Program: MSc. in Health Services Management. Universidad de Santander, Colombia
Thesis title: Determinants of access to prenatal control service among women who attended delivery care in health institutions of Floridablanca, Santander in 2017
Graduation year: 2021

Abstract

Objective: To determine the access to minimal prenatal care and associated factors in women who had delivery care in Floridablanca’s health institutions.
Methodology: A secondary analysis of cross-sectional data of live birth statistics from the Unified Registry of Affiliates, 2017 was carried out. The dependent variable was access to minimal prenatal care, defined as participating in at least 4 prenatal checkups. The sociodemographic and obstetric independent variables were classified according to the model of Aday and Andersen, 2013. The determinants of access to minimal prenatal care were evaluated using simple and multiple binary logistic regression models.
Results: In the multivariate analysis, the variables associated to access to minimal prenatal care of at least 4 prenatal checkups were the number of live births and health insurance scheme. The opportunity of meeting the recommendations of at least 4 prenatal checkups was 89% lower (OR = 0.11; 95% CI 0.02, 0.63; p = 0.013) in those women who reported between three and seven live births compared to those who had only one child born alive, and 0.73% (OR = 0.27; 95% CI 0.09; 0.75; p = 0.013) in uninsured women compared to those who belonged to the contributory or exception social insurance schemes.
Conclusion: It is recommended the implementation of a strategy that allows measuring access to prenatal care among pregnant women, to guarantee cost-effective interventions in this population of the municipality of Floridablanca.

Co-supervisors: Rocio del Pilar Martinez-Marin, Adriana Angarita-Fonseca

Program: MSc. in Health Services Management. Universidad de Santander, Colombia
Thesis title: Effectiveness of Applied Behaviour Analysis (ABA) therapy in children from 5 to 16 years diagnosed with autism spectrum disorder (ASD) during 6-month in a health institution of Cucuta, 2015.
Graduation year: 2015

Abstract

Objective: To establish the effectiveness of Applied Behaviour Analysis ABA therapy among a population of 5 to 16 years diagnosed with autism spectrum disorder (ASD), applied for 6 months in the city of Cucuta IPS, 2015.
Methodology: A quasi-experimental design was used to compare the before and after of the ABA therapy. The Barthel scale was used to evaluate functionality. We included 9 boys and 3 girls diagnosed with ASD aged between 5 and 16 years attending a psychology and therapy Center.
Results: Although the sample was small, the median of the Barthel index increased after the intervention. Moreover, after the intervention, 100% of the participants had bowel control and 83.3% had urinary control. No participant was found with severe dependence, 25% had mild dependence, and 75% had a moderate dependency.
Conclusion: ABA therapy can be applied in patients with disruptive behavior, where the prevalence of age and the severity of the diagnosis does not play a major role.
Co-supervisors: Juan Carlos Uribe, Adriana Angarita-Fonsecca

Program: MSc. in Health Services Management. Universidad de Santander, Colombia
Thesis Title: Levels of User Satisfaction in the Area of Ambulatory Surgery of the Fundación Oftalmológica de Santander (FOSCAL Internacional) Floridablanca, 2015″
Graduation year: 2015

Abstract

Objective: To determine the level of satisfaction of users of the area of ambulatory surgery of the FOSCAL international, Floridablanca, Santander in April 2015.
Methods: A cross-sectional study was conducted. The sample was comprised of 136 users of the services of ambulatory surgery of the FOSCAL international in Floridablanca, Santander. Patient satisfaction was assessed using the SERVQHOS questionnaire (“service quality” questionnaire). The SERVQHOS questionnaire items were divided into subjective quality (human assistance) and objective quality (organisational and facility issues).
Results: The type of surgery most conducted in the clinic were the general and orthopedic with 66.3%. Moreover, 63.5% had not had previous interventions. The percentage of users reporting better assistance than expected in the objective quality ranged between 68 and 91% and in the subjective quality ranged between 71.2% and 87.5%.
Conclusión: Users of the area of ambulatory surgery of the FOSCAL international are getting the assistance that they expected of the service.

Program: MSc. in Health Services Management. Universidad de Santander, Colombia
Thesis Title: Socioeconomic determinants of access to primary prevention, outpatient care, and emergency services in Colombia: A secondary analysis of the National Survey of Quality of Life, 2013
Graduation year: 2014

Abstract

Objective: To establish the socioeconomic determinants of access to health services such as primary prevention, primary care consultation, and emergency consultation in the Colombian population.
Methods: It was made a secondary analysis of the National Survey on Quality of Life in Colombia during 2013. At first, people older than 15 years were included, and those who belonged to the special social security health regimes were excluded. The dependent variables were: Without being sick and to attend for prevention to primary care at least once a year to the physician, dentist, or both. In the second part of the analysis, people who had no health issues in the past 30 days were excluded. The dependent variable was: The formal health care provided in outpatient consultation and emergency caused by a health issue. To identify the determinants of real access was used generalized linear models for complex samples where the link function was logarithm ratio of the dependent variable and Poisson’s error distribution. The explanatory variables were categorized according to Andersen’s model (1995) in predisposing components by resources, capacity, and need.
Results: About the access to primary prevention, 50,532 individuals representing 31,968,124 Colombians were included. The results of the multivariate data analysis showed that being male, people who belong to an ethnic group, those who worked in the week prior to the survey, which inhabited housing deficit, which had no classification of socioeconomic status, which were affiliated to the subsidized regime, that did not know if were affiliated to the social security health and who had filed outa petition right for protection had the probability of access to primary prevention health services significantly lower than the rest of the population. On the other hand, people between 39 and 103 years, that had a life partner, with a secondary or higher level of education, middle or high socioeconomic status, in the urban area, with permanent restrictions, poor health status or even very poor, who received shares promotion and prevention of the secretariat or municipality, that have received contributions, and those who were in the top two quintiles of household income had a significantly higher probability of accessing prevention services. 5,758 individuals representing 3,348,977 Colombians were included in the analysis of access to emergency services or outpatient consultation. The prevalence of access to those was 74.3%. In multivariate data analysis, a significant and positive association was found between
access and poor or very poor health status; and a lower probability statistically significant of access to health services with the variable poverty perception and being part of subsidized regime or not knowing or not being affiliated to the social security health.
Conclusions: The characteristics of resource capacity and necessity Andersen’s model still continue influencing access to primary health services and tertiary prevention in Colombia.
Co-supervisors: Rocio del Pilar Martinez Marin, Adriana Angarita-Fonseca.

Program: MSc. in Health Services Management. Universidad de Santander, Colombia
Thesis Title: Factors associated with access to physical therapy, speech therapy, or occupational therapy services in people with cerebral palsy from Bucaramanga and the metropolitan area.
Graduation year: 2013

Abstract

Objective: To describe the factors that influence access to physical rehabilitation services by the General Social Security Health System (GSSHS) among people with cerebral palsy (PCP) of Bucaramanga and its metropolitan area, 2013.
Methods: A case-control study was performed. Cases were those who were not cover by the GSSHS or those registered in the GSSS but who did not have access to physiotherapy, speech-language therapy, or occupational therapy services (hereafter rehabilitation services) in the last year. Controls were those covered by the SGSSS, who have had access to rehabilitation services at least once in the last year through the GSSHS; the expenses caused by these services should have been covered by the territorial entity. The sample included 89 cases and 91 controls aged between 0 to 60.
Results: The multivariable model showed an association between lack of access to rehabilitation services and being covered by the subsidized health-care scheme or being poor without social security, having filed a legal action for protection (acción de tutela), having received between 5 to 15 rehabilitation sessions in the last week, delaying in the appointment assignment, being independent (not requiring help). There was an interaction between income and transportation (OR= 0.31; IC95% 0.12, 0.77).
Conclusion: Our findings show the inequity in access to rehabilitation services that people with cerebral palsy face in Bucaramanga, Colombia.

Program: MSc. in Health Services Management. Universidad de Santander, Colombia
Thesis Title: Factors associated with access to physical therapy, speech therapy, or occupational therapy services in people with cerebral palsy from Bucaramanga and the metropolitan area.
Graduation year: 2013

Abstract

Objective: To describe the factors that influence access to physical rehabilitation services by the General Social Security Health System (GSSHS) among people with cerebral palsy (PCP) of Bucaramanga and its metropolitan area, 2013.
Methods: A case-control study was performed. Cases were those who were not cover by the GSSHS or those registered in the GSSS but who did not have access to physiotherapy, speech-language therapy, or occupational therapy services (hereafter rehabilitation services) in the last year. Controls were those covered by the SGSSS, who have had access to rehabilitation services at least once in the last year through the GSSHS; the expenses caused by these services should have been covered by the territorial entity. The sample included 89 cases and 91 controls aged between 0 to 60.
Results: The multivariable model showed an association between lack of access to rehabilitation services and being covered by the subsidized health-care scheme or being poor without social security, having filed a legal action for protection (acción de tutela), having received between 5 to 15 rehabilitation sessions in the last week, delaying in the appointment assignment, being independent (not requiring help). There was an interaction between income and transportation (OR= 0.31; IC95% 0.12, 0.77).
Conclusion: Our findings show the inequity in access to rehabilitation services that people with cerebral palsy face in Bucaramanga, Colombia.
Supervisor: Adriana Angarita-Fonseca