The gatekeeper policy has been implemented for approximately ten years on a pilot population in China. It is necessary to assess the satisfaction of patients utilizing community health service (CHS) under the gatekeeper system. Our study showed that the cognition of gatekeeper policy was associated with four dimensions including doctor-patient relationships, information and support, organization of care, and accessibility (P < 0.001). One or more factors such as gender and self-perceived health scores also affected their satisfaction. General practitioners must be prepared to focus on these aspects of information and support, organization of care, and accessibility as indicators of potential opportunities for improvement. Additionally, policymakers can improve patients' satisfaction with CHS by strengthening their awareness of the gatekeeper policy.
Adolescent ; Adult ; China ; Community Health Services ; organization & administration ; Data Collection ; Female ; Humans ; Male ; Middle Aged ; Patient Satisfaction ; statistics & numerical data ; Young Adult

INTRODUCTIONThe objectives of this current study were to: 1) examine the prevalence and correlates of diabetes mellitus (DM) among older adults (aged 60 years and above) in a multi-ethnic population; 2) examine the prevalence and correlates of comorbid DM and depression among them; and 3) assess the effect of comorbid depression on disability, cognition and healthcare utilisation.

MATERIALS AND METHODSData for the current study came from the Well-being of the Singapore Elderly (WiSE) study; a single phase, cross-sectional survey conducted among Singapore residents aged 60 years and above. A total of 2565 respondents completed the survey; depression was assessed using the Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT) while a diagnosis of DM was considered if respondents stated that a doctor had diagnosed them with DM.

RESULTSDM was reported by 25.5% of the population. The prevalence of depression was significantly higher in those diagnosed with DM than those without DM (6% vs 3%). After adjusting for sociodemographic correlates, smoking and other chronic conditions, DM remained significantly associated with depression and subsyndromal depression. However, after including measures of functioning and cognitive impairment as covariates, DM was not significantly related to depression and subsyndromal depression. Those with comorbid DM and depression were more likely to be of Indian and Malay ethnicity, aged 75 to 84 years (versus 60 to 74 years) and widowed.

CONCLUSIONGiven the significant association of certain sociodemographic groups with comorbid depression among those with DM, targeted interventions for prevention and early diagnosis in these groups should be considered.

Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; statistics & numerical data ; Comorbidity ; Cross-Sectional Studies ; Depression ; epidemiology ; Depressive Disorder ; epidemiology ; Diabetes Mellitus ; epidemiology ; Ethnic Groups ; statistics & numerical data ; Female ; Health Services ; utilization ; Humans ; India ; ethnology ; Malaysia ; ethnology ; Male ; Middle Aged ; Prevalence ; Severity of Illness Index ; Singapore ; epidemiology ; Surveys and Questionnaires

We investigated trends in perioperative chemotherapy use, and determined factors associated with neoadjuvant chemotherapy (NAC) and adjuvant chemotherapy (AC) use in Korean patients with muscle-invasive bladder cancer (MIBC). We recruited 1,324 patients who had MIBC without nodal invasion or metastases and had undergone radical cystectomies (RC) between 2003 and 2013. The study's cut-off time for AC was three months after surgery, and the study's timespan was divided into three periods based on NAC use, namely, 2003-2005, 2006-2009, and 2010-2013. Complete remission was defined as histologically confirmed T0N0M0 after RC. NAC and AC were administered to 7.3% and 18.1% of the patients, respectively. The median time interval between completing NAC and undergoing RC was 32 days and the mean number of cycles was 3.2. The median time interval between RC and AC was 43 days and the mean number of cycles was 4.1. Gemcitabine and cisplatin were most frequently used in combination for NAC (49.0%) and AC (74.9%). NAC use increased significantly from 4.6% between 2003 and 2005 to 8.4% between 2010 and 2013 (P < 0.05), but AC use did not increase. Only 1.9% of patients received NAC and AC. Complete remission after NAC was achieved in 12 patients (12.5%). Multivariable modeling revealed that an advanced age, the earliest time period analyzed, and clinical tumor stage < or = cT2 bladder cancer were negatively associated with NAC use (P < 0.05). While NAC use has slowly increased over time, it remains an underutilized therapeutic approach in Korean clinical practice.
Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents/*therapeutic use ; Chemotherapy, Adjuvant/trends/utilization ; Cystectomy/trends/*utilization ; Drug Administration Routes ; Drug Administration Schedule ; Female ; Health Services Misuse/statistics & numerical data/trends ; Humans ; Male ; Middle Aged ; Muscle, Smooth/*pathology ; Neoadjuvant Therapy/statistics & numerical data/trends ; Neoplasm Invasiveness ; Practice Patterns, Physicians'/statistics & numerical data/trends ; Prevalence ; Republic of Korea/epidemiology ; Risk Factors ; Treatment Outcome ; Urinary Bladder Neoplasms/epidemiology/*pathology/*therapy

Participation in a screening program by itself may not improve clinical outcomes. Treatment gaps in the program may limit its full benefit. We evaluated statin prescription rates for subjects with sustained hypercholesterolemia to assess the treatment gaps in the National Health Screening Program (NHSP) in Korea. A retrospective, random cohort was established among National Health Insurance Corporation (NHIC) members. Finally, we examined 465,499 individuals who attended the NHSP from 2003 to 2010 without any history of dyslipidemia, statin prescription, or hospitalization for cardiovascular events until the end of 2002. The subsequent statin prescription rates were identified from the NHIC medical service claim database from 2003 to 2011. Descriptive data and odds ratio from multivariate logistic analyses on statin prescription rates and the corresponding correlations were evaluated. The NHSP detected 114,085 (24.5%) cases of newly diagnosed hypercholesterolemia. However, only 8.6% of these received statin prescription within 6 months of diagnosis. For cases of sustained hypercholesterolemia determined in the next screening visit by the NHSP, the statin prescription rate increased, but only to 12.2%. Statin prescriptions were more common among females, older individuals, and hypertension or diabetes patients. Furthermore, the statin prescription rates had increased over the study period. The NHSP exhibited low statin prescription rate which has been improving. For the NHSP to be effective, it would be worthwhile to decrease the gap between the diagnosis of hypercholesterolemia and the following treatment.
Adult ; Chronic Disease ; Drug Prescriptions/statistics & numerical data ; Female ; Health Services Accessibility/statistics & numerical data ; Healthcare Disparities/*statistics & numerical data ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use ; Hypercholesterolemia/*diagnosis/epidemiology/*prevention & control ; Insurance Claim Reporting/statistics & numerical data ; Male ; Mass Screening/*utilization ; Middle Aged ; National Health Programs/*utilization ; Prevalence ; Republic of Korea/epidemiology ; Risk Assessment ; Treatment Outcome ; Young Adult

INTRODUCTIONThere is a high prevalence of polypharmacy and inappropriate medication use in Singapore nursing homes. This study primarily explored the benefits of pharmacist reviews in local nursing homes. The secondary aims were to review the potential cost savings gained from following the pharmacists' recommendations and to identify the possible risks associated with polypharmacy and inappropriate medication use.

METHODSA retrospective period prevalence study was performed. We analysed the pharmacotherapy problems highlighted by pharmacists in three nursing homes and the rate of acceptance of pharmacists' recommendations. Data was collected in two phases: (a) a one-month pre-setup period, during which 480 patients were reviewed (i.e. one-time review before weekly pharmacist visits); and (b) a six-month post-setup period, during which the 480 patients were reviewed again. Pharmacotherapy problems were classified according to a clinical pharmacist recommendation taxonomy and potential risks were identified. Monthly cost savings were calculated and compared with the monthly costs of pharmacist reviews.

RESULTSA total of 392 pharmacotherapy problems were identified, with pharmacist recommendations noted for each problem. Among the 392 recommendations, 236 (60.2%) were accepted. The pharmacotherapy problems were analysed for potential risks, including falls (16.0%) and constipation (13.1%). The acceptance rates were higher during the post-setup period compared to the pre-setup period (p < 0.0001). Total direct acquisition cost savings during the pre- and post-setup periods were SGD 388.30 and SGD 876.69, respectively.

CONCLUSIONThe provision of pharmaceutical care to nursing home residents resulted in improved medication safety and quality of care.

Aged ; Drug Costs ; Drug Utilization Review ; economics ; statistics & numerical data ; Female ; Health Care Costs ; Humans ; Inappropriate Prescribing ; economics ; statistics & numerical data ; Male ; Nursing Homes ; Pharmaceutical Services ; economics ; Pharmacists ; Polypharmacy ; Prevalence ; Retrospective Studies ; Risk ; Singapore

INTRODUCTIONStudies examining mental health treatment dropout have primarily focused on Western populations and less so on Asian samples. The current study explored the prevalence and correlates of mental health treatment dropout across the various healthcare sectors in Singapore.

MATERIALS AND METHODSData was utilised from the Singapore Mental Health Study (SMHS), a cross-sectional epidemiological survey conducted among an adult population (n = 6616) aged 18 years and above. Statistical analyses were done on a subsample of respondents (n = 55) who had sought treatment from the various treatment providers (i.e. mental health, medical, social services and religious healers) in the past 12 months. The World Mental Health (WMH) Composite International Diagnostic Interview version 3.0 (CIDI 3.0) was used to determine diagnoses of mental disorders, chronic medical disorders and service utilisation.

RESULTSOf those who had received treatment, 37.6% had ended treatment prematurely, 23.2% had completed treatment and 39.2% were still in treatment. The religious and spiritual sector (83.1%) had the highest dropout, followed by the general medical sector (34.6%), mental health services sector (33.9%) and the social services sector (30%). Marital status emerged as the only sociodemographic factor that significantly predicted treatment dropout-with those who were married being significantly less likely to drop out than those who were single.

CONCLUSIONThe overall dropout rate across the various healthcare sectors was comparable to past studies. While the small sample size limits the generalisability of findings, the current study provides useful insight into treatment dropout in an Asian population.

Adolescent ; Adult ; Age Factors ; Asian Continental Ancestry Group ; statistics & numerical data ; Cross-Sectional Studies ; Educational Status ; Employment ; statistics & numerical data ; Female ; Health Services ; utilization ; Humans ; Income ; statistics & numerical data ; Male ; Marital Status ; statistics & numerical data ; Mental Disorders ; epidemiology ; therapy ; Mental Health Services ; utilization ; Middle Aged ; Patient Dropouts ; statistics & numerical data ; Prevalence ; Sex Factors ; Singapore ; epidemiology ; Social Work ; statistics & numerical data ; Spiritual Therapies ; utilization ; Surveys and Questionnaires ; Young Adult

Recently in Korea, the commercialization of health services has come to the fore, and the issue of egalitarianism/universal coverage in health is a matter for debate. This study explored the extent of Korean citizen's preference for egalitarian health policies focusing on the provision of health care service, financing and related factors. The data came from the 2011 Korean General Social Survey (KGSS) and the International Social Survey Program (ISSP). The preference for an egalitarian health policy (dependent variable) was divided into a preference for an egalitarian health services provision (ES) and a willingness to contribute (WC) to it. Each index was linearly regressed with demographic factors, socioeconomic status, ideology, and health-related factors. ES was significantly associated with an individual's egalitarianism and political liberalism, having illness/disability, having no additional private health insurance, and their perception of health insurance coverage. WC was associated with age, sex, household income, education, egalitarianism, and their perception of health insurance coverage. There were evidently different factors between ES and WC, mainly socioeconomic factors. WC was strongly influenced by socioeconomic status, whereas ES seemed to be linked more closely to economic affordability. Moreover, the results showed that Korean citizens prefer ES but do not like WC. These results deserve great attention, and the authorities should keep it in perspective. If the government wants to make a successful attempt to change the healthcare system through public policy, it will need to take public preferences into account.
Adolescent ; Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Consumer Behavior/*statistics & numerical data ; Employment/statistics & numerical data ; Female ; *Health Policy ; Health Services Accessibility/*statistics & numerical data ; Humans ; Income ; Male ; Middle Aged ; Patient Preference/*statistics & numerical data ; *Politics ; Republic of Korea/epidemiology ; Sex Distribution ; Social Class ; Socioeconomic Factors ; Surveys and Questionnaires ; Universal Coverage/*statistics & numerical data ; Young Adult

Against the backdrop of population aging, this paper presents the analysis of need-standardised health care utilization among elderly in India. Based on nationally representative morbidity and health care survey 2004, we demonstrate that the need for health care utilization is indeed pro-poor in nature. However, the actual health care utilization is concentrated among richer sections of the population. Further, the decomposition analysis reveals that income has a very strong role in shifting the distribution of health care away from the poor elderly. The impact of income on utilization is well-demonstrated even at the ecological-level as states with higher per capita incomes have higher elderly health care utilization even as the levels of need-predicted distribution across these states are similar. We also find that the distribution of elderly across social groups and their educational achievements favours the rich and significantly contributes to overall inequality. Nevertheless, contribution of need-related self-assessed health clearly favours pro-poor inequality. In concluding, we argue that to reduce such inequities in health care utilization it is necessary to increase public investments in health care infrastructure including geriatric care particularly in rural areas and underdeveloped regions to enhance access and quality of health care for the elderly.
Aged ; Aged, 80 and over ; *Cultural Characteristics ; Evidence-Based Medicine ; Female ; Health Care Rationing/*statistics & numerical data ; Health Equity/*statistics & numerical data ; Health Services for the Aged/*utilization ; Humans ; Income/*statistics & numerical data ; India/epidemiology ; Male ; Middle Aged ; Socioeconomic Factors ; *Utilization Review

INTRODUCTIONIn the context of rapid population ageing and the increase in number of activity of daily living (ADL) limitations with age, the number of older persons requiring human assistance in Singapore is likely to grow. To promote informed planning for the needs of these elderly, we project the number of resident Singaporeans 60 years of age and older with 1 or more ADL limitations requiring human assistance through 2030.

MATERIALS AND METHODSThe proportion of community-dwelling older adults with ADL limitations requiring human assistance, stratified by gender and age group, was calculated utilising a recent nationally-representative survey of older Singaporeans. The proportion of older adults in nursing homes with ADL limitations was estimated based on available literature. Together, these prevalence estimates were applied to a simulation of the future population of older adults in Singapore to derive an estimate of the number of individuals with ADL limitations requiring human assistance through 2030.

RESULTSBy 2030, the number of resident Singaporeans aged 60 years or older with 1 or more ADL limitations requiring human assistance is projected to be 82,968 persons (7% of the total population aged 60 years or older). Of this number, 38,809 (47%) are estimated to have 1 or 2 ADL limitations, and 44,159 (53%) are estimated to have 3 or more.

CONCLUSIONThe number of elderly Singaporeans with activity limitations is expected grow rapidly from 31,738 in 2010 to 82,968 in 2030. Estimates of the number of older individuals with ADL limitations requiring human assistance are of value for policymakers as well as acute and long-term care capacity planners as they seek to meet demand for health and social services in Singapore.

Activities of Daily Living ; Aged ; Aged, 80 and over ; Female ; Forecasting ; Health Services for the Aged ; statistics & numerical data ; Homes for the Aged ; statistics & numerical data ; Humans ; Independent Living ; Long-Term Care ; statistics & numerical data ; trends ; Male ; Middle Aged ; Singapore

OBJECTIVETo investigate the knowledge, attitudes, and practices regarding blood-borne occupational exposure among reproductive health staff in Tianjin, China.

METHODSBy random, stratified, and clustered sampling, 507 reproductive health-related medical workers in Tianjin were selected. A Self-Administered KAP Questionnaire on blood-borne occupational exposure was employed to gauge the general characteristics, awareness of knowledge, attitudes to occupational exposure, implementation of pre-exposure protection, incidence of occupational exposure, and demands for continuing education.

RESULTSAmong all respondents, 63.15% (305/483) were aware of the reporting procedures and related departments after the incidence of occupational exposure. The awareness rate of classification of HIV occupational exposure was 48.45% (234/483). About preventive medication time after HIV and hepatitis B virus exposure, the awareness rates were 37.89% (183/483) and 31.47% (152/483), respectively. The average score of occupational exposure knowledge among respondents was 74.45±14.00. The multivariate analysis indicated that medical staff of obstetrics and gynecology, females, doctors and high-level medical institutions showed significantly higher awareness than urology professionals, males, nurses, and medical staff of primary health care institutions, respectively (t = 12.140, t = 5.428, t = 2.582, F = 4.218, P<0.05). Of the respondents, 93.17% (450/483) and 94.41% (456/483) thought that washing hands properly and wearing protective glasses were effective methods for the prevention of occupational exposure, but only 15.94% (89/483) and 3.93% (19/483) adhered to proper hand washing and wearing protective glasses within nearly one year in practical work. Of the respondents, 60.46% (292/483) had experienced the occupational exposure during their vocation, and 95.65% (462/483) needed respective trainings.

CONCLUSIONThe awareness of occupational exposure among reproductive health-related medical staff is lacking, especially in preventative medication and reporting procedures after the incidence of occupational exposure. The implementation of protective measures is inadequate and incidence of occupational exposure is higher. Therefore, continuing education is necessary to improve the knowledge and attitudes towards occupational exposure in medical staff. At the same time, strict and effective supervision and management system should be established.

Adult ; Blood-Borne Pathogens ; Female ; Health Knowledge, Attitudes, Practice ; Health Personnel ; statistics & numerical data ; Humans ; Male ; Middle Aged ; Occupational Exposure ; prevention & control ; Reproductive Health Services ; manpower ; Surveys and Questionnaires ; Young Adult