DOI: http://doi.org/10.4038/jccpsl.v25i3.8229 Oral Presentations Day 1: 19th September 2019, 8:30 am - 10:30 am, Oak Room 1 FREE PAPER SESSION 1: UNIVERSAL HEALTH COVERAGE Chairpersons : Prof. Upul Senarath Dr. Anil C. Mathew OP 001 and feasible policy option through which OOPE can be reduced. Determinants of out-of-pocket health care expenditure in Sri Lanka: From Diagnosis to Reforms Key words: Out-of-pocket-expenditure, Root-cause- analysis, Healthcare effciency A. U. Gamage1*, S. C. Athukorale1, E. Undurraga2, C. Fabrizio3 OP 002 1Ministry of Health, Nutrition and Indigenous Medicine; 2Pontifcia Universidad Católica de Chile; 3Vital Strategies Barriers for seeking health care for refractive errors among children aged 5-15 years in the Colombo District *Correspondence: [email protected] Background: Out-of-pocket-expenditure (OOPE) is rising Dushyanthi Jayawardene1*, Nalika Gunawardena2, and currently, remains at 51% (2016) of the current health Madhuwanthi Dissanayake3 expenditure of the country. High out-of-pocket expenses for 1Department of Community Medicine, Faculty of Medicine, University healthcare have been shown to impede seeking healthcare, of Colombo; 2World Health Organisation, Country Offce, Sri Lanka; health status and quality of life. It can drive families 3Department of Anatomy, Faculty of Medicine, University of Colombo towards impoverishment and threaten equity in healthcare. *Correspondence: [email protected] An effectively conducted Root-cause-analysis (RCA) Background: Although Sri Lanka has a well-established could help to identify determinants of ineffcient healthcare primary health-care system, which screens the vision of performance leading to high OOPE. school children of grades one, four seven and ten, the burden Aims: To identify determinants of high out-of-pocket of refractive errors implies that further provoking into the expenditure for modifable and impactful policy options issue is needed to identify and rectify causative situations. Methods: A root-cause-analysis (RCA) was conducted Aims: This study determined the barriers for seeking health to obtain a deep insight into high OOPE as it would help care related to refractive errors among children aged 5-15 policy-makers know the origin of the question through which years attending state schools in the Colombo district. prioritization of the modifable causes can be undertaken. Methods: Descriptive design using qualitative techniques Extensive literature search and exploration of available was used among members of the preventive healthcare team data and statistics i.e. Household Income and Expenditure in 15 Medical Offcer of Health (MOH) areas in Colombo data (HIES), Global Health Expenditure Database District. Theoretical sampling was used to identify the (GHED) and brain storming were utilized to identify categories of people to be sampled. Purposive sampling the root causes. Later the root-causes were grouped into was used to select the MOH areas. Purposeful random categories. The identifed root causes were then categorized sampling was used to select categories of health staff using using the “TPN system” (TPN: totally, partially and non- three different purposely chosen sample frames from which modifable). The root-causes that would have the greatest cases were randomly selected. In depth interviews were impact once modifed were identifed, based on evidence, conducted among the health staff until theoretical saturation expert opinions from economists, public health specialists, was achieved. healthcare fnancing specialists, and model based economic evaluation using available data. This analysis identifed the Results: The themes that emerged among the public most modifable, impactful causal factors for ''high OOPE health inspectors were related to the following: defects in amongst patients with NCDs''. Thereafter feasibility of the screening of school children for visual problems; problems proposed option/s was considered from both political and at the home front where they felt that issues in the family operational perspectives. prevented students from obtaining health care services; inadequate motivation from the school staff where they felt Results: Four main categories of underlying root causes that that the support obtained from teachers was inadequate; are related to government service provision leading to high inadequate resources available to them for the screening of OOPE amongst patients with NCDs were identifed. When school children; lack of training with regards to the screening prioritized by TPN, they were as follows: 1. Improving of visual defects of school children; lack of national data the timely availability of drugs and laboratory services 2. pertaining to refractive errors and lack of monitoring for Extending after-hour government laboratory, pharmacy, public health inspectors with regards to refractive errors. and clinic services 3. Implementation of Electronic-Health- The themes that emerged from the supervising public health Record (EHR) for continuity of care. The approximate inspectors were related to the following: reduced quality of cost of implementing EHR is Rs. 23 billion and it has a the screening and follow up of school children for refractive relatively high feasibility as the most cost-effective strategy errors; inadequate support from parents and teachers for to reduce 30% OOPE. providing health care facilities for children with refractive errors; lack of provision of health care services at school Conclusion: Out of the key determinants identifed level for the provision of spectacles for children identifed Electronic-Health-Record system as the most cost-effective as having refractive errors and lack of responsibility by the 24th Annual Academic Sessions of the College of Community Physicians of Sri Lanka 2019 11 FREE PAPER SESSION 1 education sector in supporting the screening and treating of Key words: HIV/AIDS, Telemedicine, High risk population, refractive error. The themes that emerged from the medical E-health offcers of health were related to reduced quality of the screening and follow up of children with refractive errors, OP 004 poor parental support, lack of monitoring and evaluation of the screening programme and the necessity for the revision Pattern of admission to Emergency Treatment Units at of cadre positions of medical offcers and the lack of in- divisional hospitals in Galle District service training programmes for Medical Offcers of Health. Chanika Rangani1*, Amıla Chandrasırı2 Conclusions & Recommendations: Barriers identifed 1Department of Nursing, Faculty of Allied Health Sciences, University of within the existing system of services related to refractive Ruhuna; 2 Regıonal Dırector of Health Servıces, errors should be rectifed by incorporating these changes into the school health programme in order to effectively *Correspondence: [email protected] treat children with refractive errors. Background: Emergency care is an important component in primary medical care. In improving emergency care Key words: Refractive errors, Barriers, Health-seeking at primary care level, it is vital to understand the current behaviour, School-children pattern of admission to emergency Treatment Units (ETUs). OP 003 Aims: To describe pattern of admissions to Emergency Treatment Units at Divisional hospitals in Galle District. Role of telemedicine to reach out to hidden population at risk of HIV in India Methods: A hospital based descriptive cross- sectional study was conducted with a sample of 480 ETU admissions that Abhishek Royal1*, Ashish Arora2, 3 were reported to 10 randomly selected divisional hospitals, out of 19, in Galle district. Basic socio demographic data 1ART Centre, National Institute of Tuberculosis and Respiratory Diseases; 2ATC Pvt Ltd; 3Guest Faculty, Public Health Foundation of India & and reason for admission were obtained from documents Faculty of Management Sciences, Delhi University available at the ETU using a data extraction sheet. Data *Correspondence: [email protected] were analysed using SPSS version 20. Background: The HIV epidemic has been effectively Results: Out of a total number of ETU admissions majority contained in India. However, there are signifcant number were males 61.7 % (n=296) and mean age (SD) was 41.82 of people who are at high risk of acquiring HIV and other (23.26) years. Accidental injury was the commonest sexually transmitted infections who may not be covered by individual main reason and 21. 3% (n=102) for seeking existing healthcare system and interventions. This may be care from ETUs followed by Road Traffc Accidents 15% due to their cultural and social inhibitions, social stigma (n=72). Other reasons for seeking care from ETUs were and fear of disclosure of their risky behavior. This hidden chest pain (8.5%, n=41), respiratory problems (9.4%, population is increasingly seeking e-platforms for solutions. n=45), animal bites (5%, n=24) and poisoning (3.1%, n=15) Out of Accidental injuries 77.45% (n=79) were males and Aims: To observe and analyze a pilot telemedicine HIV their mean age (SD) was 32.61 (21.80) years. Similarly, preventive and diagnostic intervention out of admissions due to Road Traffc Accidents there 72% Methods: The secondary data from January 2018 - (n=52) were of males and mean age (SD) was 31.02 (16.80) December 2018 were collected from a telemedicine years. Among those who presented with RTA’s majority portal Dr Safe Hands. Following data were collected and were less than 30 years (X2 =11.43,