incorporating cancer patient needs into national pandemic mitigation plans.

My fellow research candidates and colleagues were always ready to talk through ideas and approaches and suggest alternative viewpoints. This fostered an encouraging research environment and opportunities to stretch my thoughts and approach in many ways. I hope I can assist them in the same way as they continue on their own research journeys. The staff and management at Ryde Hospital Maternity Department provided a great case study environment and the midwives involved contributed to the patient journey modeling sessions with fantastic vigour and passion. The results have been beneficial for us all.

In this article, we focus on the design method of mapping the patient journey in order to support the inclusion of the patient perspective into care service innovations. Increasingly, designers in health use the patient journey approach, however, its method is relatively poorly documented. To ground the activities of the patient journey method, we conducted an in-depth case study of integrated service design with impact on improved patient satisfaction the case of gastrointestinal diagnose service with video endoscopy technology. The results revealed four distinct activities of the patient journey method: (1) Analyse the care service system; (2) Experience the journey yourself, observe and sketch it; (3) Co-design the patient journey: craft the journey toolkit, interview and synthesize; (4) Evaluate the patient journey for integrated service design.

Human-centered design is about understanding human needs and how design can respond to these needs. With its systemic humane approach and creativity, human-centered design can play an essential role in dealing with today’s care challenges. ‘Design’ refers to both the process of designing and the outcome of that process, which includes physical products, services, procedures, strategies and policies. In this article, we address the three key characteristics of human-centered design, focusing on its implementation in health care: (1) developing an understanding of people and their needs; (2) engaging stakeholders from early on and throughout the design process; (3) adopting a systems approach by systematically addressing interactions between the micro-, meso- and macro-levels of sociotechnical care systems, and the transition from individual interests to collective interests.

As health tourism emerges as a distinct market niche, airlines have the opportunity to strategically align their services to meet its unique demands. This paper presents a nuanced approach to enhancing the airline health tourism experience through the implementation of Key Performance Indicators (KPIs). We examine how a targeted KPI framework can refine patient journeys and bolster operational performance, drawing from a synthesis of industry best practices and cross-disciplinary research.
The methodology employs a qualitative review of existing literature coupled with a comparative analysis of successful airline service models. Key findings indicate that airlines can significantly improve service delivery and customer satisfaction by adopting a KPI-centric strategy. The research identifies critical metrics that correlate with patient care excellence and operational efficiency, advocating for a model where KPIs drive continuous improvement.
Discussions within the article explore the implications of strategic KPI deployment in crafting memorable patient experiences and achieving competitive differentiation. The conclusion posits that the integration of thoughtful KPIs is imperative for airlines to thrive within the health tourism sector, suggesting a redefined role for service providers in the health tourism ecosystem.
This study lays the groundwork for airlines to transition towards a more data-driven, patient-centric service model, ultimately contributing to the sector's sustainable growth and profitability.

This study aimed to characterize the cervical cancer diagnosis experience of Kenyan women undergoing treatment for cervical cancer. We analyzed qualitative interviews with 29 women living in rural Kenya who were currently undergoing cervilccancer treatment at Machakos Cancer Care and Research Centre at Machakos Level 5 Referral Hospital in eastern Kenya. Semistructured qualitative interviews were conducted in Kiswahili and English and then de-identified and translated to English during transcription. The main themes generated were identified through an inductive approach to determine how women experienced cervical cancer symptoms and their process of navigating healthcare. Three themes emerged from the qualitative interviews: (1) delaying seeking care, (2) misinterpreting or misdiagnoses, and (3) grappling with the costly diagnosis process. Women misattributed early signs of cervical cancer to benign conditions. Women sought care only after experiencing severe symptoms. When they sought care, women reported facing lengthy and costly screening processes before receiving a cervical cancer diagnosis. There is a need to educate women on the early symptoms of cervical cancer and to increase the institutional capacity and availability of cervical cancer screening resources in healthcare facilities.

Background Tenosynovial giant cell tumor (TGCT) is a rare, locally aggressive neoplasm arising from the synovium of joints, bursae, and tendon sheaths affecting small and large joints. It represents a wide spectrum ranging from minimally symptomatic to massively debilitating. Most findings to date are mainly from small, retrospective case series, and thus the morbidity and actual impact of this rare disease remain to be elucidated. This study prospectively explores the management of TGCT in tertiary sarcoma centers. Methods The TGCT Observational Platform Project registry was a multinational, multicenter, prospective observational study involving 12 tertiary sarcoma centers in 7 European countries, and 2 US sites. This study enrolled for 2 years all consecutive ≥ 18 years old patients, with histologically diagnosed primary or recurrent cases of diffuse-type TGCT. Patient demographic and clinical characteristics were collected at baseline and every 6 months for 24 months. Quality of ...

Cancer has now become a widely discussed and feared disease among the public in India. This study is a qualitative approach in order to understand the ways in which ordinary people, called ‘laymen’ by medical practitioners, understand and experience cancer. Based on in-depth interviews and observations among fifty informants drawn from the middle class and wealthy backgrounds at a private hospital in Hyderabad city. The study takes medical anthropology’s approach to disease and illness by examining cancer patients’ ‘illness narratives’ (Kleinman 1989).This study focuses on tracing the journey of the patients through their explanations for various issues related to cancer. The ‘illness narratives’ highlight the trauma that cancer patients undergo, particularly in the questions they ask about their own individual ‘selves’, and their social obligations. One should give space for the patients to express how they experience the impact of the disease and subsequent treatments such as chem...

Background. Currently the majority of cancer deaths occur in low and middle-income countries where there are appreciable funding concerns. In Kenya, most patients currently pay out of pocket for treatment and those who are insured are generally not covered for the full costs of treatment. This places a considerable burden on households if family members develop cancer. However, the actual cost of cancer treatment in Kenya is unknown. Such an analysis is essential to better allocate resources as Kenya strives towards universal healthcare. Objectives. Evaluate the economic burden of treating cancer patients. Method. Descriptive cross-sectional cost of illness study in the leading teaching and referral hospital in Kenya, with data collected from the hospital files of sampled adult patients for treatment during 2016. Results: 412 patient files were reviewed, of which 63.4% (n=261) were female and 36.6% (n=151) male. Cost of cancer care is highly dependent on the modality. Most reviewed patients had surgery, chemotherapy and palliative care. The cost of cancer therapy varied with the type of cancer. Patients on chemotherapy alone cost an average of KES 138,207 (USD 1364.3); while those treated with surgery cost an average of KES 128,207 (1265.6), and those on radiotherapy KES 119,036 (1175.1). Some patients had a combination of all three, costing on average KES 333,462 (3291.8) per patient during the year. Conclusion. The cost of cancer treatment in Kenya depends on the type of cancer, the modality, cost of medicines and the type of inpatient admission. The greatest contributors are currently the cost of medicines and inpatient admissions. This pilot study can inform future initiatives among the government as well as private and public insurance companies to increase available resources, and better allocate available resources, to more effectively treat patients with cancer in Kenya. We will be monitoring developments and conducting further research.

Globally, cancer patients and care givers experience numerous social economic needs that range from and are related to financial constraints, transportation obstacles, accommodation, poverty and inflexible working conditions, non-availability of services, socio-cultural and gender-related factors among others. To establish the socio-economic supportive care needs among cancer patients attending hospice/palliative care clinic in Meru level five Hospital (in Kenya), a descriptive cross-sectional study design that adopted qualitative approach in data collection was used, with purposive sampling being applied to select the study respondents. To collect data, the researcher conducted two focused group discussions (one with male patients only and another one with female patients). Two sets of interviews were conducted (one interview with the cancer patients and another one with the key informants). Interview schedule was used to collect data through interview till redundancy was achieved,...

In this article we present a narrative approach to conceptualizing and representing patients' experiences of healthcare across a trajectory of care. We empirically investigate, analyze and represent the diagnostic and care trajectories of people with the aggressive skin cancer melanoma, conceiving a model of lived narratives in which the patients are the central characters moving through a longitudinal series of events. Melanoma is a malignant form of skin cancer that makes heavy, long-term demands on patients and healthcare resources. The perspectives of people with melanoma are under-represented in studies of melanoma patient experience. In our study, we make that missing perspective visible. From data collected on the pre-symptom ordinary world of the patient through phases of medical care and into resolution of the initial disease presentation, we identify the thick plot of patients' care experiences in an archetypal narrative form of patient journey. Our findings identify the potential of this analytic framework as a flexible methodology for the reflection of outset-to-outcome melanoma care experiences in healthcare policy and practice. ABOUT THE AUTHOR The overarching aim of the research reported in this paper was to produce new qualitative research linking the singular to the common patient experience. As individuals and as a research team our work supports innovation through multidisciplinary investigations into patients' experiences of health practices. We brought together expertise from: the Centre for

Early diagnosis and start of treatment are fundamental goals in cancer care. This study determines the time lag and the factors that influence the time to diagnosis and start of treatment. Study participants were parents of childhood cancer patients diagnosed between August 2013 and July 2014 in a hospital in Kenya. Patient, physician, diagnosis, treatment, health care system, and total delay were explored using a questionnaire. Demographic and medical data were collected from the patients' medical records. Parents of 99 childhood cancer patients were interviewed (response rate: 80%). Median total delay was 102 (9-1021) days. Median patient delay (4 days) was significantly shorter than health care system delay (median 87 days;P < .001). Diagnosis delay (median 94 days) was significantly longer than treatment delay (median 6 days; P < .001). days. Lack of health insurance at diagnosis and use of alternative medicine before attending conventional health services were associated with a significantly longer patient delay (P = .041 and P = .017, respectively). The type of cancer had a significant effect on treatment delay (P = .020). The type of health facility attended affected only patient delay (P = .03). Gender, age at diagnosis, stage of disease, parents' education level or income, and distance from hospital did not have a significant effect on the length of any type of delay. Training on childhood cancer should be included in the curricula for medical training institutes. In-service workshops should be held for the health workers already working. Families must be obligated to get health insurance. Families should be encourage to attend conventional health facilities and informed on symptoms of cancer through mass media

SummaryBackgroundHypertension in low‐ and middle‐income countries, including Kenya, is of economic importance due to its increasing prevalence and its potential to present an economic burden to households. In this study, we examined the patient costs associated with obtaining care for hypertension in public health care facilities in Kenya.MethodsWe conducted a cross‐sectional study among adult respondents above 18 years of age, with at least 6 months of treatment in two counties. A total of 212 patients seeking hypertension care at five public facilities were interviewed, and information on care seeking and the associated costs was obtained. We computed both annual direct and indirect costs borne by these patients.ResultsOverall, the mean annual direct cost to patients was US$ 304.8 (95% CI, 235.7‐374.0). Medicines (mean annual cost, US$ 168.9; 95% CI, 132.5‐205.4), transport (mean annual cost, US$ 126.7; 95% CI, 77.6‐175.9), and user charges (mean annual cost, US$ 57.7; 95% CI, 43....

Health insurance is currently being considered as a mechanism for promoting progress to Universal health Coverage and reducing out-of-pocket payments in many African countries including Kenya which is prompting the use of NHIF. In Kenya, penetration of health insurance is 20% and 11% in Bungoma County. The main objective of the study was to establish the scheme-related factors influencing uptake of health insurance cover among patients attending Bungoma County Referral hospital. The study adopted across sectional descriptive survey of 300 systematically sampled patients, 4 purposively sampled departmental heads in Bungoma County Referral Hospital and all the 5 insurance company branch managers. Data was collected using questionnaires administered and Key Informant Interview schedule. Crude odds ratio was used to establish association between ownership of health insurance and scheme-related factors. Findings showed that 37% of patients owned health insurance covers mostly public heal...

Background: National and county governments in Kenya have introduced various health insurance schemes to protect households against financial hardship as a result of large health expenditure. This study examines the relationship between health insurance and medicine expenditure in eight counties in Kenya. Methods: A cross-sectional study of collected primary data via household survey in eight counties was performed. Three measures of medicine expenditure were analysed: the probability of any out-of-pocket expenditure (OOPE) on medicines in the last 4 weeks; amount of OOPE on medicines; and OOPE on medicines as a proportion of total OOPE on health. Results: Out of the 452 individuals, those with health insurance (n = 225) were significantly different from individuals without health insurance (n = 227): overall, they were older, had a higher level of educational attainment and possessed more assets. Adjusting for covariates, individuals with health insurance had a reduced probability of OOPE on medicines

BackgroundNational and county governments in Kenya have introduced various health insurance schemes to protect households against financial hardship as a result of large health expenditure. This study examines the relationship between health insurance and medicine expenditure in eight counties in Kenya.MethodsA cross‐sectional study of collected primary data via household survey in eight counties was performed. Three measures of medicine expenditure were analysed: the probability of any out‐of‐pocket expenditure (OOPE) on medicines in the last 4 weeks; amount of OOPE on medicines; and OOPE on medicines as a proportion of total OOPE on health.ResultsOut of the 452 individuals, those with health insurance (n = 225) were significantly different from individuals without health insurance (n = 227): overall, they were older, had a higher level of educational attainment and possessed more assets. Adjusting for covariates, individuals with health insurance had a reduced probability of OOPE ...

Background: Reducing maternal morbidity and mortality remains a top global health agenda especially in high HIV/AIDS endemic locations where there is increased likelihood of mother to child transmission (MTCT) of HIV. Social health insurance (SHI) has emerged as a viable option to improve population access to health services, while improving outcomes for disenfranchised populations, particularly HIV+ women. However, the effect of SHI on healthcare access for HIV+ persons in limited resource settings is yet to undergo rigorous empirical evaluation. This study analyzes the effect of health insurance on obstetric healthcare access including institutional delivery and skilled birth attendants for HIV+ pregnant women in Kenya. Methods: We analyzed cross-sectional data from HIV+ pregnant women (ages 15-49 years) who had a delivery (full term, preterm, miscarriage) between 2008 and 2013 with their insurance enrollment status available in the electronic medical records database of a HIV healthcare system in Kenya. We estimated linear and logistic regression models and implemented matching and inverse probability weighting (IPW) to improve balance on observable individual characteristics. Additionally, we estimated heterogeneous effects stratified by HIV disease severity (CD4 < 350 as "Severe HIV disease", and CD4 > 350 otherwise). Findings: Health Insurance enrollment is associated with improved obstetric health services utilization among HIV+ pregnant women in Kenya. Specifically, HIV+ pregnant women covered by NHIF have greater access to institutional delivery (12.5-percentage points difference) and skilled birth attendants (19-percentage points difference) compared to uninsured. Notably, the effect of NHIF on obstetric health service use is much greater for those who are sicker (CD4 < 350)-20 percentage points difference. Conclusion: This study confirms conceptual and practical considerations around health insurance and healthcare access for HIV+ persons. Further, it helps to inform relevant policy development for health insurance and HIV financing and delivery in Kenya and in similar countries in sub-Saharan Africa in the universal health coverage (UHC) era.

Myotonic dystrophy (DM) is an inherited autosomal dominant disease with progressive myopathy and comorbidities involving multiple organ systems. There is no cure, but a deeper understanding of the patient journey, the use of healthcare resources, and the cost of care before and after diagnosis would assist in managing supportive care. This longitudinal analysis of medical and pharmacy insurance claims between January 2010 and March 2021 included 1,694 patients with two or more DM diagnostic claims compared with 8,470 matched control (MC) patients who were propensity-score matched by index date (i.e., month of diagnosis), age, region, sex, plan, and payer type. Eligible patients had a minimum of 12 months of continuous data. Comorbidities consistent with the clinical profile of DM were more prevalent in patients with DM than in the MC cohort.

Cancer patients’ pathways: evidence and implications for policy Other How to cite: Makene, Fortunata Songora; Ngilangwa, Richard Gordon; Mackintosh, Maureen; Santos, Cristina; Cross, Charlotte; Mujinja, Phares G.M. and Ngoma, Twalib (2020). Cancer patients’ pathways: evidence and implications for policy. Economic and Social Research Foundation (ESRF), Innovation for Cancer Care in Africa (ICCA), The Open University.

Background: Understanding the pattern of care use can provide valuable information for reform interventions. This study investigates the pattern of healthcare utilization and its association with drug acquisition patterns and expenses in the National Health Insurance Fund (NHIF) of Al Jazira State in Sudan. Methods: A cross-sectional survey was conducted at NHIF primary healthcare centers of Al Jazirah state in Sudan. Results: A total of 768 beneficiaries were interviewed, of which 63.2% reported using out-of-network physician care, while 36.8% receive care from the NHIF physician network only. More than half (60.8%) of NHIF-interviewed clients reported a heavy burden of medication costs. The pattern of physician utilization was significantly associated with the number and source of regular drugs, the burden of out-of-pocket payment, and monthly out-of-pocket expenditures on medications, (p &lt; 0.001). The regression analysis revealed that gender, marital status, number of chronic ...

Introduction: Strategies for access and utilization of health care by all its citizens to ensure equity and equality in terms of quality health services is an important factor for governments to consider. The three basic goals of a country's health care system are illness prevention, treating the sick and protecting people from financial catastrophes that come with medical bills. Despite this, the threat that out-of-pocket (OOP) expenditures pose to households' living standards is increasingly recognized as a major consideration in financing health care Objective: The objective of the study was to determine the percentage contribution made by out of pocket expenditure on health care from the total household income of health care consumers in Kakamega County and also establish the association between out of pocket expenditure and insurance premium payments in Kakamega County. Design: The study design was a descriptive cross-sectional survey that utilized both quantitative methods. Setting: The study was carried out in Kakamega County Sample: A simple random sampling was applied to get participants (n = 348) Analysis: Data were analyzed through descriptive statistics, chi-square test of independence and logistic regression. Main outcome measures: Household income, expenditure on health and health insurance Results: Bivariate analysis on respondents' factors that are associated with household income showed that there was a borderline significant relationship between the level of education and household income in the study area (OR: 0.8; 95% CI: 0.6-1.2; p=0.02.Out of the 348 participants, 56.6%(n=197) of the respondents reported earning directly from business proceeds from their farm, as their key source of income,14.7%(n=51) reported to get

ObjectivesOur objectives were to characterise the nature and extent of delay times to essential surgical care in a developing nation by measuring the actual stages of delay for patients receiving Bellwether procedures.SettingThe study was conducted at Timor Leste’s national referral hospital in Dili, the country’s capital.ParticipantsAll patients requiring a Bellwether procedure over a 2-month period were included in the study. Participants whose procedure was undertaken more than 24 hours from initial hospital presentation were excluded.Primary and secondary outcome measuresData pertaining to the patient journey from onset of symptoms to emergency procedure was collected by interview of patients, their treating surgeons or anaesthetists and the medical records. Timelines were then calculated against the Three Delays Framework.ResultsFifty-six patients were entered into the study. Their mean delay from symptom onset to entering the anaesthesia bay for a procedure was 32.3 hours (+/-...

Background Non-communicable diseases (NCDs) can impose a substantial financial burden to households in the absence of an effective financial risk protection mechanism. The national health insurance fund (NHIF) has included NCD services in its national scheme. We evaluated the effectiveness of NHIF in providing financial risk protection to households with persons living with hypertension and/or diabetes in Kenya. Methods We carried out a prospective cohort study, following 888 households with at least one individual living with hypertension and/or diabetes for 12 months. The exposure arm comprised households that are enrolled in the NHIF national scheme, while the control arm comprised households that were not enrolled in the NHIF. Study participants were drawn from two counties in Kenya. We used the incidence of catastrophic health expenditure (CHE) as the outcome of interest. We used coarsened exact matching and a conditional logistic regression model to analyse the odds of CHE amo...

Introduction/objectives To evaluate the journey to diagnosis, disease characteristics and burden of disease in male and female patients with axial spondyloarthritis (axSpA) across Europe. Method Data from 2846 unselected patients participating in the European Map of Axial Spondyloarthritis (EMAS) study through an online survey (2017-2018) across 13 countries were analysed. Sociodemographic characteristics, lifestyle, diagnosis, disease characteristics and patient-reported outcomes (PROs) [disease activity-BASDAI (0-10), spinal stiffness (3-12), functional limitations (0-54) and psychological distress (GHQ-12)] were compared between males and females using chi-square (for categorical variables) and student t (for continuous variables) tests. Results In total, 1100 (38.7%) males and 1746 (61.3%) females participated in the EMAS. Compared with males, females reported considerable longer diagnostic delay (6.1 ± 7.4 vs 8.2 ± 8.9 years; p < 0.001), higher number of visits to physiotherapists (34.5% vs 49.5%; p < 0.001) and to osteopaths (13.3% vs 24.4%; p < 0.001) before being diagnosed and lower frequency of HLA-B27 carriership (80.2% vs 66.7%; p < 0.001). In addition, females reported higher degree of disease activity in all BASDAI aspects and greater psychological distress through GHQ-12 (4.4 ± 4.2 vs 5.3 ± 4.1; p < 0.001), as well as a greater use of alternative therapies. Conclusion The patient journey to diagnosis of axSpA is much longer and arduous in females, which may be related to physician bias and lower frequency of HLA-B27 carriership. Regarding PROs, females experience higher disease activity and poorer psychological health compared with males. These results reflect specific unmet needs in females with axSpA needing particular attention. Key Points • Healthcare professionals' perception of axSpA as a predominantly male disease may introduce some bias during the diagnosis and management of the disease. However, evidence about male-female differences in axSpA is scarce. • EMAS results highlight how female axSpA patients report longer diagnostic delay and higher burden of the disease in a large sample of 2846 participants of 13 European countries. • Results reflect unmet needs of European female patients. Healthcare professionals should pay close attention in order to accurately diagnose and efficiently manage axSpA cases while further research should be developed on the cause of reported gender differences.

Purpose of Review This narrative review will focus on concepts and methods of Information Design and User Experience for patient education in orthopedics, with osteoarthritis as an application example. Recent Findings Information design can make complex health information clear according to the needs of the patients. Digital health presents new opportunities to design scalable educational interventions and may be improved with User Experience Design. Human-centered design methods such as user research, co-design, and prototype testing are being applied in orthopedics to achieve patient-centered care. Current international guidelines on osteoarthritis put patient education as one of the key care strategies. Educational interventions target preoperative education and osteoarthritis self-management, but current models could be enhanced. Summary Patient education and health literacy are fundamental to face the burden of musculoskeletal pain. The collaboration between design and health is essential to deal with the demand for education, behavioral, and social change.

The prevalence of non-communicable diseases (NCDs) is rising in low- and middle-income countries, including Kenya, disproportionately to the rest of the world. Our objective was to quantify patient payments to obtain NCD screening, diagnosis, and treatment services in the public and private sector in Kenya and evaluate patients&#39; ability to pay for the services. We collected payment data on cardiovascular diseases, diabetes, breast and cervical cancer, and respiratory diseases from Kenyatta National Hospital, the main tertiary public hospital, and the Kibera South Health Center-a public outpatient facility, and private sector practitioners and hospitals. We developed detailed treatment frameworks for each NCD and used an itemization cost approach to estimate payments. Patient affordability metrics were derived from Kenyan government surveys and national datasets. Results compare public and private costs in U.S. dollars. NCD screening costs ranged from $4 to $36, while diagnostic ...

The aim of the European Brain Council project &quot;The Value of Treatment&quot; was to provide evidence-based, cost-effective policy recommendations for a patient-centered and sustainable coordinated care model for brain disorders. The first part of schizophrenia study examined the needs and gaps in the patients&#39; care pathway. Descriptive analysis was based on an inventory of needs and treatment opportunities, using focus group sessions, expert interviews, users&#39; input, and literature review. Three patient pathways were selected: indicated prevention, duration of untreated psychosis, and relapse prevention. The analysis identified several critical barriers to optimal treatment. Available health care services often miss or delay detection of symptoms and diagnosis in at-risk individuals. There is a lack of illness awareness among patients, families, and the public; scarcity of information, training and education among primary care providers; stigmatizing beliefs. Early sympt...

The modern development of telecommunications and telecommunication providers requires an increasing level of service provision. It is explained by the fact that the formation of a market for network services has increased attention to issues of quality control, both by regulators and by providers themselves. To ensure compliance with the specified level of quality of service provision, telecommunication providers develop algorithms and solutions to control the quality of service provision, based on different criteria, by themselves. However, these solutions are not universal for different types (quantitative, qualitative, etc.) of service quality indicators. This article proposes an improved approach to quality control of telecommunication service providers. The implementation of the proposed approach is performed using the ontological model of service quality indicators given by the provider and the dynamically changing workflow, which provides versatility and computer-aided qualit...

Background Non-communicable diseases (NCDs) can impose a substantial financial burden to households in the absence of an effective financial risk protection mechanism. The national health insurance fund (NHIF) has included NCD services in its national scheme. We evaluated the effectiveness of NHIF in providing financial risk protection to households with persons living with hypertension and/or diabetes in Kenya. Methods We carried out a prospective cohort study, following 888 households with at least one individual living with hypertension and/or diabetes for 12 months. The exposure arm comprised households that are enrolled in the NHIF national scheme, while the control arm comprised households that were not enrolled in the NHIF. Study participants were drawn from two counties in Kenya. We used the incidence of catastrophic health expenditure (CHE) as the outcome of interest. We used coarsened exact matching and a conditional logistic regression model to analyse the odds of CHE amo...

Background: Understanding the pattern of care use can provide valuable information for reform interventions. This study investigates the pattern of healthcare utilization and its association with drug acquisition patterns and expenses in the National Health Insurance Fund (NHIF) of Al Jazira State in Sudan. Methods: A cross-sectional survey was conducted at NHIF primary healthcare centers of Al Jazirah state in Sudan. Results: A total of 768 beneficiaries were interviewed, of which 63.2% reported using out-of-network physician care, while 36.8% receive care from the NHIF physician network only. More than half (60.8%) of NHIF-interviewed clients reported a heavy burden of medication costs. The pattern of physician utilization was significantly associated with the number and source of regular drugs, the burden of out-of-pocket payment, and monthly out-of-pocket expenditures on medications, (p &lt; 0.001). The regression analysis revealed that gender, marital status, number of chronic ...

Durch die nachgewiesene Einschränkung der gedankliche Einbeziehung weiblicher, trans und intersexueller Menschen (Vgl. lrmen et al. 2005; Menzel, 2019) wird in der vorliegenden Arbeit geschlechtsneutrale Sprache verwendet. Dies erfolgt in der Verwendung des Asteriskus (z.B. Proband*innen) oder geschlechtsneutralen Substantiven. Eine daraus möglicherweise resultierende Unterbrechung des Leseflusses wird hingenommen. Zitate werden unverändert eingefügt.

BACKGROUND: Financial toxicity negatively affects the well-being of cancer survivors. We examined the incidence, cost drivers, and factors associated with financial toxicity after cancer in an upper-middle-income country with universal health coverage. METHODS: Through the Association of Southeast Asian Nations Costs in Oncology study, 1,294 newly diagnosed patients with cancer (Ministry of Health [MOH] hospitals [n = 577], a public university hospital [n = 642], private hospitals [n = 75]) were observed in Malaysia. Cost diaries and questionnaires were used to measure incidence of financial toxicity, encompassing financial catastrophe (FC; out-of-pocket costs ≥ 30% of annual household income), medical impoverishment (decrease in household income from above the national poverty line to below that line after subtraction of cancer-related costs), and economic hardship (inability to make necessary household payments). Predictors of financial toxicity were determined using multivariable...

Background Kenya is in the process of implementing universal health care whose success and sustainability will be determined by its funding mechanism and by uptake of National Hospital Insurance Fund (NHIF) by its populace. Unfortunately, NHIF enrollment is currently voluntary hence geared to those in formal employment who represent only 16.4% of the population. To improve the voluntary uptake of the scheme, it is important to have increased awareness as well as implement strategies that address factors that currently affect NHIF uptake. Methods This was a cross sectional community-based survey conducted in Busia, Trans Nzoia, Vihiga and Siaya counties between October and December 2018. It utilized multistage stratified sampling technique. Interviewer assisted questionnaires were used to collect socio-demographic, socio-economic, Non-Communicable Diseases (NCD) knowledge, NHIF awareness and uptake data. Descriptive statistical analysis and multiple logistic regression were conducted...

Background Population ageing and the associated increase in the health care needs of older people are putting pressure on the health care system in Viet Nam. The country prioritizes health care for older people and has developed financial protection policies to mitigate financial hardship due to out-of-pocket health expenditures (OOPHEs) borne by their households. This study examines the level and determinants of the financial burden of OOPHE among households with people aged ≥60 years in Viet Nam. Methods A cross-sectional household survey was conducted among a sample of 1536 older people living in 1477 households in three provinces representing the North, Central and South regions of Viet Nam during 2019–2020. The financial outcomes were catastrophic health expenditure (CHE), using the World Health Organization&#39;s definition, and financial distress due to OOPHE. Multivariate binary logistic regression analysis was employed to determine the factors associated with these outcomes...

Introduction: Like many countries in sub-Saharan Africa, Kenya is experiencing a rapid rise in the burden of non-communicable diseases (NCDs): NCDs now contribute to over 50% of inpatient admissions and 40% of hospital deaths in the country. The Academic Model Providing Access to Healthcare (AMPATH) Chronic Disease Management (CDM) programme builds on lessons and capacity of HIV care to deliver chronic NCD care layered into both HIV and primary care platforms to over 24,000 patients across 69 health facilities in western Kenya. We conducted a cost and budget impact analysis of scaling up the AMPATH CDM programme in western Kenya using the International Society for Pharmacoeconomics and Outcomes Research guidelines. Methods: Costs of the CDM programme for the health system were measured retrospectively for 69 AMPATH clinics from 2014 to 2018 using programmatic records and clinic schedules to assign per clinic monthly costs. We quantified the additional costs to provide NCD care above those associated with existing HIV or acute care services, including clinician, staff, training, travel and equipment costs, but do not include drugs or consumables as they would be paid by the patient. We projected the budget impact of increasing CDM coverage to 50% of the eligible population from 2021 to 2025, and compared it with the county budgets from 2019.

BACKGROUND: Financial toxicity negatively affects the well-being of cancer survivors. We examined the incidence, cost drivers, and factors associated with financial toxicity after cancer in an upper-middle-income country with universal health coverage. METHODS: Through the Association of Southeast Asian Nations Costs in Oncology study, 1,294 newly diagnosed patients with cancer (Ministry of Health [MOH] hospitals [n = 577], a public university hospital [n = 642], private hospitals [n = 75]) were observed in Malaysia. Cost diaries and questionnaires were used to measure incidence of financial toxicity, encompassing financial catastrophe (FC; out-of-pocket costs ≥ 30% of annual household income), medical impoverishment (decrease in household income from above the national poverty line to below that line after subtraction of cancer-related costs), and economic hardship (inability to make necessary household payments). Predictors of financial toxicity were determined using multivariable...

Objective. To evaluate the effectiveness of utilizing the patient journey survey (PJS) method in healthcare accreditation processes. Design. Randomized trial of the PJS method in parallel with the current accreditation survey (CAS) method of the Australian Council on Healthcare Standards (ACHS). Setting. Acute healthcare organizations in Australia. Participants. Seventeen organizations, 28 organizational staff, nine surveyors and 38 patients. Main Outcome Measures. The results of each surveying method were compared. Participants provided feedback, via 18 interviews and 40 questionnaire surveys, about the benefits and disadvantages of a PJS compared to a CAS. Results. The PJS method is not as comprehensive as the CAS method for accreditation assessment. In matched assessments the majority of items were rated lower by the PJS method than by the CAS. PJSs were shown to be appropriate for assessing mandatory clinical criteria, but were less effective for assessing corporate and support criteria. The two methods diverged in their final assessments of which organizations met the accreditation threshold. Participants endorsed the use of PJSs within accreditation processes. Conclusions. The PJS methodology complements but is not a substitute for existing accreditation methods. There is significant stakeholder support for the inclusion of the PJS method within the current accreditation programme.

The aim of the European Brain Council project &quot;The Value of Treatment&quot; was to provide evidence-based, cost-effective policy recommendations for a patient-centered and sustainable coordinated care model for brain disorders. The first part of schizophrenia study examined the needs and gaps in the patients&#39; care pathway. Descriptive analysis was based on an inventory of needs and treatment opportunities, using focus group sessions, expert interviews, users&#39; input, and literature review. Three patient pathways were selected: indicated prevention, duration of untreated psychosis, and relapse prevention. The analysis identified several critical barriers to optimal treatment. Available health care services often miss or delay detection of symptoms and diagnosis in at-risk individuals. There is a lack of illness awareness among patients, families, and the public; scarcity of information, training and education among primary care providers; stigmatizing beliefs. Early sympt...

Globally, cancer patients and care givers experience numerous social economic needs that range from and are related to financial constraints, transportation obstacles, accommodation, poverty and inflexible working conditions, non-availability of services, socio-cultural and gender-related factors among others. To establish the socio-economic supportive care needs among cancer patients attending hospice/palliative care clinic in Meru level five Hospital (in Kenya), a descriptive cross-sectional study design that adopted qualitative approach in data collection was used, with purposive sampling being applied to select the study respondents. To collect data, the researcher conducted two focused group discussions (one with male patients only and another one with female patients). Two sets of interviews were conducted (one interview with the cancer patients and another one with the key informants). Interview schedule was used to collect data through interview till redundancy was achieved,...

Integration of Palliative Care into Primary Health Care will have a substantial amount of positive impact on Health Care in Nakuru County, Kenya. Consequently, all aspects of Palliative Care should be given to more than 2/3 population that suffer from cancers and chronic illnesses which sometimes overflow to some acute conditions. While Palliative Care focuses on Holistic Care encompassing physical, psychological, social, and spiritual aspects to adults and children, Primary Health Care operates on the principles of equity, solidarity, universal access to services, multisectoral action, social justice, centralization, and community participation. Thus, there are similarities in Palliative Care and Primary Health Care putting into consideration that the latter is based on practical, scientifically sound and socially accepted methods and technology. It is affordable, universally accessible to individuals and families in the community. Universal Health Coverage ensures that all people and communities have access to promotive, preventive, curative, rehabilitative, and palliative health services they need, of sufficient quality to be effective while also ensuring that the use of these services does not expose the users to financial hardships. The 60% of the Nakuru County population are in need of Palliative Care services, but only about 20% access these services. They suffer from cancers, non-communicable diseases, dementia, and frailty. Geographical challenges, staff shortages, and lack of Palliative Care knowledge are the main barriers to provision of care.

Background Kaposi sarcoma is one of the most prevalent HIV-associated malignancies in sub-Saharan Africa and is often diagnosed at advanced stage of disease. Only 50% of KS patients who qualify for chemotherapy receive it and adherence is sub-optimal. Methods 57 patients &gt; 18 years with newly diagnosed KS within the AMPATH clinic network in Western Kenya were purposively selected to participate in semi-structured interviews stratified by whether they had completed, partially completed, or not completed chemotherapy for advanced stage KS. We based the interview guide and coding framework on the situated Information, Motivation, Behavioral Skills (sIMB) framework, in which the core patient centered IMB constructs are situated into the socioecological context of receiving care. Results Of the 57 participants, the median age was 37 (IQR 32–41) and the majority were male (68%). Notable barriers to chemotherapy initiation and adherence included lack of financial means, difficulty with ...

The objective of this study was to explore patients' experiences when preparing for and undergoing general surgery at a large tertiary hospital. Findings aimed to inform the development of a prehabilitation program to empower patients to optimize their recovery and enhance their experience of general surgery. A qualitative exploratory research approach was utilized. Patients (>18 years) attending for elective general surgery between May and July 2018 were invited to participate. Four focus groups (n=18) and an interview were conducted to reach saturation. Deductive content analysis was used to map responses against theoretical determinants of health behavior change. Patients described their overall experience of general surgery as positive but provided key insights about the surgical journey that impacted their capability, opportunity and motivation to optimally engage and address their recovery. Interaction and information from health professionals, understanding expectations, timely access to treatment and support of family members greatly enhanced their experience. Lack of personalized exercise and nutrition prescriptions, access to shared patient experiences of the surgical journey and not being asked about personal goals were key inhibitors. Patients also expressed feelings of frustration and anxiety regarding hospital procedures, including repetitive gathering of information and poor communication across departments. Patients' experiences of the surgical journey identified gaps that impacted their capability, opportunity and motivation to effectively prepare and rehabilitate, that could be addressed by a multimodal prehabilitation program. Intervention options at patient and policy level were identified for trial to enhance the patient experience of general surgery.

Background: Understanding the pattern of care use can provide valuable information for reform interventions. This study investigates the pattern of healthcare utilization and its association with drug acquisition patterns and expenses in the National Health Insurance Fund (NHIF) of Al Jazira State in Sudan. Methods: A cross-sectional survey was conducted at NHIF primary healthcare centers of Al Jazirah state in Sudan. Results: A total of 768 beneficiaries were interviewed, of which 63.2% reported using out-of-network physician care, while 36.8% receive care from the NHIF physician network only. More than half (60.8%) of NHIF-interviewed clients reported a heavy burden of medication costs. The pattern of physician utilization was significantly associated with the number and source of regular drugs, the burden of out-of-pocket payment, and monthly out-of-pocket expenditures on medications, (p &lt; 0.001). The regression analysis revealed that gender, marital status, number of chronic ...

Background Kaposi sarcoma is one of the most prevalent HIV-associated malignancies in sub-Saharan Africa and is often diagnosed at advanced stage of disease. Only 50% of KS patients who qualify for chemotherapy receive it and adherence is sub-optimal. Methods 57 patients &gt; 18 years with newly diagnosed KS within the AMPATH clinic network in Western Kenya were purposively selected to participate in semi-structured interviews stratified by whether they had completed, partially completed, or not completed chemotherapy for advanced stage KS. We based the interview guide and coding framework on the situated Information, Motivation, Behavioral Skills (sIMB) framework, in which the core patient centered IMB constructs are situated into the socioecological context of receiving care. Results Of the 57 participants, the median age was 37 (IQR 32–41) and the majority were male (68%). Notable barriers to chemotherapy initiation and adherence included lack of financial means, difficulty with ...

Background In most countries, including those with national health insurance or comprehensive public insurance, some expenses for cancer treatment are borne by the ill and their families. Objectives This study aims to identify the areas of out-of-pocket (OOP) spending in the last half-year of the lives of cancer patients and examine the extent of that spending; to examine the probability of OOP spending according to patients’ characteristics; and to examine the financial burden on patients’ families. Methods 491 first-degree relatives of cancer patients (average age: 70) who died 3–6 months before the study were interviewed by telephone. They were asked about their OOP payments during the last-half year of the patient&#39;s life, the nature of each payment, and whether it had imposed a financial burden on them. A logistic regression and ordered logit models were used to estimate the probability of OOP expenditure and the probability of financial burden, respectively. Results Some 84...

Honest communication between oncologists and patients is important in alleviating the financial burden of cancer care. This study explored patient–relative–oncologist communication regarding the affordability of out-of-pocket (OOP) medication and the extent to which this communication addresses itself to the families’ financial burden. A cross-sectional survey was conducted among primary caregivers of deceased cancer patients. About 43% of relatives said that they and/or the patients had paid out of pocket for medications during the last six months of the patient’s life. Most (73%) oncologists suggested an OOP medication without asking about financial ability, 43% hardly explained the advantages of an OOP medication, and 52% hardly explained any treatment alternatives. Older age and female gender were related to less communication about an OOP medication, and better education, greater affluence, and having private health insurance were related to more communication. About 56% of rel...

BACKGROUND: Financial toxicity negatively affects the well-being of cancer survivors. We examined the incidence, cost drivers, and factors associated with financial toxicity after cancer in an upper-middle-income country with universal health coverage. METHODS: Through the Association of Southeast Asian Nations Costs in Oncology study, 1,294 newly diagnosed patients with cancer (Ministry of Health [MOH] hospitals [n = 577], a public university hospital [n = 642], private hospitals [n = 75]) were observed in Malaysia. Cost diaries and questionnaires were used to measure incidence of financial toxicity, encompassing financial catastrophe (FC; out-of-pocket costs ≥ 30% of annual household income), medical impoverishment (decrease in household income from above the national poverty line to below that line after subtraction of cancer-related costs), and economic hardship (inability to make necessary household payments). Predictors of financial toxicity were determined using multivariable...

The construction industry in Kenya is multi-layered with most workers working under subcontractors , contractors, and clients, who are also mostly informal and not registered with authorities. This makes it difficult to monitor and enforce labour laws, regulations, and standards in the sector. The workers have neither an employer who can share the cost burden that Social protection measures entail nor do they have rights as required by government policies, regulations, and standards. Most workers are hired on a short-term basis ranging from daily, a few days, weekly, and monthly with very few having steady employment with one employer for more than six months. This makes them not qualify for any worker benefits since they are considered casual workers. In a few cases, employers cater for some aspects of their social protection but without full commitment, leaving workers straddling between formal and informal social protection models. Chapter 4 (Bill of Rights) of the Constitution of Kenya (ROK, 2010) guarantees all Kenyans' social, economic, and cultural rights. It calls upon the state to provide appropriate social security to persons unable to support themselves and their dependents which is closely linked to other rights including the right to health, human dignity, reasonable working conditions, and access to justice. The Kenya Vision 2030 complements the Constitution with its three key pillars of economic, social, and political aspects (ROK, 2007). The objective of the social pillar is investing in the people of Kenya in order to improve the quality of life for all. A goal guided by the National Social Protection (NSP) policy, which identifies three aspects of social protection which are geared towards improving human capability, that is, social assistance (e.g. cash transfer programmes), and social security consisting of pensions and health insurance. These three social protection measures fall under what in the Devereux and Sabates-Wheeler (2004) framework is called preventive and protective measures. In addition, this framework also includes promotive and transformative measures as discussed in Chapter 1 of this edited volume. Social protection is a safety net mechanism which is crucial in building the human, financial, natural, and physical assets of poor people enabling them to grow out of poverty (Shepherd, Marcus & Barrientos, 2004). The informal