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Johnson A, Swenson KS, Dillner E, Klie KA, Duncan R, Brandspigel S, Breen K. Addressing Perinatal Substance Use: A Triad Approach Led by the Colorado Perinatal Care Quality Collaborative. J Midwifery Womens Health 2024. [PMID: 38339840 DOI: 10.1111/jmwh.13615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/06/2023] [Indexed: 02/12/2024]
Abstract
Unintentional overdose is a leading driver of maternal death in Colorado. The high volume of maternal deaths from preventable causes lends questions to failures in our clinical and community-based care for pregnant and postpartum people. The Colorado Maternal Mortality Review Committee identified 3 main contributors including stigma in the community and health care system, fragmentation of the health care system, and the need for more clinician training. The Colorado Perinatal Care Quality Collaborative led a 3-pronged intervention to address these challenges and improve perinatal care. The first intervention, the Colorado Alliance for Innovation on Maternal Health Substance Use Disorder quality improvement initiative, partnered with birthing hospitals statewide to institute universal screening and timely referral for individuals at risk of substance use disorder (SUD) and perinatal mood and anxiety disorders. The second intervention, the Improve Perinatal Access, Coordination, and Treatment for Behavioral Health initiative, established a perinatal support network within communities. This program assists individuals with SUD, perinatal mood and anxiety disorders, or social needs to navigate the perinatal period. The third intervention, the Colorado Maternal Overdose Matters Plus program, has enhanced in-hospital access to pharmacotherapy for pregnant and postpartum individuals with SUD through training and technical support. These collaborative initiatives aim to minimize barriers to care by integrating inpatient screening, treatment referrals, pharmacotherapy access, and community care support to mitigate maternal mortality in Colorado.
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Affiliation(s)
- Amber Johnson
- Colorado Perinatal Care Quality Collaborative, Denver, Colorado
| | - Karli S Swenson
- Colorado Perinatal Care Quality Collaborative, Denver, Colorado
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Elena Dillner
- Colorado Perinatal Care Quality Collaborative, Denver, Colorado
| | - Kaylin A Klie
- The Naloxone Project, Denver, Colorado
- Departments of Family Medicine and Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
| | | | | | - Katie Breen
- Colorado Perinatal Care Quality Collaborative, Denver, Colorado
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Cargnel M, Kelly M, Imberechts H, Catry B, Filippitzi ME. Using a Stakeholder Analysis to Implement the Belgian One Health National Report for Antimicrobial Use and Resistance. Antibiotics (Basel) 2024; 13:84. [PMID: 38247644 PMCID: PMC10812551 DOI: 10.3390/antibiotics13010084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/04/2024] [Accepted: 01/06/2024] [Indexed: 01/23/2024] Open
Abstract
(1) Background. Antimicrobial resistance (AMR) poses a substantial global health threat with profound economic implications. Acknowledging the imperative for a One Health (OH) strategy to combat this menace, Belgium introduced an annual national OH report, known as the "BELMAP report," encompassing antimicrobial use (AMU) and AMR, with the first edition completed in 2021. The integration of innovations for the healthcare system demands a meticulously planned process. (2) Methods. We introduced a three-step stakeholder analysis (SA) as a prospective framework for navigating this new report process, fostering complementary collaboration, pinpointing obstacles, suggesting approaches to overcome them, and facilitating national policy development. The SA unfolds in three steps: stakeholders identify and list their relevant activities, assess their positions regarding the BELMAP report, and complete "actor mapping" of national AMR and AMU stakeholders. (3) Results. Stakeholder identification reveals a fragmented landscape of AMR and AMU activities across Belgium. Assessment of stakeholder positions uncovers diverse expectations, collaborative challenges, and resource considerations. "Actor mapping" identifies key stakeholders, emphasizing the importance of high-interest and high-power actors. (4) Conclusions. This SA approach not only provides insights into the present stakeholder landscape in Belgium, it can also serve as a blueprint for other countries in the process of developing OH reports.
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Affiliation(s)
- Mickaël Cargnel
- Coordination of Veterinary Activities Service, Infectious Diseases in Animals Department, Sciensano, 1050 Brussels, Belgium
| | - Moira Kelly
- Healthcare-Associated Infections and Antimicrobial Resistance Service, Epidemiology and Public Health Department, Sciensano, 1050 Brussels, Belgium; (M.K.); (B.C.)
| | - Hein Imberechts
- Strategy and External Positioning, Sciensano, 1050 Brussels, Belgium;
| | - Boudewijn Catry
- Healthcare-Associated Infections and Antimicrobial Resistance Service, Epidemiology and Public Health Department, Sciensano, 1050 Brussels, Belgium; (M.K.); (B.C.)
- Faculty of Medicine, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Maria-Eleni Filippitzi
- Animal Production, Ichthyology, Ecology and Protection of the Environment Department, Health Sciences School, Faculty of Veterinary Medicine, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece;
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Ravi SJ, Vecino-Ortiz AI, Potter CM, Merritt MW, Patenaude BN. Group-based trajectory models of integrated vaccine delivery and equity in low- and middle-income countries. Int J Equity Health 2024; 23:5. [PMID: 38195588 PMCID: PMC10775446 DOI: 10.1186/s12939-023-02088-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/26/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Integrated vaccine delivery - the linkage of routine vaccination with provision of other essential health services - is a hallmark of robust primary care systems that has been linked to equitable improvements in population health outcomes. METHODS We gathered longitudinal data relating to routine immunization coverage and vaccination equity in 78 low- and middle-income countries that have ever received support from Gavi, the Vaccine Alliance, using multiple imputation to handle missing values. We then estimated several group-based trajectory models to describe the relationship between integrated vaccine delivery and vaccination equity in these countries. Finally, we used multinomial logistic regression to identify predictors of group membership. RESULTS We identified five distinct trajectories of geographic vaccination equity across both the imputed and non-imputed datasets, along with two and four trajectories of socioeconomic vaccination equity in the imputed and non-imputed datasets, respectively. Integration was associated with reductions in the slope index of inequality of measles vaccination in the countries analyzed. Integration was also associated with an increase in the percentage of districts reporting high measles vaccination coverage. CONCLUSIONS Integrated vaccine delivery is most strongly associated with improvements in vaccination equity in settings with high baseline levels of inequity. Continued scholarship is needed to further characterize the relationship between integration and health equity, as well as to improve measurement of vaccination coverage and integration.
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Affiliation(s)
- Sanjana J Ravi
- Center for Health Security, Johns Hopkins Bloomberg School of Public Health, 700 East Pratt Street, Suite 900, Baltimore, MD, 21202, USA.
| | - Andrés I Vecino-Ortiz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Suite E8527, Baltimore, MD, 21205, USA
| | - Christina M Potter
- Center for Health Security, Johns Hopkins Bloomberg School of Public Health, 700 East Pratt Street, Suite 900, Baltimore, MD, 21202, USA
| | - Maria W Merritt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Suite E8527, Baltimore, MD, 21205, USA
- Berman Institute of Bioethics, Johns Hopkins Bloomberg School of Public Health, 1809 Ashland Avenue, Baltimore, MD, 21205, USA
| | - Bryan N Patenaude
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Suite E8527, Baltimore, MD, 21205, USA
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, 5th Floor, Baltimore, MD, 21231, USA
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Nunemo MH, Gidebo KD, Woticha EW, Lemu YK. Integration Challenges and Opportunity of Implementing Non-Communicable Disease Screening Intervention with Tuberculosis Patient Care: A Mixed Implementation Study. Risk Manag Healthc Policy 2023; 16:2609-2633. [PMID: 38045564 PMCID: PMC10693204 DOI: 10.2147/rmhp.s432943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/18/2023] [Indexed: 12/05/2023] Open
Abstract
Background Despite the comorbidity, early detection and treatment of the two diseases are highly recommended; however, a few pilot studies were conducted, which are mainly focused on diabetes mellitus screening and the integration opportunity and challenges were not known. The study aimed to identify integrated implementation challenges and opportunities of non-communicable disease and risk factors screening intervention with tuberculosis patient care. Methods A mixed implementation study design was used. Data were collected from a sample of 443 tuberculosis patients, 21 key informants and facility observations. For quantitative data, descriptive statistics for proportion were summarized in tables and figures. Four distinct implementation frame was adapted for thematic analysis of audio recordings, daily verbatim transcription, and descriptive field notes. Results The prevalence of hypertension and diabetes mellitus among tuberculosis patients were 6.55% and 5.64%, respectively. Totally 9 subthemes and 21 new codes were developed, of which 13 and 8 new codes were developed for integrated implementation challenges and opportunities, respectively. The absence of medical equipment, skill and knowledge training, record and report system, cooperative integration, feedback, referral system, shortage of supporting agencies, and services not free were external challenges, whereas lack of trained health workers, focal persons, and increased workload and absence of awareness creation were internal challenges. Despite the challenges, the presence of health extension programs, non-governmental organizations, community health care insurance and associations for diabetes mellitus were external opportunities. Availability of assigned focal persons, trained stakeholders, guidelines, information systems and compatible tuberculosis program structure were internal opportunities. Conclusion The majority of TB patients were not comorbid with NCDs. We build a favourable system for integrated implementation developing an integration platform and structural authority at a different organization by addressing identified challenges and applying facilitators is crucial.
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Affiliation(s)
| | - Kassa Daka Gidebo
- Department of Public Health, Wolaita Sodo University, Wolaita, South Region, Ethiopia
| | | | - Yohannes Kebede Lemu
- Department of Health, Behaviour and Society, Jimma University, Jimma, Oromia Region, Ethiopia
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Betru KT, Makua T. Challenges Experienced and Observed during the Implementation of Leprosy Strategies, Sidama Region, Southern Ethiopia: An inductive thematic analysis of qualitative study among health professionals who working with leprosy programs. PLoS Negl Trop Dis 2023; 17:e0011794. [PMID: 38033161 PMCID: PMC10715652 DOI: 10.1371/journal.pntd.0011794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 12/12/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Prompt diagnosis and treatment of leprosy are crucial for preventing the disease's spread as well as for avoiding negative medical and social effects and reducing the disease's burden. The likelihood of nerve damage and subsequent disability rises as the length of the diagnostic delay. We aimed to explore the challenges of health professionals faced regarding their involvement in early leprosy case detection strategies. METHODS The study employed a qualitative, descriptive and phenomenological explorative research design to answer the research questions. By the use of non-probability purposive sampling, research participants were identified. During the study, in-depth interviews were conducted to gather information regarding the experiences of health workers (medical doctors, public health officers, clinical nurses, health centre heads and regional and Woreda district health office technical and programme experts) and health extension workers. To analyse the qualitative data, inductive thematic analysis techniques were used. For analysis, open code software version 4.0 was used. The data transcription, coding, display, reduction (theme) and interpretation of the discovered results were the processes undertaken for the analysis. RESULT The findings of the study revealed that leprosy prevention and control programmes are still problematic. Themes that emerged from the data gleaned from the health workers included: lack of the existence of practice-oriented training, Integration of TB and leprosy training, lack of focus or other competing health priorities, Inadequate supportive supervision of health facilities, Multiple tasks for health workers, poor coordination and communications, lack of motivation in health workers, disruption in treatment, and Importance of training related to leprosy. CONCLUSION Strengthening comprehensive leprosy training for health workers, carrying out efficient and thorough contact tracing, enhancing monitoring, supervision, assessment and surveillance, boosting managerial skills, lobbying political commitment, and motivating healthcare workers may help in early detection of leprosy cases strategies.
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Affiliation(s)
- Kebede Tefera Betru
- Hawassa University, College of Medicine and Health Sciences, School of Public Health, Hawassa, Ethiopia
| | - Thuledi Makua
- University of South Africa, College of Human Sciences, Pretoria, South Africa
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Sharma N, Braakman-Jansen LMA, Oinas-Kukkonen H, Croockewit JH, Gemert-Pijnen JV. Exploring the Needs and Requirements of Informal Caregivers of Older Adults With Cognitive Impairment From Sensor-Based Care Solutions: Multimethod Study. JMIR Aging 2023; 6:e49319. [PMID: 37878353 PMCID: PMC10632915 DOI: 10.2196/49319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/19/2023] [Accepted: 08/25/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND With the increase in the older adult population, sensor-based care solutions that can monitor the deviations in physical, emotional, and physiological activities in real-time from a distance are demanded for prolonging the stay of community-dwelling older adults with cognitive impairment. To effectively develop and implement these care solutions, it is important to understand the current experiences, future expectations, perceived usefulness (PU), and communication needs of the informal caregivers of older adults with cognitive impairment regarding such solutions. OBJECTIVE This comprehensive study with informal caregivers of older adults with cognitive impairment aims to (1) highlight current experiences with (if any) and future expectations from general sensor-based care solutions, (2) explore PU specifically toward unobtrusive sensing solutions (USSs), (3) determine the information communication (IC) needs and requirements for communicating the information obtained through USSs in different care scenarios (fall, nocturnal unrest, agitation, and normal daily life), and (4) elicit the design features for designing the interaction platform in accordance with the persuasive system design (PSD) model. METHODS A multimethod research approach encompassing a survey (N=464) and in-depth interviews (10/464, 2.2%) with informal caregivers of older adults with cognitive impairment was used. The insights into past experiences with and future expectations from the sensor-based care solutions were obtained through inductive thematic analysis of the interviews. A convergent mixed methods approach was used to explore PU and gather the IC needs from USSs by using scenario-specific questions in both survey and interviews. Finally, the design features were elicited by using the PSD model on the obtained IC needs and requirements. RESULTS Informal caregivers expect care infrastructure to consider centralized and empathetic care approaches. Specifically, sensor-based care solutions should be adaptable to care needs, demonstrate trust and reliability, and ensure privacy and safety. Most informal caregivers found USSs to be useful for emergencies (mean 4.09, SD 0.04) rather than for monitoring normal daily life activities (mean 3.50, SD 0.04). Moreover, they display variations in information needs including mode, content, time, and stakeholders involved based on the care scenario at hand. Finally, PSD features, namely, reduction, tailoring, personalization, reminders, suggestions, trustworthiness, and social learning, were identified for various care scenarios. CONCLUSIONS From the obtained results, it can be concluded that the care scenario at hand drives PU and IC design needs and requirements toward USSs. Therefore, future technology developers are recommended to develop technology that can be easily adapted to diverse care scenarios, whereas designers of such sensor-driven platforms are encouraged to go beyond tailoring and strive for strong personalization while maintaining the privacy of the users.
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Affiliation(s)
- Nikita Sharma
- Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Enschede, Netherlands
- Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland
| | - Louise M A Braakman-Jansen
- Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Enschede, Netherlands
| | - Harri Oinas-Kukkonen
- Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland
| | | | - Jewc van Gemert-Pijnen
- Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Enschede, Netherlands
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Gómez-Dantés O, Flamand L, Cerecero-García D, Morales-Vazquez M, Serván-Mori E. Origin, impacts, and potential solutions to the fragmentation of the Mexican health system: a consultation with key actors. Health Res Policy Syst 2023; 21:80. [PMID: 37525130 PMCID: PMC10388521 DOI: 10.1186/s12961-023-01025-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/23/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND One of the central debates in health policy is related to the fragmentation of health systems. Fragmentation is perceived as a major obstacle to UHC. This article presents the results of a consultation with a group of actors of the Mexican policy arena on the origins and impacts of the fragmentation of the Mexican health system. METHODS We used a consultation to nine key actors to collect thoughts on the fragmentation of the Mexican health system. The group included national and local decision makers with experience in health care issues and researchers with background in health systems and/or public policies. The sessions were recorded, transcribed verbatim and analyzed thematically. RESULTS Participants defined the term 'fragmentation' as the separation of the various groups of the population based on characteristics which define their access to health care services. This is a core characteristic of health systems in Latin America (LA). In general, those affiliated to social security institutions have a higher per capita expenditure than those without social security, which translates into differential health benefits. According to the actors in this consultation, fragmentation is the main structural problem of the Mexican health system. Actors agreed that the best way to end fragmentation is through the creation of a universal health system. Defragmentation plans should include a research component to document the impacts of fragmentation, and design and test the instruments needed for the integration process. CONCLUSIONS First, health system fragmentation in Mexico has created problems of equity since different population groups have unequal access to public resources and different health benefits. Second, Mexico needs to move beyond the fragmentation of its health system and guarantee, through its financial integration, access to the same package of health services to all its citizens. Third, defragmentation plans should include a research component to document the impacts of fragmentation, and design and test the instruments needed for the integration process. Fourth, defragmentation of health systems is not an easy task because there are vested interests that oppose its implementation. Political strategies to meet the resistance of these groups are an essential component of any defragmentation plan.
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Affiliation(s)
- Octavio Gómez-Dantés
- Center for Health Systems Research, The National Institute of Public Health, 62100, Cuernavaca, Morelos, Mexico
| | - Laura Flamand
- Center for International Studies, College of Mexico, A.C., Mexico City, Mexico
| | - Diego Cerecero-García
- Center for Health Systems Research, The National Institute of Public Health, 62100, Cuernavaca, Morelos, Mexico
| | | | - Edson Serván-Mori
- Center for Health Systems Research, The National Institute of Public Health, 62100, Cuernavaca, Morelos, Mexico.
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Ferrah N, Parker C, Ibrahim J, Gabbe B, Cameron P. A qualitative descriptive study exploring clinicians' perspectives of the management of older trauma care in rural Australia. BMC Health Serv Res 2023; 23:704. [PMID: 37381004 DOI: 10.1186/s12913-023-09545-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 05/14/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND For older trauma patients who sustain trauma in rural areas, the risk of adverse outcomes associated with advancing age, is compounded by the challenges encountered in rural healthcare such as geographic isolation, lack of resources, and accessibility. Little is known of the experience and challenges faced by rural clinicians who manage trauma in older adults. An understanding of stakeholders' views is paramount to the effective development and implementation of a trauma system inclusive of rural communities. The aim of this descriptive qualitative study was to explore the perspectives of clinicians who provide care to older trauma patients in rural settings. METHOD We conducted semi-structured interviews of health professionals (medical doctors, nurses, paramedics, and allied health professionals) who provide care to older trauma patients in rural Queensland, Australia. A thematic analysis consisting of both inductive and deductive coding approaches, was used to identify and develop themes from interviews. RESULTS Fifteen participants took part in the interviews. Three key themes were identified: enablers of trauma care, barriers, and changes to improve trauma care of older people. The resilience of rural residents, and breadth of experience of rural clinicians were strengths identified by participants. The perceived systemic lack of resources, both material and in the workforce, and fragmentation of the health system across the state were barriers to the provision of trauma care to older rural patients. Some changes proposed by participants included tailored education programs that would be taught in rural centres, a dedicated case coordinator for older trauma patients from rural areas, and a centralised system designed to streamline the management of older trauma patients coming from rural regions. CONCLUSIONS Rural clinicians are important stakeholders who should be included in discussions on adapting trauma guidelines to the rural setting. In this study, participants formulated pertinent and concrete recommendations that should be weighed against the current evidence, and tested in rural centres.
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Affiliation(s)
- Noha Ferrah
- School of Public Health and Preventive Medicine, Monash University, Prahan, VIC, 3004, Australia.
| | - Catriona Parker
- School of Public Health and Preventive Medicine, Monash University, Prahan, VIC, 3004, Australia
| | - Joseph Ibrahim
- School of Public Health and Preventive Medicine, Monash University, Prahan, VIC, 3004, Australia
- Department of Forensic Medicine, Monash University, The Victorian Institute of Forensic Medicine, Southbank, VIC, Australia
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, Prahan, VIC, 3004, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Prahan, VIC, 3004, Australia
- Health Data Research UK, Swansea University Medical School, Swansea, Wales
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Kehoe MacLeod K, Flores KN, Chandra K. Identifying facilitators and barriers to integrated and equitable care for community-dwelling older adults with high emergency department use from historically marginalized groups. Int J Equity Health 2023; 22:97. [PMID: 37208757 DOI: 10.1186/s12939-023-01900-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/27/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND High rates of emergency department (ED) use by older adults persist despite attempts to improve accessibility of appropriate and comprehensive care. Understanding the drivers of ED visits from the perspective of older adults from historically marginalized groups could help reduce ED use by patients with needs that are preventable or could have been treated in a more appropriate setting. This interpretivist, feminist study aims to explore the unmet care needs of older adults (age 65 +) with high ED use and belonging to historically marginalized groups to better understand how social and structural inequities reinforced by neoliberalism; federal and provincial governance structures and policy frameworks; and regional processes and local institutional practices, shape the experiences of these older adults, particularly those at risk of poor health outcomes based on the social determinants of health (SDH). METHODS/DESIGN This mixed methods study will employ an integrated knowledge translation (iKT) approach, starting with a quantitative phase followed by a qualitative phase. Older adults self-identifying as belonging to a historically marginalized group, having visited an ED three or more times in the past 12 months, and living in a private dwelling, will be recruited using flyers posted at two emergency care sites and by an on-site research assistant. Data obtained through surveys, short answer questions, and chart review will be used to compile case profiles of patients from historically marginalized groups with potentially avoidable ED visits. Descriptive and inferential statistical analyses and inductive thematic analysis will be conducted. Findings will be interpreted using the Intersectionality-Based Policy Analysis Framework to identify the interconnections between unmet care needs, potentially avoidable ED admissions, structural inequalities, and the SDH. Semi-structured interviews will be conducted with a subset of older adults at risk of poor health outcomes based on SDH, family care partners, and health care professionals to validate preliminary findings and collect additional data on perceived facilitators and barriers to integrated and accessible care. DISCUSSION Exploring the linkages between potentially avoidable ED visits by older adults from marginalized groups and how their care experiences have been shaped by inequities in the systems, policies, and institutions that structure health and social care provision will enable researchers to offer recommendations for equity-focused policy and clinical practice reforms to improve patient outcomes and system integration.
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Affiliation(s)
- Krystal Kehoe MacLeod
- Bruyère Research Institute, Ottawa, Ontario, Canada.
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
- Horizon Health Network, Saint John, New Brunswick, Canada.
| | - Karyle Nama Flores
- Horizon Health Network, Saint John, New Brunswick, Canada
- Faculty of Health Sciences and Nursing, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Kavish Chandra
- Horizon Health Network, Saint John, New Brunswick, Canada
- Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
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Kehoe MacLeod K. Using Independent Contracting Arrangements in Integrated Care Programs for Older Adults: Implications for Clients and the Home Care Workforce in a Time of Neoliberal Restructuring. J Appl Gerontol 2023; 42:536-543. [PMID: 36201193 DOI: 10.1177/07334648221130743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Integrated care programs reshape the processes of health and social care delivery in the home care sector to be more continuous, cooperative, equitable, and efficient. An independent contracting model is one approach being used to overcome issues related to home care fragmentation. To better understand the implications of this model of service delivery for clients and carers, interviews were conducted in 2013 with 22 key informants. Data were analyzed using thematic analysis and interpreted using a feminist political economy framework. This study finds that independent contracting arrangements improve care continuity for clients while simultaneously reinforcing precarious working conditions for home care workers. This research calls for reform to this model of service delivery to better support home care workers as they provide the care necessary for older adults to age in place.
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Affiliation(s)
- Krystal Kehoe MacLeod
- Centre for Research in Integrated Care, 96944University of New Brunswick Saint John, New Brunswick, Canada
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Leon N, Xu H. Implementation considerations for non-communicable disease-related integration in primary health care: a rapid review of qualitative evidence. BMC Health Serv Res 2023; 23:169. [PMID: 36803143 PMCID: PMC9938355 DOI: 10.1186/s12913-023-09151-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 02/03/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Integrated delivery of primary health care (PHC) services is a health reform recommended for achieving ambitious targets of the Sustainable Development Goals and Universal Health Coverage, responding to growing challenges of managing non-communicable and multimorbidity. However, more evidence is needed on effective implementation of PHC integration in different country settings. OBJECTIVE This rapid review synthesized qualitative evidence on implementation factors affecting integration of non-communicable disease (NCD) into PHC, from the perspective of implementers. The review contributes evidence to inform the World Health Organizations' guidance on integration of NCD control and prevention to strengthen health systems. METHOD The review was guided by standard methods for conducting rapid systematic reviews. Data analysis was guided by the SURE and WHO health system building blocks frameworks. We used Confidence in the Evidence of Reviews of Qualitative Research (GRADE-CERQual) to assess the confidence of the main findings. RESULTS The review identified 81 records eligible for inclusion, from 595 records screened. We sampled 20 studies for analysis (including 3 from expert recommendations). Studies covered a wide range of countries (27 countries from 6 continents), the majority from low-and middle-income countries (LMICs), with a diverse set of NCD-related PHC integration combinations and implementation strategies. The main findings were categorised into three overarching themes and several sub-themes. These are, A: Policy alignment and governance, B: Health systems readiness, intervention compatibility and leadership, and C: Human resource management, development, and support. The three overarching findings were assessed as each having a moderate level of confidence. CONCLUSION The review findings present insights on how health workers responses may be shaped by the complex interaction of individual, social, and organizational factors that may be specific to the context of the intervention, the importance of cross-cutting influences such as policy alignment, supportive leadership and health systems constraints, knowledge that can inform the development of future implementation strategies and implementation research.
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Affiliation(s)
- N. Leon
- Independent Public Health Researcher, Charlottesville, VA USA ,grid.40263.330000 0004 1936 9094Department of Epidemiology, Brown University School of Public Health, Providence, RI USA ,grid.415021.30000 0000 9155 0024South African Medical Research Council, Cape Town, South Africa
| | - H. Xu
- grid.3575.40000000121633745Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
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Løken TD, Helgesen MK, Bjørkquist C. Collective Competence as an Enabler for Service Integration in Health and Social Care Services. J Multidiscip Healthc 2022; 15:2817-2830. [DOI: 10.2147/jmdh.s387719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/20/2022] [Indexed: 12/14/2022] Open
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Grayson N, Quinones N, Oseguera T. A Model of True CHOICES: Learnings from a Comprehensive Sexual and Reproductive Health Clinic in Tennessee that Provides Abortions and Opened the City's First Birth Center. J Midwifery Womens Health 2022; 67:689-695. [PMID: 36471539 DOI: 10.1111/jmwh.13448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 08/16/2022] [Accepted: 09/26/2022] [Indexed: 12/12/2022]
Abstract
CHOICES Memphis Center for Reproductive Health staff is passionate about ensuring that everyone has access to the full continuum of comprehensive reproductive health care (including abortion, gender-affirming care, miscarriage management, and community birth) regardless of race, gender identity, sexual orientation, HIV status, economic status, or religious beliefs. Memphis, Tennessee, has a history of limited community birth options (birthing outside of hospital walls). In 2017, when home birth services were added to CHOICES and plans for opening Memphis' first freestanding birth center were being imagined, it was intentional to create a model in which midwifery care could be accessible for patients who may be eligible for state-funded health care services, those considered at higher health risk than traditional low-risk midwifery patients, or both. In fact, individuals and their families with limited out-of-pocket funds and those historically marginalized would purposely receive holistic, individualized care based on their unique health care needs and personal desires, driven by a reproductive justice framework. In this article, we outline the success and challenges of addressing the reproductive health needs of marginalized communities, including the benefits of a nonprofit business model, operationalizing reproductive justice concepts, and the reclamation of Black midwifery. We also discuss the challenges of caring for Black birthing people and providing abortion and gender-affirming care in a politically hostile environment. Although individuals have complex needs, at its core, CHOICES believes that every person must be seen as whole human beings and that each can be cared for by a midwife. The CHOICES approach is informed by evidence-based information, clinical judgment, and an intentional partnership with and investment in a people who have historically been and are presently pushed to the margins, neglected, and blamed for poor health outcomes and demise. Striving to adapt the CHOICES model of care in other parts of the country is important now more than ever following the Supreme Court decision to overturn Roe v. Wade.
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Affiliation(s)
- Nikia Grayson
- CHOICES: Center for Reproductive Health, Memphis, Tennessee, United States
| | - Nicole Quinones
- CHOICES: Center for Reproductive Health, Memphis, Tennessee, United States
| | - Talita Oseguera
- CHOICES: Center for Reproductive Health, Memphis, Tennessee, United States
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Using More Equitable Integrated Care Programs to Reduce Fragmentation in Home Care. Int J Integr Care 2022; 22:17. [PMID: 36213218 PMCID: PMC9503896 DOI: 10.5334/ijic.6553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/30/2022] [Indexed: 11/20/2022] Open
Abstract
Integrated care programs have been developed to deliver care across providers, settings, and support systems to meet the needs of community-dwelling older adults. This research asks how these programs are being used to combat issues of fragmentation in a home care sector fundamentally reshaped by neoliberalism. Data was collected through 118 key informant interviews in five Canadian integrated care programs and interpreted using a thematic analysis informed by Feminist Political Economy. This dissertation argues that integrated care programs are most useful as a policy solution to fragmented home care when they adopt policy techniques that promote equitable processes and outcomes.
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Oviedo-Cáceres MDP, Arias-Valencia S, Hernández-Quirama A, Ruiz-Rodríguez M, Guisasola-Valencia L. Intersectionality and access to visual rehabilitation services: Experiences of people with low vision, a qualitative study. BRITISH JOURNAL OF VISUAL IMPAIRMENT 2022. [DOI: 10.1177/02646196221104902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Low vision is a condition of visual impairment, generated by an underlying pathology that affects visual functioning and the development of daily activities. In the field of visual impairment, the developments in the analysis of access to rehabilitation services are scarce and incipient. The study approaches the understanding of the experiences of people with low vision in Medellín, Colombia, in their search for visual rehabilitation services. Ethnographic collective case study was conducted. Intersectionality was adopted to explore people’s experiences with low vision management health services. Five women and four men with low vision who attended the healthcare center participated in the study. Twenty-nine interviews and 16 participant observation exercises were carried out. Three categories emerged in the study: (1) I had never heard of low vision services; (2) Interaction with the health system: A path of struggles; and (3) Barriers that are exacerbated by the intersection of multiple identities and systems of oppression. The Colombian health system acts as an axis of structural oppression that interacts with the economic condition, educational level, and geographical location to generate greater difficulties for the identification of low vision management options, which also interact with the multiple and dynamic identities of each subject.
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16
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Løken TD, Helgesen MK, Vike H, Bjørkquist C. Being bound and tied by the ropes of frugality: a case study on public management values and service integration. J Health Organ Manag 2022; ahead-of-print. [PMID: 35294136 PMCID: PMC9616016 DOI: 10.1108/jhom-10-2020-0401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Purpose New Public Management (NPM) has increased fragmentation in municipal health and social care organizations. In response, post-NPM reforms aim to enhance integration through service integration. Integration of municipal services is important for people with complex health and social challenges, such as concurrent substance abuse and mental health problems. This article explores the conditions for service integration in municipal health and social services by studying how public management values influence organizational and financial structures and professional practices. Design/methodology/approach This is a case study with three Norwegian municipalities as case organizations. The study draws on observations of interprofessional and interagency meetings and in-depth interviews with professionals and managers. The empirical field is municipal services for people with concurrent substance abuse and mental health challenges. The data were analyzed both inductively and deductively. Findings The study reveals that opportunities to assess, allocate and deliver integrated services were limited due to organizational and financial structures as the most important aim was to meet the financial goals. The authors also find that economic and frugal values in NPM doctrines impede service integration. Municipalities with integrative values in organizational and financial structures and in professional approaches have greater opportunities to succeed in integrating services. Originality/value Applying a public management value perspective, this study finds that the values on which organizational and financial structures and professional practices are based are decisive in enabling and constraining service integration.
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Affiliation(s)
- Therese Dwyer Løken
- Faculty of Health, Welfare and Organisation, Østfold University College, Halden, Norway
| | | | - Halvard Vike
- Department of Health, Social and Welfare Studies, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Catharina Bjørkquist
- Faculty of Health, Welfare and Organisation, Østfold University College, Halden, Norway
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17
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Bajeux E, Corvol A, Somme D. Integrated Care for Older People in France in 2020: Findings, Challenges, and Prospects. Int J Integr Care 2021; 21:16. [PMID: 34824565 PMCID: PMC8588900 DOI: 10.5334/ijic.5643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 10/15/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND We analyze here major changes over the last decade in the French healthcare system for older people, in terms of the integrated care concept. POLICIES During this period, the major theme of public policies was "care coordination." Despite some improvements, the multiplication of experimental programs and the multiplicity of stakeholders distanced the French healthcare system from an integrated care model. Professionals and organizations generally welcomed these numerous programs. However, most often, the programs were insufficiently implemented or articulated, notably at a clinical level, because of the persistence of a high level of fragmentation of governance, despite the creation of regional health agencies 10 years ago. The COVID-19 crisis has highlighted this fragmentation. Moreover, we still lack data on the impact of these programs on people's health trajectories and personal experiences. CONCLUSION The French healthcare system seems more fragmented in 2020 than in 2010, despite improvements in the culture of professional collaboration. The future health reform is an opportunity to capitalize upon this progress and to implement "integrated care." This implies a strong and continuous national leadership in governance and change management.
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Affiliation(s)
- Emma Bajeux
- Department of Epidemiology and Public Health, Rennes CHU, FR
| | - Aline Corvol
- Department of Geriatrics, Rennes CHU – Univ Rennes, CNRS, Arènes-UMR 6051, F-35000, Rennes, FR
| | - Dominique Somme
- Department of Geriatrics, Rennes CHU – Univ Rennes, CNRS, Arènes-UMR 6051, F-35000, Rennes, FR
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18
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Ghanouni P, Seaker L. Healthcare Services During the Transitions to Adulthood Among Individuals with ASD Aged 15-25 Years Old: Stakeholders' Perspectives. J Autism Dev Disord 2021; 52:2575-2588. [PMID: 34216328 DOI: 10.1007/s10803-021-05159-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 10/20/2022]
Abstract
Although previous research has shown that the transition to adulthood may be challenging, there exists a lack of research regarding perspectives of stakeholders on the transition of individuals with Autism Spectrum Disorder (ASD). This study aimed to investigate stakeholders' experiences regarding healthcare services for youth with ASD during their transition. We involved 20 stakeholders, including 17 parents of youth with ASD as well as 3 services providers. The study yielded three major themes including: (a) accessibility and quality of care; (b) tensions and conflicts; and (c) navigation and integrated care. The findings can be used to direct change within the healthcare services towards better practices for youth with ASD and increasing the likelihood of positive health outcomes.
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Affiliation(s)
- Parisa Ghanouni
- Department of Occupational Therapy, Dalhousie University, PO Box 15000, Halifax, NS, B3H 4R2, Canada.
| | - Liam Seaker
- Department of Occupational Therapy, Dalhousie University, PO Box 15000, Halifax, NS, B3H 4R2, Canada
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19
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Nunu WN, Makhado L, Mabunda JT, Lebese RT. Indigenous Health Systems and Adolescent Sexual Health in Umguza and Mberengwa Districts of Zimbabwe: Community Key Stakeholders' Perspectives. Health Serv Insights 2021; 14:11786329211013553. [PMID: 33994795 PMCID: PMC8111273 DOI: 10.1177/11786329211013553] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/06/2021] [Indexed: 11/17/2022] Open
Abstract
Different stakeholders play varying roles in shaping up adolescent sexual behaviours that, in turn, influence their sexual experiences. In Zimbabwe, it has been reported that adolescents from cultural districts exhibit poor sexual health outcomes as compared to other districts. Therefore, this study sought to explore the role of different key community stakeholders in the indigenous health system and how it impacts on adolescent sexual health issues. The study further explored how the indigenous health system could be integrated into the modern health system. A qualitative cross-sectional survey was conducted on purposively and snowballed respondents in Umguza and Mberengwa districts. Interviews and focus group discussions were used to gather and record data from participants. The recorded data were transcribed verbatim, translated to English, coded and thematically analysed on MAXQDA Analytics Pro 2020. Four superordinate and 12 subordinate themes emerged from the data during analysis. Stakeholders play varied roles in adolescents’ upbringing and support though there are contradicting teachings from the indigenous health system and modern health system. It is possible to integrate these two systems though there were foreseen logistical challenges and clashes in the values and belief systems. Participants made suggestions on how these challenges could be overcome. There is a window of opportunity to pursue the suggested ways of integrating indigenous health systems and modern health systems for improved adolescent sexual health outcomes.
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Affiliation(s)
- Wilfred Njabulo Nunu
- Department of Public Health, School of Health Sciences, University of Venda, Thohoyandou, South Africa.,Department of Environmental Science and Health, Faculty of Applied Sciences, National University of Science and Technology, Bulawayo, Zimbabwe
| | - Lufuno Makhado
- Department of Public Health, School of Health Sciences, University of Venda, Thohoyandou, South Africa
| | - Jabu Tsakani Mabunda
- Department of Public Health, School of Health Sciences, University of Venda, Thohoyandou, South Africa
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20
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Shahabi S, Skempes D, Mojgani P, Bagheri Lankarani K, Heydari ST. Stewardship of physiotherapy services in Iran: common pitfalls and policy solutions. Physiother Theory Pract 2021; 38:2086-2099. [PMID: 33760676 DOI: 10.1080/09593985.2021.1898705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Physiotherapy (PT) is a key component of the rehabilitative health strategy and an effective approach to the management and treatment of a wide range of health conditions. However, it remains underdeveloped and poorly implemented in many national health systems. Previous studies show that weak stewardship of rehabilitation services is, among others, a significant barrier to equitable access to services and supports in many parts of the world, including in Iran. This study investigated the common pitfalls and potential policy solutions to improve the stewardship of PT services in Iran from the perspective of key stakeholders. Semi-structured interviews were conducted by telephone, via the internet, and in face-to-face sessions in Iran with a purposive sample of health planners and policy decision-makers, university professors, rehabilitation managers, and physiotherapists. In total, 30 individuals agreed to participate. Participants identified several pitfalls across the six dimensions of stewardship: 1) strategy formulation; 2) inter-sectoral collaboration; 3) governance and accountability; 4) health system design; 5) policy and regulation; and 6) intelligence generation. In addition, several policy options and solutions to address critical deficiencies in the system were suggested to improve the stewardship of PT services. The study identified challenges and pitfalls affecting the stewardship of the PT sector in Iran as perceived by key stakeholders. Participants' insights can inform deliberative dialogue processes, agenda-setting, and strategy formulation to support the development, expansion, and implementation of PT services.
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Affiliation(s)
- Saeed Shahabi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, School of Medicine, Shiraz, Iran
| | - Dimitrios Skempes
- Disability Policy and Implementation Research Group, Swiss Paraplegic Research (SPF), Nottwil, Switzerland
| | - Parviz Mojgani
- Iran-Helal Institute of Applied Science and Technology, Tehran.,Research Center for Emergency and Disaster Resilience, Red Crescent Society of The Islamic Republic of Iran, Tehran, Tehran
| | - Kamran Bagheri Lankarani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, School of Medicine, Shiraz, Iran
| | - Seyed Taghi Heydari
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, School of Medicine, Shiraz, Iran
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21
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Elkhuizen SG, Vissers JMH, Mahdavi M, van de Klundert JJ. Modeling Patient Journeys for Demand Segments in Chronic Care, With an Illustration to Type 2 Diabetes. Front Public Health 2020; 8:428. [PMID: 33014961 PMCID: PMC7493672 DOI: 10.3389/fpubh.2020.00428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/14/2020] [Indexed: 11/18/2022] Open
Abstract
Chronic care is an important area for cost-effective and efficient health service delivery. Matching demand and services for chronic care is not easy as patients may have different needs in different stages of the disease. More insight is needed into the complete patient journey to do justice to the services required in each stage of the disease, to the different experiences of patients in each part of the journey, and to outcomes in each stage. With patient journey we refer to the “journey” of the patient along the services received within a demand segment of chronic care. We developed a generic framework for describing patient journeys and provider networks, based on an extension of the well-known model of Donabedian, to relate demand, services, resources, behavior, and outcomes. We also developed a generic operational model for the detailed modeling of services and resources, allowing for insight into costs. The generic operational model can be tailored to the specific characteristics of patient groups. We applied this modeling approach to type 2 diabetes (T2D) patients. Diabetes care is a form of chronic care for patients suffering diabetes mellitus. We studied the performance of T2D networks, using a descriptive model template. To identify and describe demand we made use of the following demand segments within the diabetes type 2 population: patients targeted for prevention; patients with stage 1 diabetes treated by their GP with lifestyle advice; patients with diabetes stage 2 treated by their GP with lifestyle advice and oral medication; patients with stage 3 diabetes treated by their GP with lifestyle advice, oral medication, and insulin injections; patients with stage 4 diabetes with complications (treated by internal medicine specialists). We used a Markov model to describe the transitions between the different health states. The model enables the patient journey through the health care system for cohorts of newly diagnosed T2D patients to be described, and to make a projection of the resource requirements of the different demand segments over the years. We illustrate our approach with a case study on a T2D care network in The Netherlands and reflect on the role of demand segmentation to analyse the case study results, with the objective of improving the T2D service delivery.
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Affiliation(s)
- Sylvia G Elkhuizen
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Jan M H Vissers
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Mahdi Mahdavi
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands.,National Institute for Health Research/Tehran University of Medical Sciences, Tehran, Iran.,Harvard T. H. Chan School of Public Health, The Bernard Lown Scholar for Cardiovascular Health, Department of Global Health and Population, Boston, MA, United States
| | - Joris J van de Klundert
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands.,Prince Mohammad bin Salman School for Business and Entrepreneurship/King Abdullah Economic City, King Abdullah Economic City, Saudi Arabia
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22
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Merryman MB, Synovec C. Integrated Care: Provider referrer perceptions of occupational therapy services for homeless adults in an integrated primary care setting. Work 2020; 65:321-330. [PMID: 32007976 DOI: 10.3233/wor-203084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Occupational therapists have a long history of addressing community performance and participation challenges faced by individuals with complex, chronic conditions, including those with serious mental illnesses (SMI) and cognitive issues that present with a traumatic brain injury (TBI). Healthcare reform has shifted incentives to support practices that promote successful community life for people with complex medical conditions. Community based care models emphasizing integrated primary care, such as Federally Qualified Health Centers (FQHC) are emerging, and a generalist role for occupational therapy is being defined. Those with complex comorbid conditions such as mental illness, substance abuse and traumatic brain injury are at risk for negative health outcomes that are further compounded by homelessness. There is a critical need to understand effective treatment options for this population to reduce the negative effects of chronic health conditions. As occupational therapists further define a role serving traditional clients in less traditional settings, such as the FQHC, it is helpful to explore the perceptions of the utility of OT services on the part of provider referrers. OBJECTIVE This study explored provider referrer perceptions of a new occupational therapy service for homeless adults in an FQHC to assist effective allocation of scarce resources. METHODS Twelve provider referrers at an FQHC were interviewed regarding their perception of the role and utility of occupational therapy in this setting. Interviews were then coded for themes. RESULTS Providers identified the unique value of occupational therapy, emphasizing critical information gleaned from the performance-based assessment of functional cognition, and the positive impact on team interactions and subsequent care decisions. CONCLUSION Occupational therapy provides a distinct perspective on client performance in FQHC settings indicating benefit for inclusion of services.
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Affiliation(s)
- M Beth Merryman
- Department of Occupational Therapy & Occupational Science, Towson University, Towson, MD, USA
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23
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León-Arce HG, Mogollón-Pérez AS, Vargas I, Vázquez ML. Changes in knowledge and use of clinical coordination mechanisms between care levels in healthcare networks of Colombia. Int J Health Plann Manage 2020; 36:134-150. [PMID: 32954542 DOI: 10.1002/hpm.3073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 08/10/2020] [Accepted: 09/02/2020] [Indexed: 11/11/2022] Open
Abstract
Clinical coordination mechanisms (CCMs) have become key tools in healthcare networks for improving coordination between primary care (PC) and secondary care (SC) and are particularly relevant in health systems with highly fragmented healthcare provision. However, their implementation has been little studied to date in Latin America and particularly in Colombia. This study analyses the level of knowledge and use of CCMs between care levels and their changes between 2015 and 2017 in two public healthcare networks in Bogotá, Colombia. Comparison of two cross-sectional studies based on surveys among PC and SC doctors working in their networks (174 doctors per network/year). The COORDENA questionnaire was used for measuring knowledge concerning CCMs and the frequency of use and difficulties involved in using referral/reply letters (R/RLs) and hospital discharge reports (HDRs). Descriptive bivariate analysis and Poisson regression models with robust variance were used for analysing differences between networks and years. The results for both networks and years revealed greater knowledge and use of information coordination mechanisms than those regarding clinical management coordination (though their knowledge increased in 2017). Although widely known and used, significant problems regarding infrequent and late receipt of RLs and HDRs in PC as well as the poor quality of their contents limits their effective use, which may affect the quality of care. Strategies are required to improve CCMs use.
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Affiliation(s)
- Heisel Gloria León-Arce
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia.,Departamento de Pediatría, de Obstetricia y Ginecología y de Medicina Preventiva, Universidad Autónoma de Barcelona, Barcelona, España
| | | | - Ingrid Vargas
- Servei d'Estudis i Prospectives en Polítiques de Salut, Grup de Recerca en Polítiques de, Salut i Serveis Sanitaris (GRPSS), Consorci de Salut i Social de Catalunya, Barcelona, Spain
| | - María-Luisa Vázquez
- Servei d'Estudis i Prospectives en Polítiques de Salut, Grup de Recerca en Polítiques de, Salut i Serveis Sanitaris (GRPSS), Consorci de Salut i Social de Catalunya, Barcelona, Spain
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24
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Yue X, Mu K, Liu L. Selection of Policy Instruments on Integrated Care in China: Based on Documents Content Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072327. [PMID: 32235602 PMCID: PMC7177394 DOI: 10.3390/ijerph17072327] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 12/24/2022]
Abstract
Facing the aggravating trend of an aging population and a fragmented medical service delivery system, the Chinese Central Government has introduced a series of policies to promote the development of integrated care against the background of the “Healthy China Strategy”. The achievement of integrated care depends on the choice of policy instruments. However, few studies have focused on how policy instruments promote the practice of integrated care in China. This article aims to obtain a deeper understanding of the use of policy instruments in the development of integrated care in China. Policy documents are the carriers of policy instruments. National-level integrated care policy documents from 2009 to 2019 were selected. Using the qualitative document analysis method, this paper conducts an analysis of integrated care policy instruments. In order to comprehensively view the integrated care policy instruments, a three-dimensional analytical framework consisting of the policy instruments dimension, stakeholders dimension, and health service supply chains dimension is proposed. The results are as follows. (1) From the perspective of policy instruments, the integrated care policy has adopted supply-side policy instruments, demand-side policy instruments, and environmental policy instruments. Among the three types of policy instruments, environmental policy instruments are used most frequently, supply-side policies are preferred, while demand-side policy instruments are relatively inadequate. (2) As for the stakeholders dimension, the central policy instruments focus on the health service providers, while less attention is paid to the health service demanders. (3) In terms of health service supply chains, the number of policy instruments used in the prevention stage is the highest, followed by the treatment stage, whereas less attention paid to the rehabilitation stage. Finally, suggestions were made for the development of integrated care by better perfecting policy instruments.
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Affiliation(s)
- Xin Yue
- School of Public Administration, Central South University, Changsha 410083, China;
| | - Kaining Mu
- School of Nursing, Xi’an Jiaotong University, Xi’an 710061, China;
| | - Lihang Liu
- School of Public Administration, Central South University, Changsha 410083, China;
- Correspondence:
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25
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Mourtada R, Bottomley C, Houben F, Bashour H, Campbell OMR. A mixed methods analysis of factors affecting antenatal care content: A Syrian case study. PLoS One 2019; 14:e0214375. [PMID: 30908532 PMCID: PMC6433263 DOI: 10.1371/journal.pone.0214375] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 03/12/2019] [Indexed: 12/04/2022] Open
Abstract
Background Maternity care services provide critical interventions aimed at improving maternal and newborn health. In this study, we examined determinants of antenatal care (ANC) content in Syria, together with changes over time. Methods We analysed two national surveys conducted by the Central Bureau of Statistics in Damascus (PAPFAM 2001 and MICS 2006). Findings of this initial analysis led to a qualitative study on adequacy of antenatal care content in two Syrian governorates, Aleppo and Latakia in 2010, which in turn informed further quantitative analysis. The perspectives and practices of doctors, women, midwives and health officials were explored using in-depth interviews. A framework approach was used to analyse the data. Results The quantitative analysis demonstrated that women’s education level, the type of health facility they attended and whether they had experienced health complications were important determinants of adequacy of ANC content received. The qualitative study revealed that additional factors related to supply side and demand side factors (e.g. organization of health services, doctors' selective prescription of ANC tests and women's selective uptake of those tests), influenced the quality of ANC and explained some regional differences between Aleppo and Latakia. Conclusions The percentage of women who received adequate ANC content was probably higher in Latakia than in Aleppo because women in Latakia were more educated, and because services were more available, accessible, and acceptable to them.
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Affiliation(s)
- Rima Mourtada
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Christian Bottomley
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Fiona Houben
- Faculty of Health and Wellbeing, Canterbury Christ Church University, Canterbury, Kent, United Kingdom
| | | | - Oona M. R. Campbell
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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26
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Doubova SV, García-Saisó S, Pérez-Cuevas R, Sarabia-González O, Pacheco-Estrello P, Leslie HH, Santamaría C, Torres-Arreola LDP, Infante-Castañeda C. Barriers and opportunities to improve the foundations for high-quality healthcare in the Mexican Health System. Health Policy Plan 2018; 33:1073-1082. [PMID: 30544258 PMCID: PMC6415720 DOI: 10.1093/heapol/czy098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2018] [Indexed: 11/15/2022] Open
Abstract
This study aimed to describe the foundations for quality of care (QoC) in the Mexican public health sector and identify barriers to quality evaluation and improvement from the perspective of the QoC leaders of the main public health sector institutions: Ministry of Health (MoH), the Mexican Institute of Social Security (IMSS) and the Institute of Social Security of State Workers (ISSSTE). We administered a semi-structured online questionnaire that gathered information on foundations (governance, health workforce, platforms, tools and population), evaluation and improvement activities for QoC; 320 leaders from MoH, IMSS and ISSSTE participated. We used thematic content and descriptive analyses to analyse the data. We found that QoC foundations, evaluation and improvement activities pose essential challenges for the Mexican health sector. Governance for QoC is weakly aligned across MoH, IMSS and ISSSTE. Each institution follows its own agenda of evaluation and improvement programmes and has distinct QoC indicators and information systems. The institutions share similar barriers to strengthening QoC: poor organizational structure at a facility level, scarcity of financial resources, lack of training in QoC for executive/managerial staff and health professionals and limited public participation. In conclusion, a stronger legal framework and policy dialogue is needed to foster governance by the MoH, to define and align health sector-wide QoC policies, and to set common goals and articulate QoC improvement actions among institutions. Robust QoC organizational structure with designated staff and clarity on their responsibilities should be established at all levels of healthcare. Investment is necessary to fund formal and in-service QoC training programmes for health professionals and to reinforce quality evaluation and improvement activities and quality information systems. QoC evaluation results should be available to healthcare providers and the population. Active public participation in the design and implementation of improvement initiatives should be strengthened.
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Affiliation(s)
- Svetlana V Doubova
- Epidemiology and Health Services Research Unit, CMN Siglo XXI, Mexican Institute of Social Security, Av. Cuauhtemoc 330, Col. Doctores, Del. Cuauhtemoc, Mexico City, Mexico
| | - Sebastián García-Saisó
- General Directorate for Quality of Healthcare and Education, Ministry of Health, Mexico City, Mexico
| | - Ricardo Pérez-Cuevas
- Health System Research Center, National Institute of Public Health, Cuernavaca, Mexico
| | - Odet Sarabia-González
- General Directorate for Quality of Healthcare and Education, Ministry of Health, Mexico City, Mexico
| | - Paulina Pacheco-Estrello
- General Directorate for Quality of Healthcare and Education, Ministry of Health, Mexico City, Mexico
| | - Hannah H Leslie
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
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Abstract
Introduction: Emerging from the epidemiological transition and accelerated aging process, China’s fragmentated healthcare systems struggle to meet the demands of the population. On Sept 1st 2017, China’s National Health and Family Planning Commission encouraged all cities to learn from the Luohu model of integration adopted in Luohu as an approach to meeting these challenges. In this paper, we study the integration process, analyze the core mechanisms, and conduct preliminary evaluations of integrated policy development in the Luohu model. Policy development: The Luohu hospital group was established in Aug 2015, consists of five district hospitals, 23 community health stations and an institute of precision medicine. The group adopted a series of professional, organizational, system, functional and normative strategies for integrated care, which was provided for the residents of Luohu, especially for the elderly population and patients with chronic conditions. According to a preliminary evaluation of the past two years, the Luohu model showed improvement in the structure and process towards integrated care. New preventive programs conducted in the hospital group resulted in changes of disease incidence. Residents were more satisfied with the Luohu model. However, spending exceeded the global budget for health insurance because of short-term increases in the demand for health care. Lessons learned: First, engagement of multiple stakeholders is essential for the design and implementation of reform. Second, organizational integration is a prerequisite for integrated care in China. Third, effective care integration requires alignment with payment reforms. Fourth, normative integration could promote collaboration in an integrated healthcare system. Conclusion: Core strategies and mechanisms of the Luohu model will promote integrated care in urban China and other countries facing the same challenges. However, it is necessary to study the effects of the Luohu model over the long term and continue to strive for integrated care.
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Wang X, Sun X, Birch S, Gong F, Valentijn P, Chen L, Zhang Y, Huang Y, Yang H. People-centred integrated care in urban China. Bull World Health Organ 2018; 96:843-852. [PMID: 30505032 PMCID: PMC6249708 DOI: 10.2471/blt.18.214908] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 09/07/2018] [Accepted: 09/07/2018] [Indexed: 11/27/2022] Open
Abstract
In most countries, the demand for integrated care for people with chronic diseases is increasing as the population ages. This demand requires a fundamental shift of health-care systems towards more integrated service delivery models. To achieve this shift in China, the World Health Organization, the World Bank and the Chinese government proposed a tiered health-care delivery system in accordance with a people-centred integrated care model. The approach was pioneered in Luohu district of Shenzhen city from 2015 to 2017 as a template for practice. In September 2017, China’s health ministry introduced this approach to people-centred integrated care to the entire country. We describe the features of the Luohu model in relation to the core action areas and implementation strategies proposed and we summarize data from an evaluation of the first two years of the programme. We discuss the challenges faced during implementation and the lessons learnt from it for other health-care systems. We consider how to improve collaboration between institutions, how to change the population’s behaviour about using community health services as the first point of contact and how to manage resources effectively to avoid budget deficits. Finally, we outline next steps of the Luohu model and its potential application to strengthen health care in other urban health-care systems.
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Affiliation(s)
- Xin Wang
- School of Public Health, SUN Yat-sen University, No. 74, Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, China
| | - Xizhuo Sun
- Shenzhen Luohu Hospital Group, Shenzhen, China
| | - Stephen Birch
- Centre for the Business and Economics of Health, University of Queensland, Brisbane, Australia
| | | | - Pim Valentijn
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Lijin Chen
- School of Public Health, SUN Yat-sen University, No. 74, Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, China
| | - Yong Zhang
- School of Public Health, SUN Yat-sen University, No. 74, Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, China
| | - Yixiang Huang
- School of Public Health, SUN Yat-sen University, No. 74, Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, China
| | - Hongwei Yang
- China National Health Development Research Centre, Beijing, China
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Thi Hoai Thu N, McDonald F, Witter S, Wilson A. "Three Nooses on Our Head": The Influence of District Health Reforms on Maternal Health Service Delivery in Vietnam. Int J Health Policy Manag 2018; 7:593-602. [PMID: 29996579 PMCID: PMC6037493 DOI: 10.15171/ijhpm.2017.134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 11/11/2017] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The impact of reorganisation on health services delivery is a recurring issue in every healthcare system. In 2005 Vietnam reorganised the delivery of health services at the district level by splitting preventive, curative, and administrative roles. This qualitative study explored how these reforms impacted on the organisation of maternal health service delivery at district and commune levels. METHODS Forty-three semi-structured interviews were conducted with health staff and managers involved in the provision of maternal health services from the commune to the central level within five districts of two Northern provinces in Vietnam. The data were analysed thematically. RESULTS The results showed that 10 years after the reforms created three district-level entities, participants reported difficulties in management of health services at the district and commune levels in Vietnam. The reforms were largely perceived to negatively affect the efficient and effective use of clinical and other resources. At the commune level, the reforms are said to have affected the quality of supervision of the communes and their staff and increased the workload in community health centres. CONCLUSION The findings from this study suggest that the current organisation of district health services in Vietnam may have had unintended negative consequences. It also indicates that countries which decide to reform their systems in a manner similar to Vietnam need to pay attention to coordination between a multiplicity of agencies at the district level.
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Affiliation(s)
- Nguyen Thi Hoai Thu
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Fiona McDonald
- Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, QLD, Australia
| | - Sophie Witter
- Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
| | - Andrew Wilson
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW, Australia
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Doubova SV, Pérez-Cuevas R. Going further to measure improvements in health-care access and quality. Lancet 2018; 391:2190-2192. [PMID: 29803588 DOI: 10.1016/s0140-6736(18)30987-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 04/23/2018] [Indexed: 10/16/2022]
Affiliation(s)
- Svetlana V Doubova
- Epidemiology and Health Services Research Unit, CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico 06725.
| | - Ricardo Pérez-Cuevas
- Health System Research Center, National Institute of Public Health, Cuernavaca City, Mexico
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Mahdavi M, Vissers J, Elkhuizen S, van Dijk M, Vanhala A, Karampli E, Faubel R, Forte P, Coroian E, van de Klundert J. The relationship between context, structure, and processes with outcomes of 6 regional diabetes networks in Europe. PLoS One 2018; 13:e0192599. [PMID: 29447220 PMCID: PMC5813938 DOI: 10.1371/journal.pone.0192599] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 01/28/2018] [Indexed: 12/02/2022] Open
Abstract
Background While health service provisioning for the chronic condition Type 2 Diabetes (T2D) often involves a network of organisations and professionals, most evidence on the relationships between the structures and processes of service provisioning and the outcomes considers single organisations or solo practitioners. Extending Donabedian’s Structure-Process-Outcome (SPO) model, we investigate how differences in quality of life, effective coverage of diabetes, and service satisfaction are associated with differences in the structures, processes, and context of T2D services in six regions in Finland, Germany, Greece, Netherlands, Spain, and UK. Methods Data collection consisted of: a) systematic modelling of provider network’s structures and processes, and b) a cross-sectional survey of patient reported outcomes and other information. The survey resulted in data from 1459 T2D patients, during 2011–2012. Stepwise linear regression models were used to identify how independent cumulative proportion of variance in quality of life and service satisfaction are related to differences in context, structure and process. The selected context, structure and process variables are based on Donabedian’s SPO model, a service quality research instrument (SERVQUAL), and previous organization and professional level evidence. Additional analysis deepens the possible bidirectional relation between outcomes and processes. Results The regression models explain 44% of variance in service satisfaction, mostly by structure and process variables (such as human resource use and the SERVQUAL dimensions). The models explained 23% of variance in quality of life between the networks, much of which is related to contextual variables. Our results suggest that effectiveness of A1c control is negatively correlated with process variables such as total hours of care provided per year and cost of services per year. Conclusions While the selected structure and process variables explain much of the variance in service satisfaction, this is less the case for quality of life. Moreover, it appears that the effect of the clinical outcome A1c control on processes is stronger than the other way around, as poorer control seems to relate to more service use, and higher cost. The standardized operational models used in this research prove to form a basis for expanding the network level evidence base for effective T2D service provisioning.
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Affiliation(s)
- Mahdi Mahdavi
- National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jan Vissers
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | - Sylvia Elkhuizen
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | | | | | - Raquel Faubel
- Joint Research Unit in ICT applied to Healthcare Process Re-engineering (eRDSS), Valencia, Spain
- University of Valencia, Valencia, Spain
| | - Paul Forte
- The Balance of Care Group, London, United Kingdom
| | - Elena Coroian
- Institute for Learning Innovation, Friedrich-Alexander-University Nuremberg-Erlangen, Nuremberg, Germany
| | - Joris van de Klundert
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Ding J, Hu X, Zhang X, Shang L, Yu M, Chen H. Equity and efficiency of medical service systems at the provincial level of China's mainland: a comparative study from 2009 to 2014. BMC Public Health 2018; 18:214. [PMID: 29402260 PMCID: PMC5799902 DOI: 10.1186/s12889-018-5084-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 01/16/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The astonishing economic achievements of China in the past few decades have remarkably increased not only the quantity and quality of medical services but also the inequalities in health resources allocation across regions and inefficiency of the medical service delivery. METHODS A descriptive analysis was used to compare the inequities in inputs and outputs of the provincial medical service systems, a non-radial super-efficiency data envelopment analysis model was then used to estimate the efficiency, and a regression analysis of the panel data was used to explore the determinants. RESULTS The inputs and outputs of most provincial medical service systems increased gradually from 2009 to 2014. Overall, the eastern region allocated more human and capital resources than the other two regions, and produced more than 50% of the total outpatient and emergency room visits, whereas the western region produced more inpatient services (about 30% of the total volume of inpatient services) according to the distribution of the population. The average efficiency scores of the provincial medical systems in China's mainland were 0.895, 0.927, 0.929, 0.963, 0.977 and 0.968 from 2009 to 2014, with a slight average improvement of 1.60%. The efficiency score of each provincial medical service system varied greatly from one another: Tibet (1.475 ± 0.057) performed extremely well, whereas several others including Heilongjiang (0.579 ± 0.001) performed poorly. Furthermore, the proportion of high-class medical facilities was negatively associated with efficiency, whereas the proportion of the vulnerable population, the per capita Gross Domestic Product, the proportion of the illiterate population and the improvement of primary health care had positive effects on efficiency. CONCLUSION Inequity in health resources allocation and service provision existed across the regions, but not all the gaps have begun to narrow since 2009. The difference of efficiency was great among provincial medical service systems but minor across regions, and the score changed very little over time. More importantly, the central region held the lowest average efficiency score in the past 6 years, while the western region held the largest average efficiency score at the first 5 years, which should receive enough attention of the government and decision-makers. In practice, efficiency was related to many complicated factors, indicating that the improvement of efficiency is a complex and iterative process that requires the strong cooperation of many sectors.
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Affiliation(s)
- Jingmei Ding
- Department of health services, The Fourth Military Medical University, 169 West of Changle Road, Xincheng District, Xi’an, Shaanxi China
| | - Xuejun Hu
- Department of health services, The Fourth Military Medical University, 169 West of Changle Road, Xincheng District, Xi’an, Shaanxi China
| | - Xianzhi Zhang
- Department of health services, The Fourth Military Medical University, 169 West of Changle Road, Xincheng District, Xi’an, Shaanxi China
| | - Lei Shang
- Department of statistics, The Fourth Military Medical University, 169 West of Changle Road, Xincheng District, Xi’an, Shaanxi China
| | - Min Yu
- Institution of health services, Academy of Military Medical Sciences, 27 Taiping Road, Haidian District, Beijing, China
| | - Huoliang Chen
- Department of health services, The Fourth Military Medical University, 169 West of Changle Road, Xincheng District, Xi’an, Shaanxi China
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Vargas I, Garcia-Subirats I, Mogollón-Pérez AS, De Paepe P, da Silva MRF, Unger JP, Aller MB, Vázquez ML. Patient perceptions of continuity of health care and associated factors. Cross-sectional study in municipalities of central Colombia and north-eastern Brazil. Health Policy Plan 2017; 32:549-562. [PMID: 28104694 DOI: 10.1093/heapol/czw168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2016] [Indexed: 12/11/2022] Open
Abstract
Despite the fragmentation of healthcare provision being considered one of the main obstacles to attaining effective health care in Latin America, very little is known about patients' perceptions. This paper analyses the level of continuity of health care perceived by users and explores influencing factors in two municipalities of Colombia and Brazil, by means of a cross-sectional study based on a survey of a multistage probability sample of people who had suffered at least one health problem within the previous three months (2163 in Colombia; 2167 in Brazil). An adapted and validated version of the CCAENA© (Questionnaire of care continuity across levels of health care) was applied. Logistic regression models were generated to assess the relationship between perceptions of the different types of health care continuity and sociodemographic characteristics, health needs, and organizational factors. The results show lower levels of continuity across care levels in information transfer and care coherence and higher levels for the ongoing patient-doctor relationship, albeit with differences between the two countries. They also show greater consistency of doctors in the Brazilian study areas, especially in primary care. Consistency of doctors was not only positively associated with the patient-doctor ongoing relationship in the study areas of both countries, but also with information transfer and care coherence across care levels. The study area and health needs (the latter negatively for patients with poor self-rated health and positively for those with at least one chronic condition) were associated with all types of continuity of care. The influence of the sex or income varied depending on the country. The influence of the insurance scheme in the Colombian sample was not statistically significant. Both countries should implement policies to improve coordination between care levels, especially regarding information transfer and job stability for primary care doctors, both key factors to guarantee quality of care.
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Affiliation(s)
- Ingrid Vargas
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avenida Tibidabo, 21, Barcelona, Spain
| | - Irene Garcia-Subirats
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avenida Tibidabo, 21, Barcelona, Spain
| | - Amparo Susana Mogollón-Pérez
- Escuela de Medicina y Ciencias de la Salud. Universidad del Rosario, Carrera 24, Número 63C-69, Bogotá, Colombia
| | - Pierre De Paepe
- The Prince Leopold Institute of Tropical Medicine, Nationalestraat 15, Antwerpen, Belgium
| | | | - Jean-Pierre Unger
- The Prince Leopold Institute of Tropical Medicine, Nationalestraat 15, Antwerpen, Belgium
| | - M B Aller
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avenida Tibidabo, 21, Barcelona, Spain
| | - María Luisa Vázquez
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avenida Tibidabo, 21, Barcelona, Spain
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Abstract
Purpose
Integration is policy, practice as well as object of systematic investigation. What we do not know is whether or not integration can be understood as a science. In his book The Structure of Scientific Revolutions, Thomas Kuhn formulated a notion of (natural) sciences based on the emergence of commitments amongst a community of scientists to a set of logics, model and exemplars. He called this a paradigm. The purpose of this paper is to assess the scientific nature of integration by perceiving it as a paradigm in Kuhn’s sense.
Design/methodology/approach
The paper proceeds by conceptual reflection through matching existing components, theories and exemplifications of integration to Kuhn’s model of a scientific paradigm. Integration is understood broadly, either vertical or horizontal, and located within the practical domains of policy formulation, policy implementation and evaluation research. The nature, scope and depth of group commitments amongst students and practitioners of integration receive particular attention in line with Kuhn’s social interactionist approach.
Findings
Employing Kuhn’s notion of paradigm in the context of integration highlights the fundamental tension between integration efforts and integration outcomes. Whilst integration defines itself in contradistinction to professional boundaries and fragmentation, the paper argues that it fails to develop a strong theoretical and empirical foundation for a robust and stable group commitment. The reason is that the key motivational force that may create a stable group commitment amongst those engaged in integration, the patient perspective, remains outside the integration paradigm. This leaves integration as a practice and policy model underdeveloped, mainly paradigmatically illustrated by singular exemplars and rooted in aspirational policy vocabulary, while clustered around a near dogmatic belief that working together between services must lead to improved quality of care. To become a scientific paradigm the group commitment in integration would have to coalesce around a clear ontology (symbolic generalisations), epistemology (models of knowledge) and manifestations in practice (exemplars).
Research limitations/implications
At present both the ontology and epistemological foundations of integration practice and research are insufficiently clear. This hampers the development of integration practice as well as a better understanding of how to evaluate integration outcomes. Future studies should focus on the depth, nature and subject of group commitments to assess whether integration is a viable candidate for scientific paradigm or an assorted construct of policy aspirations.
Originality/value
The paper questions the rigour and trajectory of integration practice, policy and research. It identifies a tension at the centre of the field between group commitments to scientific exemplars (case studies) and symbolic generalisations, encapsulated in the desire to improve patient care. The notion of a scientific paradigm thus helps to re-frame the discussion about research and practice in integration.
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Shah PA, Coj M, Rohloff P. Delays in diagnosis and treatment of extrapulmonary tuberculosis in Guatemala. BMJ Case Rep 2017; 2017:bcr-2017-220777. [PMID: 28993352 DOI: 10.1136/bcr-2017-220777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 23-year-old indigenous Guatemalan man presented in 2016 to our clinic in Sololá, Guatemala, with 10 months of recurrent neck swelling, fevers, night sweats and weight loss. Previously, he had sought care in three different medical settings, including a private physician-run clinic, a tertiary private cancer treatment centre and, finally, a rural government health post. With assistance from our institution's accompaniment staff, the patient was admitted to a public tertiary care hospital for work-up. Rifampin-susceptible tuberculosis was diagnosed, and appropriate treatment was begun. The case illustrates how low tuberculosis recognition among community health workers and health system segmentation creates obstacles to appropriate care, especially for patients with limited means. As a result, significant diagnostic and treatment delays can occur, increasing the public health burden of tuberculosis.
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Affiliation(s)
| | - Merida Coj
- Wuqu' Kawoq-Maya Health Alliance, Santiago, Sacatépequez, Guatemala
| | - Peter Rohloff
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Abstract
Purpose
The purpose of this paper is to outline relevant policies on the integration of health and social care (HSC) in the four home nations: Scotland, Wales, Northern Ireland and England and offer a comparison of emphasis and approaches and draw out general insights on the implementation of integrated care policy.
Design/methodology/approach
The paper is written as a piece of critical reflection by drawing on the authors’ knowledge and expertise and wider evidence where available.
Findings
Since 2010, HSC integration has started to diverge significantly in the four constituent countries of the UK. Although England and Wales have undergone considerable re-organisation of the NHS, Scotland and Northern Ireland have largely been marked by organisational continuity. However, beyond organisational differences, policy approaches, policy emphases and implementation strategies have also started to show considerable dissimilarity across the UK. An important contributory factor may be different ideological perspectives on the role of competition and pilots, partnership, patient choice and organisational incentives to bring about change in the field.
Research limitations/implications
The paper identifies a serious lack of comparative research in integration policy, despite the considerable opportunities for quasi-experimental studies. This lack of empirical research impedes shared learning across the home nations.
Originality/value
The paper presents a descriptive comparison of current integration policy between HSC providers in the four home nations. It reveals considerable opportunities for further research and comparative modelling of integration approaches.
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Wang X, Birch S, Zhu W, Ma H, Embrett M, Meng Q. Coordination of care in the Chinese health care systems: a gap analysis of service delivery from a provider perspective. BMC Health Serv Res 2016; 16:571. [PMID: 27733145 PMCID: PMC5062922 DOI: 10.1186/s12913-016-1813-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 10/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increases in health care utilization and costs, resulting from the rising prevalence of chronic conditions related to the aging population, is exacerbated by a high level of fragmentation that characterizes health care systems in China. There have been several pilot studies in China, aimed at system-level care coordination and its impact on the full integration of health care system, but little is known about their practical effects. Huangzhong County is one of the pilot study sites that introduced organizational integration (a dimension of integrated care) among health care institutions as a means to improve system-level care coordination. The purposes of this study are to examine the effect of organizational integration on system-level care coordination and to identify factors influencing care coordination and hence full integration of county health care systems in rural China. METHODS We chose Huangzhong and Hualong counties in Qinghai province as study sites, with only Huangzhong having implemented organizational integration. A mixed methods approach was used based on (1) document analysis and expert consultation to develop Best Practice intervention packages; (2) doctor questionnaires, identifying care coordination from the perspective of service provision. We measured service provision with gap index, overlap index and over-provision index, by comparing observed performance with Best Practice; (3) semi-structured interviews with Chiefs of Medicine in each institution to identify barriers to system-level care coordination. RESULTS Twenty-nine institutions (11 at county-level, 6 at township-level and 12 at village-level) were selected producing surveys with a total of 19 schizophrenia doctors, 23 diabetes doctors and 29 Chiefs of Medicine. There were more care discontinuities for both diabetes and schizophrenia in Huangzhong than in Hualong. Overall, all three index scores (measuring service gaps, overlaps and over-provision) showed similar tendencies for the two conditions. The gap indices of schizophrenia (> 5.10) were bigger for diabetes (< 2.60) in both counties. The over-provision indices of schizophrenia (> 3.25) were bigger than diabetes (< 1.80) in both counties. Overlap indices for the two conditions exceeded justified overlaps, especially for diabetes. Gap index scores for schizophrenia interventions at the township-level and over-provision index scores for diabetes interventions at both village- and township-level showed big differences between the two counties. Insufficient medical staff with appropriate competencies, lack of motivation for care coordination and related supportive policies as well as unconnected information system were identified as barriers to system-level care coordination in both counties. CONCLUSION Findings demonstrate that organizational integration in Huangzhong has not achieved a higher level of care coordination at this stage. System-level care coordination is most problematic at village-level institutions in Hualong, but at county-level institutions in Huangzhong. These findings suggest that attention be given to other aspects of integration (e.g., clinical and service integration) to promote system-level care coordination and contribute to the full integration of health care system in the pilot county.
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Affiliation(s)
- Xin Wang
- School of Health Care Management, Shandong University, Jinan, China
| | - Stephen Birch
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada
| | - Weiming Zhu
- China Center for Health Development Studies, Peking University, 38 Xueyuan Road, Haidian district, Beijing, China
| | - Huifen Ma
- China Center for Health Development Studies, Peking University, 38 Xueyuan Road, Haidian district, Beijing, China
| | - Mark Embrett
- Health policy, Faculty of health science, McMaster University, Hamilton, Canada
| | - Qingyue Meng
- China Center for Health Development Studies, Peking University, 38 Xueyuan Road, Haidian district, Beijing, China.
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Timmons S, O'Shea E, O'Neill D, Gallagher P, de Siún A, McArdle D, Gibbons P, Kennelly S. Acute hospital dementia care: results from a national audit. BMC Geriatr 2016; 16:113. [PMID: 27245979 PMCID: PMC4886443 DOI: 10.1186/s12877-016-0293-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 05/27/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Admission to an acute hospital can be distressing and disorientating for a person with dementia, and is associated with decline in cognitive and functional ability. The objective of this audit was to assess the quality of dementia care in acute hospitals in the Republic of Ireland. METHODS Across all 35 acute public hospitals, data was collected on care from admission through discharge using a retrospective chart review (n = 660), hospital organisation interview with senior management (n = 35), and ward level organisation interview with ward managers (n = 76). Inclusion criteria included a diagnosis of dementia, and a length of stay greater than 5 days. RESULTS Most patients received physical assessments, including mobility (89 %), continence (84 %) and pressure sore risk (87 %); however assessment of pain (75 %), and particularly functioning (36 %) was poor. Assessment for cognition (43 %) and delirium (30 %) was inadequate. Most wards have access at least 5 days per week to Liaison Psychiatry (93 %), Geriatric Medicine (84 %), Occupational Therapy (79 %), Speech & Language (81 %), Physiotherapy (99 %), and Palliative Care (89 %) Access to Psychology (9 %), Social Work (53 %), and Continence services (34 %) is limited. Dementia awareness training is provided on induction in only 2 hospitals, and almost half of hospitals did not offer dementia training to doctors (45 %) or nurses (48 %) in the previous 12 months. Staff cover could not be provided on 62 % of wards for attending dementia training. Most wards (84 %) had no dementia champion to guide best practice in care. Discharge planning was not initiated within 24 h of admission in 72 % of cases, less than 40 % had a single plan for discharge recorded, and 33 % of carers received no needs assessment prior to discharge. Length of stay was significantly greater for new discharges to residential care (p < .001). CONCLUSION Dementia care relating to assessment, access to certain specialist services, staffing levels, training and support, and discharge planning is sub-optimal, which may increase the risk of adverse patient outcomes and the cost of acute care. Areas of good practice are also highlighted.
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Affiliation(s)
- Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, The Bungalow, Block 13, St. Finbarr's Hospital, Douglas Road, Cork, Ireland
| | - Emma O'Shea
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, The Bungalow, Block 13, St. Finbarr's Hospital, Douglas Road, Cork, Ireland.
| | - Desmond O'Neill
- Centre for Ageing, Neuroscience and the Humanities, Trinity Centre for Health Sciences, Tallaght Hospital, Dublin, Ireland
| | - Paul Gallagher
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, The Bungalow, Block 13, St. Finbarr's Hospital, Douglas Road, Cork, Ireland
| | - Anna de Siún
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, The Bungalow, Block 13, St. Finbarr's Hospital, Douglas Road, Cork, Ireland
| | - Denise McArdle
- Quality and Patient Safety Audit Services, Health Service Executive, Dublin, Ireland
| | - Patricia Gibbons
- Quality and Patient Safety Audit Services, Health Service Executive, Dublin, Ireland
| | - Sean Kennelly
- Centre for Ageing, Neuroscience and the Humanities, Trinity Centre for Health Sciences, Tallaght Hospital, Dublin, Ireland
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Vargas I, Mogollón-Pérez AS, De Paepe P, Ferreira da Silva MR, Unger JP, Vázquez ML. Barriers to healthcare coordination in market-based and decentralized public health systems: a qualitative study in healthcare networks of Colombia and Brazil. Health Policy Plan 2016; 31:736-48. [PMID: 26874327 PMCID: PMC4916317 DOI: 10.1093/heapol/czv126] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2015] [Indexed: 12/26/2022] Open
Abstract
Although integrated healthcare networks (IHNs) are promoted in Latin America in response to health system fragmentation, few analyses on the coordination of care across levels in these networks have been conducted in the region. The aim is to analyse the existence of healthcare coordination across levels of care and the factors influencing it from the health personnel' perspective in healthcare networks of two countries with different health systems: Colombia, with a social security system based on managed competition and Brazil, with a decentralized national health system. A qualitative, exploratory and descriptive-interpretative study was conducted, based on a case study of healthcare networks in four municipalities. Individual semi-structured interviews were conducted with a three stage theoretical sample of (a) health (112) and administrative (66) professionals of different care levels, and (b) managers of providers (42) and insurers (14). A thematic content analysis was conducted, segmented by cases, informant groups and themes. The results reveal poor clinical information transfer between healthcare levels in all networks analysed, with added deficiencies in Brazil in the coordination of access and clinical management. The obstacles to care coordination are related to the organization of both the health system and the healthcare networks. In the health system, there is the existence of economic incentives to compete (exacerbated in Brazil by partisan political interests), the fragmentation and instability of networks in Colombia and weak planning and evaluation in Brazil. In the healthcare networks, there are inadequate working conditions (temporary and/or part-time contracts) which hinder the use of coordination mechanisms, and inadequate professional training for implementing a healthcare model in which primary care should act as coordinator in patient care. Reforms are needed in these health systems and networks in order to modify incentives, strengthen the state planning and supervision functions and improve professional working conditions and skills.
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Affiliation(s)
- Ingrid Vargas
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain,
| | | | - Pierre De Paepe
- Prince Leopold Institute of Tropical Medicine, Antwerpen, Belgium and
| | | | - Jean-Pierre Unger
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - María-Luisa Vázquez
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
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Strasser-Weippl K, Chavarri-Guerra Y, Villarreal-Garza C, Bychkovsky BL, Debiasi M, Liedke PER, Soto-Perez-de-Celis E, Dizon D, Cazap E, de Lima Lopes G, Touya D, Nunes JS, St Louis J, Vail C, Bukowski A, Ramos-Elias P, Unger-Saldaña K, Brandao DF, Ferreyra ME, Luciani S, Nogueira-Rodrigues A, de Carvalho Calabrich AF, Del Carmen MG, Rauh-Hain JA, Schmeler K, Sala R, Goss PE. Progress and remaining challenges for cancer control in Latin America and the Caribbean. Lancet Oncol 2016; 16:1405-38. [PMID: 26522157 DOI: 10.1016/s1470-2045(15)00218-1] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/03/2015] [Accepted: 08/04/2015] [Indexed: 12/22/2022]
Abstract
Cancer is one of the leading causes of mortality worldwide, and an increasing threat in low-income and middle-income countries. Our findings in the 2013 Commission in The Lancet Oncology showed several discrepancies between the cancer landscape in Latin America and more developed countries. We reported that funding for health care was a small percentage of national gross domestic product and the percentage of health-care funds diverted to cancer care was even lower. Funds, insurance coverage, doctors, health-care workers, resources, and equipment were also very inequitably distributed between and within countries. We reported that a scarcity of cancer registries hampered the design of credible cancer plans, including initiatives for primary prevention. When we were commissioned by The Lancet Oncology to write an update to our report, we were sceptical that we would uncover much change. To our surprise and gratification much progress has been made in this short time. We are pleased to highlight structural reforms in health-care systems, new programmes for disenfranchised populations, expansion of cancer registries and cancer plans, and implementation of policies to improve primary cancer prevention.
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Affiliation(s)
- Kathrin Strasser-Weippl
- Centre for Oncology and Hematology, Wilhelminen Hospital, Vienna, Austria; The Global Cancer Institute, Boston, MA, USA
| | - Yanin Chavarri-Guerra
- The Global Cancer Institute, Boston, MA, USA; Hemato-Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Cynthia Villarreal-Garza
- Instituto de Cancerología, Centro de Cáncer de Mama, Tecnologico de Monterrey, Monterrey, Nuevo León, Mexico; Departmento de Investigación y de Tumores Mamarios, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - Brittany L Bychkovsky
- Dana Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Marcio Debiasi
- Hospital Mae de Deus, Porto Alegre, Rio Grande do Sul, Brazil; Hospital Sao Lucas da PUCRS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Pedro E R Liedke
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Instituto do Câncer Mãe de Deus, Porto Alegre, Rio Grande do Sul, Brazil
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Cancer Care in the Elderly Clinic, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
| | - Don Dizon
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Eduardo Cazap
- Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina
| | - Gilberto de Lima Lopes
- Medical Oncology, Centro Paulista de Oncologia and Oncoclinicas do Brasil Group, São Paulo, Brazil; Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Diego Touya
- Department of Oncology, University of the Republic, Montevideo, Uruguay
| | | | - Jessica St Louis
- The Global Cancer Institute, Boston, MA, USA; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Caroline Vail
- The Global Cancer Institute, Boston, MA, USA; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Alexandra Bukowski
- The Global Cancer Institute, Boston, MA, USA; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Pier Ramos-Elias
- Instituto de Cancerología, Centro de Cáncer de Mama, Tecnologico de Monterrey, Monterrey, Nuevo León, Mexico
| | - Karla Unger-Saldaña
- Cátedra CONACYT, Unidad de Epidemiología, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | | | - Mayra E Ferreyra
- Oncology Department, Maria Curie Hospital, Buenos Aires, Argentina
| | - Silvana Luciani
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Angelica Nogueira-Rodrigues
- Federal University, Minas Gerais, Brazil; EVA-Group Brasileiro de Tumores Ginecológicos, Brazilian Gynecologic Oncology Group, Bahia, Brazil
| | | | - Marcela G Del Carmen
- Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Jose Alejandro Rauh-Hain
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Raúl Sala
- Grupo Argentino de Investigación Clínica en Oncología-GAICO, Rosario, Santa Fe, Argentina
| | - Paul E Goss
- The Global Cancer Institute, Boston, MA, USA; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Rodrigues LBB, Dos Santos CB, Goyatá SLT, Popolin MP, Yamamura M, Deon KC, Lapão LMV, Santos Neto M, Uchoa SADC, Arcêncio RA. Assessment of the coordination of integrated health service delivery networks by the primary health care: COPAS questionnaire validation in the Brazilian context. BMC FAMILY PRACTICE 2015; 16:87. [PMID: 26198100 PMCID: PMC4510885 DOI: 10.1186/s12875-015-0299-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 06/26/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND Health systems organized as networks and coordinated by the Primary Health Care (PHC) may contribute to the improvement of clinical care, sanitary conditions, satisfaction of patients and reduction of local budget expenditures. The aim of this study was to adapt and validate a questionnaire - COPAS - to assess the coordination of Integrated Health Service Delivery Networks by the Primary Health Care. METHODS A cross sectional approach was used. The population was pooled from Family Health Strategy healthcare professionals, of the Alfenas region (Minas Gerais, Brazil). Data collection was performed from August to October 2013. The results were checked for the presence of floor and ceiling effects and the internal consistency measured through Cronbach alpha. Construct validity was verified through convergent and discriminant values following Multitrait-Multimethod (MTMM) analysis. RESULTS Floor and ceiling effects were absent. The internal consistency of the instrument was satisfactory; as was the convergent validity, with a few correlations lower then 0.30. The discriminant validity values of the majority of items, with respect to their own dimension, were found to be higher or significantly higher than their correlations with the dimensions to which they did not belong. CONCLUSION The results showed that the COPAS instrument has satisfactory initial psychometric properties and may be used by healthcare managers and workers to assess the PHC coordination performance within the Integrated Health Service Delivery Network.
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Affiliation(s)
- Ludmila Barbosa Bandeira Rodrigues
- Institute for Health Sciences, Federal University of Mato Grosso (UFMT), 1200 Alexandre Ferronato Avenue - Industrial Sector, 78557267, Sinop, MT, Brazil.
| | - Claudia Benedita Dos Santos
- Mother-Baby Department, University of São Paulo at Ribeirão Preto, College of Nursing, 3900 Bandeirantes Avenue, 14040-902, Ribeirão Preto, SP, Brazil.
| | - Sueli Leiko Takamatsu Goyatá
- Nursing Department, Federal University of Alfenas, 700 Gabriel Monteiro da Silva St., 37130000, Alfenas, MG, Brazil.
| | - Marcela Paschoal Popolin
- Mother-Baby Department, University of São Paulo at Ribeirão Preto, College of Nursing, 3900 Bandeirantes Avenue, 14040-902, Ribeirão Preto, SP, Brazil.
| | - Mellina Yamamura
- Mother-Baby Department, University of São Paulo at Ribeirão Preto, College of Nursing, 3900 Bandeirantes Avenue, 14040-902, Ribeirão Preto, SP, Brazil.
| | - Keila Christiane Deon
- Physical Education Department, Federal University of Rio Grande do Sul Physical Education College, 750 Felizardo St., Jardim Botânico, 90690-200, Porto Alegre, RS, Brazil.
| | - Luis Miguel Veles Lapão
- WHO Collaborating Center for Health Workforce Policy and Planning, International Public Health and Biostatistics, Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, 100 Junqueira, Lisbon, 1349-008, Portugal.
| | - Marcelino Santos Neto
- Mother-Baby Department, University of São Paulo at Ribeirão Preto, College of Nursing, 3900 Bandeirantes Avenue, 14040-902, Ribeirão Preto, SP, Brazil.
| | - Severina Alice da Costa Uchoa
- Public Health Department, Federal University of Rio Grande do Norte. Campus Universitário, Salgado Filho Avenue, Natal, RN, Brazil.
| | - Ricardo Alexandre Arcêncio
- Mother-Baby Department, University of São Paulo at Ribeirão Preto, College of Nursing, 3900 Bandeirantes Avenue, 14040-902, Ribeirão Preto, SP, Brazil.
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Abstract
Interest in the emerging role for occupational therapy in the primary care practice setting has increased due to implementation of the Patient Protection and Affordable Care Act (ACA), which intends to expand health care coverage to uninsured Americans while improving coordination of care, health outcomes, and cost savings. Expanding occupational therapy to encompass promotion of wellness and prevention in a primary care context provides an opportunity for occupational therapy. The purpose of this article is to describe the role of occupational therapy in primary care and how the Scholarship of Practice model can guide the development of occupation-based and evidence-based best practice in primary care.
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Affiliation(s)
- Catherine Killian
- a 1 Occupational Therapy, University of Illinois at Chicago , Chicago, IL, USA
| | - Gail Fisher
- a 1 Occupational Therapy, University of Illinois at Chicago , Chicago, IL, USA
| | - Sherry Muir
- b 1 2 Occupational Science & Occupational Therapy, Doisy College of Health Sciences, Saint Louis University , St. Louis, MO, USA
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Gonzalez FJ, Gaona C, Quintero M, Chavez CA, Selga J, Maestre GE. Building capacity for dementia care in Latin America and the Caribbean. Dement Neuropsychol 2014; 8:310-316. [PMID: 25932285 PMCID: PMC4412169 DOI: 10.1590/s1980-57642014dn84000002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Latin America and the Caribbean (LAC) have limited facilities and professionals
trained to diagnose, treat, and support people with dementia and other forms of
cognitive impairment. The situation for people with dementia is poor, and
worsening as the proportion of elderly in the general population is rapidly
expanding. We reviewed existing initiatives and provided examples of actions
taken to build capacity and improve the effectiveness of individuals,
organizations, and national systems that provide treatment and support for
people with dementia and their caregivers. Regional barriers to capacity
building and the importance of public engagement are highlighted. Existing
programs need to disseminate their objectives, accomplishments, limitations, and
overall lessons learned in order to gain greater recognition of the need for
capacity-building programs.
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Affiliation(s)
| | - Ciro Gaona
- Fundación Alzheimer de Venezuela, Caracas, Venezuela ; Neurosciences Laboratory, Faculty of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Marialcira Quintero
- Neurosciences Laboratory, Faculty of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Carlos A Chavez
- Neurosciences Laboratory, Faculty of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Joyce Selga
- Fundación Alzheimer de Venezuela, Nueva Esparta Chapter, Porlamar, Venezuela
| | - Gladys E Maestre
- Neurosciences Laboratory, Faculty of Medicine, University of Zulia, Maracaibo, Venezuela ; Dept. Psychiatry, Neurology and G.H. Sergievsky Center, Columbia University, New York, NY, USA
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Affiliation(s)
- Sherry Muir
- Department of Occupational Science and Occupational Therapy, St. Louis University School of Medicine, St. Louis, MO 63103, USA.
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