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Thorax Feb 1997
Topics: Diagnostic Services; Family Practice; Humans; Lung Neoplasms; Neoplasm Staging; Oncology Service, Hospital; Referral and Consultation; Time Factors; Treatment Failure; United Kingdom
PubMed: 9059467
DOI: 10.1136/thx.52.2.107 -
The Lancet. Global Health Nov 2021Pathology and laboratory medicine diagnostics and diagnostic imaging are crucial to achieving universal health coverage. We analysed Service Provision Assessments (SPAs)...
BACKGROUND
Pathology and laboratory medicine diagnostics and diagnostic imaging are crucial to achieving universal health coverage. We analysed Service Provision Assessments (SPAs) from ten low-income and middle-income countries to benchmark diagnostic availability.
METHODS
Diagnostic availabilities were determined for Bangladesh, Haiti, Malawi, Namibia, Nepal, Kenya, Rwanda, Senegal, Tanzania, and Uganda, with multiple timepoints for Haiti, Kenya, Senegal, and Tanzania. A smaller set of diagnostics were included in the analysis for primary care facilities compared with those expected at hospitals, with 16 evaluated in total. Surveys spanned 2004-18, including 8512 surveyed facilities. Country-specific facility types were mapped to basic primary care, advanced primary care, or hospital tiers. We calculated percentages of facilities offering each diagnostic, accounting for facility weights, stratifying by tier, and for some analyses, region. The tier-level estimate of diagnostic availability was defined as the median of all diagnostic-specific availabilities at each tier, and country-level estimates were the median of all diagnostic-specific availabilities of each of the tiers. Associations of country-level diagnostic availability with country income as well as (within-country) region-level availability with region-specific population densities were determined by multivariable linear regression, controlling for appropriate covariates including tier.
FINDINGS
Median availability of diagnostics was 19·1% in basic primary care facilities, 49·2% in advanced primary care facilities, and 68·4% in hospitals. Availability varied considerably between diagnostics, ranging from 1·2% (ultrasound) to 76·7% (malaria) in primary care (basic and advanced) and from 6·1% (CT scan) to 91·6% (malaria) in hospitals. Availability also varied between countries, from 14·9% (Bangladesh) to 89·6% (Namibia). Availability correlated positively with log(income) at both primary care tiers but not the hospital tier, and positively with region-specific population density at the basic primary care tier only.
INTERPRETATION
Major gaps in diagnostic availability exist in many low-income and middle-income countries, particularly in primary care facilities. These results can serve as a benchmark to gauge progress towards implementing guidelines such as the WHO Essential Diagnostics List and Priority Medical Devices initiatives.
FUNDING
Bill & Melinda Gates Foundation.
Topics: Africa; Developing Countries; Diagnostic Services; Health Care Surveys; Health Facilities; Health Services Accessibility
PubMed: 34626546
DOI: 10.1016/S2214-109X(21)00442-3 -
Malaria Journal Apr 2011Correct diagnosis of malaria is crucial for proper treatment of patients and surveillance of the disease. However, laboratory diagnosis of malaria in Tanzania is...
BACKGROUND
Correct diagnosis of malaria is crucial for proper treatment of patients and surveillance of the disease. However, laboratory diagnosis of malaria in Tanzania is constrained by inadequate infrastructure, consumables and insufficient skilled personnel. Furthermore, the perceptions and attitude of health service providers (laboratory personnel and clinicians) and users (patients/care-takers) on the quality of laboratory services also present a significant challenge in the utilization of the available services. This study was conducted to assess perceptions of users and health-care providers on the quality and utilization of laboratory malaria diagnostic services in six districts from three regions in Tanzania.
METHODS
Questionnaires were used to collect information from laboratory personnel, clinicians and patients or care-takers.
RESULTS
A total of 63 laboratory personnel, 61 clinicians and 753 patients/care-takers were interviewed. Forty-six (73%) laboratory personnel claimed to be overworked, poorly motivated and that their laboratories were under-equipped. About 19% (N = 12) of the laboratory personnel were lacking professional qualification. Thirty-seven clinicians (60.7%) always requested for blood smear examination to confirm malaria. Only twenty five (41.0%) clinicians considered malaria microscopy results from their respective laboratories to be reliable. Forty-five (73.8%) clinicians reported to have been satisfied with malaria diagnostic services provided by their respective laboratories. Majority (90.2%, N = 679) of the patients or care-takers were satisfied with the laboratory services.
CONCLUSION
The findings show that laboratory personnel were not satisfied with the prevailing working conditions, which were reported to undermine laboratory performance. It was evident that there was no standard criteria for ordering malaria laboratory tests and test results were under-utilized. Majority of the clinicians and patients or care-takers were comfortable with the overall performance of laboratories, but laboratory results were having less impact on patient management.
Topics: Attitude of Health Personnel; Clinical Competence; Clinical Laboratory Techniques; Diagnostic Services; Female; Humans; Job Satisfaction; Malaria; Male; Patient Satisfaction; Quality of Health Care; Surveys and Questionnaires; Tanzania; Workforce
PubMed: 21470427
DOI: 10.1186/1475-2875-10-78 -
Canadian Medical Association Journal Jan 1949
Topics: Diagnostic Services; Female; Humans; Neoplasms
PubMed: 18122347
DOI: No ID Found -
International Journal of Health Care... 2013The purpose of this paper is to discuss the challenges faced in Australia to maintain and sustain quality in pathology services, and present new strategic directions to... (Review)
Review
PURPOSE
The purpose of this paper is to discuss the challenges faced in Australia to maintain and sustain quality in pathology services, and present new strategic directions to address such challenges.
DESIGN/METHODOLOGY/APPROACH
The paper is a review of the literature on pathology services and its quality of delivery and emerging issues.
FINDINGS
Major issues are emerging in pathology services which threaten to impact on the quality of future service delivery. These issues include workforce shortages, growth in inappropriate testing, advancing technology, rural and remote region servicing, and a negative image of the sector. New strategic directions are shown to be necessary in terms of workforce planning and addressing the escalation of new technology and innovation. In order to sustain quality of services, a significant change from current practice is recommended, with strong leadership as the change driver.
PRACTICAL IMPLICATIONS
This paper highlights the potential impact of emerging issues on future pathology-service quality. Significant implications for service delivery and patient care quality are reviewed.
ORIGINALITY/VALUE
This paper provides valuable information on current strategic and planning issues impacting on pathology services. It provides new solutions from the perspective of leadership of health and health services.
Topics: Australia; Diagnostic Services; Health Services Misuse; Health Services Needs and Demand; Humans; Leadership; Pathology; Quality of Health Care; Workforce
PubMed: 24003751
DOI: 10.1108/IJHCQA-10-2011-0058 -
International Journal For Quality in... Jun 2001To describe the content and variability for clinical service standards related to quality of care among a convenience sample of academic health centers.
OBJECTIVE
To describe the content and variability for clinical service standards related to quality of care among a convenience sample of academic health centers.
DESIGN
We used the membership of the University HealthSystem Consortium, an alliance of academic health centers in the United States for clinical services, to survey electronically 53 of these centers regarding clinical service standards. The survey evaluated service standards in four areas; general communications, communications between physicians, ambulatory and inpatient clinical services and administrative standards.
RESULTS
Thirty-four institutions responded to the survey (64%). Of these, 16 (47%) had clinical service standards, while the remaining 18 (53%) had not established formal standards. A few of the centers had established standards for patient communications, such as policies for answering telephones by staff. More had developed standards for communications between physicians and most centers had established standards for appointment availability, especially for urgent visits. However, clinical service standards were less typical for inpatient consultative or diagnostic services. A small number of the academic health centers had standards for hours of operation and for handling administrative matters, such as patient complaints. For many clinical service standards at the centers, there were notable variations (e.g. non-urgent primary care visits ranged 3-14 days).
CONCLUSION
Some academic health centers have developed and implemented patient-centered clinical service standards for diverse areas of practice, however, the standards used appear to vary for some aspects of care, but not for others.
Topics: Academic Medical Centers; Communication; Diagnostic Services; Diffusion of Innovation; Health Care Surveys; Humans; Interprofessional Relations; Managed Care Programs; Organizational Policy; Practice Guidelines as Topic; Quality Assurance, Health Care; Referral and Consultation; United States
PubMed: 11476149
DOI: 10.1093/intqhc/13.3.247 -
American Journal of Mental Deficiency Oct 1955
Topics: Diagnostic Services; Humans; Intellectual Disability; Persons with Mental Disabilities
PubMed: 13258610
DOI: No ID Found -
AIDS (London, England) Jul 2007Access to necessary diagnostic tests in support of HIV/AIDS and tuberculosis treatment, such as CD4 cell counts, viral load, tuberculosis culture, and susceptibility... (Review)
Review
Access to necessary diagnostic tests in support of HIV/AIDS and tuberculosis treatment, such as CD4 cell counts, viral load, tuberculosis culture, and susceptibility testing, has significantly lagged the provision of drug therapy in developing countries. This is an outcome of the fundamental limitations in overall access to basic health services in the developing world, particularly in sub-Saharan Africa. Among health services, laboratory capacity and access are particularly deficient, and often non-existent in rural settings. As such, treatment is commonly administered in the absence of diagnostic testing, potentially accelerating the incidence of drug-related toxicity and the onset of drug resistance if therapy results in incomplete viral suppression. Factors constraining the expansion of necessary diagnostic testing include a severe shortage of qualified laboratory personnel, limited access to training for specific diagnostic tests, and a lack of national standards and systems for laboratory accreditation, proficiency testing, quality control and logistics. Additional factors include insufficient funding for improvements in laboratory services, limited availability of technical support, and the cost of diagnostic instrumentation and consumables. As a result, laboratory tests that are routine and expected in the industrialized world are often not performed in developing countries, despite the massive scale-up in treatment access for HIV/AIDS. This results in unintended consequences such as higher levels of mortality among patients who have not been properly diagnosed, additional costs for providing ART to patients who may not yet require drug therapy, and earlier onset of resistance to first-line therapies among patients predisposed to drug resistance.
Topics: AIDS-Related Opportunistic Infections; Clinical Laboratory Techniques; Developing Countries; Diagnostic Services; HIV Infections; Health Services Accessibility; Humans; Tuberculosis
PubMed: 17620757
DOI: 10.1097/01.aids.0000279710.47298.5c -
Journal of the American College of... Jun 2020• ASE guidance for patient and provider protection during echo exams in the COVID-19 pandemic. • Triaging approach for prioritizing echo exams during the COVID-19...
• ASE guidance for patient and provider protection during echo exams in the COVID-19 pandemic. • Triaging approach for prioritizing echo exams during the COVID-19 pandemic. • Recommended imaging approach and appropriate PPE use during echo exams.
Topics: Betacoronavirus; COVID-19; Cardiovascular Diseases; Coronavirus Infections; Diagnostic Services; Echocardiography; Humans; Infection Control; Organizational Innovation; Pandemics; Pneumonia, Viral; Risk Adjustment; SARS-CoV-2; United States
PubMed: 32272153
DOI: 10.1016/j.jacc.2020.04.002 -
Journal of Comparative Effectiveness... May 2013This article develops a framework for understanding how financial and nonfinancial incentives can complicate point-of-care decision-making by physicians, leading to the...
This article develops a framework for understanding how financial and nonfinancial incentives can complicate point-of-care decision-making by physicians, leading to the overuse or underuse of healthcare services. By examining the types of decisions that clinicians and patients make at the point-of-care, the framework clarifies how incentives can distort physicians' decisions about testing, diagnosis and treatment, as well as efforts to enhance patient adherence. The analysis highlights contributing factors that promote and impede evidence-based decision-making, using examples from the 'Choosing Wisely' program. It concludes with a summary of how the existing fee-for-service payment system in the USA may contribute to the problems of over- and under-testing, diagnosis and treatment, highlighted through the efforts of Choosing Wisely.
Topics: Decision Making; Diagnostic Services; Evidence-Based Medicine; Fee-for-Service Plans; Health Services Misuse; Humans; Motivation; Physician-Patient Relations; Point-of-Care Systems; Practice Patterns, Physicians'; United States
PubMed: 24236623
DOI: 10.2217/cer.13.26