Dialysis in Barbados: the cost of hemodialysis provision at the Queen Elizabeth Hospital.

OBJECTIVE: The purpose of this study was to assess the health service cost of hemodialysis delivered at the Queen Elizabeth Hospital in St. Michael, Barbados. METHODS: A cost analysis was performed from the viewpoint of the tertiary hospital studied here, using treatment protocols based on current practice for establishing vascular access sites (surgical set-up) and dialysis maintenance. Cost and patient data were collected for the period from 1 April 1998 to 31 March 1999. Sixty-four patients were studied and a total of 7 488 hemodialysis sessions were performed in the study period. The costs analyzed were personnel, drug expenditure, supplies (dialysis and nondialysis), inpatient costs, laboratory and other ancillary services, and indirect or overhead costs such as engineering, housekeeping, laundry and administration. RESULTS: The cost per hemodialysis treatment was calculated as US$ 156.64 in the first year and US$ 145.55 in subsequent years. The total cost per patient per year was US$ 18 327.22 in the first year of dialysis including surgical set-up, and US$ 17 029.54 thereafter. Direct costs (determined by patients' utilization of resources and labor costs for physicians and nurses) contributed to 80.7% of the total cost. The main expenditures were dialysis-related supplies, labor and overheads. CONCLUSION: These findings are important in the light of limited economic resources available to health services in Caribbean countries coupled with the spiraling prevalence of kidney failure in these countries. Further analyses are recommended to review the provision of renal replacement therapy services in Barbados and to develop plans to expand and optimize services.     

Insulin adherence and the associated factors among patients with type 2 diabetes mellitus at the Hospital Queen Elizabeth II,Sabah

Journal of Public Health - The purposes of this study were to: (a) determine the insulin adherence rate and reasons for non-adherence among patients with T2DM, (b) determine the relationship...     

Rising prevalence of genital Chlamydia trachomatis infection in heterosexual patients at the Sydney Sexual Health Centre, 1994 to 2000.

This study sought to investigate trends in the prevalence of genital Chlamydia trachomatis infection in heterosexual patients attending an urban sexual health service. Data from cases of C. trachomatis in all new self-referred heterosexual patients who were tested at the Sydney Sexual Health Centre from 1994 to 2000 were extracted from the Centre's database. Female sex workers and homosexually active men were excluded. Over the study period the prevalence of C. trachomatis infection doubled from 1.8 per cent to 3.5 per cent among the women (p=0.004) and tripled from 2.1 per cent to 6.6 per cent among the men (p<0.001) who were tested. Both men and women reported an increasing overall trend in the mean (but not median) number of sexual partners during the previous 3 months (p=0.039 and p=0.001, respectively). There were modest increases in the proportion of men and women that reported unprotected vaginal or anal sex in the previous 3 months, from 76.5 per cent to 81.7 per cent for males (p=0.122) and from 65.1 per cent to 70.2 per cent (p=0.01) for females. The introduction of more sensitive DNA-based testing probably only accounted for 8 per cent of the rise in prevalence among women and 16 per cent among men. These findings complement the rising trends in national notifications of C. trachomatis infection. Further investigation and interventions on a national scale to reduce the prevalence of C. trachomatis seem timely.     

Registry based analysis of cost-of-illness study among stage C heart failure patients at Hospital Queen Elizabeth II,Sabah, Malaysia

Background

Numerous cost-of-illness studies of heart failure (HF) have been published in developed countries, but such knowledge is lacking in Malaysia. To fill the gap, this study estimated the cost of HF in Hospital Queen Elizabeth II (HQEII).

The Challenge of Evaluating Programs in a Large Health Sciences Centre

This article illustrates how the logic model and a course on program evaluation at a large health sciences centre were instrumental in preparing staff to evaluate their own programs. Staff and physicians need basic skills in program evaluation. The logic model is a simple yet useful tool in helping to identify key measurables. A short course to teach the theory and practice of logic models, evaluation design, choice and design of measures, and data analysis has been shown to be a practical solution in preparing staff and physicians to evaluate their own programs.     

The teaching of medicine at the University Centre for Health Sciences Yaounde,Cameroon: its concordance with the Edinburgh Declaration on Medical Education

Summary. The University Centre for Health Sciences (UCHS) or as it is referred to in French ‘Centre Universitaire des Sciences de la Santé’ (CUSS), became functional in 1969 with the enrolment of the first group of students. The objective of this training programme was to produce a scientifically sound, multipurpose doctor who would be fully operational in a rural setting with minimal equipment and supplies ( Monekosso 1970, 1972 ). The graduate had to be able to adapt readily to new situations and improvise whenever possible, calling for a high degree of competence and initiative. The training strategies adopted by UCHS in 1969 which met this requirement were later found to be in close concordance with the tenets of the World Conference on Medical Education held in Edinburgh in 1988, the Edinburgh Declaration. While some of the terminology may not have been worked out at the time, the programme developed embraced some new concepts hitherto untried or undeveloped:

• — the problem-solving approach in the first to the sixth year;
• — an integrated teaching approach during the first to sixth year of medical training;
• — an integrated medicine internship in district hospitals in the sixth year;
• — a community-based training approach throughout the training;
• — team training of three different health professionals;
• — competency-based training;
• — health services linked research;
• — health services linked training ( Monekosso & Quenum 1978 ).

The concordance of this programme to the Edinburgh Declaration is of great interest in realizing the World Federation for Medical Education programme and implementing the Edinburgh Declaration. The involvement of the three innovative medical schools in the planning stage of the curriculum explains this concordance.     

Health services administration education: meeting the challenge of a culturally diverse work force

Curriculum revision is a continuous and an ongoing process. Health services administration programs must revise course offerings to reflect current demands and changing trends within our society. Given the expected changes in the work force by the year 2000, health services administration programs must consider incorporating cultural diversity issues as they relate to the management of a diverse work force within the health care industry. Labor force and population trends are projected to include a slowly growing work force population, a decline in the pool of young workers, entrance of more females, increased participation of minorities into the labor force, an increased non-white percentage of new entrants and the largest work force increase attributed to increasing numbers of immigrants. In preparation for the diversity within the work force by the 21st century, health administration programs may find the approaches outlined as conducive for teaching students to become sensitive and cognizant of culturally diverse employees. Incorporation of cultural diversity issues may occur in a variety of ways, however, a close examination of the best way to integrate this content lies within each educational program.