Background Pre-hospital and emergency services in Indonesia are still developing. Despite recent improvements in the Indonesian healthcare system, issues with the provision of pre-hospital and emergency services persist. The demand for pre-hospital and emergency services has not been the subject of previous research and, therefore, has not been fully understood. Our research explored the utilization of emergency medical services by patients attending hospital emergency departments in Jakarta, Indonesia. Methods The study used a cross-sectional survey design involving five general hospitals (four government-funded and one private). Each patient’s demographic profile, medical conditions, time to treatment, and mode of transport to reach the hospital were analysed using descriptive statistics. Results A total of 1964 (62%) patients were surveyed. The median age of patients was 44 years with an interquartile range (IQR) of 26 to 58 years. Life-threatening conditions such as trauma and cardiovascular disease were found in 8.6 and 6.6% of patients, respectively. The majority of patients with trauma travelled to the hospital using a motorcycle or car (59.8%). An ambulance was used by only 9.3% of all patients and 38% of patients reported that they were not aware of the availability of ambulances. Ambulance response time was longer as compared to other modes of transportation (median: 24 minutes and IQR: 12 to 54 minutes). The longest time to treatment was experienced by patients with neurological disease, with a median time of 120 minutes (IQR: 78 to 270 minutes). Patients who used ambulances incurred higher costs as compared to those patients who did not use ambulances. Conclusion The low utilization of emergency ambulances in Jakarta could be contributed to patients’ lack of awareness of medical symptoms and the existence of ambulance services, and patients’ disinclination to use ambulances due to high costs and long response times. The emergency ambulance services can be improved by increasing population awareness on symptoms that warrant the use of ambulances and reducing the cost burden related to ambulance use.

PurposeThe study aims to summarise the literature on cancer care pathways at the diagnostic and treatment phases. The objectives are to find factors influencing the delivery of cancer care pathways; to highlight any interrelating factors; to find gaps in the literature concerning areas of research; to summarise the strategies and recommendations implemented in the studies.Design/methodology/approachThe study used a qualitative approach and developed a causal loop diagram to summarise the current literature on cancer care pathways, from screening and diagnosis to treatment. A total of 46 papers was finally included in the analysis, which highlights the recurring themes in the literature.FindingsThe study highlights the myriad areas of research applied to cancer care pathways. Factors influencing the delivery of cancer care pathways were classified into different albeit interrelated themes. These include access barriers to care, hospital emergency admissions, fast track diagnostics, delay in diagnosis, waiting time to treatment and strategies to increase system efficiency.Originality/valueAs far as the authors know, this is the first study to present a visual representation of the complex relationship between factors influencing the delivery of cancer care pathways.

Background Pre-hospital and emergency services in Indonesia are still developing. Despite recent improvements in the Indonesian healthcare system, issues with the provision of pre-hospital and emergency services persist. The demand for pre-hospital and emergency services has not been the subject of previous research and, therefore, has not been fully understood. Our research explored the characteristics of patients attending hospital emergency departments in Jakarta, Indonesia. Methods The study used a cross-sectional survey design involving five general hospitals (four government-funded and one private). The patients’ demographic profile, medical conditions, time to treatment based on different medical conditions, and methods of transport to reach the hospitals were analysed using descriptive statistics. The Kruskal-Wallis test was used to compare groups and the result was considered significant if the p-value < 0.05. Results A total of 1,964 patients was surveyed. The median age of patients was 44 years with an interquartile range (IQR) of 26 to 58 years. IQR describes the range of the middle 50% of values in the data when it is ordered from lowest to highest. Life-threatening conditions such as trauma and cardiovascular diseases were found in 8.6% and 6.6% of patients respectively, the general medical category accounted for 63%. The majority of patients with trauma travelled to the hospital using a motorcycle or car (59.8%). Ambulance was used by 9.3% of the patients, 38% of patients were not aware of the availability of ambulances. The median travel time by ambulances to the hospital was 42 minutes (IQR: 12 to 54 minutes). The median time to treatment for patients with cardiovascular disease was 102 minutes (IQR: 66 to 300 minutes). Conclusion Investing resources in pre-hospital and emergency services in Indonesia and in particular the provision of ambulance services, would create real benefits for the population and result in a significant reduction in deaths following heart disease and stroke.

IntroductionDepression is a common mental health condition that affects millions of people worldwide. Care pathways for depression are complex and the demand across different parts of the healthcare system is often uncertain and not entirely understood. Clinical progression with depression can be equally complex and relates to whether or not a patient is seeking care, the care pathway they are on, and the ability for timely access to healthcare services. Considering both pathways and progression for depression are however rarely studied together in the literature.MethodsThis paper presents a hybrid simulation modeling framework that is uniquely able to capture both disease progression, using Agent Based Modeling, and related care pathways, using a System Dynamics. The two simulation paradigms within the framework are connected to run synchronously to investigate the impact of depression progression on healthcare services and, conversely, how any limitations in access to services may impact clinical progression. The use of the developed framework is illustrated by parametrising it with published clinical data and local service level data from Wales, UK.Results and discussionThe framework is able to quantify demand, service capacities and costs across all care pathways for a range of different scenarios. These include those for varying service coverage and provision, such as the cost-effectiveness of treating patients more quickly in community settings to reduce patient progression to more severe states of depression, and thus reducing the costs and utilization of more expensive specialist settings.