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Liu X, Zhang L, Fan X, Chen W. Impact of family doctor system on diabetic patients with distinct service utilisation patterns: a difference-in-differences analysis based on group-based trajectory modelling. BMJ Glob Health 2024; 9:e014717. [PMID: 39313253 PMCID: PMC11418535 DOI: 10.1136/bmjgh-2023-014717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 09/06/2024] [Indexed: 09/25/2024] Open
Abstract
INTRODUCTION This study examines the impact of China's family doctor system (FDS) on healthcare utilisation and costs among diabetic patients with distinct long-term service utilisation patterns. METHODS Conducted in City A, eastern China, this retrospective cohort study used data from the Health Information System and Health Insurance Claim Databases, covering diabetic patients from 1 January 2014 to 31 December 2019.Patients were categorised into service utilisation trajectories based on quarterly outpatient visits to community health centres (CHCs) and secondary/tertiary hospitals from 2014 to 2017 using group-based trajectory models. Propensity score matching within each trajectory group matched FDS-enrolled patients (intervention) with non-enrolled patients (control). Difference-in-differences analysis compared outcomes between groups, with a SUEST test for cross-model comparison. Outcomes included outpatient visits indicator, costs indicator and out-of-pocket (OOP) expenses. RESULTS Among 17 232 diabetic patients (55.21% female, mean age 62.85 years), 13 094 were enrolled in the FDS (intervention group) and 4138 were not (control group). Patients were classified into four trajectory groups based on service utilisation from 2014 to 2017: (1) low overall outpatient utilisation, (2) high CHC visits, (3) high secondary/tertiary hospital visits and (4) high overall outpatient utilisation. After enrolled in FDS From 2018 to 2019, the group with high secondary/tertiary hospital visits saw a 6.265 increase in CHC visits (225.4% cost increase) and a 3.345 decrease in hospital visits (55.5% cost reduction). The high overall utilisation group experienced a 4.642 increase in CHC visits (109.5% cost increase) and a 1.493 decrease in hospital visits. OOP expenses were significantly reduced across all groups. CONCLUSION The FDS in China significantly increases primary care utilisation and cost, while reducing hospital visits and costs among diabetic patients, particularly among patients with historically high hospital usage. Policymakers should focus on enhancing the FDS to further encourage primary care usage and improve chronic disease management.
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Affiliation(s)
- Xinyi Liu
- School of Public Health, Fudan University, Shanghai, China
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Luying Zhang
- School of Public Health, Fudan University, Shanghai, China
| | - Xianqun Fan
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen Chen
- School of Public Health, Fudan University, Shanghai, China
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Mubambe M, Mwanza J, Moyo E, Dzinamarira T. Enhancing maternal health in Zambia: a comprehensive approach to addressing postpartum hemorrhage. Front Glob Womens Health 2024; 5:1362894. [PMID: 39165380 PMCID: PMC11333204 DOI: 10.3389/fgwh.2024.1362894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 07/29/2024] [Indexed: 08/22/2024] Open
Affiliation(s)
- Mulaya Mubambe
- Department of Obstetrics and Gynaecology, Levy Mwanawasa University Teaching Hospital, Lusaka, Zambia
| | | | - Enos Moyo
- Department of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Tafadzwa Dzinamarira
- ICAP in Zambia, Lusaka, Zambia
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
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Renna ME, Shrout MR. You can't spell distress without stress: Expanding our perspective of the intersection between mental and physical health in cancer survivors. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2024; 19:100240. [PMID: 38774516 PMCID: PMC11107216 DOI: 10.1016/j.cpnec.2024.100240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/23/2024] [Accepted: 05/07/2024] [Indexed: 05/24/2024] Open
Abstract
Although many breast cancer survivors adjust to cancer treatment and survivorship, a sizable subgroup of women do not do so, resulting in psychological distress. Over time, this psychological distress can contribute to immune dysfunction and accompanying worsened physical symptoms as women navigate survivorship. Dr. Kiecolt-Glaser's work and mentorship has been integral to our understanding of breast cancer survivors' immune risks, and how behavioral factors may enhance these risks. As a postdoctoral fellow in the Stress and Health Lab, under Dr. Kiecolt-Glaser's mentorship, my research focused on understanding how distress is associated with immune functioning and physical health in breast cancer survivors. In this paper, we highlight Dr. Kiecolt-Glaser's influence on our careers as a strong female research and mentor, the work completed under her mentorship, and how the field of psychoneuroimmunology can continue to expand her research to better understand how distress in the cancer context confers long-term health risks.
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Arsenijevic DJ, Seibel DV. Do immigrants know less than natives about cancer screening tests? - the case of Netherlands. J Migr Health 2024; 10:100258. [PMID: 39220098 PMCID: PMC11363821 DOI: 10.1016/j.jmh.2024.100258] [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: 01/29/2024] [Revised: 07/10/2024] [Accepted: 07/25/2024] [Indexed: 09/04/2024] Open
Abstract
Introduction The Netherlands was one of the first countries in Europe to offer breast, colorectal and cervical cancer screening tests free of charge. Yet, a significant share of migrants in the Netherlands forgo the use of these preventive screenings. Qualitative research suggests, that lack of system knowledge on how the healthcare system operates (e.g. age eligibility of cancer screenings), is one factor contributing to this underuse among migrants. However, little is known about the extent to which migrants differ from natives in their system knowledge and about potential causes of this ethnic gap. The contribution of this study is therefore twofold: First, we examine whether migrants in the Netherlands have lower system knowledge regarding cancer screenings than the natives. Second, we examine which factors explain potential ethnic differences in system knowledge between migrants and non-migrants. Method Using the Longitudinal Internet Study for Social Sciences (LISS), we matched newly collected data on system knowledge about healthcare with Health module (wave 14). To assess the difference in system knowledge among migrants and non-migrants, while taking into account potential selection bias, we applied propensity score matching, one-to-one matching procedure with no replacement. We compared first generation non - Western migrants (FNWM) and second-generation non-western migrants (SNWM) with their most similar non-migrants group regarding their knowledge about breast, colorectal, and cervical screening. A Blinder-Oaxaca decomposition with non-matched samples was used to examine which factors can explain the differences in system knowledge among migrants and non-migrants. Results Our results show that first generation migrants have lower system knowledge about all three screening tests, while second generation migrants differ from non-migrants only with regard to knowledge about breast and colorectal cancer screenings. The ethnic differences found are not caused by personal or social factors such as education or income. Conclusion We recommend Dutch healthcare policy makes to focus in the strengthen of cancer screening system knowledge among migrant populations in order to increase their participation in these screening programs.
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Affiliation(s)
- Dr Jelena Arsenijevic
- Faculty of Law, Economics and Governance, Utrecht University, Utrecht, the Netherlands
| | - Dr Verena Seibel
- Faculty of Social and Behavioral Science, Utrecht University, the Netherlands
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Al-Shammari S, Al-Wathinani AM, Abahussain MA, Albaqami NA, Alhallaf MA, Farhat H, Goniewicz K. Integrating Inter-Professional Insights for Enhanced Disaster Response: A Cross-Sectional Analysis in Jubail's Royal Commission Hospital, Saudi Arabia. Risk Manag Healthc Policy 2024; 17:1745-1756. [PMID: 38979106 PMCID: PMC11228075 DOI: 10.2147/rmhp.s458606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 06/25/2024] [Indexed: 07/10/2024] Open
Abstract
Introduction This study aimed to evaluate disaster preparedness and management among an inter-professional team at the Royal Commission Hospital (RCH) in Jubail, Saudi Arabia. Methods Conducted between May and July 2023, this cross-sectional study involved healthcare providers in both patient-facing and non-patient-facing roles. Participants responded to a comprehensive online questionnaire comprising 22 questions across seven sections covering aspects of emergency response, disaster management, and infection control. The study targeted a minimum sample size of 500 participants, successfully garnering responses from 512 individuals. Results Of the 512 participants, 59.9% (n=312) were healthcare providers in patient-facing roles, and 40.1% (n=209) were in non-patient-facing roles. The results revealed notable disparities in awareness and preparedness between these two groups. Healthcare providers demonstrated higher awareness levels compared to their non-patient-facing counterparts. For instance, 76.9% of healthcare providers were aware of the hospital's emergency response plan compared to 56.2% of non-healthcare providers (χ² = 52.165, p < 0.001). Similar disparities were observed in understanding the term "disaster" (86.5% vs 54.1%, χ² = 27.931, p < 0.001), and awareness of a command center (73.4% vs 45.2%, χ² = 42.934, p < 0.001). Discussion These findings underscore the critical need for enhancing awareness, education, and preparedness within healthcare facilities, emphasizing an integrated approach that includes both healthcare and non-healthcare staff. By addressing these gaps, healthcare facilities can significantly improve their emergency response efficiency, disaster management capabilities, and infection control measures, thereby enhancing the overall safety and quality of patient care.
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Affiliation(s)
- Sarah Al-Shammari
- Day Surgery Unit, Royal Commission Hospital, Jubail Industrial City, Al Jubail 31961, Saudi Arabia
| | - Ahmed M Al-Wathinani
- Department of Emergency Medical Services, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed A Abahussain
- Department of Emergency Medical Services, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| | - Nawaf A Albaqami
- Day Surgery Unit, Royal Commission Hospital, Jubail Industrial City, Al Jubail 31961, Saudi Arabia
| | - Mohammad A Alhallaf
- Department of Emergency Medical Services, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| | - Hassan Farhat
- Ambulance Service, Hamad Medical Corporation, Doha, Qatar
- Faculty of Medicine Ibn El Jazzar, University of Sousse, 4000, Sousse, Tunisia & Faculty of Sciences, University of Sfax, Sfax, Tunisia
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Tamene FB, Mihiretie EA, Dagnew FN, Gubae K, Tafesse FA, Wondm SA. Health-related quality of life and associated factors among health care providers in the northwest of Ethiopia: a multicenter cross-sectional study, 2023. Front Public Health 2024; 12:1357856. [PMID: 38628850 PMCID: PMC11018960 DOI: 10.3389/fpubh.2024.1357856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/21/2024] [Indexed: 04/19/2024] Open
Abstract
Background The diminished quality of life among healthcare providers (HCPs) could impact both their personal well-being and their ability to effectively fulfill healthcare needs and provide necessary facilities to the public. Furthermore, this decline in quality of life may also significantly influence the overall health of HCPs, regardless of their professional training and duties. Objectives The aim of this study was to assess the health-related quality of life (HRQoL) and associated factors among healthcare providers at comprehensive specialized hospitals in the Northwest Ethiopia. Method A cross-sectional study was conducted among 412 healthcare providers at comprehensive specialized hospitals in Northwest Ethiopia from June to July 2023. Study participants were enrolled using simple random sampling. Health-related quality of life (HRQoL) was measured using the World Health Organization Quality of Life Scale-Bref Version. Data entry and analysis were performed using Epi-data version 4.6.1 and SPSS version 24, respectively. Binary logistic regression was employed to assess the association between quality of life and independent variables. Variables with a p-value <0.05 at a 95% confidence interval were considered statistically significant. Result Out of the 422 study participants approached, 412 respondents were included in the final analysis. Poor quality of life was observed in 54.6% of participants. Factors such as working hours per day (AOR = 1.85, 95% CI: 1.12; 3.05), working experience (AOR = 1.95, 95% CI: 1.04; 3.65), and the presence of chronic disease (AOR = 2.11, 95% CI: 1.18; 3.75) were significantly associated with poor quality of life. Conclusion This study revealed that more than half of the participants experienced poor quality of life. Specific attention is needed for healthcare providers working for more than 8 h per day, those with less work experience, and those with chronic illnesses in order to improve their quality of life.
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Affiliation(s)
- Fasil Bayafers Tamene
- Department of Pharmacy, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | | | - Fisseha Nigussie Dagnew
- Department of Pharmacy, College of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Kale Gubae
- Department of Pharmacy, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Fasika Argaw Tafesse
- Department of Pharmacy, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Samuel Agegnew Wondm
- Department of Pharmacy, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
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Ran X, Meara E, Morden NE, Moen EL, Rockmore DN, O’Malley AJ. Estimating the impact of physician risky-prescribing on the network structure underlying physician shared-patient relationships. RESEARCH SQUARE 2024:rs.3.rs-4139630. [PMID: 38585838 PMCID: PMC10996792 DOI: 10.21203/rs.3.rs-4139630/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Social network analysis and shared-patient physician networks have become effective ways of studying physician collaborations. Assortative mixing or "homophily" is the network phenomenon whereby the propensity for similar individuals to form ties is greater than for dissimilar individuals. Motivated by the public health concern of risky-prescribing among older patients in the United States, we develop network models and tests involving novel network measures to study whether there is evidence of geographic homophily in prescribing and deprescribing in the specific shared-patient network of physicians linked to the US state of Ohio in 2014. Evidence of homophily in risky-prescribing would imply that prescribing behaviors help shape physician networks and could inform interventions to reduce risky-prescribing (e.g., should interventions target groups of physicians or select physicians at random). Furthermore, if such effects varied depending on the structural features of a physician's position in the network (e.g., by whether or not they are involved in cliques - groups of actors that are fully connected to each other - such as closed triangles in the case of three actors), this would further strengthen the case for targeting of select physicians for interventions. Using accompanying Medicare Part D data, we converted patient longitudinal prescription receipts into novel measures of the intensity of each physician's risky-prescribing. Exponential random graph models were used to simultaneously estimate the importance of homophily in prescribing and deprescribing in the network beyond the characteristics of physician specialty (or other metadata) and network-derived features. In addition, novel network measures were introduced to allow homophily to be characterized in relation to specific triadic (three-actor) structural configurations in the network with associated non-parametric randomization tests to evaluate their statistical significance in the network against the null hypothesis of no such phenomena. We found physician homophily in prescribing and deprescribing in both the state-wide and multiple HRR sub-networks, and that the level of homophily varied across HRRs. We also found that physicians exhibited within-triad homophily in risky-prescribing, with the prevalence of homophilic triads significantly higher than expected by chance absent homophily. These results may explain why communities of prescribers emerge and evolve, helping to justify group-level prescriber interventions. The methodology could be applied to arbitrary shared-patient networks and even more generally to other kinds of network data that underlies other kinds of social phenomena.
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Affiliation(s)
- Xin Ran
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, 03756, NH, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, 03756, NH, USA
| | - Ellen Meara
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, 02115, MA, USA
- National Bureau of Economic Research, Cambridge, 02139, MA, USA
| | - Nancy E. Morden
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, 03756, NH, USA
- United HealthCare, Minnetonka, 55343, MN, USA
| | - Erika L. Moen
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, 03756, NH, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, 03756, NH, USA
| | - Daniel N. Rockmore
- Department of Mathematics, Dartmouth College, Hanover, 03755, NH, USA
- Department of Computer Science, Dartmouth College, Hanover, 03755, NH, USA
- The Santa Fe Institute, Santa Fe, 87502, NM, USA
| | - A. James O’Malley
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, 03756, NH, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, 03756, NH, USA
- Department of Mathematics, Dartmouth College, Hanover, 03755, NH, USA
- Department of Computer Science, Dartmouth College, Hanover, 03755, NH, USA
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Eshghi F, Pourgholam N, Kianian T, Kashani M, Azami M. Innovative services in home health nursing: a scoping review protocol. BMJ Open 2024; 14:e077174. [PMID: 38531577 PMCID: PMC10966785 DOI: 10.1136/bmjopen-2023-077174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 03/01/2024] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION Advances in the use of technology in home health nursing (HHN) not only can facilitate the delivery of home care but can also influence the entire healthcare system. Additionally, it can contribute to the individual autonomy in the area of health. The aim of this scoping review protocol is to identify, describe and map the types of innovative services and their delivery approaches in the HHN structure worldwide. METHODS AND ANALYSIS The main question of the research is as follows: what are different types of innovative services and their delivery approaches in the HHN structure around the world? The Joanna Briggs Institute (JBI) method for scoping reviews will guide the conducting this scoping review, and the participants, concept and context framework will be used as eligibility criteria. MEDLINE databases via PubMed, Embase, Cochrane Library, Scopus, Web of Science, Science Direct, Persian scientific databases and grey literature will be searched prior to May 2024 to include eligible studies, without any language restrictions. To be included, studies will be reviewed by two independent reviewers. A data extraction form developed for the study purpose will be used to extract the data relevant to the review questions. Data analysis will be performed based on each innovative service and answering the subquestions about it. According to the concepts of interest, the results will be analysed and presented using tables, figures, images and a narrative summary. ETHICS AND DISSEMINATION This study will not involve human or animal participants. Data will be sourced from the published literature. To be published, the results of the study will be submitted to an international peer-reviewed, open-access journal as well as scientific meetings on HHN and innovative services research.
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Affiliation(s)
- Fateme Eshghi
- Shahid Beheshti University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Nima Pourgholam
- Nursing and Midwifery Care Research Center, Department of Medical Surgical Nursing, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Toktam Kianian
- Nursing and Midwifery Care Research Center, Department of Community Health and Geriatric Nursing, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Maryam Kashani
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Masoomeh Azami
- Shahid Beheshti University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
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Vidal-Silva C, Sánchez-Ortiz A, Serrano-Malebrán J, Arriagada V, Flores M, Godoy M, Vargas C. Social influence, performance expectancy, and price value as determinants of telemedicine services acceptance in Chile. Heliyon 2024; 10:e27067. [PMID: 38562504 PMCID: PMC10982984 DOI: 10.1016/j.heliyon.2024.e27067] [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: 05/11/2023] [Revised: 02/16/2024] [Accepted: 02/23/2024] [Indexed: 04/04/2024] Open
Abstract
Medicine is a discipline based on and nurtured by scientific research and technological development. The use of health services supported by information technology is increasing worldwide, and Latin America is no exception. Factors such as needing more specialists in peripheral cities, large geographic areas, and socio-cultural aspects limit the possibility of receiving timely and quality medical care services. Information Technology (IT) for health purposes, such as e-health, is a cost-effective solution for equitable access to quality healthcare services and optimization of the rising associated costs. As an e-health service, telemedicine facilitates and mediates distance communication between the patient and medical staff. Even though Latin America is at the beginning of the development of telemedicine, it would have a relevant impact, given the geographic and socioeconomic conditions of the population in this part of the world. Drawing on the extended Unified Theory of Acceptance and Use of Technology (UTAUT2) theory, we developed a theoretical model to identify the latent factors influencing the public acceptance of telemedicine and examined their interrelationships. A survey questionnaire was designed and administered to 391 residents in Antofagasta, a mine region of Chile. After that, structural equation modeling was employed to analyze the survey data. The results reveal that the UTAUT2 factors' performance expectancy, social influence, and price value significantly impact the intention to use (R 2 = 0.693). Additionally, the model presented a good fit. This study enriches the existing theoretical research on the acceptance of telemedicine services and offers insights into understanding and managing technology in the Chilean health sector.
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Affiliation(s)
- Cristian Vidal-Silva
- School of Videogame Development and Virtual Reality Engineering, Faculty of Engineering, University of Talca, Av. Lircay S/N, Talca, 3460000, Maule, Chile
| | - Aurora Sánchez-Ortiz
- Department of Administration, Universidad Católica del Norte, Angamos 0610, Antofagasta, 1240000, Antofagasta, Chile
| | - Jorge Serrano-Malebrán
- Department of Administration, Universidad Católica del Norte, Angamos 0610, Antofagasta, 1240000, Antofagasta, Chile
| | - Vanessa Arriagada
- Department of Administration, Universidad Católica del Norte, Angamos 0610, Antofagasta, 1240000, Antofagasta, Chile
| | - Moisés Flores
- Department of Administration, Universidad Católica del Norte, Angamos 0610, Antofagasta, 1240000, Antofagasta, Chile
| | - Mónica Godoy
- Department of Administration, Universidad Católica del Norte, Angamos 0610, Antofagasta, 1240000, Antofagasta, Chile
| | - Cristopher Vargas
- Department of Administration, Universidad Católica del Norte, Angamos 0610, Antofagasta, 1240000, Antofagasta, Chile
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Tikouk J, Ait Boubkr A. Transportation and Access to Healthcare in Morocco: An Exploratory Study of Guelmim-Oued Noun Region. Ann Glob Health 2024; 90:11. [PMID: 38344006 PMCID: PMC10854410 DOI: 10.5334/aogh.4063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 01/07/2024] [Indexed: 02/15/2024] Open
Abstract
Objective The aim of this study was to examine the correlation between accessibility to healthcare facilities and transportation in the Guelmim Oued Noun region of Morocco, where transportation barriers continue to pose a major challenge to accessing healthcare, despite efforts aimed at reducing access barriers. Methods Data collection for this study involved the administration of a survey among 328 outpatients residing in the Guelmim Oued Noun region, Morocco. The utilization of canonical correlation served as the analytical method, employed to quantify and assess the relationship between transportation related barriers and the access of healthcare services in the specified region. Results Our research reveals that transportation factors account for approximately 25% of the variation in access to healthcare services. The number of transportation modes utilized by outpatients and the affordability of transportation were found to be significant contributors to the transportation dimension. These findings confirm the significant relationship between transportation and access to healthcare facilities in the region under investigation. Conclusion Further research is recommended to specifically address transportation barriers to healthcare access services among socially excluded populations, with a focus on promoting mobility inclusivity.
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Affiliation(s)
- Jamal Tikouk
- Applied Modeling in Economics and Management Laboratory, University of Hassan II Casablanca, Casablanca, Morocco
| | - Asmaa Ait Boubkr
- Applied Modeling in Economics and Management Laboratory, University of Hassan II Casablanca, Casablanca, Morocco
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Giese A, Khanam R, Nghiem S, Staines A, Rosemann T, Boes S, Havranek MM. Assessing the excess costs of the in-hospital adverse events covered by the AHRQ's Patient Safety Indicators in Switzerland. PLoS One 2024; 19:e0285285. [PMID: 38315675 PMCID: PMC10843032 DOI: 10.1371/journal.pone.0285285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 04/19/2023] [Indexed: 02/07/2024] Open
Abstract
There currently exists no comprehensive and up-to date overview on the financial impact of the different adverse events covered by the Patient Safety Indicators (PSIs) from the Agency for Healthcare Research and Quality. We conducted a retrospective case-control study using propensity score matching on a national administrative data set of 1 million inpatients in Switzerland to compare excess costs associated with 16 different adverse events both individually and on a nationally aggregated level. After matching 8,986 cases with adverse events across the investigated PSIs to 26,931 controls, we used regression analyses to determine the excess costs associated with the adverse events and to control for other cost-related influences. The average excess costs associated with the PSI-related adverse events ranged from CHF 1,211 (PSI 18, obstetric trauma with instrument) to CHF 137,967 (PSI 10, postoperative acute kidney injuries) with an average of CHF 27,409 across all PSIs. In addition, adverse events were associated with 7.8-day longer stays, 2.5 times more early readmissions (within 18 days), and 4.1 times higher mortality rates on average. At a national level, the PSIs were associated with CHF 347 million higher inpatient costs in 2019, which corresponds to about 2.2% of the annual inpatient costs in Switzerland. By comparing the excess costs of different PSIs on a nationally aggregated level, we offer a financial perspective on the implications of in-hospital adverse events and provide recommendations for policymakers regarding specific investments in patient safety to reduce costs and suffering.
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Affiliation(s)
- Alice Giese
- Competence Center for Health Data Science, Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- School of Business and Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Rasheda Khanam
- School of Business and Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Son Nghiem
- College of Health & Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Anthony Staines
- IFROSS Institute, University of Lyon III, Lyon, France
- Hospital Federation of Vaud, Prilly, Vaud, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Stefan Boes
- Competence Center for Health Data Science, Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Michael M. Havranek
- Competence Center for Health Data Science, Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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George J, Jack S, Gauld R, Colbourn T, Stokes T. Impact of health system governance on healthcare quality in low-income and middle-income countries: a scoping review. BMJ Open 2023; 13:e073669. [PMID: 38081664 PMCID: PMC10729209 DOI: 10.1136/bmjopen-2023-073669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Improving healthcare quality in low-/middle-income countries (LMICs) is a critical step in the pathway to Universal Health Coverage and health-related sustainable development goals. This study aimed to map the available evidence on the impacts of health system governance interventions on the quality of healthcare services in LMICs. METHODS We conducted a scoping review of the literature. The search strategy used a combination of keywords and phrases relevant to health system governance, quality of healthcare and LMICs. Studies published in English until August 2023, with no start date limitation, were searched on PubMed, Cochrane Library, CINAHL, Web of Science, Scopus, Google Scholar and ProQuest. Additional publications were identified by snowballing. The effects reported by the studies on processes of care and quality impacts were reviewed. RESULTS The findings from 201 primary studies were grouped under (1) leadership, (2) system design, (3) accountability and transparency, (4) financing, (5) private sector partnerships, (6) information and monitoring; (7) participation and engagement and (8) regulation. CONCLUSIONS We identified a stronger evidence base linking improved quality of care with health financing, private sector partnerships and community participation and engagement strategies. The evidence related to leadership, system design, information and monitoring, and accountability and transparency is limited.
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Affiliation(s)
- Joby George
- Department of General Practice & Rural Health, University of Otago, Dunedin, New Zealand
| | - Susan Jack
- Te Whatu Ora - Southern, National Public Health Service, Dunedin, New Zealand
- Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand
| | - Robin Gauld
- Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand
- Otago Business School, University of Otago, Dunedin, New Zealand
| | | | - Tim Stokes
- Department of General Practice & Rural Health, University of Otago, Dunedin, New Zealand
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Eze RA, Sulaiman N, Daud Z'AM, Babadoko A. Socio-demographic and food insecurity associated with adherence to antiretroviral therapy among HIV adults in Ahmadu Bello University teaching hospital Zaria, Kaduna State Nigeria. Afr Health Sci 2023; 23:236-246. [PMID: 38974269 PMCID: PMC11225438 DOI: 10.4314/ahs.v23i4.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Background Socio-demographic characteristics may have an impact on HIV-positive people's prognosis and survival. In addition, food insecurity could make it harder for HIV patients to stick to their treatment plans as effectively as possible. Objective This research aimed to determine the association between socio-demographic and food insecurity with adherence to antiretroviral therapy among people living with HIV on ART in Ahmadu Bello University Teaching Hospital Zaria, Kaduna State, Nigeria. Method Using a cross-sectional design, a systematic random sampling method was used to select respondents aged 18-64 years on antiretroviral therapy for at least six months at Ahmadu Bello University Teaching Hospital Zaria, Kaduna State, Nigeria, outpatients of the President's Emergency Plan for AIDS Relief clinic. Socio-demographic, food insecurity status and adherence to ART was obtained using self-administered questionnaire. Descriptive statistics, chi-square test, and multiple logistic regression were used for data analysis. Results Among the 385 people who took part in the study, about 67.5% of females and 32.5% of males took part in the survey, respectively. About 54% of adults adhered to ART. The majority of the respondents (87.0%) had a low level of food security. Food insecurity (OR = 1.2, p = <0.05), government employment (OR = 2.842, p = <0.01), self-employment (OR = 2.6, p = <0.001), and being divorced or widowed (OR = 2.0, p = <0.01) were all significantly associated with ART adherence. Conclusion Food insecurity, employment, and marital status influenced adherence to ART. As a result, health care providers and HIV control programme implementers must continually emphasis and encourage strict adherence.
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Affiliation(s)
- Rosemary Ada Eze
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang Selangor, Malaysia
| | - Norhasmah Sulaiman
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang Selangor, Malaysia
| | - Zulfitri 'Azuan Mat Daud
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang Selangor, Malaysia
| | - Aliyu Babadoko
- Department of Haematology, Ahmadu Bello University Teaching Hospital, PMB 06, Zaria, Kaduna State, Nigeria
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Bekyieriya E, Isang S, Baguune B. Mobile health technology in providing maternal health services - Awareness and challenges faced by pregnant women in upper West region of Ghana. PUBLIC HEALTH IN PRACTICE 2023; 6:100407. [PMID: 37449294 PMCID: PMC10336575 DOI: 10.1016/j.puhip.2023.100407] [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: 11/10/2022] [Revised: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 07/18/2023] Open
Abstract
Objectives The study assessed awareness on Mobile Health (mhealth) Technology as well as challenges pregnant women encounter in the utilization of mhealth technology to improve maternal health in rural settings in the Upper West Region (UWR) of Ghana. Study design The study was an exploratory design that employed the qualitative method of data collection. Methods Semi-structured interview guide was used to conduct six (6) Focus Group Discussions (FGDs) and nine (9) Key Informant Interviews (KIIs) among pregnant women and health workers respectively from three (3) selected rural districts in the Upper West Region. Data was collected in August 2020. Thematic analysis was conducted and some statements from participants were presented verbatim to illustrate the themes realized. Results Participants were aware of the mhealth intervention that had been implemented by Savanna Signatures in their districts. Major sources of information on the mhealth services were from durbars, health education sessions and health care providers. Challenges faced by pregnant women, in the mhealth technology intervention were; financial challenges, lack of mobile network connectivity, lack of electricity in some rural areas, low female literacy rate at household level and cultural barriers. Conclusion The Savanna Signatures mhealth intervention is widely known but some challenges exist that impede the smooth implementation of the intervention. The mhealth technology intervention implementers should partner with other sectors and policy makers to address the challenges identified by the study.
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Affiliation(s)
- E. Bekyieriya
- REJ Institute, Research and ICT Consultancy Services, P.O. Box TL1139, Tamale, Ghana
- School of Hygiene, Environmental Health Programme, Ministry of Health, Tamale, Ghana
| | - S. Isang
- Ghana School of Law, Kwame Nkrumah University Science Technology, Kumasi, Ghana
| | - B. Baguune
- School of Hygiene, Environmental Health Programme, Ministry of Health, Tamale, Ghana
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15
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Ismail R, Ismail NH, Md Isa Z, Mohd Tamil A, Ja'afar MH, Mat Nasir N, Abdul-Razak S, Zainol Abidin N, Ab Razak NH, Joseph P, Yusof KH. Prevalence and Factors Associated with Prehypertension and Hypertension Among Adults: Baseline Findings of PURE Malaysia Cohort Study. AMERICAN JOURNAL OF MEDICINE OPEN 2023; 10:100049. [PMID: 39035240 PMCID: PMC11256272 DOI: 10.1016/j.ajmo.2023.100049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/23/2024]
Abstract
Background Although prehypertension and hypertension can be detected at the primary healthcare level and low-cost treatments can effectively control its complications, hypertension is still the world's leading preventable risk factor. Therefore, the present study aimed to determine its prevalence and its risk factors among Malaysian adults. Methods A cross-sectional study involving 7585 adults was performed covering the rural and urban areas. Respondents with systolic blood pressure (SBP) of 120-139 mmHg and/or diastolic blood pressure (DBP) of 80-89 mmHg were categorized as prehypertensive, and hypertensive categorization was used for respondents with an SBP of ≥140 mmHg and/or DBP of ≥90 mmHg. Results Respondents reported to have prehypertension and hypertension were 40.7% and 38.0%, respectively. Those residing in a rural area, older age, male, family history of hypertension, and overweight or obese were associated with higher odds of prehypertension and hypertension. Unique to hypertension, the factors included low educational level (AOR: 1.349; 95% CI: 1.146, 1.588), unemployment (1.350; 1.16, 1.572), comorbidity of diabetes (1.474; 1.178, 1.844), and inadequate fruit consumption (1.253; 1.094, 1.436). Conclusions As the prehypertensive state may affect the prevalence of hypertension, proactive strategies are needed to increase early detection of the disease among specific group of those residing in a rural area, older age, male, family history of hypertension, and overweight or obese.
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Affiliation(s)
- Rosnah Ismail
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Noor Hassim Ismail
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Zaleha Md Isa
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Azmi Mohd Tamil
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Mohd Hasni Ja'afar
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Nafiza Mat Nasir
- Department of Primary Care Medicine, Faculty of Medicine Universiti Teknologi MARA (UiTM), Selayang Campus, Selangor, Malaysia
| | - Suraya Abdul-Razak
- Department of Primary Care Medicine, Faculty of Medicine Universiti Teknologi MARA (UiTM), Selayang Campus, Selangor, Malaysia
- Cardio Vascular and Lungs Research Institute (CaVaLRI), Pusat Perubatan UiTM, Kampus Sungai Buloh, Sungai Buloh, Selangor, Malaysia
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Najihah Zainol Abidin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
- Department of Diagnostic and Allied Health Science, Faculty of Health and Life Sciences, Management and Science University, Shah Alam, Selangor, Malaysia
| | - Nurul Hafiza Ab Razak
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Philip Joseph
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Khairul Hazdi Yusof
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
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Christian BIN, Christian NG, Keshinro MI, Olutade-Babatunde O. How to build bridges for Universal Health Coverage in Nigeria by linking formal and informal health providers. BMJ Glob Health 2023; 8:e014165. [PMID: 38007226 PMCID: PMC10680001 DOI: 10.1136/bmjgh-2023-014165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/12/2023] [Indexed: 11/27/2023] Open
Affiliation(s)
| | | | - Maryam I Keshinro
- Department of Paediatrics, State House Medical Centre, Hospital Authority Head Office, Aso Rock, Abuja, Nigeria
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Blanken M, Mathijssen J, van Nieuwenhuizen C, Raab J, van Oers H. Examining preconditions for integrated care: a comparative social network analysis of the structure and dynamics of strong relations in child service networks. BMC Health Serv Res 2023; 23:1146. [PMID: 37875928 PMCID: PMC10598897 DOI: 10.1186/s12913-023-10128-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/08/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND To help ensure that children and families get the right support and services at the right time, strong and stable relationships between various child service organizations are vital. Moreover, strong and stable relationships and a key network position for gatekeepers are important preconditions for interprofessional collaboration, the timely and appropriate referral of clients, and improved health outcomes. Gatekeepers are organizations that have specific legal authorizations regarding client referral. However, it is largely unclear how strong relations in child service networks are structured, whether the gatekeepers have strong and stable relationships, and what the critical relations in the overall structure are. The aim of this study is to explore these preconditions for integrated care by examining the internal structure and dynamics of strong relations. METHODS A comparative case study approach and social network analysis of three inter-organizational networks consisting of 65 to 135 organizations within the Dutch child service system. Multiple network measures (number of active organizations, isolates, relations, average degree centrality, Lambda sets) were used to examine the strong relation structure and dynamics of the networks. Ucinet was used to analyze the data, with use of the statistical test: Quadratic Assignment Procedure. Visone was used to visualize the graphs of the networks. RESULTS This study shows that more than 80% of the organizations in the networks have strong relations. A striking finding is the extremely high number of strong relations that gatekeepers need to maintain. Moreover, the results show that the most important gatekeepers have key positions, and their strong relations are relatively stable. By contrast, considering the whole network, we also found a considerable measure of instability in strong relationships, which means that child service networks must cope with major internal dynamics. CONCLUSIONS Our study addressed crucial preconditions for integrated care. The extremely high number of strong relations that particularly gatekeepers need to build and maintain, in combination with the considerable instability of strong relations considering the whole network, is a serious point of concern that need to be managed, in order to enable child service networks to improve internal coordination and integration of service delivery.
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Affiliation(s)
- Mariëlle Blanken
- TRANZO - Scientific center for care and wellbeing, Tilburg University, 5000 LE, Tilburg, PO BOX 90153, the Netherlands.
| | - Jolanda Mathijssen
- TRANZO - Scientific center for care and wellbeing, Tilburg University, 5000 LE, Tilburg, PO BOX 90153, the Netherlands
| | - Chijs van Nieuwenhuizen
- TRANZO - Scientific center for care and wellbeing, Tilburg University, 5000 LE, Tilburg, PO BOX 90153, the Netherlands
| | - Jörg Raab
- Department of Organization Studies, School of Social and Behavioral Sciences, Tilburg University, NL-5000 LE, Tilburg, P.O. Box 90153, The Netherlands
| | - Hans van Oers
- TRANZO - Scientific center for care and wellbeing, Tilburg University, 5000 LE, Tilburg, PO BOX 90153, the Netherlands
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Alemu TG, Fentie EA, Asmamaw DB, Shewarega ES, Negash WD, Eshetu HB, Belay DG, Aragaw FM, Fetene SM, Teklu RE. Multilevel analysis of factors associated with untreated diarrhea among under five children in Ethiopia using Ethiopian demographic and health survey. Sci Rep 2023; 13:16126. [PMID: 37752329 PMCID: PMC10522699 DOI: 10.1038/s41598-023-43107-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 09/20/2023] [Indexed: 09/28/2023] Open
Abstract
Diarrhea refers to the abrupt onset of three or more loose or liquid stools per day. It is the second leading cause of death in infants worldwide. It is an endemic disease and continues to be a serious threat to children in Ethiopia. Despite being a condition that may be prevented, diarrhea can have a negative impact on a child's health. Also, studies have not been able to explore the role of socio-economic characteristics in hindering the treatment. Therefore, this study aimed to explore socio-economic factors that influence treatment of childhood diarrhea. Secondary data analysis was conducted based on the demographic and health surveys data conducted in Ethiopia. A total weighted sample of 1227 under-five children was included for this study. Mixed-effect binary logistic regression analysis was done to identify associated factors of untreated diarrhea. Adjusted Odds Ratio with 95% CI was used to declare the strength and significance of the association. Prevalence of untreated diarrhea among under five children in Ethiopia was 57.32% (95% CI 54.52-60.06%). In the mixed-effect analysis; Children aged 6-11, 12-23, and 24-35 (AOR 0.384, 95% CI 0.187-0.789), 71% (AOR 0.29, 95% CI 0.149-0.596), and 51% (AOR 0.49, 95% CI 0.238-0.995). Children from family number six and above (AOR 1.635, 95% CI 1.102-2.426). Children from middle wealth of family (AOR 1.886, 95% CI 1.170-3.3040). Children from a community with high level of uneducated (AOR 2.78, 95% CI 1.065-3.442) were significantly associated with untreated diarrhea. The prevalence of untreated diarrhea among under-five children in Ethiopia is high. Age of child, family number, household wealth, and community-level educational status were significantly associated with untreated diarrhea among under-five children in Ethiopia. Hence, increasing community educational status, boosting the economic status of the community, and family planning for the community should get due attention.
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Affiliation(s)
- Tewodros Getaneh Alemu
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Elsa Awoke Fentie
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Desale Bihonegn Asmamaw
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ever Siyoum Shewarega
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wubshet Debebe Negash
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Habitu Birhan Eshetu
- Department of Health Promotion and Health Behavior, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Daniel Gashaneh Belay
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Samrawit Mihret Fetene
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Rediet Eristu Teklu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Singh C, Shoqirat N, Thorpe L, Villaneuva S. Sustainable pressure injury prevention. BMJ Open Qual 2023; 12:bmjoq-2022-002248. [PMID: 37286297 DOI: 10.1136/bmjoq-2022-002248] [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: 12/30/2022] [Accepted: 05/23/2023] [Indexed: 06/09/2023] Open
Abstract
The quality department used adaptive leadership and the plan-do-study-act cycle to decrease pressure injury (PI) rates. After identifying gaps, the pressure injury prevention bundle was developed and implemented to bring evidence-based nursing practice to frontline nurses. Organisational rates of PI was followed for 4 years (2019-2022) and a smaller subset of 88 patients were followed in the prospective arm. Using statistical analysis, the decrease in PI rates (90%) and severity is significant (p<0.5) and sustained compared with the year prior to interventions.
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Affiliation(s)
- Charleen Singh
- Nursing, University of California Davis Betty Irene Moore School of Nursing, Sacramento, California, USA
- Wound Care, Regional Medical Center of San Jose, San Jose, California, USA
- General Surgery, Cottage Hospital, Santa Barbara, California, USA
| | - Noordeen Shoqirat
- Nursing, Mu'tah University College of Nursing, Mu'tah, Jordan
- Health Sciences, Higher Colleges of Technology, Sharjah, UAE
| | - Lee Thorpe
- Quality, Regional Medical Center of San Jose, San Jose, California, USA
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Wuni FK, Kukeba MW, Zakariah Y, Nyaabila EA, Saanwie AS. Contributory factors to early neonatal deaths in the Upper East Regional Hospital in Ghana. Ghana Med J 2023; 57:128-133. [PMID: 38504758 PMCID: PMC10846648 DOI: 10.4314/gmj.v57i2.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
Objective This study examined factors identified during early neonatal death audits contributing to preventable newborn deaths at the Upper East Regional Hospital. Method Data for this study was collected retrospectively from perinatal death audit forms using three data collectors. Data collection lasted two weeks, from 18th June to 2nd July 2021. The data collectors submitted 113 filled hard copy data collection forms. This was then entered into a designed Excel sheet and exported to STATA software version 15.0 for analysis. The analysis was descriptive statistics with cross-tabulation. The results were presented in charts and tables focusing on percentages. Results Most of the 113 neonatal deaths were from birth asphyxia (63%). Forty-six (40.7%) of the deaths occurred within 24 hrs after birth. There were 38 factors reported 254 times in the audits as contributory to all the newborn deaths; 17 health personnel-related factors stated 141 (55.5%) times, four transportation and communication-related factors stated 43 (16.9%) times, seven health facility factors stated 31 (12.2%) times. Inappropriate care during transportation to the regional hospital was reported most - 21 times, followed by delay in referral - 18 times. Conclusion The study identified many factors, such as medical personnel-related factors, transportation and communication factors, family-related factors, and health facility administration factors, contributing to early neonatal deaths. Effective implementation of neonatal death audit-based recommendations arising from these contributory factors is critical to preventing avoidable newborn deaths. Funding This project was funded by Upper East Regional Hospital.
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Affiliation(s)
| | - Margaret W. Kukeba
- CK Tedam University for Technology and Applied Sciences, Navrongo, Upper East Region, Ghana
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Zhang Q, Zhang R, Lu X, Zhang X. What drives the adoption of online health communities? An empirical study from patient-centric perspective. BMC Health Serv Res 2023; 23:524. [PMID: 37221504 DOI: 10.1186/s12913-023-09469-6] [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: 09/14/2022] [Accepted: 04/28/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Online health communities (OHCs) provide platforms for patients to seek advice from physicians and receive professional suggestions online. It can improve the efficiency of patients' diagnosis of simple diseases and alleviate hospital congestion. However, few empirical studies have comprehensively explored the factors influencing patients' intention to use OHCs through objective data. This study aims to fill this gap by identifying key factors that influence patients' acceptance of OHCs and proposing effective ways to promote the applications of OHCs in China. METHODS Based on the Unified Theory of Acceptance and Usage of Technology (UTAUT), extended with additional constructs identified with patients' information demands in OHCs, this study developed a research model and proposed nine hypotheses. An online survey involving 783 valid responses was conducted in China to collect data to validate the proposed model. Confirmatory factor analysis and partial least squares (PLS) path model were conducted for instrument validation and hypothesis testing. RESULTS Price value, eHealth literacy, and performance expectancy are the most prominent constructs in the study context. Interestingly, relation quality was also found to have a significant positive relationship with behavioral intention. CONCLUSIONS Based on these findings, OHC operators need to create a user-friendly platform, improve information quality, set reasonable prices, and establish consummate security systems. Physicians and related organizations can raise awareness and assist patients in developing the skills to appropriately comprehend and utilize information in OHCs. This study contributes to both technology adoption theory and practice.
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Affiliation(s)
- Qianyao Zhang
- Department of Information Management, School of Economics and Management, Beijing Jiaotong University, Beijing, 100044, China
| | - Runtong Zhang
- Department of Information Management, School of Economics and Management, Beijing Jiaotong University, Beijing, 100044, China.
| | - Xinyi Lu
- School of Management and E-business, Zhejiang Gongshang University, Hangzhou, Zhejiang, China
| | - Xijing Zhang
- Department of Information Management, School of Economics and Management, Beijing Jiaotong University, Beijing, 100044, China
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Belay AS, Asmare WN, Kassie A. Cervical cancer screening utilization and its predictors among women in bench Sheko Zone, Southwest Ethiopia: using health belief model. BMC Cancer 2023; 23:472. [PMID: 37221482 PMCID: PMC10204309 DOI: 10.1186/s12885-023-10927-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/07/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Cervical cancer is the fourth most frequently diagnosed and found to be the leading cause of cancer death in women, especially in low and middle-income countries. Even though cervical cancer is a preventable disease, its preventive measures have not been equitably implemented across and within different countries; especially in low and middle-income countries, due to different contributing factors. OBJECTIVE This study aimed to assess cervical cancer screening utilization and its' predictors among Women in Bench Sheko Zone, Southwest Ethiopia. METHOD A community-based cross-sectional study design was employed in Bench Sheko Zone from February 2021 to April 2021. Using a multi-stage stratified sampling method, a total of 690 women in the age range of 30-49 years were included in the study. The logistic regression analysis was used considering a 95% confidence interval and a P-value of < 0.05. RESULTS Ninety-six (14.2%) of the participants have utilized cervical cancer screening. Predictors like; age between 40-49 years (AOR = 5.35, 95% CI = [2.89, 9.90]), partner educational status of certificate and above (AOR = 4.36, 95% CI = [1.65, 11.51]), first sexual intercourse before eighteen years (AOR = 4.85, 95% CI = [2.29, 10.26]), ever used of alcohol (AOR = 3.99, 95% CI = [1.23, 12.89]), good knowledge (AOR = 8.98, 95% CI = [4.06, 19.89]), favorable attitude (AOR = 3.56, 95% CI = [1.78, 7.09]), and high perceived benefit (AOR = 2.94, 95% CI = [1.48, 5.84]) were strongly associated with cervical cancer screening utilization. CONCLUSION In this study, cervical cancer screening utilization was relatively low. Therefore, promotion of the perception of women towards cervical cancer screening, and provision of health-related information towards different behavioral-related factors should have to be addressed at each level of health care.
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Affiliation(s)
- Alemayehu Sayih Belay
- College of Medicine and Health Sciences, Department of Nursing, Mizan Tepi University, P.O. Box: 260, Mizan Aman, Ethiopia.
| | - Wondwossen Niguse Asmare
- College of Medicine and Health Sciences, Department of Nursing, Mizan Tepi University, P.O. Box: 260, Mizan Aman, Ethiopia
| | - Aychew Kassie
- College of Medicine and Health Sciences, Department of Nursing, Mizan Tepi University, P.O. Box: 260, Mizan Aman, Ethiopia
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Afetor M, Harris E, Der JB, Narh CT. Using routine healthcare data to determine the factors associated with hospital length of stay for hypertensive inpatients in Ghana, 2012-2017. BMJ Open 2023; 13:e066457. [PMID: 37156576 PMCID: PMC10173975 DOI: 10.1136/bmjopen-2022-066457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVE Hospitalisation for hypertension continues to rise in Ghana. It has been revealed that in Ghana, patients hospitalised for hypertension spend between 1 and 91 days on admission. This study therefore sought to estimate the hospital length of stay (LoS) of hypertensive patients and individual or health-related factors that may influence the hospitalisation duration in Ghana. METHODS We employed a retrospective study design that used routinely collected health data on hospitalised hypertensive patients in Ghana from the District Health Information Management System database between 2012 and 2017 to model LoS using survival analysis. The cumulative incidence function for discharge stratified by sex was computed. To investigate the factors that influence hospitalisation duration, multivariable Cox regression was used. RESULTS Out of a total of 106 372 hypertension admissions, about 72 581 (68.2%) were women. The mean age of the patients was 55.3 (SD=17.5) years. Overall, the median LoS was 3 days with almost 90% of all patients being discharged by the 10th day of admission. Patients admitted in Volta region (HR: 0.89, p<0.001) and Eastern region (HR: 0.96, p=0.002) experienced late discharge as compared with patients admitted in Greater Accra. It was revealed that women (HR: 1.09, p<0.001) were discharged earlier than men. However, having a surgical procedure (HR: 1.07, p<0.001) and having comorbidities such as diabetes (HR: 0.76, p<0.001) and cardiovascular diseases other than hypertension (HR: 0.77, p<0.001) increased the LoS of patients. CONCLUSION This study provides the first comprehensive assessment of factors influencing hospitalisation duration of admissions due to hypertension in Ghana. Female sex, all regions except Volta region and Eastern region, experienced early discharge. However, patients with a surgical intervention and comorbidity experienced late discharge.
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Affiliation(s)
- Maxwell Afetor
- Department of Mathematics and Actuarial Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Ghana Health Service, Accra, Volta Region, Ghana
| | - Emmanuel Harris
- Department of Mathematics and Actuarial Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Joyce B Der
- Department of Epidemiology and Biostatistics, University of Health and Allied Sciences, Ho, Ghana
| | - Clement T Narh
- Department of Epidemiology and Biostatistics, University of Health and Allied Sciences, Ho, Ghana
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Maulina F, Hasanbasri M, Busari JO, Scheele F. Primary care doctors' perceived needs for physician leadership development in rural and remote settings of Aceh province, Indonesia. BMJ LEADER 2023:leader-2023-000757. [PMID: 37192122 DOI: 10.1136/leader-2023-000757] [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: 02/08/2023] [Accepted: 04/25/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Globally, rural/remote health systems fall short of optimal performance. Lack of infrastructure, resources, health professionals and cultural barriers affect the leadership in these settings. Given those challenges, doctors serving disadvantaged communities must develop their leadership skills. While high-income countries already had learning programmes for rural/remote areas, low-income and middle-income countries (LMICs), such as Indonesia, are lagging behind. Through the lens of the LEADS framework, we examined the skills doctors perceived as most essential to support their performance in rural/remote areas. METHODS We conducted a quantitative study, including descriptive statistics. Participants were 255 rural/remote primary care doctors. RESULTS We discovered that communicating effectively, building trust, facilitating collaboration, making connections and creating coalitions among diverse groups were most essential in rural/remote communities. When rural/remote primary care doctors serve in such cultures, may need to prioritise harmony within the community and social order values. CONCLUSIONS We noted that there is a need for culture-based leadership training in rural or remote settings of Indonesia as LMIC. In our view, if future doctors receive proper leadership training that focuses on being competent rural physicians, they will be better prepared and equipped with the skills that rural practice in a specific culture requires.
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Affiliation(s)
- Fury Maulina
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Public Health, Faculty of Medicine, Universitas Malikussaleh, Lhokseumawe, Aceh, Indonesia
| | - Mubasysyir Hasanbasri
- Department of Biostatistics, Epidemiology, and Population Health, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia
| | - Jamiu O Busari
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Pediatrics, Dr Horacio E Oduber Hospital, Oranjestad, Aruba
| | - Fedde Scheele
- Department of Obstetrics and Gynaecology, OLVG, Amsterdam, The Netherlands
- Department of Medical Education, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Lin J, Huang B, Kwan MP, Chen M, Wang Q. COVID-19 infection rate but not severity is associated with availability of greenness in the United States. LANDSCAPE AND URBAN PLANNING 2023; 233:104704. [PMID: 36718417 PMCID: PMC9870763 DOI: 10.1016/j.landurbplan.2023.104704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 01/14/2023] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
Human exposure to greenness is associated with COVID-19 prevalence and severity, but most relevant research has focused on the relationships between greenness and COVID-19 infection rates. In contrast, relatively little is known about the associations between greenness and COVID-19 hospitalizations and deaths, which are important for risk assessment, resource allocation, and intervention strategies. Moreover, it is unclear whether greenness could help reduce health inequities by offering more benefits to disadvantaged populations. Here, we estimated the associations between availability of greenness (expressed as population-density-weighted normalized difference vegetation index) and COVID-19 outcomes across the urban-rural continuum gradient in the United States using generalized additive models with a negative binomial distribution. We aggregated individual COVID-19 records at the county level, which includes 3,040 counties for COVID-19 case infection rates, 1,397 counties for case hospitalization rates, and 1,305 counties for case fatality rates. Our area-level ecological study suggests that although availability of greenness shows null relationships with COVID-19 case hospitalization and fatality rates, COVID-19 infection rate is statistically significant and negatively associated with more greenness availability. When performing stratified analyses by different sociodemographic groups, availability of greenness shows stronger negative associations for men than for women, and for adults than for the elderly. This indicates that greenness might have greater health benefits for the former than the latter, and thus has limited effects for ameliorating COVID-19 related inequity. The revealed greenness-COVID-19 links across different space, time and sociodemographic groups provide working hypotheses for the targeted design of nature-based interventions and greening policies to benefit human well-being and reduce health inequity. This has important implications for the post-pandemic recovery and future public health crises.
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Affiliation(s)
- Jian Lin
- Sierra Nevada Research Institute, University of California, Merced, Merced, CA, 95340, USA
| | - Bo Huang
- Department of Geography and Resource Management, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- Institute of Space and Earth Information Science, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Mei-Po Kwan
- Department of Geography and Resource Management, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- Institute of Space and Earth Information Science, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- Department of Human Geography and Spatial Planning, Utrecht University, 3584 CB Utrecht, The Netherlands
| | - Min Chen
- Key Laboratory of Virtual Geographic Environment (Ministry of Education of PRC), Nanjing Normal University, Nanjing 210023, China
| | - Qiang Wang
- State Key Laboratory for Subtropical Mountain Ecology of the Ministry of Science and Technology and Fujian Province, Fujian Normal University, Fuzhou 350007, China
- School of Geographical Sciences, Fujian Normal University, Fuzhou 350007, China
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Hedayati M, Masoudi Asl I, Maleki M, Fazaeli AA, Goharinezhad S. The Variations in Catastrophic and Impoverishing Health Expenditures, and Its Determinants in Iran: A Scoping Review. Med J Islam Repub Iran 2023; 37:44. [PMID: 37426477 PMCID: PMC10329513 DOI: 10.47176/mjiri.37.44] [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: 04/08/2022] [Indexed: 07/11/2023] Open
Abstract
Background The high reliance on out-of-pocket (OOP) payments for health financing in Iran have been led to different inequity problems such as catastrophic health expenditure (CHE) and impoverishment. This scoping review has been conducted to understand the variations in CHE and impoverishment, the underlying determinants of CHE, and its inequality in the past 20 years. Methods This scoping review is guided by Arksey and O'Malley's scoping review framework. systematically PubMed, Scopus, Web of Science, ProQuest, Scientific Information Database, IranMedex, IranDoc, Magiran Science, Google Scholar, and grey literature were searched systematically from 1 January 2000 to August 2021. We included studies that reported the rate of CHE, impoverishment, inequality, and its influencing factors. Simple descriptive statistics and narrative synthesis were used to present the review findings. Results From 112 included articles, the average incidence of CHE was 3.19% at the 40% threshold, and about 3.21% of the households had impoverished. We found an unfavorable status of health inequality indices, including the average of fair financial contribution (0.833), concentration (-0.01), Gini coefficient (0.42), and Kakwani (-0.149). The most widely applied key drivers influencing the rate of CHE in these studies were household economic status, place of residence, health insurance status, household size, head of the household's gender, education level and employment status, having a household member under 5/ above 60 years old, with chronic diseases (in particular cancer and dialysis), disability, using inpatient and outpatient and dentistry services, medicines and equipment, and low insurance coverage. Conclusion The result of this review calls for intensifying health policies and financing structures in Iran to provide more equitable access to all populations, especially the poorest and vulnerable. Moreover, the government is expected to adopt effective measures in inpatient and outpatient care, dental services, medicines, and equipment.
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Affiliation(s)
- Maryam Hedayati
- Department of Health Service Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Iravan Masoudi Asl
- Department of Health Service Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - MohammadReza Maleki
- Department of Health Service Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Akbar Fazaeli
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Salime Goharinezhad
- Preventive Medicine and Public Health Research Center, Psychosocial Research Institute, Iran University of Medical Sciences, Tehran, Iran
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Mohanty SK, Abhilasha, Mishra RS, Upadhyay AK, O'Donnell O, Maurer J. Sociodemographic and geographic inequalities in diagnosis and treatment of older adults' chronic conditions in India: a nationally representative population-based study. BMC Health Serv Res 2023; 23:332. [PMID: 37013518 PMCID: PMC10069025 DOI: 10.1186/s12913-023-09318-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 03/21/2023] [Indexed: 04/05/2023] Open
Abstract
CONTEXT Expeditious diagnosis and treatment of chronic conditions are critical to control the burden of non-communicable disease in low- and middle-income countries. We aimed to estimate sociodemographic and geographic inequalities in diagnosis and treatment of chronic conditions among adults aged 45 + in India. METHODS We used 2017-18 nationally representative data to estimate prevalence of chronic conditions (hypertension, diabetes, lung disease, heart disease, stroke, arthritis, cholesterol, and neurological) reported as diagnosed and percentages of diagnosed conditions that were untreated by sociodemographic characteristics and state. We used concentration indices to measure socioeconomic inequalities in diagnosis and lack of treatment. Fully adjusted inequalities were estimated with multivariable probit and fractional regression models. FINDINGS About 46.1% (95% CI: 44.9 to 47.3) of adults aged 45 + reported a diagnosis of at least one chronic condition and 27.5% (95% CI: 26.2 to 28.7) of the reported conditions were untreated. The percentage untreated was highest for neurological conditions (53.2%; 95% CI: 50.1 to 59.6) and lowest for diabetes (10.1%; 95% CI: 8.4 to 11.5). Age- and sex-adjusted prevalence of any diagnosed condition was highest in the richest quartile (55.3%; 95% CI: 53.3 to 57.3) and lowest in the poorest (37.7%: 95% CI: 36.1 to 39.3). Conditional on reported diagnosis, the percentage of conditions untreated was highest in the poorest quartile (34.4%: 95% CI: 32.3 to 36.5) and lowest in the richest (21.1%: 95% CI: 19.2 to 23.1). Concentration indices confirmed these patterns. Multivariable models showed that the percentage of untreated conditions was 6.0 points higher (95% CI: 3.3 to 8.6) in the poorest quartile than in the richest. Between state variations in the prevalence of diagnosed conditions and their treatment were large. CONCLUSIONS Ensuring more equitable treatment of chronic conditions in India requires improved access for poorer, less educated, and rural older people who often remain untreated even once diagnosed.
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Affiliation(s)
- Sanjay K Mohanty
- Department of Population and Development, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, India.
| | - Abhilasha
- International Institute for Population Science, R4D India Project, Mumbai, India
| | - Radhe Shyam Mishra
- International Institute for Population Science, R4D India Project, Mumbai, India
| | - Ashish Kumar Upadhyay
- International Institute for Population Science, Research Coordinator, R4D India Project, Mumbai, India
| | - Owen O'Donnell
- Professor of Applied Economics, Erasmus School of Economics, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Jürgen Maurer
- Department of Economics, Institute of Health Economics and management, University of Lausanne, Lausanne, Switzerland
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Al-Moteri M. Evidence-based information-seeking behaviors of nursing students: Concurrent think aloud technique. Heliyon 2023; 9:e15549. [PMID: 37128317 PMCID: PMC10148032 DOI: 10.1016/j.heliyon.2023.e15549] [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: 11/12/2022] [Revised: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 05/03/2023] Open
Abstract
Background With the expansion of scientific information, and the beginning of evidence-based practice (EBP), embracing "evidence-based information-seeking behaviors" is essential to provide effective up-to-date nursing care. To better support students' evidence-based information-seeking behaviors, this study explores how nursing students actually search and identify evidence-based information. Methods A concurrent think aloud technique was employed in which 12 nursing students were asked to verbalize their thoughts whilst using search engines to find EBP to inform their practice. Results In general, searching literature per se is complex and many different searching activities are employed, including triggering, recalling, scanning, linking, accessing, retrieving, relating, extracting, evaluating and referencing. The search behavior may involve some iteration of the cyclical activities of scanning, linking and accessing. It is believed that background (recalling pre-existing knowledge), assessing relevancy, evaluating and referencing are pertinent to evidence-based practice information-seeking behavior. In view of this, the study proposes a new model of evidence-based information-seeking behaviors. Conclusion This study presents an evidence-based information-seeking behavior model based on a number of identified searching features. Results may have important practical implications for nursing educators.
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Affiliation(s)
- Modi Al-Moteri
- Taif University, P.O. Box 888, Hawiyah, Taif, Saudi Arabia.
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Mensah NK, Adzakpah G, Kissi J, Boadu RO, Lasim OU, Oyenike MK, Bart-Plange A, Dalaba MA, Sukums F. Health professional's readiness and factors associated with telemedicine implementation and use in selected health facilities in Ghana. Heliyon 2023; 9:e14501. [PMID: 36945351 PMCID: PMC10022178 DOI: 10.1016/j.heliyon.2023.e14501] [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: 10/24/2022] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 03/19/2023] Open
Abstract
Background Telemedicine, which is the practice of medicine using technology to deliver health care remotely, has a low adoption rate in low- and middle-income countries (LMICs). However, the advent of coronavirus disease 2019 (COVID-19) has forced healthcare systems in these settings to begin implementing telemedicine programs. It is unknown how prepared health professionals and the healthcare system are to adopt this technology. Therefore, this study aimed to assess the readiness of health professionals and explore factors associated with telemedicine implementation in Ghana. Methods A cross-sectional study was conducted in six health facilities between March and August 2021. Convenience sampling was used to select the six health facilities, and the participants were selected randomly for the study. Questionnaires were self-completed by participants. Data was exported into STATA 15.0 for analysis, and appropriate statistical methods were employed. All statistical tests were performed at a significance level of p < 0.05. Results Of the 613 health professionals involved in the study, about 579 (94.5%) were comfortable using computers, and the majority, 503 (82.1%) of them, had access to computers at the workplace. Health professionals agreed that the measures outlined by the health facilities supported their readiness to use telemedicine for healthcare services. Analysis revealed a statistically significant positive relationship between health facilities' core readiness and health professionals' readiness, with a correlation coefficient (r) of 0.5484 and a p-value<0.0001. Of the factors associated with health professionals' readiness towards telemedicine implementation, facility core readiness, engagement readiness, staff knowledge and attitude readiness showed a statistically significant relationship with health professionals' readiness. Conclusion The study revealed that health professionals are ready to adopt telemedicine. There was a statistically significant relationship between health facilities' core readiness, engagement readiness, staff knowledge and attitude readiness, and health professionals' readiness. The study identified factors facilitating telemedicine adoption.
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Affiliation(s)
- Nathan Kumasenu Mensah
- Department of Health Information Management, School of Allied Health Science, University of Cape Coast, Cape Coast, Ghana
| | - Godwin Adzakpah
- Department of Health Information Management, School of Allied Health Science, University of Cape Coast, Cape Coast, Ghana
| | - Jonathan Kissi
- Department of Health Information Management, School of Allied Health Science, University of Cape Coast, Cape Coast, Ghana
| | - Richard Okyere Boadu
- Department of Health Information Management, School of Allied Health Science, University of Cape Coast, Cape Coast, Ghana
| | - Obed Uwumbornyi Lasim
- Department of Health Information Management, School of Allied Health Science, University of Cape Coast, Cape Coast, Ghana
| | - Martha Khainde Oyenike
- Department of Health Information Management, School of Allied Health Science, University of Cape Coast, Cape Coast, Ghana
| | - Abigail Bart-Plange
- Department of Health Information Management, School of Allied Health Science, University of Cape Coast, Cape Coast, Ghana
| | | | - Felix Sukums
- Muhimbili University of Health and Allied Sciences, Box 65001, Dar es Salaam, Tanzania
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Touré L, Boivin P, Diarra Y, Diabaté S, Ridde V. Innovations in mutuality: challenges and learnings for the Universal Health Insurance Plan in Mali. BMJ Glob Health 2023; 7:e011055. [PMID: 36898725 PMCID: PMC10439339 DOI: 10.1136/bmjgh-2022-011055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/21/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Many Sahel countries in Africa are looking for solutions for universal health coverage (UHC). Mali is in the process of adopting the Universal Health Insurance Plan, which allows for the mutualisation of existing schemes. Its operationalisation requires numerous adjustments to the current mutualist proposal and innovations in the system. The study focuses on innovations experienced in mutuality and their conditions of scale for UHC in Mali. METHODS This is qualitative research by multiple case studies. It is based on the collection of data by interviews (n=136), at a national and local level, on the analysis of documents (n=42) and a long field observation (7 months). The analytical framework concerns the dissemination and maintenance of health innovations (Greenhalgh et al, 2004). RESULT The analysis of this innovation shows an interest in the technical and institutional viability that determines its performance and scale-up. The procrastination and scepticism displayed at the highest level of the state and the international level, the reluctance, both financial and ideological, to renew the old mutualist proposal, penalise this Malian experiment. CONCLUSION This innovation is a decisive step in ensuring the health coverage of Mali's agricultural and informal sectors. The reform will need to be amplified and supported in the future to expect the scale-up of a cheaper, technically and institutionally more efficient system. Without a political intention to mobilise national resources and accept a fundamental paradigm shift in health financing, the search for the financial viability of mutuality may, again, be at the expense of the performance.
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Affiliation(s)
| | | | | | | | - Valéry Ridde
- Ceped, Université Paris Cité, IRD, Paris, France
- Institut de Santé et Développement, Université Cheikh Anta Diop, Dakar, Senegal
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Gurara MK, Draulans V, Van Geertruyden JP, Jacquemyn Y. Determinants of maternal healthcare utilisation among pregnant women in Southern Ethiopia: a multi-level analysis. BMC Pregnancy Childbirth 2023; 23:96. [PMID: 36739369 PMCID: PMC9898958 DOI: 10.1186/s12884-023-05414-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/30/2023] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite efforts to make maternal health care services available in rural Ethiopia, utilisation status remains low. Therefore, this study aimed to assess maternal health care services' status and determinants in rural Ethiopia. METHODS The study used quasi-experimental pre- and post-comparison baseline data. A pretested, semi-structured, interviewer-administered questionnaire was used to collect data. A multilevel, mixed-effects logistic regression was used to identify individual and communal level factors associated with utilisation of antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC). The adjusted odds ratio (AOR) and corresponding 95% confidence intervals (CI) were estimated with a p-value of less than 0.05, indicating statistical significance. RESULTS Seven hundred and twenty-seven pregnant women participated, with a response rate of 99.3%. Four hundred and sixty-one (63.4%) of the women visited ANC services, while 46.5% (CI: 42-50%) of births were attended by SBA, and 33.4% (CI: 30-36%) had received PNC. Women who reported that their pregnancy was planned (aOR = 3.9; 95% CI: 1.8-8.3) and were aware of pregnancy danger signs (aOR = 6.8; 95% CI: 3.8-12) had a higher likelihood of attending ANC services. Among the cluster-level factors, women who lived in lowlands (aOR = 4.1; 95% CI: 1.1-14) and had easy access to transportation (aOR = 1.9; 95% CI: 1.1-3.7) had higher odds of visiting ANC services. Moreover, women who were employed (aOR = 3.1; 95% CI: 1.3-7.3) and attended ANC (aOR = 3.3; 95% CI: 1.8-5.9) were more likely to have SBA at delivery. The likelihood of being attended by SBA during delivery was positively correlated with shorter travel distances (aOR = 2.9; 95% CI: 1.4-5.8) and ease of access to transportation (aOR = 10; 95% CI: 3.6-29) to the closest healthcare facilities. Being a midland resident (aOR = 4.7; 95% CI: 1.7-13) and having SBA during delivery (aOR = 2.1; 95% CI: 1.2-3.50) increased the likelihood of attending PNC service. CONCLUSIONS Overall, maternal health service utilisation is low in the study area compared with the recommended standards. Women's educational status, awareness of danger signs, and pregnancy planning from individual-level factors and being a lowland resident, short travel distance to health facilities from the cluster-level factors play a crucial role in utilising maternal health care services. Working on women's empowerment, promotion of contraceptive methods to avoid unintended pregnancy, and improving access to health care services, particularly in highland areas, are recommended to improve maternal health service utilisation.
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Affiliation(s)
- Mekdes Kondale Gurara
- grid.442844.a0000 0000 9126 7261Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia ,grid.5284.b0000 0001 0790 3681Faculty of Medicine and Health Sciences, Global Health Institute, University of Antwerp, Wilrijk, Belgium ,grid.5596.f0000 0001 0668 7884Faculty of Social Sciences, Centre for Sociological Research, KU Leuven, Leuven, Belgium
| | - Veerle Draulans
- grid.5596.f0000 0001 0668 7884Faculty of Social Sciences, Centre for Sociological Research, KU Leuven, Leuven, Belgium
| | - Jean-Pierre Van Geertruyden
- grid.5284.b0000 0001 0790 3681Faculty of Medicine and Health Sciences, Global Health Institute, University of Antwerp, Wilrijk, Belgium
| | - Yves Jacquemyn
- grid.5284.b0000 0001 0790 3681Faculty of Medicine and Health Sciences, Global Health Institute, University of Antwerp, Wilrijk, Belgium ,grid.411414.50000 0004 0626 3418Department of Obstetrics and Gynaecology, Antwerp University Hospital, UZA, Antwerp, Belgium
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Child Lead Screening Behaviors and Health Outcomes Following the Flint Water Crisis. J Racial Ethn Health Disparities 2023; 10:418-426. [PMID: 35041153 DOI: 10.1007/s40615-022-01233-6] [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: 10/11/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND There is little research on lead (Pb) screening behaviors and outcomes and possible health sequelae of children in Flint, Michigan in the years following the city's 2014 water crisis, which included widespread tap water contamination with elevated levels of heavy metals and other environmental contaminants. METHODS Between June and November 2019, we collected and analyzed cross-sectional data on Flint children's demographics and self-report of screenings of blood lead levels (BLLs) and results and various potential water contamination-related health symptoms and outcomes. We calculated descriptive statistics to summarize the prevalence of health outcomes and screenings in children, and fit multivariable models using generalized estimating equations to characterize the association between baseline traits and health symptoms and outcomes in children. RESULTS A total of 244 children (mean age 8.6 ± 4.8) were included in the analysis. Overall, 76.6% of the children were reported to have been screened for elevated BLLs after the water source switch. In total, after the water source switch, 25.0% of children were reported as having clinician-diagnosed elevated BLLs. Overall, 43.9% of children experienced hyperactivity, 39.3% had emotional agitation, 29.1% had comprehension issues/learning delays, while 38.9% of children had skin rashes and 10.7% experienced hair loss. A child having elevated BLLs also significantly increased the odds of experiencing adverse cognitive/behavioral outcomes (comprehension issues/learning delays OR = 4.0, hyperactivity OR = 6.6, emotional agitation OR = 3.5). CONCLUSION Child BLL screening following the crisis initiation was moderate, and BLLs and potential water contamination-related morbidity outcomes appeared heightened. Further research is needed to contextualize epidemiologic factors contributing to BLL screening patterns and results and the potential water contamination-associated sequelae observed here.
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Atey TM, Peterson GM, Salahudeen MS, Bereznicki LR, Wimmer BC. Impact of pharmacist interventions provided in the emergency department on quality use of medicines: a systematic review and meta-analysis. J Accid Emerg Med 2023; 40:120-127. [PMID: 35914923 DOI: 10.1136/emermed-2021-211660] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/19/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Pharmacists have an increasing role as part of the emergency department (ED) team. However, the impact of ED-based pharmacy interventions on the quality use of medicines has not been well characterised. OBJECTIVE This systematic review aimed to synthesise evidence from studies examining the impact of interventions provided by pharmacists on the quality use of medicines in adults presenting to ED. METHODS A systematic literature search was conducted in MEDLINE, EMBASE and CINAHL. Two independent reviewers screened titles/abstracts and reviewed full texts. Studies that compared the impact of interventions provided by pharmacists with usual care in ED and reported medication-related primary outcomes were included. Cochrane Risk of Bias-2 and Newcastle-Ottawa tools were used to assess the risk of bias. Summary estimates were pooled using random-effects meta-analysis, along with sensitivity and sub-group analyses. RESULTS Thirty-one studies involving 13 242 participants were included. Pharmacists were predominantly involved in comprehensive medication review, advanced pharmacotherapy assessment, staff and patient education, identification of medication discrepancies and drug-related problems, medication prescribing and co-prescribing, and medication preparation and administration. The activities reduced the number of medication errors by a mean of 0.33 per patient (95% CI -0.42 to -0.23, I2=51%) and the proportion of patients with at least one error by 73% (risk ratio (RR)=0.27, 95% CI 0.19 to 0.40, I2=85.3%). The interventions were also associated with more complete and accurate medication histories, increased appropriateness of prescribed medications by 58% (RR=1.58, 95% CI 1.21 to 2.06, I2=95%) and quicker initiation of time-critical medications. CONCLUSION The evidence indicates improved quality use of medicines when pharmacists are included in ED care teams. PROSPERO REGISTRATION NUMBER CRD42020165234.
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Affiliation(s)
- Tesfay Mehari Atey
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | - Gregory M Peterson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Luke R Bereznicki
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | - Barbara C Wimmer
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
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Kushitor MK, Bour H, Nyame P, Yabila S. Context of boat drowning in Ghana: a mixed qualitative research study. Inj Prev 2023; 29:8-15. [PMID: 36697022 DOI: 10.1136/ip-2022-044567] [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: 03/30/2022] [Accepted: 08/05/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Drowning is a significant public health challenge globally. In Africa and Ghana, drowning has remained a silent epidemic among poor communities. Limited evidence has challenged advances in drowning knowledge and prevention. While drowning deaths are often widely circulated in the newspapers, drowning data are not systematically organised to constitute a body of evidence sufficient for scientific exploration. Although drowning was frequent, they were poorly understood. We explore the context of drowning from multiple perspectives from the Volta-basin where the largest man-made lake in the world has become a hotspot for drowning. METHOD This study adopts a sequential-mix-qualitative study comprising content analysis of newspaper reports on drowning, structured-observations and in-depth interviews with boaters and fisherfolk. We first explored, the content of newspapers over a 10-year period. This information provided the context of drowning. We followed up with extensive observation of activities on the lake by a team of five. Photovoice qualitative interviews were conducted with 22 boaters, fishers and community members. Thematic content analysis was applied to both the newspaper reports and the in-depth interviews. RESULTS Drowning was attributed to both proximate and distal causes. Distal causes were the reasons for movement, while proximate causes were the immediate cause of the drowning. Travelling to farm, market, hospital, church, sell were important distal causes of drowning. Proximate determinants included strong winds, tree stumps, overcrowding, no-adherence to safety procedures, spiritual reasons and high tides. Four types of boat accidents were observed: boat-capsizing, boat-sinking, boat-splitting and boat-catching-fire. Ideas converged and diverged in comparing the newspaper content analysis to the photovoice interviews.
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Affiliation(s)
- Mawuli Komla Kushitor
- School of Public Health, Department of Health Policy Planning and Management, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Helen Bour
- School of Public Health, Department of Health Policy Planning and Management, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Prince Nyame
- School of Public Health, Department of Health Policy Planning and Management, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Solomon Yabila
- School of Public Health, Department of Health Policy Planning and Management, University of Health and Allied Sciences, Ho, Volta Region, Ghana
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Patey AM, Soong C. Top-down and bottom-up approaches to low-value care. BMJ Qual Saf 2023; 32:65-68. [PMID: 36517225 DOI: 10.1136/bmjqs-2022-014977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Andrea M Patey
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada .,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Christine Soong
- Division of General Internal Medicine, Sinai Health, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Center for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
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Nhemachena T, Späth C, Arendse KD, Lebelo K, Zokufa N, Cassidy T, Whitehouse K, Keene CM, Swartz A. Between empathy and anger: healthcare workers' perspectives on patient disengagement from antiretroviral treatment in Khayelitsha, South Africa - a qualitative study. BMC PRIMARY CARE 2023; 24:34. [PMID: 36698083 PMCID: PMC9878968 DOI: 10.1186/s12875-022-01957-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 12/23/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND & OBJECTIVES The benefits of long-term adherence to antiretroviral therapy (ART) are countered by interruptions in care or disengagement from care. Healthcare workers (HCWs) play an important role in patient engagement and negative or authoritarian attitudes can drive patients to disengage. However, little is known about HCWs' perspectives on disengagement. We explored HCWs' perspectives on ART disengagement in Khayelitsha, a peri-urban area in South Africa with a high HIV burden. METHOD Semi-structured interviews were conducted with 30 HCWs in a primary care HIV clinic to explore their perspectives of patients who disengage from ART. HCWs interviewed included clinical (doctors and nurses) and support staff (counsellors, social workers, data clerks, security guards, and occupational therapists). The interview guide asked HCWs about their experience working with patients who interrupt treatment and return to care. Transcripts were audio-recorded, transcribed, and analysed using an inductive thematic analysis approach. RESULTS Most participants were knowledgeable about the complexities of disengagement and barriers to sustaining engagement with ART, raising their concerns that disengagement poses a significant public health problem. Participants expressed empathy for patients who interrupted treatment, particularly when the challenges that led to their disengagement were considered reasonable by the HCWs. However, many also expressed feelings of anger and frustration towards these patients, partly because they reported an increase in workload as a result. Some staff, mainly those taking chronic medication themselves, perceived patients who disengage from ART as not taking adequate responsibility for their own health. CONCLUSION Lifelong engagement with HIV care is influenced by many factors including disclosure, family support, and HCW interactions. Findings from this study show that HCWs had contradictory feelings towards disengaged patients, experiencing both empathy and anger. Understanding this could contribute to the development of more nuanced interventions to support staff and encourage true person-centred care, to improve patient outcomes.
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Affiliation(s)
- Tsephiso Nhemachena
- grid.7836.a0000 0004 1937 1151School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Carmen Späth
- grid.7836.a0000 0004 1937 1151School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Kirsten D. Arendse
- grid.452731.60000 0004 4687 7174Médecins Sans Frontières, Khayelitsha Project, Cape Town, South Africa
| | - Keitumetse Lebelo
- grid.452731.60000 0004 4687 7174Médecins Sans Frontières, Khayelitsha Project, Cape Town, South Africa
| | - Nompumelelo Zokufa
- grid.452731.60000 0004 4687 7174Médecins Sans Frontières, Khayelitsha Project, Cape Town, South Africa
| | - Tali Cassidy
- grid.7836.a0000 0004 1937 1151School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa ,grid.452731.60000 0004 4687 7174Médecins Sans Frontières, Khayelitsha Project, Cape Town, South Africa
| | - Katherine Whitehouse
- grid.452731.60000 0004 4687 7174Médecins Sans Frontières, Southern African Medical Unit, Cape Town, South Africa
| | - Claire M. Keene
- grid.452731.60000 0004 4687 7174Médecins Sans Frontières, Khayelitsha Project, Cape Town, South Africa ,grid.4991.50000 0004 1936 8948Health Systems Collaborative, Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Alison Swartz
- grid.7836.a0000 0004 1937 1151School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa ,grid.8356.80000 0001 0942 6946Department of Psychosocial and Psychoanalytic Studies, University of Essex, Essex, England
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Farrukh A, Mayberry JF. NHS Trust Boards and Health and Well-being Boards: Do they play any role in the management of disparate levels of care for South Asian patients with Inflammatory Bowel Disease? THE ULSTER MEDICAL JOURNAL 2023; 92:38-42. [PMID: 36762141 PMCID: PMC9899024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Aims There is evidence of disparate levels of care for members of ethnic minority communities with inflammatory bowel disease in various NHS Trusts and Health Boards in England and Scotland. The purpose of this study was to investigate whether there was any association between the existence of disparate levels of care and the ethnic composition of the management boards of NHS Trusts and Health Boards. It also examined the ethnic composition of Health and Wellbeing Boards associated with these Trusts in England. Method NHS Trusts in England and Health Boards in Scotland, which had been involved in previous studies of disparate levels of care, were identified through a review of the relevant published papers. Health and Wellbeing Boards associated with these Trusts were then identified. Executive and non-executive membership of the NHS Trust, Health Boards and Health and Wellbeing Boards was determined through scrutiny of their web pages. Results The proportion of Asians, who were executive officers, was significantly lower than the proportion who were non-executive board members both for trusts who offered disparate care (z = 2.22; p < 0.03) and those which did not (z = 2.24; p < 0.03). There was no significant difference in the proportion of Asians who were non-executive board members between the two types of trust. The proportion of ethnic minority members of English Health and Well-Being Boards, where there was evidence of disparate levels of care received by South Asian patients was significantly greater than on Boards where this was not the case. (z = 2.8. p < 0.005). Conclusions The relation of these findings to disparate levels of care is unclear. However, it may point to a culture of tokenism, where either the members are not truly representative of underserved communities or they are unable to have any influence on local policy decisions. In either case there is an urgent need to develop better links with minority communities who are underserved so that issues can be effectively identified and remedied.
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The assessment of psychometric properties for the subjective wellbeing-5 dimensions (SWB-5D) questionnaire in the general Dutch population. Qual Life Res 2023; 32:237-245. [PMID: 35986860 PMCID: PMC9392428 DOI: 10.1007/s11136-022-03234-8] [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] [Accepted: 08/07/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE Financial resources for health care are limited, so assessment of intervention effectiveness in terms of health in relation to its costs is important. Measuring health outcomes in cost-effectiveness analyses is usually done by health-related quality of life measures, like the EQ-5D. However, over the past decade, innovations on the conceptual level of health have evolved and novel approaches are rising such as the capability approach, subjective wellbeing, and Positive Health. This study assesses the psychometric properties of the subjective wellbeing-5 dimension (SWB-5D) outcome measure. METHODS A quantitative, cross-sectional study design was used to determine the concurrent and construct (convergent and known group) validity for the SWB-5D. Concurrent and convergent validity were estimated as correlations between the SWB-5D and the Dutch version of the EQ-5D, ICECAP-A, and PH-17. Assessment of known-groups validity was based on the variables illness, education, and the overall happiness (Cantril Ladder) and overall health scale (EQ-5D VAS). RESULTS A representative sample of 1016 respondents of the Dutch population completed an online questionnaire. The SWB-5D showed reasonable concurrent validity and showed good convergent and known-group validity. The SWB-5D had a lower ceiling effect compared to the EQ-5D and ICECAP-A. CONCLUSION Compared to traditional health measurement approaches, novel approaches are more focused on the mental and social pillars of health. The SWB-5D shows psychometric feasibility of comprehensive measurement of health, as indicated by a range of validity measures in a large representative sample of the Dutch population.
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Adams C, Gringart E, McAullay D, Sim M, Scarfe B, Budrikis A, Strobel N. Older adults access to mental health and social care services during COVID-19 restrictions in Western Australia. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2022. [DOI: 10.1080/00049530.2022.2139196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Claire Adams
- Kurongkurl Katitjin, Edith Cowan University, Perth, Australia
- School of Arts and Humanities, Edith Cowan University, Perth, Australia
| | - Eyal Gringart
- School of Arts and Humanities, Edith Cowan University, Perth, Australia
| | - Daniel McAullay
- Kurongkurl Katitjin, Edith Cowan University, Perth, Australia
| | - Moira Sim
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Brigitta Scarfe
- Kurongkurl Katitjin, Edith Cowan University, Perth, Australia
| | - Amy Budrikis
- Kurongkurl Katitjin, Edith Cowan University, Perth, Australia
| | - Natalie Strobel
- Kurongkurl Katitjin, Edith Cowan University, Perth, Australia
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Guetz B, Bidmon S. Awareness of and interaction with physician rating websites: A cross-sectional study in Austria. PLoS One 2022; 17:e0278510. [PMID: 36584030 PMCID: PMC9803240 DOI: 10.1371/journal.pone.0278510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 11/17/2022] [Indexed: 12/31/2022] Open
Abstract
To date, the digital assessment of service experiences represents a decisive process step of a feedback culture in numerous economic areas. In view of this digitalization of service assessments, the importance of Physician Rating Websites (PRWs) has also increased steadily in recent years. Even though these websites could be perceived as a powerful communication tool for the exchange of health specific information, the knowledge about whether and how different population segments use these portals has been limited so far. For this reason, our aim was to investigate the level of awareness regarding PRWs among the study population and to discover how users interact with this specific type of online portals. We performed an online survey including 558 participants. To ensure the attention and integrity of participants, attention checks were included in the questionnaire. Study participants who did not exceed the mentioned security levels were excluded from the study. Statistical analyses were carried out, using IBM SPSS Statistics 27. To illustrate the relationship between demographic variables and dependent variables, two tailed chi square tests were performed. Comparison of means and t-testing was used to investigate the relationship between psychographic variables and the dependent variables. In addition to that, the awareness levels regarding different rating portals were evaluated using descriptive methods. Our results suggest that the general awareness regarding PRWs is relatively high (75.6%, 423/558), especially among female (x21 = 9.880, P = .002), middle-aged (x29 = 26.810, P = .002), more highly educated (x24 = 19.038, P = .001), urban (x21 = 6.274, P = .012), digitally literate (t203 = 2.63, P = .009) individuals and particularly among respondents with a higher eHealth literacy (t203 = 2.37, P = .019). Even though more than three quarters of the respondents know that PRWs exist, compared to other rating platforms, they are only in the lower midfield. The upper ranks are taken by websites on which restaurant visits (98.9%, 552/558), hotel stays (97.7%, 545/558) or movies (95.5%, 533/558) can be rated. The most popular PRWs in Austria include Docfinder.at (31.3%, 175/558; 77.8%, 434/558) followed by the evaluation tools provided by Google.at (8.24%, 46/558; 70.3%, 392/558) and Herold.at (1.61%, 9/558; 44.8%, 250/558). In Austria, PRWs seem to be characterized by a high degree of interaction (89.2%, 498/558) with a wide variety of different types of interactions. While many respondents use PRWs to retrieve general information (83.2%, 464/558), there are significantly fewer who read physicians' reviews (60.9%, 340/558) and use this portal to select a physician (60.6%, 338/558). Respondents who have already rated a doctor themselves belong to the smallest group accounting for just 14.7% (82/558). Significant effects regarding the interaction with PRWs exist between different genders, ages, education levels, marital statuses, occupations and areas of living. In addition to that, respondents with better feelings towards the internet, greater digital literacy as well as a higher eHealth literacy were also characterized with a higher interaction rate regarding PRWs. According to the high level of awareness of and interaction with PRWs within our study population, PRWs appear to be a successful medium for health-related communication. Especially for female, middle-aged, more highly educated, urban and more technology savvy population segments, PRWs seem to represent an effective tool to support the health-specific decision-making process.
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Affiliation(s)
- Bernhard Guetz
- Department of Marketing and International Management, Alpen-Adria-Universitaet Klagenfurt, Klagenfurt am Wörthersee, Austria
| | - Sonja Bidmon
- Department of Marketing and International Management, Alpen-Adria-Universitaet Klagenfurt, Klagenfurt am Wörthersee, Austria
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Hou X, Liu L, Cain J. Can higher spending on primary healthcare mitigate the impact of ageing and non-communicable diseases on health expenditure? BMJ Glob Health 2022; 7:e010513. [PMID: 36564087 PMCID: PMC9791382 DOI: 10.1136/bmjgh-2022-010513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/13/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Financing healthcare for ageing populations has become an increasingly urgent policy concern. Primary healthcare (PHC) has been viewed as the cornerstone of health systems. While most research has examined the effects of PHC on population health, there is still a relative paucity of analysis on the effects of PHC on health expenditures, particularly, in low-income and middle-income countries. Knowledge on PHC's potential role in mitigating the impact of ageing and non-communicable diseases (NCDs) on health expenditure remains limited. METHODS Using publicly accessible secondary data at country level, this paper examines the impact of ageing and the NCD burden on health expenditures. Regression with the interaction terms is used to explore whether greater expenditures on PHC can mitigate the growing fiscal pressure from ageing and the NCD burden. RESULTS The empirical evidence shows that a higher share of PHC spending is correlated with lower per capita non-PHC spending, after controlling for population aged 60 and over and NCD burden, and gross domestic product per capita. However, the mitigating effects of PHC spending to reduce non-PHC expenditure caused by ageing and NCDs are not significant. CONCLUSIONS The findings suggest that more PHC spending can potentially lower total health expenditure. However, higher primary health spending cannot fulfil that potential without scrupulous attention to the way it is delivered. More spending on PHC, together with changes in PHC service delivery, highlighting its coordination and referring roles, will put nations on a pathway to achieving universal health coverage more sustainably.
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Affiliation(s)
- Xiaohui Hou
- Health, Nutrition and Population Global Practice, World Bank Group, Washington, District of Columbia, USA
| | - Lingrui Liu
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA
| | - Jewelwayne Cain
- Health Nutrition and Population Global Practice, World Bank Group, Washington, District of Columbia, USA
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Robin G, Brown E, Davis CA, Bird L, Wilson L, Halperin R, Brundage M, Croke J, Harper C, Giuliani M, Caissie A. Patient Engagement: an Assessment of Canadian Radiotherapy Programs' Current Practices, Perceived Barriers, and Facilitators. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1834-1841. [PMID: 34518991 DOI: 10.1007/s13187-021-02049-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 06/13/2023]
Abstract
Patient engagement and education have been mandated across Canadian radiation oncology programs (ROP). Guidance documents include the 2014 Canadian Association of Radiation Oncology (CARO) Radiation Therapy Patient Charter, the 2016 Canadian Partnership for Quality Radiotherapy (CPQR) Patient Engagement Guidelines (PEG) for Canadian Radiation Treatment Programs, and Accreditation Canada's 2017 refresh of Cancer Care Standards. Since little is known regarding uptake of these guidance statements, Canadian ROP were surveyed to assess current patient engagement and education practices. An e-survey was sent to Canadian ROP (n = 44). The survey focused on awareness and uptake of the CARO Patient Charter, CPQR PEG, and patient education practices. Survey development was guided by these documents and expert consensus, including CARO's Quality and Standards Patient Education/Engagement working group. Many (71%) responding ROP were familiar with the CARO Patient Charter, while 24% reported use. More than half (53%) of ROP were aware of the CPQR PEG, but approximately third (37%) had previously completed a self-audit. Most (88%) ROP view a pan-Canadian, evidence-based approach to educational materials beneficial and feasible (80%), with the majority (89%) willing to share their best practices across the radiotherapy community. Patient engagement and education are nationally mandated and supported by guidance documents. However, gaps have been identified across ROP for awareness and use of available tools, as well as uptake of their processes critical to quality of care. Understanding current practices will inform CPQR/CARO-supported pan-Canadian initiatives to optimize uptake, including development of CPQR Patient Education Guidance for Canadian Radiation Treatment Programs.
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Affiliation(s)
- Gabrielle Robin
- Dalhousie University, Halifax, NB & NS, Canada.
- CARO Quality and Standards Working Group, Markham, ON, Canada.
| | - Erika Brown
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Canadian Partnership for Quality Radiotherapy, Halifax, Canada
| | - Carol-Anne Davis
- Dalhousie University, Halifax, NB & NS, Canada
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Canadian Partnership for Quality Radiotherapy, Halifax, Canada
| | - Louise Bird
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Canadian Partnership for Quality Radiotherapy, Halifax, Canada
| | - Lianne Wilson
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Canadian Partnership for Quality Radiotherapy, Halifax, Canada
| | - Ross Halperin
- CARO Quality and Standards Working Group, Markham, ON, Canada
- BC Cancer Agency, Vancouver, BC, Canada
| | - Michael Brundage
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Canadian Partnership for Quality Radiotherapy, Halifax, Canada
- Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada
| | - Jennifer Croke
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Cody Harper
- Dalhousie University, Halifax, NB & NS, Canada
- CARO Quality and Standards Working Group, Markham, ON, Canada
| | - Meredith Giuliani
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Amanda Caissie
- Dalhousie University, Halifax, NB & NS, Canada
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Canadian Partnership for Quality Radiotherapy, Halifax, Canada
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Anbesu EW, Ebrahim OA, Takele ND. Willingness to pay for community-based health insurance and associated factors in Ethiopia: A systematic review and meta-analysis. SAGE Open Med 2022; 10:20503121221135876. [PMID: 36385794 PMCID: PMC9643758 DOI: 10.1177/20503121221135876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/12/2022] [Indexed: 09/08/2024] Open
Abstract
In Ethiopia, there is low enrollment and a wide discrepancy in willingness to pay for community-based health insurance schemes, and there is a lack of nationally representative data on willingness to pay for community-based health insurance. Thus, this systematic review and meta-analysis aimed to estimate the pooled prevalence of willingness to pay for community-based health insurance and associated factors in Ethiopia. This was developed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases such as PubMed/Medline, CINAHL, African Journals Online, and Google Scholar searches were performed to retrieve available published and unpublished studies from December 15 to May 17, 2022. Two independent reviewers screened the retrieved articles. Critical quality appraisal was performed using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. To investigate the sources of heterogeneity, subgroup analysis and meta-regression were performed based on region, study setting (rural/urban), and sample size. RevMan software and STATA 14 software were used for the statistical analysis. A random-effect model was used to estimate the effect size at a 95% confidence interval. A total of 190 studies were retrieved, and six studies were included in the final meta-analysis. The pooled prevalence of willingness to pay for community-based health insurance was 78 (95% confidence interval: 74, 81). A subgroup analysis by region indicated the lowest proportion of willingness to pay community-based health insurance in the Oromia region, 76% (95% confidence interval: 68, 84), and the highest in the Amhara region, 79% (95% confidence interval: 77, 81). Nearly three in four households were willing to pay for community-based health insurance in Ethiopia. Thus, awareness of willingness to pay community-based health insurance is mandatory to improve the implementation of community-based health insurance.
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Affiliation(s)
- Etsay Woldu Anbesu
- Department of Public Health, College of
Medical and Health Sciences, Samara University, Samara, Ethiopia
| | | | - Nigus Desalegn Takele
- Department of Public Health, College of
Medical and Health Sciences, Samara University, Samara, Ethiopia
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Hill A, Ellis M, Gillison F. Qualitative exploration of patient and healthcare professional perspectives on barriers and facilitators to foot self-care behaviors in diabetes. BMJ Open Diabetes Res Care 2022; 10:10/6/e003034. [PMID: 36375862 PMCID: PMC9664298 DOI: 10.1136/bmjdrc-2022-003034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Diabetic foot ulcers contribute significantly to morbidity and mortality associated with diabetes, but are preventable with good foot self-care. This study sought to explore the perspectives of patients and healthcare professionals (HCPs) on barriers and/or facilitators to foot self-care behaviors in diabetes and areas of consensus and/or tension between patient and HCP perspectives. RESEARCH DESIGN AND METHODS This was a sequential, qualitative study that used a hermeneutic phenomenological approach. Phase I involved nine in-depth, semi-structured patient interviews. Phase II involved seven in-depth semi-structured interviews with HCPs (podiatrists, diabetes nurses, foot health practitioners (FHPs) and general practitioners (GPs)). In phase III, findings from phases I and II were brought back to two patient interview groups (five patients in total) to try and identify any areas of consensus and tension between HCP and patient perspectives. RESULTS Patient and HCP perspectives had several areas of alignment: concerns over consequences of diabetes complications; the importance of patient education and frustrations around aspects of health service delivery. There were also some notable tensions identified: mixed messaging from HCPs around whose responsibility patient foot health is; and who patients should initially consult following the development of a foot problem. Overall, patients expressed that motivation to undertake good foot self-care behaviors was generated from their lived experiences, and was enhanced when this aligned with the information they received from HCPs. HCPs appeared to attribute lack of patient motivation to lack of knowledge, which was not raised by patients. CONCLUSIONS This study has identified points of misalignment between the views of patients and practitioners that may help to explain why adherence to foot self-care among patients with diabetes is low. Our results suggest that better outcomes may stem from HCPs focusing on supporting autonomous motivation for self-care and enhancing the rationale through referencing patients' own experience rather than focussing on increasing patient knowledge. Renewed focus on consistency of messaging by HCPs around the roles and responsibilities relating to foot health in diabetes, and the benefit of foot-specific training being provided to non-foot specialist HCPs may also help to improve uptake and adherence to foot self-care behaviors in diabetes.
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Affiliation(s)
- Andrew Hill
- Health, University of Bath, Bath, UK
- Health, The Smae Institute, Maidenhead, Windsor and Maidenhead, UK
| | - Mairghread Ellis
- Dietetics, Nutrition & Biological Sciences, Physiotherapy, Podiatry & Readiography, Queen Margaret University, Musselburgh, UK
| | - Fiona Gillison
- Department for Health, Centre for Motivation and Health Behaviour Change, University of Bath, Bath, UK
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Copeland L, Littlecott HJ, Couturiaux D, Hoddinott P, Segrott J, Murphy S, Moore G, Evans RE. Adapting population health interventions for new contexts: qualitative interviews understanding the experiences, practices and challenges of researchers, funders and journal editors. BMJ Open 2022; 12:e066451. [PMID: 36288840 PMCID: PMC9615984 DOI: 10.1136/bmjopen-2022-066451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Research on the adaptation of population health interventions for implementation in new contexts is rapidly expanding. This has been accompanied by a recent increase in the number of frameworks and guidance to support adaptation processes. Nevertheless, there remains limited exploration of the real-world experiences of undertaking intervention adaptation, notably the challenges encountered by different groups of stakeholders, and how these are managed. Understanding experiences is imperative in ensuring that guidance to support adaptation has practical utility. This qualitative study examines researcher and stakeholder experiences of funding, conducting and reporting adaptation research. SETTING Adaptation studies. PARTICIPANTS Participants/cases were purposefully sampled to represent a range of adapted interventions, types of evaluations, expertise and countries. Semistructured interviews were conducted with a sample of researchers (n=23), representatives from research funding panels (n=6), journal editors (n=5) and practitioners (n=3). MEASURES A case study research design was used. Data were analysed using the framework approach. Overarching themes were discussed within the study team, with further iterative refinement of subthemes. RESULTS The results generated four central themes. The first three relate to the experience of intervention adaptation (1) involving stakeholders throughout the adaptation process and how to integrate the evidence base with experience; (2) selecting the intervention and negotiating the mismatch between the original and the new context; and (3) the complexity and uncertainty when deciding the re-evaluation process. The final theme (4) reflects on participants' experiences of using adaptation frameworks in practice, considering recommendations for future guidance development and refinement. CONCLUSION This study highlights the range of complexities and challenges experienced in funding, conducting and reporting research on intervention adaptation. Moving forward, guidance can be helpful in systematising processes, provided that it remains responsive to local contexts and encourage innovative practice.
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Affiliation(s)
- Lauren Copeland
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
| | - Hannah J Littlecott
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
- Pettenkofer School of Public Health (PSPH), Institute for Medical Information Processing, Biometry and Epidemiology, LMU, Munchen, Bayern, Germany
| | - Danielle Couturiaux
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
| | - Jeremy Segrott
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Simon Murphy
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
| | - Graham Moore
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
| | - Rhiannon E Evans
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
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Kaneko M, Shimizu S, Oishi A, Fushimi K. Impact of COVID-19 infection rates on admissions for ambulatory care sensitive conditions: nationwide difference-in-difference design in Japan. Fam Med Community Health 2022; 10:fmch-2022-001736. [PMID: 36241252 PMCID: PMC9577273 DOI: 10.1136/fmch-2022-001736] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES SARS-CoV-2 infection (COVID-19) has affected tertiary medical institutions and primary care. Admission for ambulatory care sensitive conditions (ACSCs) is an important indicator of primary care quality. However, no nationwide study, especially in Asia, has examined the association between admissions for ACSCs and local surges in COVID-19. This study aimed to examine how the number of admissions for ACSCs has changed in Japan between the areas with higher and lower rates of COVID-19 infection. DESIGN This was a retrospective two-stage cross-sectional study. We employed a difference-in-difference design to compare the number of hospital admissions for ACSCs between the areas with higher and lower rates of COVID-19 infection in Japan. SETTING The study used a nationwide database in Japan. PARTICIPANTS All patients were aged 20 years and above and were admitted due to ACSCs during the study period between March and September 2019 (before the pandemic) and between March and September 2020 (during the pandemic). RESULTS The total number of ACSC admissions was 464 560 (276 530 in 2019 and 188 030 in 2020). The change in the number of admissions for ACSCs per 100 000 was not statistically significant between the areas with higher and lower rates of COVID-19 infection: 7.50 (95% CI -87.02 to 102.01). In addition, in acute, chronic and preventable ACSCs, the number of admissions per 100 000 individuals did not change significantly. CONCLUSION Although admissions for ACSCs decreased during the COVID-19 pandemic, there was no significant change between the areas with higher and lower rates of COVID-19 infection. This implies that the COVID-19 pandemic affected the areas with higher infection rates and the areas with lower rates.
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Affiliation(s)
- Makoto Kaneko
- Department of Health Data Science, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Sayuri Shimizu
- Department of Health Data Science, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Ai Oishi
- Department of Health Data Science, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Bunkyo-ku, Tokyo, Japan
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Uwamahoro NS, McRae D, Zibrowski E, Victor-Uadiale I, Gilmore B, Bergen N, Muhajarine N. Understanding maternity waiting home uptake and scale-up within low-income and middle-income countries: a programme theory from a realist review and synthesis. BMJ Glob Health 2022; 7:bmjgh-2022-009605. [PMID: 36180098 PMCID: PMC9528638 DOI: 10.1136/bmjgh-2022-009605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/01/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Maternity waiting homes (MWHs) link pregnant women to skilled birth attendance at health facilities. Research suggests that some MWH-facility birth interventions are more success at meeting the needs and expectations of their intended users than others. We aimed to develop theory regarding what resources work to support uptake and scale-up of MHW-facility birth interventions, how, for whom, in what contexts and why. Methods A four-step realist review was conducted which included development of an initial programme theory; searches for evidence; selection, appraisal and extraction of data; and analysis and data synthesis. Results A programme theory was developed from 106 secondary sources and 12 primary interviews with MWH implementers. The theory demonstrated that uptake and scale-up of the MWH-facility birth intervention depends on complex interactions between three adopter groups: health system stakeholders, community gatekeepers and pregnant women and their families. It describes relationships between 19 contexts, 11 mechanisms and 31 outcomes accross nine context-mechanism-outcome configurations (CMOCs) which were grouped into 3 themes: (1) Engaging stakeholders to develop, integrate, and sustain MWH-facility birth interventions, (2) Promoting and enabling MWH-facility birth utilisation and (3) Creating positive and memorable MWH-facility birth user experiences. Belief, trust, empowerment, health literacy and perceptions of safety, comfort and dignity were mechanisms that supported diffusion and adoption of the intervention within communities and health systems. Examples of resources provided by implementers to trigger mechanisms associated with each CMOC were identified. Conclusions Implementers of MWHs cannot merely assume that communities will collectively value an MWH-facility birth experience over delivery at home. We posit that MWH-facility birth interventions become vulnerable to under-utilisation when implementers fail to: (1) remove barriers that hinder women’s access to MWH and (2) ensure that conditions and interactions experienced within the MWH and its affiliated health facility support women to feel treated with compassion, dignity and respect. PROSPERO registration number CRD42020173595.
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Affiliation(s)
- Nadege Sandrine Uwamahoro
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Faculty of Medical Sciences, Newcastle University, Population Health Sciences Institute, Newcastle upon Tyne, UK
| | - Daphne McRae
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Chilliwack Division of Family Practice, Chilliwack General Hospital, Chiliwack, British Colombia, Canada
| | - Elaine Zibrowski
- Best Care COPD, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Ify Victor-Uadiale
- Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
| | - Brynne Gilmore
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Ireland
| | - Nicole Bergen
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Nazeem Muhajarine
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Population Health and Evaluation Research Unit, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Jung HW, Kwon YD, Noh JW. How public and private health insurance coverage mitigates catastrophic health expenditures in Republic of Korea. BMC Health Serv Res 2022; 22:1042. [PMID: 35971176 PMCID: PMC9377807 DOI: 10.1186/s12913-022-08405-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/02/2022] [Indexed: 12/04/2022] Open
Abstract
Background The private health insurance (PHI) market in Republic of Korea has instituted indemnity insurance plans that provide partial reimbursements for some medical services or costs that are not covered by the National Health Insurance (NHI). To date, no study has estimated the extent to which PHI coverage lowers the economic burden of households’ access to health care. The current study aims to evaluate the design of Korea’s PHI system in terms of coverage using a catastrophic health expenditure (CHE) indicator and compare it with NHI. Methods This study determined the difference between the number of households that were subscribed to PHI and those that received reimbursements from PHI. Additionally, it compared the effects of reduced CHE by NHI benefits with PHI reimbursements. Furthermore, it compared PHI reimbursements based on income class. Finally, it analyzed the contribution of NHI and PHI to CHE reduction through a two-part model with hierarchical regression. Results The results indicated that of the 5644 households examined, 3769 subscribed to PHI, but only 246 households received reimbursements. Notably, NHI reduced CHE incidence by 15.17%, whereas PHI only reduced CHE by 1.22%. The NHI scheme indicated reduced inequality as it provided more benefits to the low-income class for their used medical services, whereas PHI paid more reimbursements to the high-income class. Accordingly, NHI coverage has protected households from CHE and improved equality to some extent; however, PHI coverage has had a relatively low effect on relieving CHE and has increased inequality. Conclusions The indemnity health insurance plans of PHI companies in Korea only cover partial medical costs or services, and so, most patients do not receive reimbursements. Thus, Korea’s PHI system needs to improve to provide benefits to patients more generously and alleviate their financial burden.
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Affiliation(s)
- Hyun Woo Jung
- Department of Health Administration, Graduate School·BK21 Graduate program of developing glocal experts in health policy and management, Yonsei University, Wonju, Republic of Korea
| | - Young Dae Kwon
- Department of Humanities and Social Medicine, College of Medicine and Catholic Institute for Healthcare Management, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin-Won Noh
- Division of Health Administration, College of Software and Digital Healthcare Convergence, Yonsei University, 1, Yeonsedae-gil, Heungeop-myeon, Wonju-si, Gangwon-do, 26493, Republic of Korea.
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George NC, Radman D, Zomahoun HTV, Boivin A, Ahmed S. Linkages between health systems and communities for chronic care: a scoping review protocol. BMJ Open 2022; 12:e060430. [PMID: 35953253 PMCID: PMC9379479 DOI: 10.1136/bmjopen-2021-060430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Linkages between health systems and communities may leverage community assets to address unmet needs and provide services for improved continuity and coordination of care. However, there are limited examples of specific strategies for such linkages for chronic disease management. Guided by a local need from stakeholders, this scoping review aims to clarify and map methods and strategies for linkages between communities and health systems across chronic diseases, to inform future implementation efforts. METHODS AND ANALYSIS The scoping review will be conducted following Arksey and O'Malley's methodological framework and latest Joanna Briggs Institute (JBI) guidelines, with continuous stakeholder engagement throughout. A structured literature search of records from January 2001 to April 2022 will be completed in MEDLINE/PubMed, CINAHL, EMBASE, PsycINFO, in addition to grey literature. Two reviewers will independently complete study selection following inclusion criteria reflecting population (chronic disease), concept (integrated care) and context (health systems and communities) and will chart the data. Data will be analysed using descriptive qualitative and quantitative methods, to map and operationalise the linkages between health systems and communities. ETHICS AND DISSEMINATION The scoping review does not require ethics approval as it will examine and collect data from publicly available materials, and all stakeholder engagement will follow guidelines for patient and public involvement. Findings will be reported through a summarising list of considerations for different linkage strategies between health systems and community resources and implications for future research, practice and policy will be discussed and presented. The results will also be used to inform an integrated knowledge translation project to implement community-health system linkages to support chronic pain management. REGISTRATION NUMBER 10.17605/OSF.IO/UTSN9.
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Affiliation(s)
- Nicole C George
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Lethbridge-Layton-Mackay Rehabilitation Centre, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada
| | - Dennis Radman
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Lethbridge-Layton-Mackay Rehabilitation Centre, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada
| | - Hervé Tchala Vignon Zomahoun
- Center for Outcome Research and Evaluation, Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Antoine Boivin
- Department of Family Medicine, University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
| | - Sara Ahmed
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Lethbridge-Layton-Mackay Rehabilitation Centre, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada
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Comprehensive geriatric assessment is associated with increased antidepressant treatment in frail older people with unplanned hospital admissions-results from the randomised controlled study CGA-Swed. BMC Geriatr 2022; 22:645. [PMID: 35931975 PMCID: PMC9354437 DOI: 10.1186/s12877-022-03324-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Frail older people are at higher risk of further deterioration if their needs are not acknowledged when they are acutely ill and admitted to hospital. Mental health comprises one area of needs assessment. AIMS The aims of this study were threefold: to investigate the prevalence of depression in frail hospital patients, to identify factors associated with depression, and to compare depression management in patients receiving and not receiving Comprehensive Geriatric Assessment (CGA). METHODS This secondary analysis from the CGA-Swed randomized control trial included 155 frail older people aged 75 years and above. Instruments included Montgomery Åsberg Depression Rating Scale (MADRS), the ICE Capability measure for older people (ICECAP-O) and the Fugl-Meyer Life Satisfaction scale (Fugl-Meyer Lisat). Depression was broadly defined as MADRS score ≥ 7. Regression models were used to identify variables associated with depression and to compare groups with and without the CGA intervention. RESULTS The prevalence of a MADRS score indicating depression at baseline was 60.7%. The inability to do things that make one feel valued (ICECAP-O) was associated with a fourfold increase in depression (OR 4.37, CI 1.50-12.75, p = 0.007). There was a two-fold increase in odds of receiving antidepressant medication in the CGA intervention group (OR 2.33, CI 1.15-4.71, p = 0.019) compared to patients in the control group who received regular medical care. CONCLUSION Symptoms of depression were common among frail older people with unplanned hospital admission. Being unable to do things that make one feel valued was associated with depression. People who received CGA intervention had higher odds of receiving antidepressant treatment, suggesting that CGA improves recognition of mental health needs during unplanned hospital admissions in frail older people. TRIAL REGISTRATION ClinicalTrials.gov, NCT02773914. Retrospectively registered 16 May 2016.
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