The rest of the authors declare no competing interests. The purpose of the workshops was to raise professional awareness of the importance of asthma and Private government grants asthma copd management within the context of public health and primary healthcare, and it included clinical case discussion. This process evaluation study showed that the delivery of integrated chronic lung care, as per programme protocols, is feasible for staff and Privatd in routine PHC settings. However, the Private government grants asthma copd did report the importance of uninterrupted supplies such as disposable mouth pieces and equipment maintenance for example, of the peak flow meter for their compliance with the patient examination requirement. Further work is needed to examine the quality of the diagnoses made by the trained primary care clinicians in the patients Lohan nude lookalike did not refer, and the sustainability of the change. Improving primary care in Australia through the Australian primary care collaboratives program: a quality improvement report.
Silk stockings and garters. COPD Costs
Your policy must have been issues at least two years age. My daughter was diagnosed with brain cancer and had to have surgery just over a year ago. Since asthma can also be triggered by stress it is important that a severe asthmatic have as stress-free of a life as possible. However, each SCCOR application from the institution must have a different principal investigator governmnt must be self-contained and independent of other SCCOR applications from the same institution. The money I received is very much needed and will be put to good use. My tears spilled out when my husband fell asleep. Your medical history and the details of your life insurance policy are Private government grants asthma copd primary factors for consideration. Oxygen assistance programs are ideal for COPD patients who have trouble getting an adequate supply of oxygen into their bloodstreams and ridding their bodies of carbon dioxide waste. I have been Private government grants asthma copd for financial help since my tumor started to grow again. What if my medical status changes? Blonde muff will I repay govrnment life insurance policy advance?
To understand how an integrated care package was experienced by care providers and patients, and to inform modifications prior to scaling up.
- Members of the program are able to engage with the Foundation and its programs at various levels to enhance its efforts in research, advocacy, care delivery, and community development.
Metrics details. Equitable access to affordable medicines and diagnostic tests is an integral component of optimal clinical care of patients with asthma and chronic obstructive pulmonary disease COPD. In Uganda, we lack contemporary data about the availability, cost and affordability of medicines and diagnostic tests essential in asthma and COPD management. Data on the availability, cost and affordability of 17 medicines and 2 diagnostic tests essential in asthma and COPD management were collected from 22 public hospitals, 23 private and 85 private pharmacies.
Spirometry and peak flow-metry as diagnostic tests were available in Affordability ranged from 2. Medicines and diagnostic tests essential in asthma and COPD care are not widely available in Uganda and remain largely unaffordable. Strategies to improve access to affordable asthma and COPD medicines and diagnostic tests should be implemented in Uganda.
Globally, chronic respiratory diseases pose a major public health threat. Notably, the burden of asthma and chronic obstructive pulmonary disease COPD is steadily increasing in both developed and developing countries.
High rates of mortality due to both conditions have been documented in low-and middle income countries LMIC. A descriptive retrospective study conducted at an urban national referral hospital reported the burden of asthma and COPD of In hospital mortality among the patients admitted with asthma and COPD was 8.
Another population based prospective cross sectional study performed in rural Masindi, a district in Western Uganda in reported the burden of COPD of This highlights that the COPD in Uganda primarily occurs among the young and this could probably be due to effects of environmental factors like increased use of biomass fuel for cooking and early infections like tuberculosis and recurrent childhood pneumonia.
The first and recently concluded nationwide population survey to determine the burden and predictors of asthma in Uganda, the Uganda National Asthma Survey UNAS has documented a prevalence of 9. Unpublished data, The challenges of low availability of affordable medicines and diagnostic tests for asthma and COPD, poor health system structures coupled with low knowledge levels of asthma and COPD management among healthcare workers and patients contribute to the suboptimal care in LMIC [ 4 , 5 , 6 , 7 , 8 ].
The WHO strategy on secondary and tertiary prevention section of chronic respiratory diseases emphasises the need to strengthen health care by identifying cost-effective interventions, upgrading standards and accessibility of care at different levels of the health care system and improving access to affordable medicines [ 9 ].
Improving access to affordable medicine is one of the key components of the millennium development goals MDG referred to as the MDG target 8E [ 10 ]. This data will help guide a pragmatic approach to address the low access to affordable asthma and COPD medicines and diagnostic tests.
It will also guide healthcare managers in Uganda on resource mobilisation and allocation for essential medicines and diagnostic tests for asthma and COPD. The data obtained will add to the existing literature on extent of availability, cost and affordability of essential asthma and COPD medicines and diagnostic tests in LMIC.
This was a cross sectional study that was conducted from 15th January to 28th February in 23 public hospitals, 22 private hospitals and 85 privately owned pharmacies that were randomly selected from the 4 regions of Uganda.
The central, eastern, western and northern regions accounted for Geographical location of the selected study sites. Map of Uganda obtained from Wikimedia Commons. All the selected hospitals were tertiary hospitals, served a significantly large local population in each geographical location and had a daily or weekly functioning outpatient general medical or respiratory clinic. None was a specialist hospital. The pharmacies selected were those in close proximity to a tertiary hospital or a health centre IV secondary hospital serving a large local population and are licensed by the regulatory body National Drug Authority to sell all classes of medicines.
A total of 2 public and 2 private hospitals were excluded because they lacked a regular outpatient medical specialist clinic. Drug shops were not included because they are not licensed to sell essential medicines for NCD. A total of 30 pharmacies were excluded because the staff declined to provide the desired information on availability and cost of the study drugs. According to the registry of ministry of Health, Republic of Uganda, there are 2 national referral hospitals, 14 regional referral hospitals and general hospitals.
About Medical care in the public hospitals is paid for the government of Uganda. A national procurement institution called the National Medical Stores NMS is constitutionally mandated to procure and distribute all drugs and diagnostic tests for all government hospitals.
Patients seek medical care from private hospitals and pharmacies as a second option in cases of unavailability of drugs and diagnostic tests. These procure their drugs and diagnostic tests from private companies. Patients also sought medical care from private pharmacies and village health workers [ 15 ]. About privately owned retail pharmacies and 90 private hospital pharmacies that sell human pharmaceutical drugs are registered by the National Drug Authority.
This study was conducted as a sub-section of the large study called the Access to Cardiovascular diseases, Chronic Obstructive pulmonary disease, Diabetes mellitus and Asthma Drugs and diagnostics ACCODAD study that assessed the availability and affordability of essential medicines and diagnostic tests of non-communicable diseases NCD in Uganda. The first published study from the ACCODAD study assessed access to key drugs and diagnostic tests in the management of diabetes and cardiovascular diseases [ 17 ].
We increased the sample size of the surveyed health units to to generate adequate information. The study data collection team underwent a brief training before commencement of the study to improve quality and standardisation of data. The diagnostic tests of interest of asthma and COPD in this study were spirometry and peak flow-metry.
Adult and paediatric spacer devices were also included due to their integral role in asthma and COPD management especially in young children and elderly patients. The cost of the medicines obtained was the retail prices charged directly to the patients at the respective pharmacies of the private hospitals and private pharmacies. Information about the availability and cost of the diagnostic tests of interest was only obtained from the hospitals.
The cost of the medicines in the public hospitals was not obtained since medical care is offered free of charge. Availability of the medicine categories were assessed using simple descriptive statistics by calculating the proportions of hospitals and private pharmacies in which any type and dose of the medicine and diagnostic test was present on the day of data collection at the study site.
The availability of the selected diagnostic tests and medicines was compared between the study sites and study regions using chi-square test to determine significant differences. The cost of the available lowest priced generic medicine was compared to the cost of the available originator brand medicine. The lowest paid skilled government worker at the time of the study scale U8 lower-non formal education teachers earns a gross salary of , UgX equivalent to After tax deductions, this translates to a net salary of , UgX equivalent to Adult and paediatric spacers were available in only Spirometry and peak flow-metry were available in only There was a stark difference in availability of medicines in the study sites and regions.
The only available medicines in the public hospitals were: inhaled SABA in There was no documented statistically significant difference in the availability of spirometry and peak flow-metry in private and public hospitals. Spirometry was available in The cost of performing spirometry was obtained from only 2 surveyed hospitals because the other hospitals offer it free of charge.
The median cost of performing spirometry was , UgX This study aimed at providing contemporary information about the availability, cost and affordability of medicines and diagnostic tests essential in asthma and COPD management in Uganda.
To our knowledge, this is the largest study to investigate the availability, cost and affordability of these essential medicines and diagnostic tests in Uganda. Generally, all the selected asthma and COPD medicines and diagnostic tests were either of moderate or low availability. The lowest levels of availability were in public hospitals.
The only available medicines in the public hospitals were inhaled SABA in This low availability of essential medicines of asthma and COPD in our study has also been widely reported in the majority of studies investigating access to chronic diseases medicines in LMIC [ 7 , 21 , 22 , 23 ] and in the annual medicine price monitor studies in Uganda [ 24 , 25 ].
In the study by Babar Z et al. Similar findings of low availability of asthma medicines was also reported by another cross sectional study by Cameron A et al. This study sought to assess the availability and pricing of 30 core medicines for acute and chronic diseases. The dismal availability of asthma and COPD medicines in Uganda especially in the public hospitals could be due to the few asthma and COPD medicines included in our essential drug list. Among the medicines of interest for this study, the asthma medicines section of the Uganda essential drug list included only aminophylline tablets, beclometasone and salbutamol inhalers [ 26 ].
Ipratropium, a key SAMA was only available in private pharmacies This could also probably be due to their absence in the Ugandan clinical guidelines and essential drug lists. The overall low and moderate availability of the key asthma and COPD medicines in the study could also be explained by the evident knowledge gaps and inapt prescription practices among healthcare practitioners in Uganda with regard to asthma and COPD management. With the exception of salbutamol inhalers, the rest of the asthma and COPD medicines were largely unaffordable when accessed from the private sector.
A wide variation in affordability of asthma and COPD medicines has been reported in the majority of similar studies across different countries. In one study investigating the availability and affordability of essential medicines in 6 LMIC documented the cost of standard asthma combination therapy of the lowest priced generic salbutamol and beclometasone inhalers were 1.
Salbutamol inhaler remains affordable in Uganda. Other asthma and COPD drugs were not studied. The majority of asthma and COPD medicines being unaffordable in the private sector in this study could probably be explained by the lack of a national policy or legislation to regulate retail prices of medicines especially for chronic diseases. Uganda also lacks a vibrant local pharmaceutical industry sector that would manufacture cheap quality generic asthma and COPD medicines for the public and private sector.
There is paucity of studies investigating the cost and affordability of performing spirometry in LMIC. The cost equivalent to This could be due to the limited hospitals and expertise capable of rendering this specialist service.
This study demonstrated that the majority of asthma and COPD medicines and diagnostic tests were largely unavailable especially in the public hospitals and unaffordable in the private sector.
In the public sector, inequity in access to medicines and diagnostic tests for asthma and COPD care can be addressed through increased awareness about optimal management of asthma and COPD among healthcare practitioners and patients, inclusion of other essential asthma and COPD medicines on the national essential drug list and clinical care guidelines, improving forecast accuracy, procurement efficiency and stock handling and boosting local production of cheap quality generic asthma and COPD medicines.
At the private sector level, access to affordable medicines can be improved through implementation of national policies aimed at regulating retail prices of medicines especially for chronic care, improving forecast accuracy, procurement efficiency, stock handling and local production of cheap generic medicines.
Due to the prohibitive costs of diagnosis and management of asthma and COPD in Uganda, national primary prevention strategies for chronic respiratory diseases should be widely implemented to reduce the disease burden. The data was collected at one point in time which does not put into consideration the temporal variations in availability and prices of medicines over time in the different surveyed hospitals and private pharmacies hence, we cannot establish a causal relationship between the investigated outcome of interest and the risk factors.
Misreporting under-or over-reporting of the data is highly possible due to selection, information or recall bias and the one point in time approach of data collection. Assessment of drug stock records was not performed to ascertain availability of drugs. We were unable to obtain the national procurement or tender prices of the mandated government institution NMS to procure and supply medicines to all government hospitals.
These would accurately reflect the prices of the few drugs procured for the public hospitals in comparison the private hospitals and pharmacies. Using the daily wage of the lowest paid unskilled government to calculate affordability of medicines and diagnostic tests has its limitations because a significant proportion of the Ugandan population earns less than 1.
Access to cardiovascular diseases, chronic obstructive pulmonary diseases, diabetes and asthma drugs and diagnostics study. Chronic respiratory diseases.
Fifth Season will then use those proceeds to repay the outstanding balance and will return any surplus proceeds to your designated beneficiary. This disease inflames and narrows the airways in the lungs making it difficult if not impossible to breathe. Director Level. If you qualify, Fifth Season will offer you immediate funds and will take over premium payments for your life insurance policy. All advances, interest, origination fees and premium payments are repaid to Fifth Season out of the life insurance policy's death benefit. Please leave this field empty:.
Private government grants asthma copd. Current Funding Opportunities
A wide range of information and resources relating to the treatment and management of asthma can be found at the Asthma Australia website and at the National Asthma Council Australia website. This includes resources for Aboriginal and Torres Strait Islanders and those of culturally and linguistically diverse backgrounds. COPD Management of COPD is mainly focused on slowing or preventing disease progression and maintaining function and quality of life for people with the disease.
Management of COPD is mainly focused on slowing or preventing disease progression and maintaining function and quality of life for people with the disease. Strategies employed include smoking cessation, treatment with medications, oxygen therapy and pulmonary rehabilitation.
Patients who experience severe COPD may require admitted hospital care. Chronic respiratory condition programs and initiatives Chronic respiratory conditions are addressed at a national level through a range of programs and initiatives that aim to support treatment and management of asthma, COPD and other chronic respiratory conditions.
Significant funding is also provided to ensure that quality clinical research is conducted into chronic respiratory conditions, and to maintain national monitoring and surveillance measures. Programs that support management and treatment of chronic respiratory conditions include: The Medicare Benefits Schedule, which provides subsidies for patient care and includes Medicare items for the planning and management of chronic and terminal conditions.
Eligible patients can also be referred by a GP for up to five Medicare subsidised allied health services that are directly related to the treatment of their chronic condition, including chronic respiratory conditions. The Pharmaceutical Benefits Scheme continues to provide subsidies for medicines used in the treatment of chronic respiratory conditions.
Support and care for chronic respiratory conditions is also provided through large-scale programs. Programs which provide training, support or incentives to GPs and primary healthcare services to improve management of asthma and COPD have also been funded. Additionally, the Australian Institute of Health and Welfare is funded to support national surveillance and monitoring of asthma and other chronic respiratory conditions. Aligned with the National Strategic Framework for Chronic Conditions , and the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan , the Strategy outlines a targeted and comprehensive approach to optimise asthma diagnosis and management.
Related links Further information about asthma can be found at the Asthma Australia website and at the National Asthma Council Australia website.
Asthma Australia also has state and territory asthma foundations. Further information about lung health can be found at the Lung Foundation Australia website. Information relating to monitoring and surveillance of chronic respiratory conditions, including publications, can be found at the Australian Institute of Health and Welfare website and at the Australian Centre for Airways Disease Monitoring website. Healthdirect Australia has information on asthma , asthma and pregnancy and obstructive lung diseases.
Sources 1 Australian Bureau of Statistics Viewed 25 July Viewed 25 November ACM Canberra: AIHW. COPD chronic obstructive pulmonary disease. Department of Health and Human Services. Atlanta: U. Australian Burden of Disease Study series no. Comments will be used to improve web content and will not be responded to.
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