Search

Objective: Community-based antiretroviral treatment (CBART) programs should aim to achieve positive quality of life outcomes. The purpose of this study was to investigate changes in the health related quality of life (HRQOL) outcomes of patients in a CBART program supported by community volunteers in one sub-county in western Uganda located 50 km from the nearest urban centre. Methods: We administered a translated version of the MOS-HIV survey and collected clinical data at baseline and after one year from 130 patients. Inclusion criteria included residency in the sub-county, eighteen years of age or, treatmentnaive, eligible for ART based on CD4 cell count <200 cells/mm3 or WHO clinical stage 3 or 4, and willing to accept daily treatment support by family/friends and to be visited by a community volunteer weekly. We assessed changes in physical health (PHS) and mental health (MHS) summary scores and examined associations between patient characteristics and changes in HRQOL. Results: After one year, we observed significant increases in mean PHS (42.7 to 50.1; p<0.01) and MHS (43.5 to 49.5; p<0.01) scores. Lower age (p<0.01) and lower baseline PHS scores (p<0.01) were associated with increases in PHS scores and lower age (p0.03) and lower baseline MHS scores (p<0.01) were associated with increases in MHS scores. Fifteen patients (12) had reductions in their HRQOL after one year which were not associated with patient or clinical characteristics, including virological suppression. Conclusions: The observed improvements in HRQOL demonstrate that positive treatment outcomes can be achieved in CBART programs in rural Uganda. However, some patients appear to experience declines in their overall well-being, despite achieving virological suppression. HRQOL surveys can be useful in identifying these patients, who may require additional attention and support to achieve the full benefits of ART.

Objective: To compare the treatment outcomes and mortality in a rural community-based ART (CBART) program with a hospital-based ART program in the same district. Methods: The study design was a non-randomized cohort study consisting of 185 persons living with HIV (PLWHIV) in the CBART cohort and 200 PLWHIV in the hospital cohort. Eligibility for both cohorts was: being HIV-infected and eligible for ART, being treatment naive, age 18 years or older, and being a resident of Rwimi sub-county. The intervention consisted of a community-based program which included weekly home visits to patients by trained volunteers who delivered antiretroviral drugs (ARVs), monitored and supported adherence to treatment, and identified and reported adverse reactions and other clinical symptoms. Outcome variables were compared to patients in a hospital-based cohort who received the standard care delivered to all other HIV patients in the hospital. The main outcome measures were HIV- 1 RNA viral load (VL), CD4 cell count and mortality after six months of treatment. Results: Successful ART treatment outcome as measured by virological suppression (VL<400 copies/ml) in the CBART cohort was similar to those in the hospital-based cohort (90.1 vs 89.3, p0.47). The median CD4 cell count increased significantly in both cohorts (community-based cohort 159 cells/l vs 145 cells/l in the hospital-based cohort). Mortality was not significantly different in both cohorts (community-based cohort 11.9, hospital-based cohort 9.0). Conclusion: The findings show that outcomes of a CBART intervention in a rural area compare favorably to outcomes of hospital-based care. If the study results are sustainable over a longer time period, this model could be considered for ART roll-out to impoverished rural/remote populations in Uganda and elsewhere.

The objectives of this study were to describe the utilization of emergency departments in the Capital Health region, Alberta, between 1998 and 2000, and temporal variations in emergency department utilization by month, day of week, and time of day in 2000. Between 1998 and 2000, the annual number of visits to emergency departments in the region increased by six percent. The mean length of stay, median length of stay and the number of patients who left without being seen increased by six minutes, eight minutes, and 4,442 patients respectively. Variations in the number of visits, mean and median lengths of stay, and numbers of patients who left without being seen by month, day of week, and time of day were modest except for patients who left without being seen. Service pressures in Capital Health emergency departments continue to exist. Temporal variations in service pressures were small. Causes of emergency department pressures are multiple and interrelated. Therefore, system-wide changes should be considered in addressing emergency department pressures.

The objectives of this study were to describe the utilization of emergency departments in the Capital Health region, Alberta, between 1998 and 2000, and temporal variations in emergency department utilization by month, day of week, and time of day in 2000. Between 1998 and 2000, the annual number of visits to emergency departments in the region increased by six percent. The mean length of stay, median length of stay and the number of patients who left without being seen increased by six minutes, eight minutes, and 4,442 patients respectively. Variations in the number of visits, mean and median lengths of stay, and numbers of patients who left without being seen by month, day of week, and time of day were modest except for patients who left without being seen. Service pressures in Capital Health emergency departments continue to exist. Temporal variations in service pressures were small. Causes of emergency department pressures are multiple and interrelated. Therefore, system-wide changes should be considered in addressing emergency department pressures.

ABSTRACTObjectives:To determine the perceptions of health care professionals and service providers with regard to emergency department (ED) overcrowding, including definitions of overcrowding, characteristics of an overcrowded ED, and causes of overcrowding, and secondarily to solicit potential solutions to the problem.Methods:Focus groups were conducted with front-line staff, physicians and managers from 7 EDs within an integrated health region. Participants received questions before the sessions, and an experienced moderator conducted the sessions and prepared transcripts from audio tapes. Analyses included identification of key themes and the interrelationships between those themes.Results:Focus group participants defined service pressures that result in overcrowding as “anything that impedes the flow of patients through the ED, affects the quality of care delivered or results in patient frustration and stress to staff.” Overcrowding, which can occur at any time of the day, was perceived to have many causes, including some seasonal factors. Two key problems were identified as causing many spin-off pressures: inefficient access to ED beds (stretchers) because of slow throughput of patients and staff shortages. Other perceived causes included the changing role and use of EDs and limited access to services such as home care, diagnostic imaging, laboratory services, social services and specialist care. Participants generally believed that the characteristics and causes of overcrowding could not be viewed independently; rather, in the search for remedies, they should be considered as interrelated variables.Conclusion:Qualitative studies of this complex issue can identify and describe complex interactions in real-world settings. The findings of such studies can lead to quantitative studies involving objective measurement.

Objective:The effect of Alberta’s health reform on length of stay for maternity cases and on subsequent mothers’ rehospitalization was examined in the present study. Methods:The data set included all Alberta acute care hospital separation records from 1991/92 to 1996/97 inclusive. A logistic regression was applied to the data in order to examine the effects of prepartum condition, type of delivery, length of stay, maternal age, and year on the likelihood of readmission. Results:Health reform proved to be associated with a dramatic decrease in length of stay for maternity cases; from 3.8 to 2.4 days on average. This was accompanied by very little variation in the 90-day readmission rate for mothers over the same time period (notably, a slight decrease). Higher readmission rates were associated with the existence of difficulties during the pregnancy and other prenatal conditions, maternal age, and with the type of delivery. There were no dramatic changes in the rates for prepartum diagnoses, nor for the type of delivery. Discussion:The data suggest that the reduction in the length of maternity stay has had no discernible negative health effects on new mothers, perhaps because of the home visiting programs that were put in place. Furthermore, there may still be room to improve outcomes by focussing on those with prepartum conditions and cases involving complicated births. Objectif:Cette étude porte sur l’effet de la réforme de la santé en Alberta sur la durée du séjour à l’hôpital après l’accouchement et sur les réhospitalisations subséquentes des mères. Méthode:Nous avons étudié les données de tous les registres de sortie des hôpitaux albertains de soins actifs, de 1991–1992 à 1996–1997, inclusivement. Nous les avons analysées par régression logistique pour déterminer les effets de diverses variables (état de santé avant l’accouchement, mode d’accouchement, durée du séjour, âge maternel et année) sur la vraisemblance d’une réadmission. Résultats:La réforme de la santé était associée à une réduction considérable de la durée du séjour à la maternité, qui est passé de 3,8 à 2,4 jours en moyenne. Elle s’est accompagnée d’un très faible écart (en fait, une légère baisse) dans le taux de réadmission des mères dans un délai de 90 jours pendant la même période. Les taux de réadmission élevés étaient associés aux grossesses difficiles et autres troubles prénatals, à l’âge maternel et au mode d’accouchement. Il n’y a pas eu de changements considérables dans les taux associés au diagnostic avant l’accouchement ou au mode d’accouchement. Discussion:Ces données portent à croire que la réduction de la durée du séjour à la maternité n’a eu aucun effet néfaste évident sur la santé des nouvelles mères, peut-être en raison de la mise en place de programmes de visites à domicile. En outre, il serait encore possible d’améliorer ces résultats en mettant l’accent sur les mères dont la grossesse a été difficile et les naissances avec complications.

Objectives:To determine variations in the rate of inpatient and outpatient dilatation and curettage (D&C), for the treatment of early pregnancy loss and for the diagnosis of abnormal uterine bleeding, in 17 health regions across a Canadian province.

Objective:Between 1994/95 and 1996/7, the healthcare system in Alberta underwent a radical transformation that saw the regionalization of service delivery and a reduction in overall healthcare funding. The aim of this study is to examine trends in utilization and associated post-operative complications and readmissions for two procedures, total hip arthroplasty (THA) and total knee arthroplasty (TKA) during this period of restructuring.Methods:This is a six-year retrospective analysis using hospital separation and healthcare insurance plan registry databases. During the study period, we looked at trends in inpatient procedure volumes, average lengths of stay, postoperative complications during the index hospital stay and readmissions within one year.Results:Over a six-year period, the age-sex standardized provincial rate of THAs increased by 18% while the rate of TKAs increased by 73%. Average lengths of stay decreased for both procedures by over 50%. The rate of procedures with at least one postoperative complication within the index episode of care decreased over the study period by 19% for THA and 21% for TKA. Readmissions due to complications of surgery increased overall by 32% for THA and 2% for TKA. Regional and sex differences were observed throughout the period.Conclusions:While the overall rate of hospitalizations has decreased in Alberta, the rates of THA and TKA procedures have increased. The lengths of stay following these procedures have, at the same time, reduced dramatically. Adverse outcomes as measured by complication rates associated with these procedures have decreased, though readmissions due to complications after surgery have increased.

Between 1994/95 and 1996/7, the healthcare system in Alberta underwent a radical transformation that saw the regionalization of service delivery and a reduction in overall healthcare funding. The aim of this study is to examine trends in utilization and associated post-operative complications and readmissions for two procedures, total hip arthroplasty (THA) and total knee arthroplasty (TKA) during this period of restructuring.

Background:In February 1994 Alberta Health announced a three-year business plan for the radical restructuring of the health care system in Alberta. The business plan outlined large reductions in funding for acute hospital care spending and the establishment of 17 Regional Health Authorities (RHAs).Objectives:The objectives of this study are to describe for the period 1991/2 to 1996/7:Results:Between 1991/2 and 1996/7, the age-sex standardized separation rate, the age-sex standardized average length of stay, and age-sex standardized hospital days rate for Alberta residents fell by 25.6%, 18.7%, and 39.5% respectively. The age-standardized hospital days rate fell in all 17 RHAs. The total number of separations (Alberta residents and non-residents) from Alberta acute care facilities fell by 19.6% while the average care intensity for all separations from Alberta acute care facilities rose by 8.7%. The ratio of the highest to lowest average RHA care intensity remained between 1.7 and 1.9 during the study period. RHA self-su flciency indices increased dramatically in one RHA and remained largely unchanged in the remaining RHAs. RHA import indices decreased for most RHAs.Conclusions:Large reductions in the use of acute hospital services have occurred in Alberta during the period of major health care restructuring. Further research is needed to examine shifts in services to other sectors and to assess the impact of these reductions on patient outcomes.

In February 1994 Alberta Health announced a three-year business plan for the radical restructuring of the health care system in Alberta. The business plan outlined large reductions in funding for acute hospital care spending and the establishment of 17 Regional Health Authorities (RHAs).