Background. In India, in addition to the national health care system, there are many non-profit Non-Governmental Organizations (NGOs) such as the Institute for Indian Mother and Child (IIMC) operating mainly in Kolkata and surrounding areas. In such settings, there are differences in the patient management, understood as the treatment of the disease and the whole person, compared to high-resource countries such as Italy where the health system provides services in different ways. Aim. Compare two experiences tested in general practice settings in low and high resource settings. Methods. Prospective comparative observational study. Data were collected by a single operator in two different settings with low and high resources. The low-resource setting refers to Kolkata, Dhaki, and surrounding areas, and was visited during a medical volunteering experience in September 2022. The high-resource setting refers to Abano, visited in May 2023, and Albignasego, where data referred to July 2022 were obtained using the Junior Bit 7 software. A predefined format was used for data collection, capable of capturing all clinical and non-clinical information pertaining to all the patients visited (or contacted by phone). Results. The data of 2.078 patients were analyzed, with 1.208 in the low-resource setting (58% of the total) and 870 in the high-resource settings. Significant differences were observed in all the studied parameters. The number of patients visited per day by physicians in the two considered settings was significantly different. In India, the number of patients seen during working hours was on average more than twice as high as in Italy. Additionally, in India, there was a lack of accessibility and almost no follow-up, whereas in Italy, patients had the opportunity to be monitored over time. Dermatological problems (almost 30% of cases had tinea), as well as infectious and respiratory diseases, were the most common clinical conditions found in the low-resource setting. These conditions were also found in the high-resource settings with different proportions. The utilization of counselling services (medical consultations providing advice and addressing doubts) was relevant in high-resource setting, while was almost absent in India. Furthermore, there was a high number of prescriptions for antifungal, antiparasitic, antibiotic, and especially antihistamine medications in India, while it was common to prescribe specialized visits, diagnostic examinations, and further tests in Italian settings. Conclusions. There are significant differences between the Indian and Italian settings that were addressed in the study. A higher number of medical visits per day is not necessarily associated with better healthcare management, and the burden of infectious diseases is certainly higher in India, leading to specific patterns in medical prescriptions. In low-resource settings, prescribed therapies should be more carefully chosen and based on scientific basis. The quality of healthcare services provided in the Indian setting appears to be lower, and the implementation of information technology in the medical profession would improve this aspect, promoting greater healthcare accessibility with potential implications for public health in rural areas of the country. The presence of non-profit organizations, such as IIMC, that facilitate healthcare access for individuals who would otherwise not have the opportunity to receive treatment in low-resource settings, is certainly important.
Background. In India, oltre al sistema sanitario nazionale, vi sono molte Organizzazioni Non-governative (ONG) non-profit come l’Institute for Indian Mother and Child (IIMC) operante principalmente a Calcutta e nelle aree circostanti. In tali contesti, vi sono differenze nella gestione del paziente, inteso come trattamento della patologia e della persona nella sua totalità, rispetto ai paesi ad alte risorse, come l’Italia dove il sistema sanitario fornisce servizi con modalità differenti. Scopo. Confrontare due esperienze sperimentate in setting di ambulatorio di medicina generale nelle basse e nelle alte risorse. Metodi. Studio osservazionale comparativo prospettico. I dati sono stati raccolti da un unico operatore in due diversi setting a basse e ad alte risorse. Il contesto a basse risorse si riferisce a Calcutta, Dhaki e dintorni, ed è stato frequentato durante un'esperienza di volontariato medico nel settembre 2022. Quello ad alte risorse si riferisce ad Abano, frequentato nel maggio 2023, e ad Albignasego, dove sono stati registrati i dati riferiti a luglio 2022 utilizzando il software Junior Bit 7. Per la raccolta dei dati è stato utilizzato un format predefinito in grado di raccogliere tutte le informazioni cliniche e non, relative a tutti i pazienti visitati (o contattati telefonicamente). Risultati. Sono stati analizzati i dati di 2.078 pazienti, di cui 1.208 nel setting a basse risorse (58% del totale) e 870 nei setting ad alte risorse. Sono state riscontrate grandi differenze in tutti i parametri studiati. Il numero di pazienti visitati al giorno è significativamente diverso nei due setting considerati. In India il numero di pazienti visitati in orario lavorativo era in media più del doppio rispetto all'Italia. Inoltre, in India l'accessibilità è risultata carente e il follow-up quasi assente, mentre in Italia i pazienti avevano l'opportunità di essere seguiti nel tempo. Le patologie dermatologiche (quasi il 30% dei casi era affetto da tinea), così come le malattie infettive e respiratorie, sono state le condizioni cliniche più comuni riscontrate nel setting a basse risorse. Queste ultime sono state riscontrate anche nel setting ad alte risorse in proporzioni differenti. L’utilizzo del servizio di counselling (consulenza medica, intesa come consigli e risoluzione di dubbi) è stato rilevante nel setting ad alte risorse, mentre era quasi assente in India. Infine, in India è stato registrato un gran numero di prescrizioni di farmaci antifungini, antiparassitari, antibiotici e soprattutto antistaminici, mentre nei setting italiani era comune la prescrizione di visite specialistiche, esami diagnostici e test di approfondimento. Conclusioni. Ci sono significative differenze tra il setting indiano e quello italiano comparati nello studio. Ad un maggior numero di visite mediche/die non è necessariamente associata una migliore gestione sanitaria e il carico di malattie infettive è certamente maggiore in India, con ripercussioni sulle prescrizioni mediche. Nel setting a basse risorse le terapie prescritte dovrebbero essere sottoposte a una scelta più accurata e basata su fondamenti scientifici. La qualità dei servizi sanitari forniti nel setting indiano sembra essere più bassa e un’implementazione informatica della professione medica migliorerebbe questo aspetto e favorirebbe una maggiore accessibilità sanitaria con possibili risvolti sulla salute pubblica nelle zone rurali del paese. È certamente importante la presenza di organizzazioni non-profit che, come IIMC, facilitano l’accessibilità sanitaria ai cittadini che altrimenti nei setting a basse risorse non avrebbero la possibilità di curarsi.
Outpatient medicine: a comparison between low and high resource system settings
RUSSO, RICCARDO
2022/2023
Abstract
Background. In India, in addition to the national health care system, there are many non-profit Non-Governmental Organizations (NGOs) such as the Institute for Indian Mother and Child (IIMC) operating mainly in Kolkata and surrounding areas. In such settings, there are differences in the patient management, understood as the treatment of the disease and the whole person, compared to high-resource countries such as Italy where the health system provides services in different ways. Aim. Compare two experiences tested in general practice settings in low and high resource settings. Methods. Prospective comparative observational study. Data were collected by a single operator in two different settings with low and high resources. The low-resource setting refers to Kolkata, Dhaki, and surrounding areas, and was visited during a medical volunteering experience in September 2022. The high-resource setting refers to Abano, visited in May 2023, and Albignasego, where data referred to July 2022 were obtained using the Junior Bit 7 software. A predefined format was used for data collection, capable of capturing all clinical and non-clinical information pertaining to all the patients visited (or contacted by phone). Results. The data of 2.078 patients were analyzed, with 1.208 in the low-resource setting (58% of the total) and 870 in the high-resource settings. Significant differences were observed in all the studied parameters. The number of patients visited per day by physicians in the two considered settings was significantly different. In India, the number of patients seen during working hours was on average more than twice as high as in Italy. Additionally, in India, there was a lack of accessibility and almost no follow-up, whereas in Italy, patients had the opportunity to be monitored over time. Dermatological problems (almost 30% of cases had tinea), as well as infectious and respiratory diseases, were the most common clinical conditions found in the low-resource setting. These conditions were also found in the high-resource settings with different proportions. The utilization of counselling services (medical consultations providing advice and addressing doubts) was relevant in high-resource setting, while was almost absent in India. Furthermore, there was a high number of prescriptions for antifungal, antiparasitic, antibiotic, and especially antihistamine medications in India, while it was common to prescribe specialized visits, diagnostic examinations, and further tests in Italian settings. Conclusions. There are significant differences between the Indian and Italian settings that were addressed in the study. A higher number of medical visits per day is not necessarily associated with better healthcare management, and the burden of infectious diseases is certainly higher in India, leading to specific patterns in medical prescriptions. In low-resource settings, prescribed therapies should be more carefully chosen and based on scientific basis. The quality of healthcare services provided in the Indian setting appears to be lower, and the implementation of information technology in the medical profession would improve this aspect, promoting greater healthcare accessibility with potential implications for public health in rural areas of the country. The presence of non-profit organizations, such as IIMC, that facilitate healthcare access for individuals who would otherwise not have the opportunity to receive treatment in low-resource settings, is certainly important.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/47993