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Non-communicable Diseases

Health outcomes and healthcare utilization associated with four undiagnosed chronic conditions: evidence from nationally representative survey data in Sri Lanka

janisha — Mon, 15 Jul 2024 07:34:33 +0000

Health outcomes and healthcare utilization associated with four undiagnosed chronic conditions: evidence from nationally representative survey data in Sri Lanka janisha Mon, 07/15/2024 - 03:34

Abstract

Background

Low awareness of chronic conditions raises the risk of poorer health outcomes and may result in healthcare utilization and spending in response to symptoms of undiagnosed conditions. Little evidence exists, particularly from lower-middle-income countries, on the health and healthcare use of undiagnosed people with an indication of a condition. This study aimed to compare health (physical, mental, and health-related quality of life (HRQoL)) and healthcare (inpatient and outpatient visits and out-of-pocket (OOP) medical spending) outcomes of undiagnosed Sri Lankans with an indication of coronary heart disease (CHD), hypertension, diabetes, and depression with the outcomes of their compatriots who were diagnosed or had no indication of these conditions.

Methods

This study used a nationally representative survey of Sri Lankan adults to identify people with an indication of CHD, hypertension, diabetes, or depression, and ascertain if they were diagnosed. Outcomes were self-reported measures of physical and mental functioning (12-Item Short Form Survey (SF-12)), HRQoL (EQ-5D-5L), inpatient and outpatient visits, and OOP spending. For each condition, we estimated the mean of each outcome for respondents with (a) no indication, (b) an indication without diagnosis, and (c) a diagnosis. We adjusted the group differences in these means for socio-demographic covariates using ordinary least squares (OLS) regression for physical and mental function, Tobit regression for HRQoL, and a generalized linear model (GLM) for healthcare visits and OOP spending.

Results

An indication of each of CHD and depression, which are typically symptomatic, was associated with a lower adjusted mean of physical (CHD -2.65, 95% CI -3.66, -1.63; depression -5.78, 95% CI -6.91, -4.64) and mental functioning (CHD -2.25, 95% CI -3.38, -1.12; depression -6.70, 95% CI -7.97, -5.43) and, for CHD, more annual outpatient visits (2.13, 95% CI 0.81, 3.44) compared with no indication of the respective condition. There were no such differences for indications of hypertension and diabetes, which are often asymptomatic.

Conclusions

Living with undiagnosed CHD and depression was associated with worse health and, for CHD, greater utilization of healthcare. Diagnosis and management of these symptomatic conditions can potentially improve health partly through substitution of effective healthcare for that which primarily responds to symptoms.

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Wijemunige, N., van Baal, P., Rannan-Eliya, R. P. & O'Donnell, O. (2024) Health outcomes and healthcare utilization associated with four undiagnosed chronic conditions: evidence from nationally representative survey data in Sri Lanka. BMC Global Public Health, 2(45). https://doi.org/10.1186/s44263-024-00075-0

This is published on BMC Public Health. Available under CC BY 4.0 License.

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Cardiovascular disease

Diabetes

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Mon, 07/08/2024 - 12:00

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Sri Lanka

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Non-communicable Diseases

The quality of outpatient primary care in public and private sectors in Sri Lanka—how well do patient perceptions match reality and what are the implications?

sachini — Thu, 27 Jun 2024 09:44:17 +0000

The quality of outpatient primary care in public and private sectors in Sri Lanka—how well do patient perceptions match reality and what are the implications? sachini Thu, 06/27/2024 - 05:44

Abstract

Objective
To compare the quality of clinical care and patient satisfaction in public and private outpatient primary care services in Sri Lanka.

Methods
A prospective, cross-sectional comparison was done by direct observation of patient encounters and exit interviews of outpatients in 10 public hospital general outpatient clinics and 66 private practitioner clinics in three districts of Sri Lanka. A total of 1027 public sector patients and 944 private sector patients were surveyed. Data were collected for 39 quality indicators covering diarrhoea, cough, hypertension, diabetes, asthma, upper respiratory tract infections (URTI) and five other conditions, along with prescribing indicators. The exit interviews collected data for 10 patient satisfaction indicators.

Results
The public sector performed better for some conditions (diarrhoea, cough and asthma) and the private sector performed better for others (hypertension, diabetes, URTI and tonsillitis). Overall quality was similar between the sectors in the domains of history taking, examination and investigations and management, but the private sector performed much better on patient education (57 vs 12%). Overall patient satisfaction was high in both sectors (98%), although the private sector performed much better in interpersonal satisfaction (94 vs 84%) and system-related indicators (95 vs 84%). Comparisons with studies from other countries suggest that both sectors perform considerably better than India, and similarly in many indicators to high-income countries.

Conclusions
Quality of outpatient primary care in Sri Lanka is generally high for a lower-middle income developing country. The public and private sectors perform similarly, except that private sector patients have longer consultations, are more likely to receive education and advice, and obtain better interpersonal satisfaction. The public system, with its limited funding, is able to deliver care in diagnosis and management that is similar to the private sector, while private sector patients, who spend more on their healthcare receive better quality care in non-clinical areas.

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Quality of inpatient care in public and private hospitals in Sri Lanka

C. Anuranga

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The quality of outpatient primary care in public and private sectors in Sri Lanka—how well do patient perceptions match reality and what are the implications?

The quality of care in outpatient primary care in public and private sectors in Malaysia

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Rannan-Eliya, R. P., Wijemanne, N., Liyanage, I. K., Jayanthan, J., Dalpatadu, S., Amarasinghe, S., & Anuranga, C. (2014). The quality of outpatient primary care in public and private sectors in Sri Lanka—how well do patient perceptions match reality and what are the implications? Health Policy and Planning, 30(suppl_1), i59–i74. https://doi.org/10.1093/heapol/czu115

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Thu, 06/27/2024 - 12:00

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Maternal and child health

quality of clinical care

quality measurement

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Sri Lanka

Legacy ID

943

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Cohort Profile: The Sri Lanka Health and Ageing Study (SLHAS)

janisha — Fri, 12 Jul 2024 03:53:51 +0000

Cohort Profile: The Sri Lanka Health and Ageing Study (SLHAS) janisha Thu, 07/11/2024 - 23:53

Abstract

Key Features

The Sri Lanka Health and Ageing Study (SLHAS) is a nationally representative cohort study of the Sri Lankan population, established to provide a multidimensional platform to understand and track health and ageing.
The SLHAS aims to undertake periodic surveys every 3–5 years. Wave 1 recruited and interviewed in person 6668 participants of all adult ages during 2018/19, with adults aged 70 years and older oversampled.
Waves 2 (2021/22) and 2x (2022/23) have interviewed 74% (n=4904) of participants by telephone, with non-response due to death, illness, emigration and refusal in an additional 4% (n=292). The remainder could not be contacted by telephone, but the study expects to reach most of these in a future field survey.
All waves cover: (i) health and general wellbeing; (ii) social determinants; (iii) health care use; and (iv) work and retirement. Wave 1 undertook physical examinations, collected biomarkers and biobanked blood and urine samples; and Waves 2/2x covered the impacts of COVID-19, economic crisis and public opinion.
The SLHAS design maximizes comparability with other international surveys, particularly the Health and Retirement Study (HRS) family, to support cross-national comparisons.
SLHAS will make data available to other researchers, with Wave 1 data to be released from 2024.

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H M Meththananda Herath

Nilmini Wijemunige

K.C. Shanti Dalpatadu

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Rannan-Eliya, R. P., Dissanayake, V. H., Perera, P., Perera, B., Herath, H. M. M., Wijemunige, N., Dalpatadu, S., Samarage, S., Gamage, A., Jayatissa, R., & Fernando, E. Y. (2024). Cohort Profile: The Sri Lanka Health and Ageing Study (SLHAS). International Journal of Epidemiology, 53(2). https://doi.org/10.1093/ije/dyae044

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Factors impacting sustained coverage in the context of donor transitions: experience from Sri Lanka

janisha — Mon, 15 Jul 2024 05:56:34 +0000

Factors impacting sustained coverage in the context of donor transitions: experience from Sri Lanka janisha Mon, 07/15/2024 - 01:56

Abstract

Although not reliant on donor funding for health, the external assistance that Sri Lanka receives contributes to the improvement of the health system and health outcomes. In this study, we evaluated transition experiences of the expanded programme on immunization (EPI) that received Gavi funding to expand the vaccine portfolio and the Anti-Malaria Campaign (AMC) that received funding from the Global Fund for AIDS, Tuberculosis and Malaria to scale-up interventions to target and achieve malaria elimination. We assessed if EPI and AMC programmes were able to sustain coverage of previously donor-funded interventions post-transition and explain the facilitators and barriers that contribute to this. We used a mixed methods approach using quantitative data to assess coverage indicators and the financing mix of the health programmes and qualitative analysis guided by a framework informed by the Walt and Gilson policy triangle that brought together document review and in-depth interviews to identify facilitators and barriers to transition success. The EPI programme showed sustained coverage of Gavi-funded vaccines post-transition and the funding gap was bridged by mobilizing domestic financing facilitated by the Gavi co-financing mechanism, full integration within existing service delivery structures, well-established and favourable pharmaceutical procurement processes for the public sector and stewardship and financial advocacy by technically competent managers. Although the absence of indigenous cases of malaria since 2012 suggests overall programme success, the AMC showed mixed transition success in relation to its different programme components. Donor-supported programme components requiring mobilization of operational expenses, facilitated by early financial planning, were successfully transitioned (e.g. entomological and parasitological surveillance) given COVID-19-related constraints. Other key programme components, such as research, training, education and awareness that are dependent on non-operational expenses are lagging behind. Additionally, concerns of AMC’s future financial sustainability within the current structure remain in the context of low malaria burden.

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Prasadini Perera

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Perera, P., Amarasinghe, S. A., Fonseka, S., Abeysinghe, N., & Rannan-Eliya, R. P. (2024) Factors impacting sustained coverage in the context of donor transitions: experience from Sri Lanka. Health Policy and Planning, 39(Supplement_1), i33–i49. https://doi.org/10.1093/heapol/czad099.

This article is available under the Creative Commons CC-BY-NC license.

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Increased Intensity Of PCR Testing Reduced COVID-19 Transmission Within Countries During The First Pandemic Wave

sachini — Wed, 03 Jul 2024 06:06:26 +0000

Increased Intensity Of PCR Testing Reduced COVID-19 Transmission Within Countries During The First Pandemic Wave sachini Wed, 07/03/2024 - 02:06

Abstract

Experts agree that reverse transcription–polymerase chain reaction (PCR) testing is critical in controlling coronavirus disease 2019(COVID-19), but decision makers disagree on how much testing is optimal. Controlling for interventions and ecological factors, we used linear regression to quantify testing's impact on COVID-19's average reproduction number, which represents transmissibility, in 173 countries and territories (which account for 99 percent of the world's COVID-19cases) during March–June 2020. Among interventions, PCR testing had the greatest influence: a tenfold increase in the ratio of tests to new cases reported reduced the average reproduction number by 9 percent across a range of testing levels. Our results imply that mobility reductions (for example, shelter-in-place orders) were less effective in developing countries than in developed countries. Our results help explain how some nations achieved near-elimination of COVID-19 and the failure of lockdowns to slow COVID-19 in others. Our findings suggest that the testing benchmarks used by the World Health Organization and other entities are insufficient for COVID-19 control. Increased testing and isolation may represent the most effective, least costly alternative in terms of money, economic growth, and human life for controllingCOVID-19.

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Ravi P. Rannan-Eliya

Nilmini Wijemunige

Nishani Gunawardana

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Increasing PCR testing reduced COVID-19 cases and deaths, and it was the most important predictor of how well countries contained the pandemic. The study also found that lockdowns did not slow the virus in most countries, and that masks and school closures had less impact than high levels of testing and isolation.

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Quality of inpatient care in public and private hospitals in Sri Lanka

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Wed, 12/15/2021 - 12:00

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The quality of care in outpatient primary care in public and private sectors in Malaysia

sachini — Tue, 02 Jul 2024 06:09:33 +0000

The quality of care in outpatient primary care in public and private sectors in Malaysia sachini Tue, 07/02/2024 - 02:09

Abstract

In Malaysia, first-contact, primary care is provided by parallel public and private sectors, which are completely separate in organization, financing and governance. As the country considers new approaches to financing, including using public schemes to pay for private care, it is crucial to examine the quality of clinical care in the two sectors to make informed decisions on public policy. This study intends to measure and compare the quality of clinical care between public and private primary care services in Malaysia and, to the extent possible, assess quality with the developed economies that Malaysia aspires to join.

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The quality of outpatient primary care in public and private sectors in Sri Lanka—how well do patient perceptions match reality and what are the implications?

The quality of care in outpatient primary care in public and private sectors in Malaysia

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We compare the quality of care in public and private sector outpatient care in Malaysia using the National Medical Care Survey 2014, using 66 internationally validated quality indicators in 27,587 patient encounters.

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Tue, 10/15/2019 - 12:00

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Quality of inpatient care in public and private hospitals in Sri Lanka

sachini — Thu, 27 Jun 2024 09:39:09 +0000

Quality of inpatient care in public and private hospitals in Sri Lanka sachini Thu, 06/27/2024 - 05:39

Abstract

Methods: A retrospective, cross-sectional comparison was done of inpatient quality, in a sample of 11 public and 10 private hospitals in three of 25 districts. Data were collected for 55 quality indicators from medical records of 2523 public and 1815 private inpatient admissions. These covered treatment of asthma, acute myocardial infarction (AMI), childbirth and five other conditions, along with outcome indicators, and medicine prescribing indicators.

Conclusions: For a range of indicators where comparisons were possible, quality of inpatient clinical care in Sri Lanka was comparable to levels reported from upper-middle income Asian countries, and often approaches that in developed countries, although the findings cannot be generalized. Quality in the public sector is better than in the private sector in many areas, despite spending being substantially less. Quality in public hospitals is resource constrained, and needs greater government investment for improvement, but when resource limitations are not critical, the public sector appears able to deliver equal or better quality than the private sector. Overall similarities in quality between the two sectors suggest the importance of physician training and other factors.

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Quality of inpatient care in public and private hospitals in Sri Lanka

Shivanthan Shanthikumar

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The quality of outpatient primary care in public and private sectors in Sri Lanka—how well do patient perceptions match reality and what are the implications?

The quality of care in outpatient primary care in public and private sectors in Malaysia

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This paper published in the Oxford Journals Health Policy and Planning March 2015 issue compares the quality of inpatient clinical care in public and private hospitals in Sri Lanka

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Maternal and child health

Inpatient care

Asthma

Cardiovascular disease

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942

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Multisectoral preventive health services in Sri Lanka: Lessons for developing countries in providing public goods in health

sachini — Thu, 27 Jun 2024 07:43:08 +0000

Multisectoral preventive health services in Sri Lanka: Lessons for developing countries in providing public goods in health sachini Thu, 06/27/2024 - 03:43

Abstract

What can other developing countries learn from Sri Lanka on achieving good health at low cost? While its
well-organized medical and maternal-child health services have been documented elsewhere, this paper fills a gap in documenting how it organizes services to reduce the population’s exposure to disease—a pure public good. The key factors underlying the effectiveness of these services are (1) strong focal points in the central Health Ministry for supporting preventive services; (2) pro-active outreach by the health line agency to collaborate with other sectors/ agents whose work influences public health outcomes; and (3) community-level delivery institutions with well-trained multivalent Public Health Inspectors— all underpinned by (4) assured tax-based financing. This paper describes this system in some detail such that other countries can learn from Sri Lanka’s successful approach to improving population health. It also makes some recommendations for strengthening the system in response to changing conditions.

Authors

Monica Das Gupta

K.C.S. Dalpatadu

C. K. Shanmugarajah

H. M. S. S. D. Herath

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World Bank Policy Research Working Paper 6558, August 2013

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Subtitle

Lessons for Developing Countries in Providing Public Goods in Health

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Health policy

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World Bank

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Thu, 08/15/2013 - 12:00

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928

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Sri Lanka’s Success Story in Population Management

sachini — Thu, 27 Jun 2024 08:34:44 +0000

Sri Lanka’s Success Story in Population Management sachini Thu, 06/27/2024 - 04:34

Abstract

The population programme in Sri Lanka is one of the most successfully implemented programmes by Government since Independence. It is a lesson for other public sector programmes. It is also a programme where right decisions were taken at the right time and right people were appointed to the right jobs. Therefore, this article describes, in some detail, the policies and programmes that influenced the transition from a high population growth rate to relatively low growth rate over the past of six decades.

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A. T. P. L. Abeykoon

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The publication by Dr. A.T.P.L. Abeykoon outlines in a nutshell the policies and programmes that influenced the transition from a high population growth rate to a relatively low growth over a period of six decades.

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Subtitle

A Lesson for Other Programmes

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Population

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