Remesh Athul M, Barathi Arivarasan, Ravichandran Arunkumar, Thulasingam Mahalakshmy, Munusamy Hemachandren
Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND.
Community Medicine, Employee's State Insurance Corporation (ESIC) Medical College and Hospital, Chennai, IND.
Cureus. 2024 Aug 4;16(8):e66127. doi: 10.7759/cureus.66127. eCollection 2024 Aug.
Background Heart valve replacement surgery is one of the most commonly performed cardiac surgeries in India. Post-surgery, the patient requires lifetime anticoagulation therapy with regular follow-up, leading to financial and nonfinancial burdens for the patients. This study aimed to determine the out-of-pocket (OOP) expenditure (OOPE) for follow-up visits to the heart valve clinic and explore and assess the challenges faced by patients during these follow-ups. Methodology This mixed methods study was conducted at a tertiary care center from June 2018 to August 2018, focusing on patients attending the Valve Replacement clinic. The qualitative component of the study involved conducting three focus group discussions, which were transcribed and manually analyzed using thematic analysis to generate categories. The monthly OOPE and the proportion of irregular patients were assessed using a pretested and validated questionnaire developed based on the findings from the qualitative study. The data from the quantitative study were entered into EpiData version 3.1 (EpiData, Odense, Denmark) and analyzed using Stata 14 (StataCorp., College Station, TX). Results The median (interquartile range [IQR]) total OOPE for patients was Rs. 765 (475-1,100). The median (IQR) direct and indirect expenditures were Rs. 420 (210-600) and Rs. 590 (330-948), respectively. The patients faced difficulties in the categories of financial, travel, hospital, family, and personal. Out of a total of 143 participants, 86 (60.14%) had incurred catastrophic health expenditures. The cost also significantly increased with the presence of an accompanying person and longer travel durations. Conclusions The major difficulties faced by the patients were distance and expense. Telemedicine can help overcome these challenges by decentralizing follow-up care to the primary care level.
背景
心脏瓣膜置换手术是印度最常见的心脏手术之一。术后，患者需要终身抗凝治疗并定期随访，这给患者带来了经济和非经济负担。本研究旨在确定心脏瓣膜门诊随访的自付费用（OOP），并探讨和评估患者在这些随访期间面临的挑战。
方法
本混合方法研究于2018年6月至2018年8月在一家三级医疗中心进行，重点关注瓣膜置换门诊的患者。研究的定性部分包括进行三次焦点小组讨论，对讨论内容进行转录，并使用主题分析进行人工分析以生成类别。使用基于定性研究结果开发的经过预测试和验证的问卷评估每月的自付费用和不定期就诊患者的比例。定量研究的数据输入到EpiData 3.1版本（丹麦欧登塞的EpiData公司），并使用Stata 14（美国德克萨斯州大学站的StataCorp公司）进行分析。
结果
患者的总自付费用中位数（四分位间距[IQR]）为765卢比（475 - 1,100）。直接和间接费用的中位数（IQR）分别为420卢比（210 - 600）和590卢比（330 - 9,48）。患者在财务、交通、医院、家庭和个人等方面面临困难。在总共143名参与者中，86名（60.14%）发生了灾难性医疗支出。随着有陪同人员以及行程时间延长，费用也显著增加。
结论
患者面临的主要困难是距离和费用。远程医疗可以通过将随访护理分散到基层医疗层面来帮助克服这些挑战。
