Journal of Preventive Medicine and Public Health

Original Article

Identification of Unmet Healthcare Needs: A National Survey in Thailand: Sukanya Chongthawonsatid; J Prev Med Public Health. 2021;54(2):129-136. Published online March 4, 2021; DOI: https://doi.org/10.3961/jpmph.20.318

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Objectives
This study examined demographic factors hampering access to healthcare at hospitals and suggests policy approaches to improve healthcare management in Thailand.
Methods
The data for the study were drawn from a health and welfare survey conducted by the National Statistical Office of Thailand in 2017. The population-based health and welfare survey was systematically carried out by skilled interviewers, who polled 21 519 384 individuals. The independent variables related to demographic data (age, sex, religion, marital status, education, occupation, and area of residence), chronic diseases, and health insurance coverage. The dependent variable was the degree of access to healthcare. Multiple logistic regression analysis was subsequently performed on the variables found to be significant in the univariate analysis.
Results
Only 2.5% of the population did not visit a hospital when necessary for outpatient-department treatment, hospitalization, or the provision of oral care. The primary reasons people gave for not availing themselves of the services offered by government hospitals when they were ill were—in descending order of frequency—insufficient time to seek care, long hospital queues, travel inconvenience, a lack of hospital beds, unavailability of a dentist, not having someone to accompany them, and being unable to pay for the transportation costs. Multiple logistic regression analysis showed that failure to access the health services provided at hospitals was associated with demographic, educational, occupational, health welfare, and geographic factors.
Conclusions
Accessibility depends not only on health and welfare benefit coverage, but also on socioeconomic factors and the degree of convenience associated with visiting a hospital.

Summary

Citations

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Factors associated with poor self-rated health among chronic kidney disease patients and their health care utilization: Insights from LASI wave-1, 2017-18
Swetalina Nayak, Soumya Ranjan Nayak, Alice Alice, Debadutta Sahoo, Srikanta Kanungo, Tanveer Rehman, Sanghamitra Pati, Subrat Kumar Palo
Frontiers in Nephrology.2023;[Epub] CrossRef
The association between health costs and physical inactivity; analysis from the Physical Activity at Work study in Thailand
Katika Akksilp, Wanrudee Isaranuwatchai, Yot Teerawattananon, Cynthia Chen
Frontiers in Public Health.2023;[Epub] CrossRef
Unmet Healthcare Needs among the Elderly Korean Population: Before and during the COVID-19 Pandemic
Hyo Lyun Roh, Sang Dol Kim
Systems.2023; 11(9): 437. CrossRef
The association of physical activity and sedentary behaviour on health-related quality of life: a cross-sectional study from the physical activity at work (PAW) trial
Katika Akksilp, Falk Müller-Riemenschneider, Yot Teerawattananon, Cynthia Chen
Journal of Activity, Sedentary and Sleep Behaviors.2023;[Epub] CrossRef
The relationship between sexual and gender stigma and difficulty accessing primary and mental healthcare services among LGBTQI+ populations in Thailand: Findings from a national survey
Soroush Moallef, Travis Salway, Nittaya Phanuphak, Katri Kivioja, Suparnee Pongruengphant, Kanna Hayashi
International Journal of Mental Health and Addiction.2022; 20(6): 3244. CrossRef
The impact of the Syrian Refugee Crisis on the health access in Turkiye: A synthetic control analysis
Hüseyin İKİZLER, Aslı DOLU, Emre YÜKSEL
Uluslararası Ekonomi ve Yenilik Dergisi.2022; 8(2): 165. CrossRef

Brief Report

Determinants of Hospital Inpatient Costs in the Iranian Elderly: A Micro-costing Analysis: Ebrahim Hazrati, zahra Meshkani, Saeed Husseini Barghazan, Sanaz Zargar Balaye Jame, Nader Markazi-Moghaddam; J Prev Med Public Health. 2020;53(3):205-210. Published online May 16, 2020; DOI: https://doi.org/10.3961/jpmph.19.250

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Abstract PDF: Objectives
Aging is assumed to be accompanied by greater health care expenditures. The objective of this retrospective, bottom-up micro-costing study was to identify and analyze the variables related to increased health care costs for the elderly from the provider’s perspective.
Methods
The analysis included all elderly inpatients who were admitted in 2017 to a hospital in Tehran, Iran. In total, 1288 patients were included. The Mann-Whitney and Kruskal-Wallis tests were used.
Results
Slightly more than half (51.1%) of patients were males, and 81.9% had a partial recovery. The 60-64 age group had the highest costs. Cancer and joint/orthopedic diseases accounted for the highest proportion of costs, while joint/orthopedic diseases had the highest total costs. The surgery ward had the highest overall cost among the hospital departments, while the intensive care unit had the highest mean cost. No statistically significant relationships were found between inpatient costs and sex or age group, while significant associations (p<0.05) were observed between inpatient costs and the type of ward, length of stay, type of disease, and final status. Regarding final status, costs for patients who died were 3.9 times higher than costs for patients who experienced a partial recovery.
Conclusions
Sex and age group did not affect hospital costs. Instead, the most important factors associated with costs were type of disease (especially chronic diseases, such as joint and orthopedic conditions), length of stay, final status, and type of ward. Surgical services and medicine were the most important cost items.; Summary

Original Articles

Reliability and Validity of the Appropriateness Evaluation Protocol for Public Hospitals in Korea: Clara Lee, Stella Jung-Hyun Kim, Changwoo Lee, Euichul Shin; J Prev Med Public Health. 2019;52(5):316-322. Published online September 12, 2019; DOI: https://doi.org/10.3961/jpmph.19.125

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Abstract Summary PDF

Objectives
This study was conducted to assess the applicability of the Appropriateness Evaluation Protocol (AEP) for public hospitals in Korea.
Methods
In May 2016, 1500 admission claims were collected from Korean public district hospitals using stratified random sampling. Of these claims, 560 admissions to 37 hospitals were retrieved for analysis. Medical records administrators determined the appropriateness of admission using the criteria detailed in the AEP, and a physician separately assessed the appropriateness of admission based on her clinical judgment. To examine the applicability of the AEP, the concordance of the decisions made between a pair of AEP reviewers and between an AEP reviewer and a physician reviewer was compared.
Results
The results showed an almost perfect inter-rater agreement between the AEP reviewers and a moderate agreement between the AEP reviewers and the physician. The sensitivity and specificity of the AEP were calculated as 0.86 and 0.56, respectively.
Conclusions
Our findings suggest that the AEP could potentially be applied to Korean public hospitals as a reliable and valid instrument for assessing the appropriateness of admissions.

Summary

Korean summary
이 연구는 우리나라 공공병원을 대상으로 Appropriateness Evaluation Protocol(AEP) 도구를 적용가능성을 검토하기 위해 실시되었다. 우리나라의 지역공공병원 입원자료(2016년 5월 기준)를 층화무작위추출을 통해 1,500건을 추출하였으며, 이중 37개 병원의 560건에 대해 입원적정성을 분석하였다. 의무기록사 2인은 AEP 도구를 이용하여 입원적정성을 각각 검토하였고, 의사 1인은 전문가적 판단을 기준으로 검토하였다. AEP 도구의 적용가능성을 판단하기 위해 의무기록사간 그리고 의무기록사-의사간 일치율을 산출하였다. 의무기록사간 일치율은 거의 완벽한 수준으로 나타났고, 의무기록사-의사간은 중등도의 일치율을 보였다. 민감도, 특이도는 각각 0.86 그리고 0.56이었다. 이러한 결과는 AEP 도구가 우리나라 공공병원의 입원적정성을 평가하기 위한 일관적이고 정확한 도구임을 제시한다.

Citations

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Inappropriate hospital admission as a risk factor for the subsequent development of adverse events: a cross-sectional study
Diego San Jose-Saras, Jorge Vicente-Guijarro, Paulo Sousa, Paloma Moreno-Nunez, Jesús María Aranaz-Andres, Cristina Díaz-Agero Pérez, Miguel Ignacio Cuchi Alfaro, Juan Manuel Ramos López, Mercedes García Haro, Abelardo Claudio Fernández Chávez, Cornelia B
BMC Medicine.2023;[Epub] CrossRef
Inappropriate Hospital Admission According to Patient Intrinsic Risk Factors: an Epidemiological Approach
D. San Jose-Saras, J. Vicente-Guijarro, P. Sousa, P. Moreno-Nunez, M. Espejo-Mambié, J. M. Aranaz-Andres
Journal of General Internal Medicine.2023; 38(7): 1655. CrossRef
Strategies to improve the flow of admissions and hospital stays: a Delphi study of an adaptation of the Appropriateness Evaluation Protocol (AEP)
A. Morillo-Rodríguez, S. Alonso-Fernández, J.M. Mòdol Deltell, B. Soldevila Madorell, Ll. Benito-Aracil, D. Parés
Revista Clínica Española (English Edition).2023; 223(5): 270. CrossRef
Estrategias para mejorar el flujo de ingresos y estancias hospitalarias: adaptación del cuestionario Appropriateness Evaluation Protocol (AEP): estudio Delphi
A. Morillo-Rodríguez, S. Alonso-Fernández, J.M. Mòdol Deltell, B. Soldevila Madorell, Ll. Benito-Aracil, D. Parés
Revista Clínica Española.2023; 223(5): 270. CrossRef

Bacterial Contamination and Disinfection Status of Laryngoscopes Stored in Emergency Crash Carts: Jae Hyung Choi, Young Soon Cho, Jung Won Lee, Hee Bong Shin, In Kyung Lee; J Prev Med Public Health. 2017;50(3):158-164. Published online April 4, 2017; DOI: https://doi.org/10.3961/jpmph.17.013

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Abstract PDF

Objectives
To identify bacterial contamination rates of laryngoscope blades and handles stored in emergency crash carts by hospital and area according to the frequency of intubation attempts.
Methods
One hundred forty-eight handles and 71 blades deemed ready for patient use from two tertiary hospitals were sampled with sterile swabs using a standardized rolling technique. Samples were considered negative (not contaminated) if no colonies were present on the blood agar plate after an 18-hour incubation period. Samples were stratified by hospital and according to the frequency of intubation attempts (10 attempts per year) using the χ²-test and Fisher exact test.
Results
One or more species of bacteria were isolated from 4 (5.6%) handle tops, 20 (28.2%) handles with knurled surfaces, and 27 (18.2%) blades. No significant differences were found in microbial contamination levels on the handle tops and blades between the two hospitals and two areas according to the frequency of intubation attempts. However, significant differences were found between the two hospitals and two areas in the level of microbial contamination on the handles with knurled surfaces (p<0.05).
Conclusions
Protocols and policies must be reviewed to standardize procedures to clean and disinfect laryngoscope blades and handles; handles should be re-designed to eliminate points of contact with the blade; and single-use, one-piece laryngoscopes should be introduced.

Summary

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Moving towards green anaesthesia: Are patient safety and environmentally friendly practices compatible? A focus on single-use devices
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Economic and Epidemiological Impact of an Improvement Plan for the Decrease of Ventilator-Associated Pneumonia in a Tertiary Hospital in Mexico
Oscar Sosa-Hernández, Bernardina Matías-Téllez, Yefté Efraín Silva-López, Verónica Alarcón-Hernández, Juan Manuel Bello-López, Mónica Alethia Cureño-Díaz, Gustavo Esteban Lugo-Zamudio
Journal of Patient Safety.2021; 17(8): e1889. CrossRef
Food poisoning: an underestimated cause of Boerhaave syndrome
Karl Dichtl, Martin B. Koeppel, Claus-Peter Wallner, Thomas Marx, Johannes Wagener, Ludwig Ney
Infection.2020; 48(1): 125. CrossRef
Contamination and Disinfection of Rigid Laryngoscopes: A Literature Review
Sharon Ann Van Wicklin
AORN Journal.2019; 110(1): 49. CrossRef
Infection Prevention for the Emergency Department
Stephen Y. Liang, Madison Riethman, Josephine Fox
Emergency Medicine Clinics of North America.2018; 36(4): 873. CrossRef

Inter-hospital Comparison of Cesarean Section Rates after Risk Adjustment.: Sang Il Lee, Young Ho Khang, Beom Man Ha, Moo Song Lee, Weechang Kang, Hee Jo Koo, Chang Yup Kim; Korean J Prev Med. 2001;34(4):337-346.

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Abstract PDF: OBJECTIVE
To determine the clinical risk factors associated with the mode of delivery decision and to compare cesarean section rates after adjusting for risk factors identified among Korean hospitals. METHODS: Data were collected from 9 general hospitals in two provincial regions by medical record abstraction during February 2000. A total of 3,467 cases were enrolled and analyzed by stepwise logistic regression. Performance of the risk-adjustment model (discrimination and calibration) was evaluated by the C statistic and the Hosmer-Lemeshow test. Crude rates, predicted rates with 95% confidence intervals, and adjusted rates of cesarean section were calculated and compared among the hospitals. RESULTS: The average crude cesarean section rate was 53.2%, ranging from 39.4% to 65.7%. Several risk factors such as maternal age, previous history of cesarean section, placenta previa, placental abruption, malpresentation, amniotic fluid abnormality, gestational anemia, infant body weight, pregnancy-induced hypertension, and chorioamnionitis were found to have statistically significant effects on the mode of delivery. It was confirmed that information about most of these risk factors was able to be collected through the national health insurance claims database in Korea. Performance of the risk-adjustment model was good (c statistic=0.815, Hosmer-Lemeshow test=0.0621). Risk factor adjustment did lead to some change in the rank of hospital cesarean section rates. The crude rates of three hospitals were beyond 95% confidence intervals of the predicted rates. CONCLUSIONS: Considering that cesarean section rates in Korean hospitals are too high, it is apparent that some policy interventions need to be introduced. The concept and methodology of risk adjustment should be used in the process of health policy development to lower the cesarean section rate in Korea.; Summary

Causes of Burn and Emergency Care on the Spot for the Patients Admitted to Three Hospitals in Taegu.: Min Chu, Jung Han Park; Korean J Prev Med. 1988;21(2):238-244.

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Abstract PDF: This study was conducted to investigate the causes of burn and emergency cares taken on the spot for the burn patient. study population included 161 burn patients admitted to 2 university hospitals and 1 general hospital in Taegu from November 1, 1987 to April 30, 1988. Patients or guardians were interviewed with a structured questionnaire. Out of 161 burn patients 111(69.8%) were males and 50(31.1%) females. Preschool children of 1-4 years old accounted for 29.8% of the total patients. Burns of children under 15 years of age took place at home in 91.0%, while 48.3% of burns of adult (15 years and over) males occurred at the working place, and 68.0% of adult females occurred at the home. Out of total burns occurred at home 39.8% took place at kitchen/dining room and 24.1% in the room. The most common cause of burns in children was the boiling water or hot food (74.3%). In adults the common causes were electrical burn(22.4%), hot water or food(19.0%) and explosion(12.1%) for males, and hot water or food(32.0%) and explosion(20.0%) for females. Common emergency cares for the burn taken on the spot were undressing(64.6%), pouring Soju(liquor)(13.7%), and pouring cold water(5.0%). There were a few cases who applied ash, soy or salt. To prevent burn, it is recommended to remodel the traditional kitchen and coal-briquet hole, to strengthen the safety control of LP Gas and LN Gas supply, to educate the public for the handling method for such gases, to strengthen the occupational safety control, to improve the safety device for the electric wire and socket, and to limit the temperature of hot water at home and public baths.; Summary

Causes of Childhood Injuries Observed at the Emergency Rooms of Five Hospitals in Taegu.: Jung Han Park, Yeong Sook Bae; Korean J Prev Med. 1988;21(2):224-237.

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Abstract PDF: To determine the causes of and related factors to childhood injuries, the emergency room records and inpatient medical records were reviewed for 4,849 injured children out of 15,790 pediatric patients(<15 years old) who visited the emergency rooms of 3 university hospitals and 2 general hospitals in Taegu from 1 January to 31 December 1987. Out of total injured children, 54.6% were 3-8 years old and the male to female ratio of the total injured children was about 2 : 1. The leading causes of injury were falls and slips (29.1%) and traffic accident(28.2%). The frequency of injury was higher in May-October than the rest of months and 51.6% of the injuries occurred between 15 and 20 o'clock. Falls and slips took place most frequently at the stairway(25.7%). The most common interpersonal violence was inflicted injuries(85.6%) and there were 11 child rapes. Dog bites accounted for 67.6% of all biting injuries and it occurred 2.9 times more in male than in female. CO intoxication was the most common cause of poisoning (45.3%) and scalding accounted for 85.2% of all burns. Common places of drownings were river (32.2%), swimming pool (22.6%) and construction site(19.3%). To prevent childhood injuries, it is recommended to eliminate the hazardous environmental factors, to provide safe playgrounds, to educate the children for safety from kindergarten and the general public through mass communication, to establish a strict safety standard for houses, public buildings and facilities, and playgrounds.; Summary

Development of the Standard Blood Inventory Level Decision Rule in Hospitals.: Byoung Yik Kim; Korean J Prev Med. 1988;21(1):195-206.

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Abstract PDF: Two major issues of the blood bank management are quality assurance and inventory control. Recently, in Korea blood donation gas gained popularity increasingly to allow considerable improvement of the quality assurance with respect to blood collection, transportation, storage, component preparation skills and hematological tests. Nevertheless the inventory control, the other issue of blood bank management, has been neglected so far. For the supply of blood by donation barely meets the demand, the blood bank policy on the inventory control has been 'the more the better'. The shortage itself by no means unnecessitated inventory control. In fact, in spite of shortage, no small amount of blood is out dated. The efficient blood inventory control makes it possible to economize the blood usage in the practice of state-of-the-art medical care. For the efficient blood inventory control in Korean hospitals, this study is to develop formulate forecasting the standard blood inventory level and suggest a set of policies improving the blood inventory control. For this study information of A+ whole bloods and packed cells inventory control were collected from a University Hospital and the Central Blood Bank of the Korean Red Cross. Using this informations, 1,461 daily blood inventory records were formulated. 48 varieties of blood inventory control environment were identified on the basis of selected combinations of 4 inventory control variables-crossmatch, transfusion, inhospital donation and age of bloods from external supply. In order to decide the optimal blood inventory level for each environment, simulation models were designed to calculate the measure of performance of each environment. After the decision of 48 optimal blood inventory levels, stepwise multiple regression analysis was started where the independent variables were 4 inventory control variables and the dependent variable was optimal inventory level of each environment. Finally the standard blood inventory level decision rule was developed using the backward elimination procedure to select the best regression equation. And the effective alternatives of issuing policy and crossmatch release period were suggested according to the measures of performance under the condition of the standard blood inventory level. The results of this study were as follows ; 1. the formulate to calculate the standard blood inventory level(S*)was. S*=2.8617 x (d)0.9342. where d is the mean daily crossmatch(demand) for a blood type. 2. The measures of performance-outdate rate, average period of storage, mean age of transfused bloods, and mean daily available inventory level-were improved after maintenance of the standard inventory level in comparison with the present system. 3. Issuing policy of First Out(FIFO) decreased the outdate rate, while Last In-First Out(LIFO) decreased the mean age of transfused bloods. The decrease of the crossmatch release period reduced the outdate rate and the mean age of transfused bloods.; Summary

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