Evidence map›Paper›PMID 39487446›Full record

Observational studyBMC health services research2024

Observations of out-of-pocket travel costs in seeking free cardiac care in India: would point-of-care ultrasound help?

Camryn J Kimura, Keshav R Nayak, Reeta Varyani, Prayaag Kini, Jill Waalen, Bruce J Kimura

Abstract readObservational Study
In one paragraph

Observational study in BMC health services research, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Camryn J KimuraDepartments of Cardiology, Scripps Mercy Hospital 1, San Diego, CA, USA.
Keshav R NayakDepartments of Cardiology, Scripps Mercy Hospital 1, San Diego, CA, USA.
Reeta VaryaniSri Sathya Institute of Higher Medical Sciences 2, Bangalore, India.
Prayaag KiniSri Sathya Institute of Higher Medical Sciences 2, Bangalore, India.
Jill WaalenScripps Research Institute 3, San Diego, CA, USA.
Bruce J KimuraDepartments of Cardiology, Scripps Mercy Hospital 1, San Diego, CA, USA. kimura.bruce@scrippshealth.org.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIn consideration of patient out-of-pocket costs in low- and middle-income countries, this observational cohort study sought to quantify the travel expenses associated with receiving free cardiac services in India and create a point-of-care ultrasound (POCUS) referral model.

methodsIn a tertiary hospital that offers free services in Bangalore, India, we interviewed outpatients awaiting cardiac evaluation regarding their out-of-pocket expenses. A subgroup underwent POCUS for signs of left atrial enlargement, inferior vena cava plethora, and extravascular lung water, and subsequent chart review for significant findings on echocardiography or need for immediate care. A model was tested in which a normal POCUS would negate the requirement for referral.

resultsPatients (N = 219), of age (mean ± SD) 49.0 ± 12.9 y, traveled [median (IQR)] 1178 miles (248-1240), spent $104 ($26-$195), and lost 4.5 (0-10) days of work at a daily wage of $3.90 ($1.95-$6.50). The one-way travel cost equated to 27 days of daily pay. In the POCUS subgroup, symptoms were commonly chest pain (57%) and dyspnea (48%) and were less than moderate in severity (71%). Abnormal echo findings were present in 54% of patients, of whom 29% needed immediate care, and 71% were dismissed without follow-up. POCUS signs were related to an abnormal echo (p < 0.001), but not immediate care (p = 0.50). POCUS-based referral would have prevented 51% (35/68) of unnecessary referrals and missed 13% (9/68) of cases that required immediate care.

conclusionsOut-of-pocket costs, relative to income, can be significant for those seeking free cardiac care. POCUS performed locally could potentially reduce the costs of travel but would risk missing cases, depending on symptom type.

Indexed as

Point-of-Care SystemsAdultEchocardiographyFemaleHealth ExpendituresHumansIndiaMaleMiddle AgedReferral and ConsultationTertiary Care CentersTravelUltrasonographyCost-effectivenessEchocardiographyHealthcare disparityLow- and middle-income countriesOut-of-pocket patient costsPoint-of-care ultrasoundPublic healthScreening

Identifiers

PMID39487446
PMCPMC11529250

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.