Bypassing proximal health care facilities for acute care: a survey of patients in a Ghanaian Accident and Emergency Centre
dc.contributor.author | Yaffee, A. Q. | en_US |
dc.contributor.author | Whiteside, L. K. | en_US |
dc.contributor.author | Oteng, R. A. | en_US |
dc.contributor.author | Carter, P. M. | en_US |
dc.contributor.author | Donkor, P. | en_US |
dc.contributor.author | Rominski, S. D. | en_US |
dc.contributor.author | Kruk, M. E. | en_US |
dc.contributor.author | Cunningham, R. M. | en_US |
dc.date.accessioned | 2012-07-12T17:25:10Z | |
dc.date.available | 2013-08-01T14:04:40Z | en_US |
dc.date.issued | 2012-06 | en_US |
dc.identifier.citation | Yaffee, A. Q.; Whiteside, L. K.; Oteng, R. A.; Carter, P. M.; Donkor, P.; Rominski, S. D.; Kruk, M. E.; Cunningham, R. M. (2012). "Bypassing proximal health care facilities for acute care: a survey of patients in a Ghanaian Accident and Emergency Centre." Tropical Medicine & International Health 17(6). <http://hdl.handle.net/2027.42/92092> | en_US |
dc.identifier.issn | 1360-2276 | en_US |
dc.identifier.issn | 1365-3156 | en_US |
dc.identifier.uri | https://hdl.handle.net/2027.42/92092 | |
dc.description.abstract | Objective To characterise the population that presents to the Accident and Emergency Centre (AEC) at Komfo Anokye Teaching Hospital (KATH) and to identify risk factors associated with bypassing proximal care facilities. Methods A structured questionnaire was verbally administered to patients presenting to the AEC over 2 weeks. The questionnaire focused on the use of health care resources and characteristics of current illness or injury. Measures recorded include demographics, socioeconomic status, chief complaint, transportation and mobility, reasons for choosing KATH and health care service utilisation and cost. Results The total rate of bypassing proximal care was 33.9%. On multivariate analysis, factors positively associated with bypassing included age older than 38 years (OR: 2.18, P 0.04) and prior visits to facility (OR 2.88, P 0.01). Bypassers were less likely to be insured (OR 0.31, P 0.01), to be seeking care due to injury (OR 0.42, P 0.03) and to have previously sought care for the problem (OR 0.10, P < 0.001). Conclusions Patients who bypass facilities near them to seek care at an urban AEC in Ghana do so for a combination of reasons including familiarity with the facility, chief complaint and insurance status. Understanding bypassing behaviour is important for guiding health care utilisation policy decisions and streamlining cost‐effective, appropriate access to care for all patients. Objectif: Caractériser la population se présentant au Centre des Accidents et des Urgences à l’Hôpital Universitaire Komfo Anokye, et identifier les facteurs de risque associés au contournement des services de soins proximaux. Méthodes: Un questionnaire structuré a été administréà des patients se présentant au Centre des Accidents et des Urgences durant deux semaines. Le questionnaire portait sur l’utilisation des ressources de soins de santé et les caractéristiques de la maladie ou la blessure en cours. Les mesures enregistrées comprenaient la démographie, le statut socioéconomique, la plainte principale, le transport et la mobilité, les raisons de choisir l’Hôpital Universitaire Komfo Anokye, l’utilisation et les coûts des services de soins de santé. Résultats: La proportion totale des contournements des soins proximaux était de 33,9%. En analyse multivariée, les facteurs positivement associés au contournement comprenaient l’âge de plus de 38 ans (OR: 2,18; P = 0,04) et des visites préalables au service (OR: 2,88; P = 0,01). Les patients contournant étaient: moins susceptibles d’être assurés (OR: 0,31, P = 0,01), à la recherche de soins pour des blessures (OR: 0,42; P = 0,03) et d’avoir recherché des soins précédemment pour le même problème (OR: 0,10; P < 0,001). Conclusions: Les patients qui contournent les services près d’eux pour rechercher des soins dans un centre urbain des accidents et des urgences au Ghana, le font pour une combinaison de raisons, y compris la familiarisation avec le service, la plainte principale et le statut d’assurance. Comprendre le comportement de contournement est important pour guider les décisions de la politique d’utilisation des soins de santé et la rationalisation du coût‐efficacité, pour l’accès approprié aux soins pour tous les patients. Objetivo: Caracterizar la población que se presenta en el Centro para Accidentes y Emergencias del Hospital Universitario de Komfo Anokye, e identificar los factores de riesgo asociados con el pasar por alto los cuidados ofrecidos en centros cercanos. Métodos: Se administró verbalmente, a lo largo de dos semanas, un cuestionario estructurado a los pacientes que se presentaron en el Centro para Accidentes y Emergencias. El cuestionario estaba enfocado al uso de recursos sanitarios y a las características de la enfermedad o lesión actual. Las medidas registradas incluían datos demográficos, estatus socioeconómico, principal motivo de consulta, transporte y movilidad, las razones para escoger el Hospital Universitario Komfo Anokye, y el uso de los servicios sanitarios y su coste. Resultado: La tasa total de haber evitado los centros cercanos fue del 33.9%. En un análisis multivariado, los factores asociados de forma positiva con el haber pasado de utilizar un centro cercano incluían tener una edad mayor de 38 años (OR: 2.18, P 0.04) y haber realizado visitas anteriores al centro sanitario (OR 2.88, P 0.01). Los pacientes que evitaban un centro cercano tenían una mayor probabilidad de no estar asegurados (OR 0.31, P 0.01), de buscar ayuda por una lesión (OR 0.42, P 0.03), y de previamente haber buscado ayuda sanitaria para el problema (OR 0.10, P < 0.001). Conclusiones: Los pacientes que pasaban de utilizar centros cercanos y buscan ayuda en un centro urbano para accidentes y emergencias en Ghana lo hacen por una combinación de razones que incluyen el estar familiarizados con el centro, la causa por la que consultan, y el estar o no asegurados. Entender el comportamiento de pasar de un centro cercano es importante para tener en cuenta a la hora de realizar políticas sanitarias y ofrecer acceso a cuidados apropiados y coste‐efectivos para todos los pacientes. | en_US |
dc.publisher | Blackwell Publishing Ltd | en_US |
dc.publisher | Wiley Periodicals, Inc. | en_US |
dc.subject.other | Evitando Cuidados Cercanos | en_US |
dc.subject.other | Estatus De Seguro MéDico | en_US |
dc.subject.other | Centro De Accidentes Y Emergencias | en_US |
dc.subject.other | Milieu Urbain | en_US |
dc.subject.other | Ghana | en_US |
dc.subject.other | Sans Passer Par Les Soins Proximaux | en_US |
dc.subject.other | Statut D’Assurance‐Maladie | en_US |
dc.subject.other | Centre Des Accidents Et Urgences | en_US |
dc.subject.other | Ghana | en_US |
dc.subject.other | Urban | en_US |
dc.subject.other | Accident and Emergency Centre | en_US |
dc.subject.other | Health Insurance Status | en_US |
dc.subject.other | Bypassing Proximal Care | en_US |
dc.subject.other | Urbana | en_US |
dc.subject.other | Ghana | en_US |
dc.title | Bypassing proximal health care facilities for acute care: a survey of patients in a Ghanaian Accident and Emergency Centre | en_US |
dc.type | Article | en_US |
dc.rights.robots | IndexNoFollow | en_US |
dc.subject.hlbsecondlevel | Medicine (General) | en_US |
dc.subject.hlbtoplevel | Health Sciences | en_US |
dc.description.peerreviewed | Peer Reviewed | en_US |
dc.contributor.affiliationum | Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA | en_US |
dc.contributor.affiliationother | Kwame Nkrumah University of Science and Technology, Kumasi, Ghana | en_US |
dc.contributor.affiliationother | Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY, USA | en_US |
dc.identifier.pmid | 22519746 | en_US |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/92092/1/j.1365-3156.2012.02984.x.pdf | |
dc.identifier.doi | 10.1111/j.1365-3156.2012.02984.x | en_US |
dc.identifier.source | Tropical Medicine & International Health | en_US |
dc.identifier.citedreference | Bonu S, Rani M & Bishai D ( 2003 ) Using willingness to pay to investigate regressiveness of user fees in health facilities in Tanzania. Health Policy and Planning, 18, 370 – 382. | en_US |
dc.identifier.citedreference | Akin JS & Hutchinson P ( 1999 ) Health‐care facility choice and the phenomenon of bypassing. Health Policy and Planning, 14, 135 – 151. | en_US |
dc.identifier.citedreference | Agyepong IA & Adjei S ( 2008 ) Public social policy development and implementation: a case study of the Ghana National Health Insurance scheme. Health Policy and Planning, 23, 150 – 160. | en_US |
dc.identifier.citedreference | WorldBank ( 2007 ) Ghana: health insurance project [Online]. http://web.worldbank.org/external/projects/main?menuPK=228424&pagePK=64283627&piPK=73230&theSitePK=40941&Projectid=P101852 (accessed March 9 2010). | en_US |
dc.identifier.citedreference | WHOSIS ( 2006 ) Ghana health indicators [Online]. http://www.who.int/whosis/en/index.html (accessed March 9 2010). | en_US |
dc.identifier.citedreference | WHO ( 2010 ) Injuries and violence: the facts [Online]. Geneva. http://www.who.int/violence_injury_prevention/key_facts/en/index.html (accessed April 30 2011). | en_US |
dc.identifier.citedreference | WHO ( 2004 ) Disease and injury country estimates: burden of disease [Online]. http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html (accessed April 4 2011). | en_US |
dc.identifier.citedreference | Vyas S & Kumaranayake L ( 2006 ) Constructing socio‐economic status indices: how to use principal components analysis. Health Policy and Planning, 21, 459 – 468. | en_US |
dc.identifier.citedreference | Sarpong N, Loag W, Fobil J et al. ( 2010 ) National health insurance coverage and socio‐economic status in a rural district of Ghana. Tropical Medicine & International Health, 15, 191 – 197. | en_US |
dc.identifier.citedreference | Quansah R, Mock C & Abantanga F ( 2004 ) Status of trauma care in Ghana. Ghana Medical Journal 38, 149 – 152. | en_US |
dc.identifier.citedreference | Quansah R ( 2006 ) Essential trauma care in Ghana: adaptation and implementation on the political tough road. World Journal of Surgery, 30, 934 – 939. | en_US |
dc.identifier.citedreference | Quansah R ( 2001 ) Availability of emergency medical services along major highways. Ghana Medical Journal, 35, 8 – 10. | en_US |
dc.identifier.citedreference | NCHS ( 2000 ) The International Classification of Diseases, 9th Revision, Clinical Modification: ICD‐9‐CM US Department of Health and Human Services, Public Health Service, Washington, DC. | en_US |
dc.identifier.citedreference | Mock C, Ofosu A & Gish O ( 2001 ) Utilization of district health services by injured persons in a rural area of Ghana. The International Journal of Health Planning and Management, 16, 19 – 32. | en_US |
dc.identifier.citedreference | Mock CN, Jurkovich GJ, Nii‐Amon‐Kotei D, Arreola‐Risa C & Maier RV ( 1998 ) Trauma mortality patterns in three nations at different economic levels: implications for global trauma system development. Journal of Trauma, 44, 804 – 812; discussion 812–4. | en_US |
dc.identifier.citedreference | London JA, Mock CN, Quansah RE, Abantanga FA & Jurkovich GJ ( 2001 ) Priorities for improving hospital‐based trauma care in an African city. Journal of Trauma, 51, 747 – 753. | en_US |
dc.identifier.citedreference | Limwattananon S, Tangcharoensathien V & Prakongsai P ( 2007 ) Catastrophic and poverty impacts of health payments: results from national household surveys in Thailand. Bulletin of the World Health Organization, 85, 600 – 606. | en_US |
dc.identifier.citedreference | Kruk ME, Mbaruku G, McCord CW, Moran M, Rockers PC & Galea S ( 2009 ) Bypassing primary care facilities for childbirth: a population‐based study in rural Tanzania. Health Policy and Planning, 24, 279 – 288. | en_US |
dc.identifier.citedreference | Kobusingye OC, Hyder AA, Bishai D, Hicks ER, Mock C & Joshipura M ( 2005 ) Emergency medical systems in low‐ and middle‐income countries: recommendations for action. Bulletin of the World Health Organization, 83, 626 – 631. | en_US |
dc.identifier.citedreference | Husum H, Gilbert M, Wisborg T, Van Heng Y & Murad M ( 2003 ) Rural prehospital trauma systems improve trauma outcome in low‐income countries: a prospective study from North Iraq and Cambodia. Journal of Trauma, 54, 1188 – 1196. | en_US |
dc.identifier.citedreference | Hsia R, Razzak J, Tsai AC & Hirshon JM ( 2010 ) Placing emergency care on the global agenda. Annals of Emergency Medicine, 56, 142 – 149. | en_US |
dc.identifier.citedreference | Hotchkiss DR, Piccinino L, Malaj A, Berruti AA & Bose S ( 2007 ) Addressing the phenomenon of bypassing in Albania: the impact of a primary health care strengthening intervention. The International Journal of Health Planning and Management, 22, 225 – 243. | en_US |
dc.identifier.citedreference | Hosmer D & Lemeshow S ( 2000 ) Applied Logistic Regression, 2nd edn. John Wiley and Sons, New York. | en_US |
dc.identifier.citedreference | Ghana Statistical Service ( 2003 ) Ghana core welfare indicators questionnaire survey [Online]. http://www.statsghana.gov.gh/nada/index.php?page=catalog (accessed September 10 2010). | en_US |
dc.identifier.citedreference | WorldBank ( 2011 ) Ghana data [Online]. http://data.worldbank.org/country/ (accessed June 22 2011). | en_US |
dc.identifier.citedreference | GhanaInfo ( 2009 ) Ghana info [Online]. http://www.ghanainfo.org (accessed November 9 2009). | en_US |
dc.identifier.citedreference | Ghana Statistical Service ( 1998 ) Ghana demographic and health survey [Online]. http://www.statsghana.gov.gh/nada/index.php?page=catalog (accessed September 9 2010). | en_US |
dc.owningcollname | Interdisciplinary and Peer-Reviewed |
Files in this item
Remediation of Harmful Language
The University of Michigan Library aims to describe library materials in a way that respects the people and communities who create, use, and are represented in our collections. Report harmful or offensive language in catalog records, finding aids, or elsewhere in our collections anonymously through our metadata feedback form. More information at Remediation of Harmful Language.
Accessibility
If you are unable to use this file in its current format, please select the Contact Us link and we can modify it to make it more accessible to you.