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2. Silver-enriched Microdomain Patterns as Advanced Bactericidal Coatings for Polymer-based Medical Devices

Author

Pryjmakova, Jana, Vokata, Barbora, Slouf, Miroslav, Hubacek, Tomas, Martinez-Garcia, Patricia, Rebollar, Esther, Slepicka, Petr, and Siegel, Jakub

Subjects
Physics - Medical Physics
Abstract

Today, it would be difficult for us to live a full life without polymers, especially in medicine, where its applicability is constantly expanding, giving satisfactory results without any harm effects on health. This study focused on the formation of hexagonal domains doped with AgNPs using a KrF excimer laser ({\lambda}=248 nm) on the polyetheretherketone (PEEK) surface that acts as an unfailing source of the antibacterial agent - silver. The hexagonal structure was formed with a grid placed in front of the incident laser beam. Surfaces with immobilized silver nanoparticles (AgNPs) were observed by AFM and SEM. Changes in surface chemistry were studied by XPS. To determine the concentration of released Ag+ ions, ICP-MS analysis was used. The antibacterial tests proved the antibacterial efficacy of Ag-doped PEEK composites against Escherichia coli and Staphylococcus aureus as the most common pathogens. Because AgNPs are also known for their strong toxicity, we also included cytotoxicity tests in this study. The findings presented here contribute to the advancement of materials design in the biomedical field, offering a novel starting point for combating bacterial infections through the innovative integration of AgNPs into inert synthetic polymers.

Published
2024

3. The QuEST LAC network uses data to promote evidence-based policies for health in Latin America

Author

García, Patricia J, Leslie, Hannah, Medina-Ranilla, Jesús, Espinoza-Pajuelo, Laura, Guglielmino, Marina, Roberti, Javier, Mazzoni, Agustina, and García-Elorrio, Ezequiel

Subjects
Biomedical and Clinical Sciences, Health Sciences, Humans, Health Policy, Latin America, Evidence-Based Practice, Medical and Health Sciences, Immunology, Biomedical and clinical sciences, Health sciences
Published
2024

5. A mild increase in nutrient signaling to mTORC1 in mice leads to parenchymal damage, myeloid inflammation and shortened lifespan

Author

Ortega-Molina, Ana, Lebrero-Fernández, Cristina, Sanz, Alba, Calvo-Rubio, Miguel, Deleyto-Seldas, Nerea, de Prado-Rivas, Lucía, Plata-Gómez, Ana Belén, Fernández-Florido, Elena, González-García, Patricia, Vivas-García, Yurena, Sánchez García, Elena, Graña-Castro, Osvaldo, Price, Nathan L., Aroca-Crevillén, Alejandra, Caleiras, Eduardo, Monleón, Daniel, Borrás, Consuelo, Casanova-Acebes, María, de Cabo, Rafael, and Efeyan, Alejo

Published
2024
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8. Informal payments in health facilities in Peru in 2018: Analysis of a cross-sectional survey

Author

Espinoza-Pajuelo, Laura, Mallma, Patricia, Leslie, Hannah Hogan, and García, Patricia Jannet

Subjects
Public Health, Health Sciences, Human Society, Behavioral and Social Science, Generic health relevance, Peace, Justice and Strong Institutions
Abstract

BackgroundThe Latin American region demonstrates the lowest levels of trust in health systems globally. Institutional corruption is a major factor in eroding trust. Corruption in health services, including extracting bribes and informal payments from patients, directly harms health outcomes and weakens services intended as public goods. In this study, we aim to characterize the frequency and distribution of informal payments within public health services in Peru.MethodsWe conducted a secondary analysis of a nationally representative cross-sectional survey, the 2018 National Household Survey of Living Conditions and Poverty, and identified all individuals reporting health insurance from the Ministry of Health (SIS-MINSA) or Social Security (ESSALUD). We defined self-reported informal payments in 2 ways: 1) being asked to pay a bribe at a health establishment in the past year (direct method), and 2) creating an overall indicator for non-zero cost of care for services that should be free (indirect method). We used descriptive statistics to quantify informal payments and bivariate analysis to identify sociodemographic characteristics of those most frequently reporting such payments.Findings132,355 people were surveyed, including 69,839 (52.8%) with coverage from SIS-MINSA and 30,461 (23.03%) from ESSALUD. Less than 1% of participants directly reported informal payments, either at SIS-MINSA services (0.22%); or at ESSALUD (0.42%). Indirect reporting was more prevalent, including up to 10% of surgery patients and 17% of those hospitalized in SIS-MINSA facilities. Wealthier patients (19%) were more likely to report such payments.InterpretationWhile direct reporting of bribery was uncommon, we found moderate prevalence of informal payments in public health services in Peru using an indirect assessment method. Indirect reporting may exceed direct reporting due to difficulty in distinguishing appropriate and inappropriate payments, fear of reporting health care workers' behavior, or social tolerance of informal payments. Informal payments were more common among those with greater financial capital, indicating they may obtain enhanced services. Further research on patients' perception and reporting of informal payments is a key step towards accurate measurement and evidence-based intervention.

Published
2024

9. Inequalities in health system coverage and quality: a cross-sectional survey of four Latin American countries

Author

Roberti, Javier, Leslie, Hannah H, Doubova, Svetlana V, Ranilla, Jesús Medina, Mazzoni, Agustina, Espinoza, Laura, Calderón, Renzo, Arsenault, Catherine, García-Elorrio, Ezequiel, and García, Patricia J

Subjects
Health Services and Systems, Public Health, Health Sciences, Health Services, Prevention, Clinical Research, Behavioral and Social Science, Health and social care services research, 8.1 Organisation and delivery of services, Generic health relevance, Good Health and Well Being, Reduced Inequalities, Humans, Aged, Latin America, Cross-Sectional Studies, Pandemics, Mexico, Income, Microbiology, Public Health and Health Services, Epidemiology, Health services and systems, Public health
Abstract

The premise of health as a human right in Latin America has been challenged by health system fragmentation, quality gaps, a growing burden of chronic disease, sociopolitical upheaval, and the COVID-19 pandemic. We characterised inequities in health system quality in Colombia, Mexico, Peru, and Uruguay. We did a cross-sectional telephone survey with up to 1250 adults in each country. We created binary outcomes in coverage, user experience, system competence, and confidence in the system and calculated the slope index of inequality by income and education. Although access to care was high, only a third of respondents reported having a high-quality source of care and 25% of those with mental health needs had those needs met. Two-thirds of adults were able to access relevant preventive care and 42% of older adults were screened for cardiovascular disease. Telehealth access, communication and autonomy in most recent visit, reasonable waiting times, and receiving preventive health checks showed inequalities favouring people with a high income. In Uruguay, inequality between government and social security services explained a substantial proportion of disparities in preventive health access. In other study countries, inequalities were also substantial within government and social security subsectors. Essential health system functions are unequal in these four Latin American countries.

Published
2024

11. A systematic review of population and patient perspectives and experiences as measured in Latin American and Caribbean surveys

Author

Medina-Ranilla, Jesús, Espinoza, Laura Angélica, Mazzoni, Agustina, Roberti, Javier, Elorrio, Ezequiel García-, Leslie, Hannah Hogan, and García, Patricia Jannet

Subjects
Health Services and Systems, Public Health, Health Sciences, Health Services, Clinical Research, Health and social care services research, 8.1 Organisation and delivery of services, Generic health relevance, Good Health and Well Being, Population surveys, quality of care, Latin America and the Caribbean, systematic review, patient-reported experiences, Public Health and Health Services, Policy and Administration, Political Science, Health Policy & Services, Health services and systems, Public health, Policy and administration
Abstract

High-quality health systems must provide accessible, people-centred care to both improve health and maintain population trust in health services. Furthermore, accurate measurement of population perspectives is vital to hold health systems accountable and to inform improvement efforts. To describe the current state of such measures in Latin America and the Caribbean (LAC), we conducted a systematic review of facility and population-based assessments that included patient-reported experience and satisfaction measures. Five databases were searched for publications on quantitative surveys assessing healthcare quality in Spanish- or Portuguese-speaking LAC countries, focusing on the domains of processes of care and quality impacts. We included articles published since 2011 with a national sampling frame or inclusion of multiple subnational regions. We tabulated and described these articles, identifying, classifying and summarizing the items used to assess healthcare quality into the domains mentioned earlier. Of the 5584 publications reviewed, 58 articles met our inclusion criteria. Most studies were cross-sectional (95%), assessed all levels of healthcare (57%) and were secondary analyses of existing surveys (86%). The articles yielded 33 unique surveys spanning 12 LAC countries; only eight of them are regularly administered surveys. The most common quality domains assessed were satisfaction (in 33 out of 58 articles, 57%), evidence-based/effective care (34%), waiting times (33%), clear communication (33%) and ease of use (31%). Items and reported ratings varied widely among instruments used, time points and geographical settings. Assessment of patient-reported quality measures through population- and facility-based surveys is present but heterogeneous in LAC countries. Satisfaction was measured frequently, although its use in accountability or informing quality improvement is limited. Measurement of healthcare quality in LAC needs to be more systematic, regular, comprehensive and to be led collaboratively by researchers, governments and policymakers to enable comparison of results across countries and to effectively inform policy implementation.

Published
2023

14. Bezlotoxumab during the first episode of Clostridioides difficile infection in patients at high risk of recurrence

Author

Escudero-Sanchez, Rosa, Ramos-Martínez, Antonio, Caballero-Bermejo, Antonio F., Díaz-Pollán, Beatriz, Ruiz-Carrascoso, Guillermo, Samperio, María Olmedo, García, Patricia Muñoz, Amador, Paloma Merino, Romo, Fernando González, Segarra, Oriol Martín, Jiménez, Gema Navarro, del Campo Albendea, Laura, García, Alfonso Muriel, and Cobo, Javier

Published
2024
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15. Mathematical Modelling of Neuroblast Chemotaxis Migration towards the Olfactory Bulb

Author

Acosta-Soba, Daniel, Castro-González, Carmen, Geribaldi-Doldán, Noelia, Guillén-González, Francisco, Núñez-Abades, Pedro, Ortega-Román, Noelia, Pérez-García, Patricia, and Rodríguez-Galván, J. Rafael

Subjects
Mathematics - Numerical Analysis
Abstract

This article is devoted to the mathematical modeling of migration of neuroblasts, precursor cells of neurons, along the pathway they usually follow before maturing. This pathway is determined mainly by chemotaxis and the heterogeneous mobility of neuroblasts in different regions of the brain. In numerical simulations, the application of novel discontinuous Galerkin methods allows to maintain the properties of the continuous model such as the maximum principle. We present some successful computer tests including parameter adjust to fit real data from rodent brains.

Published
2022

16. GTMDs and the factorization of exclusive double Drell-Yan

Author

Echevarria, Miguel G., Garcia, Patricia A. Gutierrez, and Scimemi, Ignazio

Subjects
High Energy Physics - Phenomenology, High Energy Physics - Experiment, High Energy Physics - Lattice, Nuclear Experiment, Nuclear Theory
Abstract

Different exclusive processes have been proposed to access the generalized transverse momentum dependent distributions (GTMDs) with no proof of factorization, which allows to rigorously define the GTMDs. Using Soft Collinear Effective Theory we derive for the first time the factorization of the differential cross section for the exclusive double Drell-Yan process for the exclusive double Drell-Yan process pion N to N' gamma* gamma* to N' (l^+l^-)(l^+l^-), for small transverse momenta of the photons in terms of a perturbatively calculable hard factor, GTMDs and light-cone wave functions (LCWFs). We find that the hard factor of the process can be obtained from single inclusive Drell-Yan production so that one can resum logarithms at high orders in QCD. We also discuss the evolution of the GTMDs and the LCWFs., Comment: 9 pages, 3 figure. Version accepted for publication

Published
2022
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20. Satisfacción percibida con los ingresos en unidades de hospitalización breve psiquiátricas: diseño y validación del cuestionario PSYQUEST

Author

Cocho Santalla, Clara, Vera López, Ignacio, Bardón Rivera, Belén, Gómez Olmeda, María Dolores, Duque Domínguez, Rosa, Fadón Martín, Patricia, Blanco Prieto, Margarita, García Jorge, Silvia, Martínez Hernanz, Ángeles, Molina Serrano, Almudena, Mollejo Aparicio, Encarnación, Nava García, Patricia, Salvador Robert, Mercè, Sánchez Morla, Eva María, Sanz-Aranguez Ávila, Belén, Vives Luengo, Alicia, Martínez Arias, María Rosario, and Sanz Fuentenebro, Francisco Javier

Published
2024
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21. Impact of COVID-19 infection on lung function and nutritional status amongst individuals with cystic fibrosis: A global cohort study

Author

Kasmi, Irena, Drali, Ouardia, Burghart, Sabine, Lakatos-Krepcik, Andrea, Eder, Johannes, Jaksch, Peter, Kainz, Katharina, Kallinger, Margit, Leitner, Alexander, Mozdzen, Marta, Pfleger, Andreas, Renner, Sabine, Stadlinger, Martin, Thir, Christina, Nuriyev, Emil, Boboli, Hedwige, De Wachter, Elke, Dupont, Lieven, Gohy, Sophie, Hanssens, Laurence, Knoop, Christiane, Lammertyn, Elise, Nowé, Vicky, Pirson, Jessica, Thimmesch, Matthieu, Van Braeckel, Eva, Van Hoorenbeeck, Kim, Vanderhelst, Eef, Filho, Eduardo Piacentini, Athanazio, Rodrigo Abensur, Martins, Valéria de Carvalho, Duarte, Marta Cristina, Monte, Luciana de Freitas Velloso, de Fuccio, Marcelo Bicalho, Knabben, Adriana de Siqueira Carvalho, Melloti, Roberta, Meneses, Daniela Gois, Petrova, Guergana, Tješić-Drinković, Duška, Dugac, Andrea Vukić, Bambir, Ivan, Yiallouros, Panayiotis, Bilkova, Alena, Drevinek, Pavel, Macek, Milan, Jr, Olesen, Hanne Vebert, Pressler, Tania, Fouda, Eman Mahmoud, Nasr, Samya, Weldetsadik, Abate Yeshidinber, Al-iede, Montaha, Abdrakhmanov, Olzhas, Corvol, Harriet, Lemonnier-Videau, Lydie, Abely, Michel, Piccini, Carole Bailly, Belleguic, Chantal, Bihouee, Tiphaine, Billon, Yves, Bui, Stéphanie, Camara, Boubou, Cheraud, Marie-Christine, Chiron, Raphael, Duet, Emmanuelle Coirier, Cosson, Laure, Dalphin, Marie-Laure, Boucher, Isabelle Danner, De Miranda, Sandra, Deneuville, Eric, Dubus, Jean-Christophe, Durieu, Isabelle, Epaud, Ralph, Gerardin, Michèle, Grenet, Dominique, Houdouin, Véronique, Huet, Frédéric, Reem, Kanaan, Kessler, Romain, Languepin, Jeanne, Laurans, Muriel, Leroy, Sylvie, Llerena, Cathie, Macey, Julie, Mankikian, Julie, Marguet, Christophe, Martin, Clémence, Mely, Laurent, Mittaine, Marie, Murris-Espin, Marlène, Perisson, Caroline, Prevotat, Anne, Ramel, Sophie, Rames, Cinthia, Reix, Philippe, Revillon, Marine, Reynaud-Gaubert, Martine, Richaud-Thiriez, Bénédicte, Rittie, Jean-Luc, Scalbert-Dujardin, Manuëla, Sermet-Gaudelus, Isabelle, Storni, Véronique, Tatopoulos, Aurélie, Thouvenin, Guillaume, Troussier, Françoise, Weiss, Laurence, Wizla, Nathalie, Behl, Eva-Susanne, Brinkmann, Folke, Claßen, Martin, Graepler-Mainka, Ute, Griese, Matthias, Grübl, Armin, Hammermann, Jutta, Hebestreit, Helge, Heinzmann, Andrea, Herz, Alexander, Kiefer, Alexander, Kinder, Birte, Köster, Holger, Kuhnert, Stefan, Mainz, Jochen, Mayer, Angelika, Naehrig, Susanne, Niehues, Tim, Nüßlein, Thomas, Poplawska, Krystyna, Ringshausen, Felix, Rose, Markus, Rosenecker, Josef, Ruppel, Renate, Scharschinger, Anette, Schropp, Christian, Schwarz, Carsten, Smaczny, Christina, Sommerburg, Olaf, Sutharsan, Sivagurunathan, Stolz, Simone, Thomas, Wolfgang, Wege, Sabine, Welzenbach, Britta, Wollschläger, Bettina, Diamantea, Filia, Hatziagorou, Elpis, Manika, Katerina, Cox, Des, Elnazir, Basil, Fletcher, Godfrey, Gunaratnam, Cedric, McKone, Edward F., Plant, Barry J., Cohen-Cymberknoh, Malena, Gur, Michal, Livnat, Galit, Mei-Zahav, Meir, Amato, Annalisa, Ferrari, Gianluca, Badolato, Raffaele, Poli, Piercarlo, Battistini, Fiorella, Donati, Valentina, Bignamini, Elisabetta, Folino, Anna, Carnovale, Vincenzo, Castellani, Carlo, Casciaro, Rosaria, Cimino, Giuseppe, Cipolli, Marco, Lucca, Francesca, Collura, Mirella, Ficili, Francesca, Daccò, Valeria, Gagliano, Vanessa, Pizzamiglio, Giovanna, Mencarini, Valeria, Palladino, Nicola, Leonardi, Salvatore, Rotolo, Novella, Lucanto, Maria Cristina, Quattromano, Ester, Lucidi, Vincenzina, Majo, Fabio, Alghisi, Federico, Ciciriello, Fabiana, Manca, Antonio, Leonetti, Giuseppina, Maschio, Massimo, Messore, Barbara, Pantano, Stefano, Pisi, Giovanna, Spaggiari, Cinzia, Raia, Valeria, Laezza, Caterina, Ros, Mirco, Salvatore, Donatello, Taccetti, Giovanni, Francalanci, Michela, Vitullo, Pamela, Zolin, Anna, Aleksejeva, Elina, Malakauskas, Kestutis, Misevičiene, Valdone, Charatsi, Anna-Maria, la Barrière, Hélène De, Altenburg, Josje, Bannier, Michiel, Heijerman, Harry, Janssens, Hettie, Koppelman, Gerard, van der Meer, Renske, Merkus, Peter, Nuijsink, Marianne, Terheggen, Suzanne, van der Vaart, Hester, Wesseling, Geert-Jan, de Winter, Karin, Danevska, Ivana Arnaudova, Maretti, Tatjana Jakovska, Fustik, Stojka, Dziecichowicz-Latała, Daria, Wojsyk-Banaszak, Irena, Wozniacki, Lukasz, Amorim, Adelina, Santos, Ana Sofia Araújo, Castanhinha, Susana, Gamboa, Fernanda, Silva, Teresa Reis, Gonçalves, Fabienne, Pereira, Luísa, Ciuca, Ioana, Silva, Sónia, Csilla-Enikö, Szabo, Stan, Iustina, Amelina, Elena, Boitсova, Evgeniya, Chernyavskaya, Anastasia, Gorinova, Yuliya, Krasovskiy, Stanislav, Mukhina, Maria, Sherman, Victoria, Simonova, Olga, Kondratyeva, Elena, Bérešová, Eva, Bližnáková, Nina, Kayserová, Hana, Salobir, Barbara, Šelb, Julij, Krivec, Uroš, Fernandez, Antonio José Aguilar, Fernàndez, Antonio Alvarez, García, Félix Baranda, Aparicio, Marina Blanco, Corullón, Silvia Castillo, Cortell-Aznar, Isidoro, Pérez, Inés, Colomer, Jordi Costa i, Roig, María Cols, Pecellín, Isabel Delgado, Cáceres, Layla Diab, Paredes, Carmen Luna, Gartner, Silvia, Martínez, José Ramón Gutiérrez, Labarga, Inés Herrero, Girón-Moreno, Rosa Maria, Nogueira, Esperanza Jiménez, Ferreiro, Adelaida Lamas, Neyra, Alejandro López, Castro, Enrique Blitz, Galarraga, Laura Moreno, de Vincente, Carlos Martin, Navarro, Silvia Merlos, Nieto-Royo, Rosa, Fuster, Casilda Olveira, Pastor, Maria Dolores, Pérez-Ruiz, Estela, Prados-Sánchez, Concepción, Cancelo, Isabel Ramos, de Valbuena, Marta Ruiz, Asensi, José R. Villa, Santiago, Veronica Sanz, García, Patricia Fernández, Tawfeeq, Reem Mustafa, Banki, Adrienn, Gilljam, Marita, Krantz, Christina, Lindberg, Ulrika, Lindblad, Anders, Clarenbach, Christian, Steinack, Carolin, Hage, René, Schuurmans, Macé, Fischer, Reta, Kusche, Rachel, Rochat, Isabelle, Walter, Anna-Lena, Kamalaporn, Harutai, Hamouda, Samia, Tural, Dilber Ademhan, Ozcelik, Ugur, Asfuroğlu, Pelin, Eyüboğlu, Tuğba Şişmanlar, Aslan, Ayse Tana, Bingöl, Ayşen, Çobanoğlu, Nazan, Ozcan, Gizem, Dogru, Deniz, Gökdemir, Yasemin, KÖSE, Mehmet, Pekcan, Sevgi, Cosgriff, Rebecca, Semenchuk, Julie, Naito, Yumi, Charman, Susan C., Carr, Siobhán B, Cheng, Stephanie Y., Marshall, Bruce C., Faro, Albert, Elbert, Alexander, Gutierrez, Hector H., Goss, Christopher H., Karadag, Bulent, Burgel, Pierre-Régis, Colombo, Carla, Salvatore, Marco, Padoan, Rita, Daneau, Géraldine, Harutyunyan, Satenik, Kashirskaya, Nataliya, Kirwan, Laura, Middleton, Peter G, Ruseckaite, Rasa, de Monestrol, Isabelle, Naehrlich, Lutz, Mondejar-Lopez, Pedro, Jung, Andreas, van Rens, Jacqui, Bakkeheim, Egil, Orenti, Annalisa, Zomer-van Ommen, Domenique, da Silva-Filho, Luiz Vicente RF, Fernandes, Flavia Fonseca, Zampoli, Marco, and Stephenson, Anne L.

Published
2024
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25. Evaluating patient-reported outcome measures in Peru: a cross-sectional study of satisfaction and net promoter score using the 2016 EnSuSalud survey

Author

Leslie, Hannah H, Lee, Hwa-Young, Blouin, Brittany, Kruk, Margaret E, and García, Patricia J

Subjects
Health Services and Systems, Health Sciences, Behavioral and Social Science, Health Services, Basic Behavioral and Social Science, Clinical Research, Good Health and Well Being, Cross-Sectional Studies, Humans, Patient Reported Outcome Measures, Patient Satisfaction, Personal Satisfaction, Peru, Reproducibility of Results, Surveys and Questionnaires, quality measurement, patient satisfaction, patient-centred care, ambulatory care, Health services and systems, Public health
Abstract

BackgroundPatient-reported measures attempt to quantify the value health services provide to users. Satisfaction is a common summative measure, but often has limited utility in identifying poor quality care. We compared satisfaction and the net promoter score (NPS), which was developed to help businesses quantify consumer sentiment, in a nationally representative survey in Peru. We aimed to compare NPS and satisfaction as individual ratings of care, assess the relationship of patient-reported experience ratings to these outcome measures and consider the utility of these measures as indicators of facility performance based on reliability within facilities and capacity to discriminate between facilities.MethodsWe analysed the 2016 National Survey on User Satisfaction of Health Services, a cross-sectional outpatient exit survey. We assessed ratings by patient characteristics and compared the distributions of satisfaction and NPS categories. We tested the association of patient-reported experience measures with each outcome using multilevel ordinal logistic regression. We used intraclass correlation (ICC) from these models to predict minimum sample for reliable assessment and compared patient-reported experience measures in facilities with average satisfaction but below or above average NPS.Results13 434 individuals rated services at 184 facilities. Satisfaction (74% satisfied) and NPS (17% reported at least 9 out of 10) were largely concordant within individuals but weakly correlated (0.37). Ratings varied by individual factors such as age and visit purpose. Most domains of patient-reported experience were associated with both outcomes. Adjusted ICC was higher for NPS (0.26 vs 0.11), requiring a minimum of 7 (vs 20) respondents for adequate reliability. Within the 70% of facilities classified as average based on satisfaction, NPS-based classification revealed systematic differences in patient-reported experience measures.ConclusionWhile satisfaction and NPS were broadly similar at an individual level, this evidence suggests NPS may be useful for benchmarking facility performance as part of national efforts in Peru and throughout Latin America to identify deficits in health service quality.

Published
2022

41. Genomic characterisation of the population structure and antibiotic resistance of Salmonella enterica serovar Infantis in Chile, 2009–2022

Author

Piña-Iturbe, Alejandro, Díaz-Gavidia, Constanza, Álvarez, Francisca P., Barron-Montenegro, Rocio, Álvarez-Espejo, Diana M., García, Patricia, Solís, Doina, Constenla-Albornoz, Rodrigo, Toro, Magaly, Olivares-Pacheco, Jorge, Reyes-Jara, Angélica, Meng, Jianghong, Bell, Rebecca L., and Moreno-Switt, Andrea I.

Published
2024
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45. Health care provider time in public primary care facilities in Lima, Peru: a cross-sectional time motion study

Author

Leslie, Hannah H, Laos, Denisse, Cárcamo, Cesar, Pérez-Cuevas, Ricardo, and García, Patricia J

Subjects
Health Services and Systems, Health Sciences, Health Services, Clinical Research, Generic health relevance, Good Health and Well Being, Cross-Sectional Studies, Female, Health Personnel, Humans, Latin America, Peru, Pregnancy, Primary Health Care, Absenteeism, Health information systems, Primary health care, Time motion, Library and Information Studies, Nursing, Public Health and Health Services, Health Policy & Services, Health services and systems, Public health
Abstract

BackgroundIn Peru, a majority of individuals bypass primary care facilities even for routine services. Efforts to strengthen primary care must be informed by understanding of current practice. We conducted a time motion assessment in primary care facilities in Lima with the goals of assessing the feasibility of this method in an urban health care setting in Latin America and of providing policy makers with empirical evidence on the use of health care provider time in primary care.MethodsThis cross-sectional continuous observation time motion study took place from July - September 2019. We used two-stage sampling to draw a sample of shifts for doctors, nurses, and midwives in primary health facilities and applied the Work Observation Method by Activity Timing tool to capture type and duration of provider activities over a 6-h shift. We summarized time spent on patient care, paper and electronic record-keeping, and non-work (personal and inactive) activities across provider cadres. Observations are weighted by inverse probability of selection.ResultsTwo hundred seventy-five providers were sampled from 60 facilities; 20% could not be observed due to provider absence (2% schedule error, 8% schedule change, 10% failure to appear). One hundred seventy-four of the 220 identified providers consented (79.1%) and were observed for a total of 898 h of provider time comprising 30,312 unique tasks. Outpatient shifts included substantial time on patient interaction (110, 82, and 130 min for doctors, nurses, and midwives respectively) and on paper records (132, 97, and 141 min) on average. Across all shifts, 1 in 6 h was spent inactive or on personal activities. Two thirds of midwives used computers compared to half of nurses and one third of doctors.ConclusionsThe time motion study is a feasible method to capture primary care operations in Latin American countries and inform health system strengthening. In the case of Lima, absenteeism undermines health worker availability in primary care facilities, and inactive time further erodes health workforce availability. Productive time is divided between patient-facing activities and a substantial burden of paper-based record keeping for clinical and administrative purposes. Electronic health records remain incompletely integrated within routine care, particularly beyond midwifery.

Published
2021

49. Population confidence in the health system in 15 countries: results from the first round of the People's Voice Survey

Author

Kruk, Margaret E, Kapoor, Neena R, Lewis, Todd P, Arsenault, Catherine, Boutsikari, Eleni C, Breda, João, Carai, Susanne, Croke, Kevin, Dayalu, Rashmi, Fink, Günther, Garcia, Patricia J, Kassa, Munir, Mohan, Sailesh, Moshabela, Mosa, Nzinga, Jacinta, Oh, Juhwan, Okiro, Emelda A, Prabhakaran, Dorairaj, SteelFisher, Gillian K, Tarricone, Rosanna, and Garcia-Elorrio, Ezequiel

Published
2024
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