A discrete-event simulation (DES) of the network of primary health centers (PHCs) in a region can be used to evaluate the effect of changes in patient flow on operational outcomes across the network, and can also form the base simulation to which simulations of secondary and tertiary care facilities can be added. We present a DES of a network of PHCs using stochastic metamodels developed from more detailed DES models of PHCs ('parent' simulations), which were developed separately for comprehensively analyzing individual PHC operations. The stochastic metamodels are DESs in their own right. They are simplified versions of the parent simulation with full-featured representations of only those components relevant to the analysis at hand. We show that the outputs of interest from the metamodels and the parent simulations (including the network simulations) are statistically similar and that our metamodel-based network simulation yields reductions of up to 80% in runtimes.

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Telemedicine is viewed as a crucial tool for addressing the challenges of limited medical resources at healthcare facilities. However, its adoption in healthcare is not entirely realised due to perceived barriers. This systematic review outlines the critical facilitators and barriers that influence the implementation of telemedicine in the Indian healthcare system, observed at the infrastructural, socio-cultural, regulatory and financial levels, from the perspectives of healthcare providers, patients, patient caregivers, society, health organisations and the government. This review complies with the current PRISMA-P protocol. 1200 peer-reviewed studies published from December 2016 to December 2021 in the PubMed, Cochrane, Scopus, Web of Science, CINAHL, MEDLINE and PsycInfo databases were considered for the title and abstract screening, after which 157 articles were chosen for the full-text review. In the end, 26 studies were selected for data synthesis. Data privacy and security concerns, doctor and patient resistance to information and communications technology (ICT), poor infrastructure, and lack of ICT training were considered significant barriers to implementing telemedicine. However, reduced healthcare delivery costs, improved patient access to healthcare in remote areas, and reduced patient waiting times all helped promote telemedicine implementation. The review outcomes also revealed that the barriers and facilitators at the regulatory and financial level largely influenced the adoption of telemedicine systems in India, with 59% (n=20) articles citing a reduction in healthcare delivery costs as the critical facilitator and 59% citing fear of violation of patient privacy and security as the significant barrier.

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In this work, we examined healthcare seeking behavior (HSB) of patients visiting public healthcare facilities in an urban context. We conducted a cross-sectional survey across twenty-two primary and secondary public healthcare facilities in the South-west Delhi district in India. The survey was designed to ascertain from patients at these facilities their HSB - i.e., on what basis patients decide the type of healthcare facility to visit, or which type of medical practitioner to consult. From each facility visited, we also collected operational information, such as the average number of patients visiting per day, and the medical services provided at each facility. Based on participant responses, we observed that factors such as wait time, prior experience with care providers, distance from the facility, and also socioeconomic and demographic factors such as annual income, educational qualification, and gender significantly influenced preferences of patients in choosing healthcare facilities. We used binomial and multinomial logistic regression to determine associations between HSB and socioeconomic and demographic attributes of patients at a 0.05 level of significance. Our statistical analyses revealed that patients in the lower income group preferred to seek treatment from public healthcare facilities (OR = 3.51, 95% CI = (1.65, 7.46)) irrespective of the perceived severity of their illness, while patients in the higher income group favored directly consulting specialized doctors (OR = 2.71, 95% CI = (1.34, 5.51)). Other factors such as having more than two children increased probability of seeking care from public facilities. This work contributes to the literature by providing quantitative evidence regarding overall patient HSB, especially at primary and secondary public healthcare facilities, regardless of their presenting illness, and operational information regarding healthcare delivery at these facilities. This work can inform policy designed to improve accessibility and quality of care at public primary and secondary healthcare facilities in India.