title: Utilization of day surgery services at Upper hill Medical Centre and the Karen hospital in Nairobi: the influence of medical providers, cost and patient awareness.
abstract: BACKGROUND
  Health systems face challenges of improving access to health services due to rising health care costs. Innovative services such as day surgery would improve service delivery. Day surgery is a concept where patients are admitted for surgical procedures and discharged the same day. Though used widely in developed countries due to its advantages, utilization in developing countries has been low. This study sought to establish how utilization of day surgery services was influenced by medical providers, patient awareness and cost among other factors.
  
  
  METHODS
  The study design was cross sectional with self administered questionnaires used to collect data. Data analysis was done by using statistical package for social science (SPSS) and presented as frequencies, percentages and Spearman's correlation to establish relationship among variables.
  
  
  RESULTS
  Medical providers included doctors, their employees and medical insurance providers. Most doctors were aware of day surgery services but their frequency of utilization was low. Furthermore, medical insurance providers approved only half of the requests for day surgery. Doctors' employees were aware of the services and most of them would recommend it to patients. Although, most patients were not aware of day surgery services those who were aware would prefer day surgery to in patient. Moreover, doctors and medical insurance providers considered day surgery to be cheaper than in patient.
  
  
  CONCLUSIONS
  The study showed that medical providers and patient awareness had influence over day surgery utilization, though, cost alone did not influence day surgery utilization but as a combination with other factors.
authors.affiliation: Department of Health Systems Management and Medical Education, Kenya Methodist University, Nairobi, Kenya ; Upper Hill Medical Centre, Nairobi, Kenya.
authors.forename: Mildred Adhiambo
authors.initials: MA
authors.lastname: Odhiambo
authors.affiliation: Department of Health Systems Management and Medical Education, Kenya Methodist University, Nairobi, Kenya.
authors.forename: Susan
authors.initials: S
authors.lastname: Njuguna
authors.affiliation: Department of Health Systems Management and Medical Education, Kenya Methodist University, Nairobi, Kenya.
authors.forename: Rachel
authors.initials: R
authors.lastname: Waireri-Onyango
authors.affiliation: Upper Hill Medical Centre, Nairobi, Kenya.
authors.forename: Josephat
authors.initials: J
authors.lastname: Mulimba
authors.affiliation: Upper Hill Medical Centre, Nairobi, Kenya.
authors.forename: Peter Mungai
authors.initials: PM
authors.lastname: Ngugi
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data*; D001364:Awareness; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D017048:Health Care Costs; D006297:Health Services Accessibility; D006801:Humans; D007630:Kenya; D057240:Patient Preference; D010820:Physicians / Q000706:statistics & numerical data; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires
keywords: Day surgery; cost and utilization; health system; in patient; medical insurance providers; medical providers; patient awareness