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Unnecessary hospitalisations and polypharmacy practices in Tajikistan: a health system evaluation for strengthening primary healthcare

BACKGROUND: Children and pregnant women require multiple contacts with the healthcare system. While most conditions can be managed by primary healthcare (PHC) providers, hospitalisations are common. This health system evaluation in Tajikistan quantifies unnecessary and unnecessarily prolonged hospit...

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Autores principales: Jullien, Sophie, Mirsaidova, Manzura, Hotamova, Sitora, Huseynova, Dilbar, Rasulova, Gulnora, Yusupova, Shoira, Zulfiya, Abdusamatzoda, Weber, Martin, Carai, Susanne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10313957/
https://www.ncbi.nlm.nih.gov/pubmed/36639221
http://dx.doi.org/10.1136/archdischild-2022-324991
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author Jullien, Sophie
Mirsaidova, Manzura
Hotamova, Sitora
Huseynova, Dilbar
Rasulova, Gulnora
Yusupova, Shoira
Zulfiya, Abdusamatzoda
Weber, Martin
Carai, Susanne
author_facet Jullien, Sophie
Mirsaidova, Manzura
Hotamova, Sitora
Huseynova, Dilbar
Rasulova, Gulnora
Yusupova, Shoira
Zulfiya, Abdusamatzoda
Weber, Martin
Carai, Susanne
author_sort Jullien, Sophie
collection PubMed
description BACKGROUND: Children and pregnant women require multiple contacts with the healthcare system. While most conditions can be managed by primary healthcare (PHC) providers, hospitalisations are common. This health system evaluation in Tajikistan quantifies unnecessary and unnecessarily prolonged hospitalisations and assesses antibiotic and polypharmacy practices. METHODS: Data were retrospectively collected from randomly selected medical records from 15 hospitals. Inclusion criteria were children 2–59 months of age with a primary diagnosis of acute respiratory infection or diarrhoea, or pregnant women with threatened preterm labour, threatened miscarriages, premature rupture of membranes or mild pre-eclampsia, hospitalised between January and September 2021. RESULTS: Among 440 children and 422 pregnant women, unnecessary hospitalisations accounted for 40.5% and 69.2% of hospitalisations, respectively, ranging from 0% to 92.7% across the hospitals. Among necessary hospitalisations, 63.0% and 39.2% were unnecessarily prolonged in children and women, respectively. Prior to admission, 36.8% of children had received antibiotics, in which more than half intramuscularly. During hospitalisation, 92.5% of children and 28.9% of women received antibiotics. Children and women received an average of 5 and 6.5 drugs, respectively; most were not indicated or with no evidence of benefits. CONCLUSIONS: The methodology is applicable across all health systems and can provide important insights on health service use and resource waste. Findings of this assessment in Tajikistan have led to evidence-based decisions and actions from stakeholders and policy makers with the goal of strengthening PHC and improving the management of common diseases in children and pregnant women.
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spelling pubmed-103139572023-07-02 Unnecessary hospitalisations and polypharmacy practices in Tajikistan: a health system evaluation for strengthening primary healthcare Jullien, Sophie Mirsaidova, Manzura Hotamova, Sitora Huseynova, Dilbar Rasulova, Gulnora Yusupova, Shoira Zulfiya, Abdusamatzoda Weber, Martin Carai, Susanne Arch Dis Child Global Child Health BACKGROUND: Children and pregnant women require multiple contacts with the healthcare system. While most conditions can be managed by primary healthcare (PHC) providers, hospitalisations are common. This health system evaluation in Tajikistan quantifies unnecessary and unnecessarily prolonged hospitalisations and assesses antibiotic and polypharmacy practices. METHODS: Data were retrospectively collected from randomly selected medical records from 15 hospitals. Inclusion criteria were children 2–59 months of age with a primary diagnosis of acute respiratory infection or diarrhoea, or pregnant women with threatened preterm labour, threatened miscarriages, premature rupture of membranes or mild pre-eclampsia, hospitalised between January and September 2021. RESULTS: Among 440 children and 422 pregnant women, unnecessary hospitalisations accounted for 40.5% and 69.2% of hospitalisations, respectively, ranging from 0% to 92.7% across the hospitals. Among necessary hospitalisations, 63.0% and 39.2% were unnecessarily prolonged in children and women, respectively. Prior to admission, 36.8% of children had received antibiotics, in which more than half intramuscularly. During hospitalisation, 92.5% of children and 28.9% of women received antibiotics. Children and women received an average of 5 and 6.5 drugs, respectively; most were not indicated or with no evidence of benefits. CONCLUSIONS: The methodology is applicable across all health systems and can provide important insights on health service use and resource waste. Findings of this assessment in Tajikistan have led to evidence-based decisions and actions from stakeholders and policy makers with the goal of strengthening PHC and improving the management of common diseases in children and pregnant women. BMJ Publishing Group 2023-07 2023-01-13 /pmc/articles/PMC10313957/ /pubmed/36639221 http://dx.doi.org/10.1136/archdischild-2022-324991 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Global Child Health
Jullien, Sophie
Mirsaidova, Manzura
Hotamova, Sitora
Huseynova, Dilbar
Rasulova, Gulnora
Yusupova, Shoira
Zulfiya, Abdusamatzoda
Weber, Martin
Carai, Susanne
Unnecessary hospitalisations and polypharmacy practices in Tajikistan: a health system evaluation for strengthening primary healthcare
title Unnecessary hospitalisations and polypharmacy practices in Tajikistan: a health system evaluation for strengthening primary healthcare
title_full Unnecessary hospitalisations and polypharmacy practices in Tajikistan: a health system evaluation for strengthening primary healthcare
title_fullStr Unnecessary hospitalisations and polypharmacy practices in Tajikistan: a health system evaluation for strengthening primary healthcare
title_full_unstemmed Unnecessary hospitalisations and polypharmacy practices in Tajikistan: a health system evaluation for strengthening primary healthcare
title_short Unnecessary hospitalisations and polypharmacy practices in Tajikistan: a health system evaluation for strengthening primary healthcare
title_sort unnecessary hospitalisations and polypharmacy practices in tajikistan: a health system evaluation for strengthening primary healthcare
topic Global Child Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10313957/
https://www.ncbi.nlm.nih.gov/pubmed/36639221
http://dx.doi.org/10.1136/archdischild-2022-324991
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