BackgroundEffective coordination between organizations, agencies and bodies providing or financing health services in humanitarian crises is required to ensure efficiency of services, avoid duplication, and improve equity. The objective of this review was to assess how, during and after humanitarian crises, different mechanisms and models of coordination between organizations, agencies and bodies providing or financing health services compare in terms of access to health services and health outcomes.MethodsWe registered a protocol for this review in PROSPERO International prospective register of systematic reviews under number PROSPERO2014:CRD42014009267. Eligible studies included randomized and nonrandomized designs, process evaluations and qualitative methods. We electronically searched Medline, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, and the WHO Global Health Library and websites of relevant organizations. We followed standard systematic review methodology for the selection, data abstraction, and risk of bias assessment. We assessed the quality of evidence using the GRADE approach.ResultsOf 14,309 identified citations from databases and organizations' websites, we identified four eligible studies. Two studies used mixed-methods, one used quantitative methods, and one used qualitative methods. The available evidence suggests that information coordination between bodies providing health services in humanitarian crises settings may be effective in improving health systems inputs. There is additional evidence suggesting that management/directive coordination such as the cluster model may improve health system inputs in addition to access to health services. None of the included studies assessed coordination through common representation and framework coordination. The evidence was judged to be of very low quality.ConclusionThis systematic review provides evidence of possible effectiveness of information coordination and management/directive coordination between organizations, agencies and bodies providing or financing health services in humanitarian crises. Our findings can inform the research agenda and highlight the need for improving conduct and reporting of research in this field.
COVID-19 impacted several health services, including cancer-related care. Its implications were significant due to the lapse in hospital resources, compounded by the delays stemming from the economic effects on patients’ jobs and medical coverage. Furthermore, reports suggesting an increased risk for morbidity and mortality from COVID-19 in patients with cancer and those on active cancer treatment caused additional fear and potential delays in seeking medical services. This review provides an overview of the pandemic’s impact on cancer care in the United States and suggests measures for tackling similar situations in the future.
Background: Our objective was to identify published models of coordination between entities funding or delivering health services in humanitarian crises, whether the coordination took place during or after the crises.Methods: We included reports describing models of coordination in sufficient detail to allow reproducibility. We also included reports describing implementation of identified models, as case studies. We searched Medline, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, and the WHO Global Health Library. We also searched websites of relevant organizations. We followed standard systematic review methodology.Results: Our search captured 14,309 citations. The screening process identified 34 eligible papers describing five models of coordination of delivering health services: the “Cluster Approach” (with 16 case studies), the 4Ws “Who is Where, When, doing What” mapping tool (with four case studies), the “Sphere Project” (with two case studies), the “5x5” model (with one case study), and the “model of information coordination” (with one case study). The 4Ws and the 5x5 focus on coordination of services for mental health, the remaining models do not focus on a specific health topic. The Cluster approach appears to be the most widely used. One case study was a mixed implementation of the Cluster approach and the Sphere model. We identified no model of coordination for funding of health service.Conclusion: This systematic review identified five proposed coordination models that have been implemented by entities funding or delivering health service in humanitarian crises. There is a need to compare the effect of these different models on outcomes such as availability of and access to health services.
Background Older adults are more prone to increasing comorbidities and polypharmacy. Polypharmacy is associated with inappropriate prescribing and an increased risk of adverse effects. This study examined the effect of polypharmacy in older adults on healthcare services utilization (HSU). It also explored the impact of different drug classes of polypharmacy including psychotropic, antihypertensive, and antidiabetic polypharmacy on HSU. Methods This is a retrospective cohort study. Community-dwelling older adults aged ≥ 65 years were selected from the primary care patient cohort database of the ambulatory clinics of the Department of Family Medicine at the American University of Beirut Medical Center. Concomitant use of 5 or more prescription medications was considered polypharmacy. Demographics, Charlson Comorbidity index (CCI), and HSU outcomes, including the rate of all-cause emergency department (ED) visits, rate of all-cause hospitalization, rate of ED visits for pneumonia, rate of hospitalization for pneumonia, and mortality were collected. Binomial logistic regression models were used to predict the rates of HSU outcomes. Results A total of 496 patients were analyzed. Comorbidities were present in all patients, with 22.8% (113) of patients having mild to moderate comorbidity and 77.2% (383) of patients having severe comorbidity. Patients with polypharmacy were more likely to have severe comorbidity compared to patients with no polypharmacy (72.3% vs. 27.7%, p = 0.001). Patients with polypharmacy were more likely to visit the ED for all causes as compared to patients without polypharmacy (40.6% vs. 31.4%, p = 0.05), and had a significantly higher rate of all-cause hospitalization (adjusted odds ratio aOR 1.66, 95 CI = 1.08–2.56, p = 0.022). Patients with psychotropic polypharmacy were more likely to be hospitalized due to pneumonia (crude odds ratio cOR 2.37, 95 CI = 1.03–5.46, p = 0.043), and to visit ED for Pneumonia (cOR 2.31, 95 CI = 1.00–5.31, p = 0.049). The association lost significance after adjustment. Conclusions The increasing prevalence of polypharmacy amongst the geriatric population with comorbidity is associated with an increase in HSU outcomes. As such, frequent medication revisions in a holistic, multi-disciplinary approach are needed.
Introduction All patients with newly diagnosed colorectal cancer are recommended to undergo microsatellite instability (MSI) testing. In addition, mutational testing using biomarkers such as KRAS, NRAS, and BRAF is recommended for patients with metastatic cancers. Testing for these markers is vital as they guide therapeutic decision-making and serve as prognostic indicators. Our study aims to analyze disparities in testing for MSI and KRAS biomarkers based on sociodemographic factors in patients with metastatic colorectal cancer. Furthermore, we explored the survival characteristics in these patients based on sociodemographic factors and on access to biomarker testing. Methods The National Cancer Database (NCDB) was queried for patients diagnosed with metastatic colorectal cancer (MCC). At the bivariate level, we performed chi-squared statistics and multivariate logistic regression modeling to explore variables associated with patients undergoing MSI and KRAS testing. In addition, Multivariate Cox regression and Kaplan-Meier analyses were performed for survival analysis. Results N = 51,913 patients with MCC diagnosed between 2010 to 2017 were included. The median age for Whites was 68.0 years versus 64.0 years for Blacks. Blacks had a lower probability of undergoing MSI testing (OR 0.90, [0.84-0.96] p< 0.0009). Factors associated with a lower likelihood for MSI testing included treatment at a Community Cancer Program (OR 0.61, [0.55-0.66] p<0.0001), residing in areas with people having lower education (OR 0.68, [0.62-0.74] p<0.0001) and in rural areas (OR 0.74, [0.61-0.90] p-value 0024), and a median household income of < $38,000 (OR 0.88, [0.80-0.96] p 0.0040). Patients with no insurance and Medicaid/governmental insurance were also less likely to undergo both MSI and KRAS testing. Blacks had a decreased likelihood of having high MSI levels among patients who underwent testing compared to Whites (OR 0.67, [0.50-0.91] p-value 0.0107). After controlling for confounding variables, survival analysis showed poor survival in patients who did not undergo testing for MSI and KRAS (HR 1.20, [1.17-1.23] p<0.0001 and HR 1.04, [1.01-1.06] p-value 0.0016 respectively). Conclusion Our analysis reveals that sociodemographic factors such as being from a minority race, having no insurance, residing in areas with lower education and rural settings were associated with a lower probability of undergoing MSI testing in patients with metastatic colorectal cancer. This is of concern as our study also reveals that not undergoing biomarker testing is associated with poorer survival. Addressing such sociodemographic discrepancies among racial groups is essential in achieving equitable care and narrowing gaps in outcomes. Citation Format: Saad Sabbagh, Iktej Jabbal, Barbara Dominguez, Mira Itani, Mohamed Mohanna, Arun Nagarajan. Sociodemographic disparities in access to biomarker testing in patients with advanced colorectal cancer. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5550.
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