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Shahwar DE, Naz S, Naseem M, Saleem S, Sheikh L, Malik A. Impact of the Early COVID-19 Pandemic on the Quality of Obstetric Care in a Tertiary Care Center in Karachi, Pakistan. Cureus 2024; 16:e65401. [PMID: 39184736 PMCID: PMC11344876 DOI: 10.7759/cureus.65401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2024] [Indexed: 08/27/2024] Open
Abstract
Objective This study aimed to assess the indirect impact of the COVID-19 pandemic on obstetric quality measures. Materials and methods This cross-sectional study was conducted at a private-sector tertiary care hospital in Karachi, Pakistan. Data were collected for specific antenatal, intrapartum, and postpartum care indicators during the initial six months of the COVID-19 phase (March to August 2020) and compared with baseline measures from the preceding six months before the COVID-19 phase (September 2019 to February 2020) using frequencies and percentages. Results During COVID-19, there was a 10% reduction (pre-COVID: 1041 and during COVID: 946) in outpatient obstetric volumes and a 65% increase (pre-COVID: 240 and during COVID: 396) in clinic cancellations, indicating a decreased influx of antenatal patients. Teleclinics served 8.3% (1429/18279) of the total obstetric patients during this period. Marginal decreases were observed in spontaneous vaginal deliveries 1358 (44%) vs 1049 (42.4%) and labor induction rates 818 (26.6%) vs 606 (24.2%). Additionally, there was a slight increase in instrumental deliveries, 121 (3.9%) vs 114 (4.6%) during the COVID phase. However, these changes were not statistically significant. Similarly, no substantial impact was observed on elective and emergency C-sections. Notably, there were more cases of primary postpartum hemorrhage (PPH) during the COVID-19 phase 36 (1.17%) vs 46 (1.86%), and these changes were statistically significant (p= 0.035). Similar trends were observed for eclampsia (p =0.05) and preeclampsia cases (p-value 0.074). However, other maternal morbidity indicators and intrauterine fetal deaths remained relatively unchanged. NICU admissions increased significantly (p=0.001), while early neonatal deaths remained unaffected. Patient satisfaction rates remained steady for inpatients and improved for outpatients during COVID-19. Conclusion The COVID-19 pandemic primarily affected antenatal volumes, neonatal admissions, and maternal morbidity indicators such as PPH, preeclampsia, and eclampsia. Despite the challenges, patient satisfaction and quality care standards were maintained during COVID-19 through new strategies and revised patient care processes.
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Affiliation(s)
- Dur-E- Shahwar
- Obstetrics and Gynaecology, Aga Khan University, Karachi, PAK
| | - Sumaira Naz
- Obstetrics and Gynaecology, Aga Khan University, Karachi, PAK
| | | | - Shamila Saleem
- Obstetrics and Gynaecology, Aga Khan University, Karachi, PAK
| | - Lumaan Sheikh
- Obstetrics and Gynaecology, Aga Khan University, Karachi, PAK
| | - Ayesha Malik
- Obstetrics and Gynaecology, Aga Khan University, Karachi, PAK
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Bancsik K, Ilea CDN, Daina MD, Bancsik R, Șuteu CL, Bîrsan SD, Manole F, Daina LG. Comparative Analysis of Patient Satisfaction Surveys-A Crucial Role in Raising the Standard of Healthcare Services. Healthcare (Basel) 2023; 11:2878. [PMID: 37958022 PMCID: PMC10647670 DOI: 10.3390/healthcare11212878] [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: 09/19/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
(1) Background: The study aimed to assess the patients' perception of the quality of the medical staff's care, the hotel's services, and the hospital's overall impression as well as to determine the best rating scale through a comparative analysis of patient satisfaction questionnaires. (2) Methods: A retrospective study was performed based on satisfaction questionnaires addressed to the patients hospitalized in the Orthopedics and Traumatology departments of the County Clinical Emergency Hospital Oradea between 2015 and 2019. Three different types of questionnaires were used during the study period, with the number of questions varying between 30 (variant A) and 37 (variant C). The evaluation was done using the Likert scales with three, four, or five answer variables. (3) Results: The items that we found to be present in all three categories of surveys and for which at least two different questionnaire variants used the Likert scales with various answer variables were chosen. In terms of the treatment given by the medical staff, hotel services, and the overall perception of the hospital, the patients perceive a higher level of quality. (4) Conclusions: The level of patient overall satisfaction or general impression about the hospital is strongly dependent on the quality of medical care provided by the doctors and the specific hotel conditions of the hospital. The quality assessment using the Likert rating scale with five binary variables is more accurate.
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Affiliation(s)
- Karoly Bancsik
- Faculty of Medicine and Pharmacy, Doctoral School of Biomedical Sciences, University of Oradea, 1 December Sq., 410081 Oradea, Romania
| | - Codrin Dan Nicolae Ilea
- Faculty of Medicine and Pharmacy, Doctoral School of Biomedical Sciences, University of Oradea, 1 December Sq., 410081 Oradea, Romania
| | - Mădălina Diana Daina
- Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq., 410081 Oradea, Romania
| | - Raluca Bancsik
- Clinical Emergency Hospital “Avram Iancu”, 410027 Oradea, Romania
| | - Corina Lacramioara Șuteu
- Department of Psycho-Neurosciences and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq., 410081 Oradea, Romania
| | - Simona Daciana Bîrsan
- Department of Psycho-Neurosciences and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq., 410081 Oradea, Romania
| | - Felicia Manole
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410081 Oradea, Romania
| | - Lucia Georgeta Daina
- Department of Psycho-Neurosciences and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq., 410081 Oradea, Romania
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Dhakal N, Gyanwali P, Humagain B, Bc R, Jha N, Sah P, Pradhan A, Dhimal M, Jha AK. Assessment of quality of essential medicines in public health care facilities of Nepal: Findings of nationwide study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001841. [PMID: 37228001 DOI: 10.1371/journal.pgph.0001841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/23/2023] [Indexed: 05/27/2023]
Abstract
Essential medicines are those medicines that satisfy the primary health care needs of the citizens. Poor quality of essential medicines can have serious impact on public health. Thus, this study is aimed to assess the quality of essential medicines available in public health care facilities of Nepal. A cross sectional descriptive study was carried out in 62 health facilities across 21 districts, representing all seven provinces of Nepal and selected proportionately from all three ecological regions i.e. Terai, Hill and Mountain using lottery method. Health facilities in selected districts were chosen using random number generator. Face to face interview was taken with health facility in charge using structured questionnaire. All storage conditions information was recorded through observation checklists. Temperature and humidity were measured using a digital instrument. Similarly, 20 different generic medicines were collected for quality testing. The obtained data were entered in Epidata version 3.1, cleaned in Microsoft Excel 2007 and analyzed in SPSS version 16.0. Among 62 health facilities, only 13% of health facilities were found to follow the medicine storage guidelines, with temperature and humidity levels exceeding recommended limits. Out of 244 batches of 20 different generics of essential medicines, 37 batches were found to be substandard. These substandard medicines were- Ciprofloxacin hydrochloride eye/ear drop, Iron supplement tablets, Metformin Hydrochloric tablet, Metronidazole Tablets, Paracetamol Oral suspension, Paracetamol tablet and Povidone Iodine solution. The study recommends the urgent need for the Government of Nepal to prioritize ensuring the quality of essential medicines in the country.
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Affiliation(s)
- Neelam Dhakal
- Nepal Health Research Council, Ramshahpath, Kathmandu, Nepal
| | - Pradip Gyanwali
- Department of Pharmacology, Maharajgunj Medical Campus, Kathmandu, Nepal
| | | | - Rajendra Bc
- Nepal Health Research Council, Ramshahpath, Kathmandu, Nepal
| | - Nisha Jha
- Department of Clinical Pharmacology and Therapeutics, KIST Medical College and Teaching Hospital, Lalitpur, Nepal
| | - Phoolgen Sah
- Department of Pharmacy and Pharmacology, Janamaitri Foundation, Institute Of Health Sciences, Kathmandu, Nepal
| | - Amita Pradhan
- Department of Community Dentistry, People's Dental College and Hospital, Kathmandu, Nepal
| | - Meghnath Dhimal
- Nepal Health Research Council, Ramshahpath, Kathmandu, Nepal
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Odole AC, Ogunlana MO, Odunaiya NA, Oyewole OO, Mbada CE, Onyeso OK, Ayodeji AF, Adegoke OM, Odole I, Sanuade CT, Odole ME, Awosoga OA. Influence of well-being and quality of work-life on quality of care among healthcare professionals in southwest, Nigeria. Sci Rep 2023; 13:7830. [PMID: 37188741 DOI: 10.1038/s41598-022-25057-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/24/2022] [Indexed: 05/17/2023] Open
Abstract
The Nigerian healthcare industry is bedevilled with infrastructural dilapidations and a dysfunctional healthcare system. This study investigated the influence of healthcare professionals' well-being and quality of work-life (QoWL) on the quality of care (QoC) of patients in Nigeria. A multicentre cross-sectional study was conducted at four tertiary healthcare institutions in southwest, Nigeria. Participants' demographic information, well-being, quality of life (QoL), QoWL, and QoC were obtained using four standardised questionnaires. Data were summarised using descriptive statistics. Inferential statistics included Chi-square, Pearson's correlation, independent samples t-test, confirmatory factor analyses and structural equation model. Medical practitioners (n = 609) and nurses (n = 570) constituted 74.6% of all the healthcare professionals with physiotherapists, pharmacists, and medical laboratory scientists constituting 25.4%. The mean (SD) participants' well-being = 71.65% (14.65), QoL = 61.8% (21.31), QoWL = 65.73% (10.52) and QoC = 70.14% (12.77). Participants' QoL had a significant negative correlation with QoC while well-being and quality of work-life had a significant positive correlation with QoC. We concluded that healthcare professionals' well-being and QoWL are important factors that influence the QoC rendered to patients. Healthcare policymakers in Nigeria should ensure improved work-related factors and the well-being of healthcare professionals to ensure good QoC for patients.
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Affiliation(s)
- Adesola C Odole
- Department of Physiotherapy, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Michael O Ogunlana
- Department of Physiotherapy, Federal Medical Centre, Abeokuta, Nigeria
- College of Health Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban, South Africa
| | - Nse A Odunaiya
- Department of Physiotherapy, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Olufemi O Oyewole
- College of Health Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban, South Africa
- Department of Physiotherapy, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| | - Chidozie E Mbada
- Department of Medical Rehabilitation, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - Ayomikun F Ayodeji
- Department of Physiotherapy, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Opeyemi M Adegoke
- Department of Physiotherapy, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Iyanuoluwa Odole
- University College Hospital, Ibadan, Nigeria
- Department of Public Health, Yale University, New Haven, CT, USA
| | - Comfort T Sanuade
- Department of Physiotherapy, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, Canada
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Jacobs M, Ellis C. Healthcare cost and race: analysis of young women with stroke. Int J Equity Health 2023; 22:69. [PMID: 37085848 PMCID: PMC10122319 DOI: 10.1186/s12939-023-01886-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/05/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Over the last decade, the prevalence of young stroke has increased 40% particularly among vulnerable populations. These strokes are often more severe with worse outcomes. However, few studies have examined the impact on annual healthcare costs. METHODS Data from the 2008 to 2018 Medical Expenditure Panel Survey (MEPS) was used to identify a sample of female stroke survivors aged 18 and 60. MEPS includes demographics, health status, healthcare use, and expenditures for all participants providing the largest nationally representative data source of healthcare costs in the US. First, differences in racial and ethnic healthcare expenditure among young women with stroke were evaluated controlling for insurance type and demographic characteristics. Second, the relationship between healthcare expenditure and 1) time post stroke, 2) comorbidities, 3) healthcare utilization, and 4) post-stroke functional status was assessed. Finally, differential healthcare quality was tested as a potential mitigating differential. RESULTS Young Black women with stroke spend roughly 20% more on healthcare than White women after controlling for insurance, time post-stroke, healthcare utilization, and demographic differences. Costs remain 17% higher after controlling for comorbidities. Differences in expenditure are larger if survivors have diabetes, high blood pressure, or high cholesterol (78%, 24%, and 28%, respectively). Higher expenditure could not be explained by higher healthcare utilization, but lower quality of healthcare may explain part of the differential. CONCLUSION Young Black women with stroke have 20% greater healthcare expenditure than other groups. Cost differentials cannot be explained by differentials in comorbidities, utilization, time post stroke, or functionality. Additional research is needed to explain these differences.
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Affiliation(s)
- Molly Jacobs
- Department of Health Services Research, Management and Policy, University of Florida, 1225 Center Drive, Gainesville, FL, 32603, USA.
| | - Charles Ellis
- Department of Speech, Language, and Hearing Sciences, University of Florida, 1225 Center Drive, Gainesville, FL, 32603, USA
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Ayawine A, Atinga RA. “We know it is not good, but we are constrained”: A study on quality of emergency obstetric and newborn care in Northern Ghana. Heliyon 2023; 9:e15250. [PMID: 37095927 PMCID: PMC10121449 DOI: 10.1016/j.heliyon.2023.e15250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023] Open
Abstract
Objective To explore the quality of emergency obstetric and newborn care provided to newly delivered women in rural Ghana. Methods A multiple case study design, involving in-depth face to face interviews, was deployed to draw evidence from essential health providers, clients and caretakers. Data were further derived from non-participant observation by means of an observation guide and analysis of physical artifacts using the room-by-room walk-through tool. Data analysis followed Yin's five phase process to case study analysis. Results Quality of care was compromised by non-adherence to standard practices, inadequate monitoring, crude treatment procedures, lack of basic care needs and poor health providers' relational behaviours. Limited supplies of drugs, equipment and essential care providers further weakened the provision of quality emergency obstetric and newborn care. Conclusion Inadequate supply of essential logistics and skill gaps on the part of health providers in some maternal and newborn care components adversely produced poor maternal and neonatal outcomes in rural Ghana. Elements of disrespectful care for women suggest violations of their rights in the maternal and newborn care encounter.
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Affiliation(s)
- Alice Ayawine
- School of Public Health and Allied Sciences, Catholic University of Ghana, Fiapre-Sunyani, Ghana
- Corresponding author.
| | - Roger A. Atinga
- Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Accra, Ghana
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Schwartzman JM, Williams ZJ, Paterson AV, Jacobs AX, Corbett BA. Community-guided measurement-based care for autistic youth and adults receiving psychotherapy: A conceptual overview and pilot implementation study of MBC-AUT. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023:13623613221143587. [PMID: 36632662 PMCID: PMC10333447 DOI: 10.1177/13623613221143587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
LAY ABSTRACT Autistic youth and adults are more likely to experience psychiatric symptoms (e.g. depression, anxiety) and to use psychiatric services than non-autistic people, yet research on evidence-based approaches to enhance psychiatric care for autistic people is limited. Measurement-based care is an evidence-based approach to psychotherapy that improves outcomes for clients, clinicians, and organizations by routinely administering and evaluating measures to clients. Despite this, research on measurement-based care systems for autistic clients is sparse. To address this gap, we developed an autism-adapted measurement-based care (MBC-AUT) system for and with autistic people and pilot tested the system in an outpatient psychiatry clinic to investigate the preliminary feasibility, acceptability, benefits, and barriers to this system for clients and clinicians. Findings suggested that the MBC-AUT system was a feasible and acceptable system for the first 18 autistic youth, their caregivers, and autistic adults to use the system. In semi-structured interviews, clients and clinicians discussed the benefits of the MBC-AUT system to various therapeutic processes, as well as several important barriers to the use of the system. We offer potential solutions to address these barriers and to reduce client and clinician burden, and propose future directions for this line of research to increase access to more autistic people. As autistic clients continue to seek psychological services amid social landscapes of increasing complexity (e.g. COVID-19 pandemic), efforts to enhance the delivery of psychotherapy for this population are critical.
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Affiliation(s)
| | | | | | | | - Blythe A Corbett
- Vanderbilt University Medical Center, USA.,Vanderbilt University, USA
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8
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Gorgani F, Esfahani Z, Ghamari SH, Ghasemi E, Azadnajafabad S, Shobeiri P, Mohammadi E, Moghaddam SS, Abbasi-Kangevari M, Fattahi N, Tehrani YS, Farzi Y, Rezaei N, Larijani B, Farzadfar F. Global, regional, and national burden and quality of care index of liver cirrhosis by cause from global burden of disease 1990-2019. J Gastroenterol Hepatol 2023; 38:119-128. [PMID: 36287036 DOI: 10.1111/jgh.16041] [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] [Received: 06/29/2022] [Revised: 09/21/2022] [Accepted: 10/17/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND AIM Cirrhosis and other chronic liver diseases are complex disorders with a known burden. Currently health systems have different approaches to dealing with this issue. The objective of this study is to describe the burden attributed to and quality of care for cirrhosis and other chronic liver diseases. METHODS Data of cirrhosis and other chronic liver diseases extracted from Global-Burden-of-Diseases 2019. Four indicators, including mortality to incidence ratio, prevalence to incidence ratio, disability-adjusted-life-years (DALYs) to prevalence ratio, and years-of-life-lost (YLLs) to years-lived-with-disability (YLDs) ratio, were defined and combined by the principal-components-analysis to construct the Quality-of-Care-Index (QCI). RESULTS The global QCI of cirrhosis increased from 71.0 in 1990 to 79.3 in 2019. The QCI showed a favorable situation in higher SDI countries compared with lower SDI countries, with a QCI of 86.8 in high SDI countries and 60.1 in low SDI countries. The highest QCI was found in Western Pacific Region (90.2), and the lowest was for African Region (60.4). Highest QCI belonged to the 50-54 age group (99.5), and the lowest was for the 30.34 age group (70.9). Among underlying causes of cirrhosis, the highest QCI belonged to alcohol use, followed by hepatitis C and NAFLD with QCIs of 86.1, 85.3, and 81.1. CONCLUSIONS There was a considerable variation in the QCI of cirrhosis and other chronic liver diseases. Countries with low QCI, mainly located in developing regions, need organized action to control the burden of cirrhosis and its underlying causes and improve their quality of care.
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Affiliation(s)
- Fateme Gorgani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Esfahani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Seyyed-Hadi Ghamari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Ghasemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Parnian Shobeiri
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mohammadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Abbasi-Kangevari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Fattahi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Division of Gastroenterology, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Yeganeh Sharifnejad Tehrani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Yosef Farzi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Bercu C, Jacobson LE, Gebrehanna E, Ramirez AM, Katz AJ, Filippa S, Baum SE. "I was afraid they will be judging me and even deny me the service": Experiences of denial and dissuasion during abortion care in Ethiopia. Front Glob Womens Health 2022; 3:984386. [PMID: 36386432 PMCID: PMC9663468 DOI: 10.3389/fgwh.2022.984386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/07/2022] [Indexed: 09/09/2023] Open
Abstract
INTRODUCTION Disrespect and abuse are components of poor quality abortion care. This analysis aimed to understand negative experiences of care from perspectives of abortion clients in public and private facilities in Ethiopia. STUDY DESIGN We conducted 23 in-depth interviews with people who obtained abortion care in Addis Ababa, Ethiopia as well as Aksum and Mekele in Tigray State, Ethiopia. The interviews were coded using a priori and emergent codes and we conducted thematic analysis to understand negative interactions with providers from participant's perspectives. RESULTS Participants experienced denial of abortion services along their pathway to care and attempts by providers to dissuade them prior to providing an abortion. Underlying both the denial and the dissuasion were reports of disrespect and condemnation from providers. Participants described how providers doubted or forced them to justify their reasons for having an abortion, stigmatized them for seeking multiple abortions or later abortions, and ascribed misinformation about abortion safety. Despite reports of denial, dissuasion, and disrespect, abortion clients generally felt that providers had their best interest at heart and were grateful for having access to an abortion. CONCLUSIONS Participants in Ethiopia experienced providers as gatekeepers to legal abortion services, facing disrespect and judgment at facilities where they sought care. Interventions aimed at increasing awareness of abortion laws such that clients understand their rights and values clarification interventions for providers could help reduce barriers to accessing care and improve the quality of abortion services.
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Affiliation(s)
- Chiara Bercu
- Ibis Reproductive Health, Oakland, CA, United States
| | - Laura E. Jacobson
- School of Public Health, Oregon Health and Science University-Portland State University (OHSU-PSU), Portland, OR, United States
| | - Ewenat Gebrehanna
- St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Anna J. Katz
- Ibis Reproductive Health, Oakland, CA, United States
| | - Sofía Filippa
- Ibis Reproductive Health, Oakland, CA, United States
| | - Sarah E. Baum
- Ibis Reproductive Health, Oakland, CA, United States
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Derriennic J, Nabbe P, Barais M, Le Goff D, Pourtau T, Penpennic B, Le Reste JY. A systematic literature review of patient self-assessment instruments concerning quality of primary care in multiprofessional clinics. Fam Pract 2022; 39:951-963. [PMID: 35230419 PMCID: PMC9508876 DOI: 10.1093/fampra/cmac007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Quality of care remains a priority issue and is correlated with patient experience. Measuring multidimensional patient primary care experiences in multiprofessional clinics requires a robust instrument. Although many exist, little is known about their quality. OBJECTIVE To identify patient perception instruments in multiprofessional primary care and evaluate their quality. METHODS Systematic review using Medline, Pascal, PsycINFO, Google Scholar, Cochrane, Scopus, and CAIRN. Eligible articles developed, evaluated, or validated 1 or more self-assessment instruments. The instruments had to measure primary care delivery, patient primary care experiences and assess at least 3 quality-of-care dimensions. The COnsensus-based Standards for the selection of health status Measurement Instruments (COSMIN) checklist was used to assess methodological quality of included studies. Instrument measurement properties were appraised using 3 possible quality scores. Data were combined to provide best-evidence synthesis based on the number of studies, their methodological quality, measurement property appraisal, and result consistency. Subscales used to capture patient primary care experiences were extracted and grouped into the 9 Institute of Medicine dimensions. RESULTS Twenty-nine articles were found. The included instruments captured many subscales illustrating the diverse conceptualization of patient primary care experiences. No included instrument demonstrated adequate validity and the lack of scientific methodology for assessing reliability made interpreting validity questionable. No study evaluated instrument responsiveness. CONCLUSION Numerous patient self-assessment instruments were identified capturing a wide range of patient experiences, but their measurement properties were weak. Research is required to develop and validate a generic instrument for assessing quality of multiprofessional primary care. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Jérémy Derriennic
- Department of General Practice, University of Western Brittany, 22, av. Camille Desmoulins, Brest, FR, France.,ER 7479 SPURBO, University of Western Brittany, 22, av. Camille Desmoulins, Brest, FR, France
| | - Patrice Nabbe
- Department of General Practice, University of Western Brittany, 22, av. Camille Desmoulins, Brest, FR, France.,ER 7479 SPURBO, University of Western Brittany, 22, av. Camille Desmoulins, Brest, FR, France
| | - Marie Barais
- Department of General Practice, University of Western Brittany, 22, av. Camille Desmoulins, Brest, FR, France.,ER 7479 SPURBO, University of Western Brittany, 22, av. Camille Desmoulins, Brest, FR, France
| | - Delphine Le Goff
- Department of General Practice, University of Western Brittany, 22, av. Camille Desmoulins, Brest, FR, France.,ER 7479 SPURBO, University of Western Brittany, 22, av. Camille Desmoulins, Brest, FR, France
| | - Thomas Pourtau
- Department of General Practice, University of Western Brittany, 22, av. Camille Desmoulins, Brest, FR, France
| | - Benjamin Penpennic
- Department of General Practice, University of Western Brittany, 22, av. Camille Desmoulins, Brest, FR, France
| | - Jean-Yves Le Reste
- Department of General Practice, University of Western Brittany, 22, av. Camille Desmoulins, Brest, FR, France.,ER 7479 SPURBO, University of Western Brittany, 22, av. Camille Desmoulins, Brest, FR, France
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Ferede Gebremedhin A, Dawson A, Hayen A. Evaluations of effective coverage of maternal and child health services: A systematic review. Health Policy Plan 2022; 37:895-914. [PMID: 35459943 PMCID: PMC9347022 DOI: 10.1093/heapol/czac034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 03/25/2022] [Accepted: 04/21/2022] [Indexed: 11/27/2022] Open
Abstract
Conventionally used coverage measures do not reflect the quality of care. Effective coverage (EC) assesses the extent to which health care services deliver potential health gains to the population by integrating concepts of utilization, need and quality. We aimed to conduct a systematic review of studies evaluating EC of maternal and child health services, quality measurement strategies and disparities across wealth quantiles. A systematic search was performed in six electronic databases [MEDLINE, EMBASE, Cumulative Index of Nursing and Allied Health (CINAHL), Scopus, Web of Science and Maternity and Infant Care] and grey literature. We also undertook a hand search of references. We developed search terms having no restrictions based on publication period, country or language. We included studies which reported EC estimates based on the World Health Organization framework of measuring EC. Twenty-seven studies, all from low- and middle-income settings (49 countries), met the criteria and were included in the narrative synthesis of the results. Maternal and child health intervention(s) and programme(s) were assessed either at an individual level or as an aggregated measure of health system performance or both. The EC ranged from 0% for post-partum care to 95% for breastfeeding. When crude coverage measures were adjusted to account for the quality of care, the EC values turned lower. The gap between crude coverage and EC was as high as 86%, and it signified a low quality of care. The assessment of the quality of care addressed structural, process and outcome domains individually or combined. The wealthiest 20% had higher EC of services than the poorest 20%, an inequitable distribution of coverage. More efforts are needed to improve the quality of maternal and child health services and to eliminate the disparities. Moreover, considering multiple dimensions of quality and the use of standard measurements are recommended to monitor coverage effectively.
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Affiliation(s)
- Aster Ferede Gebremedhin
- Department of Public Health, College of Health Sciences, Debre Markos University, PO Box 269, Debre Markos, Ethiopia
- School of Public Health, University of Technology Sydney, PO Box 123, Broadway NSW 2007, Sydney, Australia
| | - Angela Dawson
- School of Public Health, University of Technology Sydney, PO Box 123, Broadway NSW 2007, Sydney, Australia
| | - Andrew Hayen
- School of Public Health, University of Technology Sydney, PO Box 123, Broadway NSW 2007, Sydney, Australia
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Gebremeskel AT, Omonaiye O, Yaya S. Determinants of community health workers effectiveness for delivery of maternal and child health in Sub Saharan Africa: A Systematic review protocol. PLoS One 2022; 17:e0271528. [PMID: 35853027 PMCID: PMC9295951 DOI: 10.1371/journal.pone.0271528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/04/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Countries in sub-Sahara African continue to have the highest maternal and under- five child death occurrences in the world and this has become a key health challenge in the region and persists as global public health agenda. Although Community Health Workers (CHWs) are increasingly being acknowledged as crucial members of the healthcare workforce in reducing health disparity, evidence is limited on perspective of community health workers. The objective of this protocol is to outline the methodological process of a systematic review that will gather qualitative data to examine determinants of community health workers effectiveness for delivery of maternal and child health in Sub Saharan Africa. Synthesizing the perspectives of community health workers' perceived experience is crucial to inform decision makers, policy makers, and practitioners to address barriers to and scaleup facilitators of CHWs program to ensure maternal and child health equity and a resilience community health system. METHODS The protocol has been registered in the PROSPERO (CRD42020206874). We will systematically conduct a literature search from inception in MEDLINE complete, EMBASE, CINAHL complete and Global Health for relevant studies. Eligible studies will be reports of original research, peer reviewed articles having a qualitative component (i.e., qualitative, mixed, or multi-method studies) on empowerment of CHWs associated with maternal and child health in the sub-Saharan Africa. Eligibility will be restricted to studies published in English. Two reviewers will independently screen all included abstracts and full-text articles. The primary outcome will be CHWs' perceived barriers to and facilitators of effectiveness of community health workers in maternal and child health in sub-Saharan Africa. Study methodological quality (or bias) will be appraised using appropriate tools. Narrative analysis will be conducted, and narrative summary of findings will be presented. We will use the 'best fit' framework method as a systematic approach to analyzing the qualitative data. DISCUSSION This study will systematically and comprehensively search literature and integrate evidence on perceived barriers to and facilitators of effectiveness of community health workers led maternal and child health program in sub-Saharan Africa. Our findings will inform policy and practice on maternal and child health equity and a resilient communities health system. The resulting manuscript will be disseminated in a peer-reviewed journal and at international and national conferences.
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Affiliation(s)
- Akalewold T. Gebremeskel
- Faculty of Health Sciences, University of Ottawa, Ontario, Canada
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
| | - Olumuyiwa Omonaiye
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Melbourne Burwood Campus, Burwood, Australia
- Centre for Nursing and Midwifery Research, James Cook University, Townsville, Queensland, Australia
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- University of Parakou, Faculty of Medicine, Parakou, Benin
- The George Institute for Global Health, Imperial College London, London, United Kingdom
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13
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Muzigaba M, Chitashvili T, Choudhury A, Were WM, Diaz T, Strong KL, Jackson D, Requejo J, Detjen A, Sacks E. Global core indicators for measuring WHO's paediatric quality-of-care standards in health facilities: development and expert consensus. BMC Health Serv Res 2022; 22:887. [PMID: 35804384 PMCID: PMC9270792 DOI: 10.1186/s12913-022-08234-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are currently no global recommendations on a parsimonious and robust set of indicators that can be measured routinely or periodically to monitor quality of hospital care for children and young adolescents. We describe a systematic methodology used to prioritize and define a core set of such indicators and their metadata for progress tracking, accountability, learning and improvement, at facility, (sub) national, national, and global levels. METHODS We used a deductive methodology which involved the use of the World Health Organization Standards for improving the quality-of-care for children and young adolescents in health facilities as the organizing framework for indicator development. The entire process involved 9 complementary steps which included: a rapid literature review of available evidence, the application of a peer-reviewed systematic algorithm for indicator systematization and prioritization, and multiple iterative expert consultations to establish consensus on the proposed indicators and their metadata. RESULTS We derived a robust set of 25 core indicators and their metadata, representing all 8 World Health Organization quality standards, 40 quality statements and 520 quality measures. Most of these indicators are process-related (64%) and 20% are outcome/impact indicators. A large proportion (84%) of indicators were proposed for measurement at both outpatient and inpatient levels. By virtue of being a parsimonious set and given the stringent criteria for prioritizing indicators with "quality measurement" attributes, the recommended set is not evenly distributed across the 8 quality standards. CONCLUSIONS To support ongoing global and national initiatives around paediatric quality-of-care programming at country level, the recommended indicators can be adopted using a tiered approach that considers indicator measurability in the short-, medium-, and long-terms, within the context of the country's health information system readiness and maturity. However, there is a need for further research to assess the feasibility of implementing these indicators across contexts, and the need for their validation for global common reporting.
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Affiliation(s)
- Moise Muzigaba
- Department of Maternal, Newborn, Child, and Adolescent Health, and Ageing, World Health Organization, Avenue Appia 20, 1202, Geneva, Switzerland.
| | - Tamar Chitashvili
- University Research Co. LLC, 4600 Creek Shore Dr. Rockville, Rocville, MD, 20852, USA
| | - Allysha Choudhury
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Dr, Chapel Hill, Chapel Hill, NC, 27599, USA
- Data & Analytics Section, UNICEF, 3 UN Plaza, New York, NY, 10017, USA
| | - Wilson M Were
- Department of Maternal, Newborn, Child, and Adolescent Health, and Ageing, World Health Organization, Avenue Appia 20, 1202, Geneva, Switzerland
| | - Theresa Diaz
- Department of Maternal, Newborn, Child, and Adolescent Health, and Ageing, World Health Organization, Avenue Appia 20, 1202, Geneva, Switzerland
| | - Kathleen L Strong
- Department of Maternal, Newborn, Child, and Adolescent Health, and Ageing, World Health Organization, Avenue Appia 20, 1202, Geneva, Switzerland
| | - Debra Jackson
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, Department of Infectious Disease Epidemiology, Keppel Street, London, UK
- School of Public Health, University of the Western Cape, Bellville, PBX17, South Africa
| | - Jennifer Requejo
- Data & Analytics Section, UNICEF, 3 UN Plaza, New York, NY, 10017, USA
| | - Anne Detjen
- Child and Community Health Unit, UNICEF, 3 UN Plaza, New York, NY, 10017, USA
| | - Emma Sacks
- Child and Community Health Unit, UNICEF, 3 UN Plaza, New York, NY, 10017, USA
- Department of International Health, Johns Hopkins School of Public Health, 615 North Wolfe St, Baltimore, MD, USA
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Couceiro J, Elger BS, Satalkar P. Stakeholder perspectives on ‘Swiss quality’ healthcare in the context of inbound medical tourism to Switzerland: An exploratory qualitative study. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2022. [DOI: 10.1177/25160435221102124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Global literature on medical travel focuses on patients from high-income countries traveling to middle-income countries reputed for providing high quality care at significantly lower costs. However, little is known about the movement of wealthy foreign patients to high-income countries such as the USA, the UK or Switzerland. Objective In this paper, we focus on Swiss medical tourism stakeholders and their strategies to attract a niche of self-paying foreign patients to undergo medical treatment in Switzerland. We describes how they harness the label of ‘Swiss quality’ healthcare to promote Switzerland in global medical travel industry. Methods We conducted semi-structured, in-depth interviews with 30 medical tourism stakeholders including 15 healthcare professionals (HCPs) treating self-paying foreign patients in publicly funded and privately owned hospitals in French- and German-speaking regions of Switzerland. The data were inductively coded using thematic analysis. Results We present their views on ‘Swiss quality’ healthcare under three themes: health-related human resources, Swiss medical infrastructure, and foreign patients’ perceived trust in the ‘Swiss quality’ label. Participants equated Switzerland's global image and ‘Swiss quality’ as a ‘brand’ and believed that foreign patients’ trust in ‘Swiss quality’ is a unique selling point of Swiss healthcare system. Conclusion By problematizing the use of ‘Swiss quality’ label to attract wealthy patients to Switzerland, we highlight a few ethical questions that deserve further scrutiny.
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Affiliation(s)
- João Couceiro
- University of Basel Institute for Biomedical Ethics, Basel, Switzerland
| | - Bernice S. Elger
- University of Basel Institute for Biomedical Ethics, Basel, Switzerland
| | - Priya Satalkar
- University of Basel Institute for Biomedical Ethics, Basel, Switzerland
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15
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Bercu C, Filippa S, Ramirez AM, Katz A, Grosso B, Zurbriggen R, Vázquez S, Baum SE. Perspectives on high-quality interpersonal care among people obtaining abortions in Argentina. Reprod Health 2022; 19:107. [PMID: 35501904 PMCID: PMC9059438 DOI: 10.1186/s12978-022-01401-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 03/24/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Little is known about how people who have abortions describe high-quality interpersonal care in Argentina. This qualitative study aimed to understand preferences and priorities in their interactions with providers. Study design We conducted 24 in-depth interviews with people who obtained abortions at a comprehensive reproductive health clinic or with support from a feminist accompaniment group in Buenos Aires and Neuquén, Argentina. We iteratively coded transcripts using a thematic analysis approach based on interpersonal domains present in current quality of care frameworks. Results Participants described high-quality abortion care as feeling acompañamiento and contención from their providers – terms that imply receiving kind, caring, compassionate and emotionally supportive care throughout their abortion. They described four key elements of interpersonal interactions: attentive communication from providers and accompaniers, clear and understandable information provision, non-judgmental support, and individualized options for pain management. Conclusions People obtaining abortions in Argentina consistently identified receiving compassionate and supportive care throughout an abortion as a key aspect of care. The findings have implications for incorporating people’s perspectives in the development of care guidelines, training of providers, and monitoring and improving of services. This is particularly important as the government of Argentina prepares to expand legal access to abortion. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-022-01401-1. Little is known about how people who have abortions perceive the quality of the care they receive and what aspects of interpersonal interactions with providers matter to them. This qualitative study aimed to understand preferences of people who had abortions at both a reproductive health clinic and with an accompaniment group in Argentina. We interviewed 24 people who obtained abortion care in Buenos Aires and Neuquén, Argentina. We asked them about their preferences for and experiences of abortion care. Then we analyzed the interviews, specifically assessing aspects of interpersonal care based on quality of care frameworks from the literature. Participants described high-quality abortion care as feeling acompañamiento and contención from their providers—terms that imply receiving kind, caring, compassionate and emotionally supportive care throughout their abortions. They described four key elements of interpersonal interactions: attentive communication from providers and accompaniers, clear and understandable information provision, non-judgmental support, and individualized options for pain management. In conclusion, people obtaining abortions in two distinct models of care in Argentina consistently identified receiving compassionate and supportive care throughout an abortion as a key aspect of care. The findings have implications for incorporating people’s perspectives in the development of care guidelines, training of providers, and monitoring and improving of services. This is particularly important as the government of Argentina prepares to expand legal access to abortion.
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Saric J, Kiefer S, Peshkatari A, Wyss K. Assessing the Quality of Care at Primary Health Care Level in Two Pilot Regions of Albania. Front Public Health 2022; 9:747689. [PMID: 35004572 PMCID: PMC8727515 DOI: 10.3389/fpubh.2021.747689] [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: 07/26/2021] [Accepted: 12/02/2021] [Indexed: 12/02/2022] Open
Abstract
The quality of care (QoC) of primary health care (PHC) services in Albania faces challenges on multiple levels including governance, access, infrastructure and health care workers. In addition, there is a lack of trust in the latter. The Health for All Project (HAP) funded by the Swiss Agency for Development and Cooperation therefore aimed at enhancing the population's health by improving PHC services and implementing health promotion activities following a multi-strategic health system strengthening approach. The objective of this article is to compare QoC before and after the 4 years of project implementation. A cross-sectional study was implemented at 38 PHC facilities in urban and rural locations in the Diber and Fier regions of Albania in 2015 and in 2018. A survey measured the infrastructure of the different facilities, provider–patient interactions through clinical observation and patient satisfaction. During clinical observations, special attention was given to diabetes and hypertensive patients. Infrastructure scores improved from base- to endline with significant changes seen on national level and for rural facilities (p < 0.01). Facility infrastructure and overall cleanliness, hygiene and basic/essential medical equipment and supplies improved at endline, while for public accountability/transparency and guidelines and materials no significant change was observed. The overall clinical observation score increased at endline overall, in both areas and in rural and urban setting. However, infection prevention and control procedures and diabetes treatment still experienced relatively low levels of performance at endline. Patient satisfaction on PHC services is generally high and higher yet at endline. The changes observed in the 38 PHC facilities in two regions in Albania between 2015 and 2018 were overall positive with improvements seen at all three levels assessed, e.g., infrastructure, service provision and patient satisfaction. However, to gain overall improvements in the QoC and move toward a more efficient and sustainable health system requires continuous investments in infrastructure alongside interventions at the provider and user level.
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Affiliation(s)
- Jasmina Saric
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Sabine Kiefer
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Kaspar Wyss
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Kim MK, Baumgartner JN, Headley J, Kirya J, Kaggwa J, Egger JR. Medical record bias in documentation of obstetric and neonatal clinical quality of care indicators in Uganda. J Clin Epidemiol 2021; 136:10-19. [PMID: 33667620 DOI: 10.1016/j.jclinepi.2021.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 11/30/2020] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To achieve a high quality of care (QoC), accurate measurements are needed. This study evaluated the validity of QoC data from the medical records for childbirth deliveries and assessed whether medical records can be used to evaluate the efficacy of interventions to improve QoC. STUDY DESIGN AND SETTING This study was part of a larger study of QoC training program in Uganda. Study data were collected in two phases: (1) validation data from 321 direct observations of deliveries paired with the corresponding medical records; (2) surveillance data from 1,146 medical records of deliveries. Sensitivity, specificity, and predictive values were used to measure the validity of the medical record from the validation data. Quantitative bias analysis was conducted to evaluate QoC program efficacy in the surveillance data using prevalence ratio and odds ratio. RESULTS On average, sensitivity (84%) of the medical record was higher than the specificity (34%) across 11 QoC indicators, showing a higher validity in identifying the performed procedure. For 5 out of 11 indicators, bias-corrected odds ratios and prevalence ratios deviated significantly from uncorrected estimates. CONCLUSION The medical records demonstrated poor validity in measuring QoC compared with direct observation. Using the medical record to assess QoC program efficacy should be interpreted carefully.
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Affiliation(s)
- Min Kyung Kim
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Joy Noel Baumgartner
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27708, USA
| | - Jennifer Headley
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27708, USA
| | | | - James Kaggwa
- Makerere University - Johns Hopkins University (MI-JHU) Research Collaboration, Kampala, Uganda
| | - Joseph R Egger
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27708, USA.
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Helfinstein S, Jain M, Ramesh BM, Blanchard J, Kemp H, Gothalwal V, Namasivayam V, Kumar P, Sgaier SK. Facilities are substantially more influential than care providers in the quality of delivery care received: a variance decomposition and clustering analysis in Kenya, Malawi and India. BMJ Glob Health 2021; 5:bmjgh-2020-002437. [PMID: 32816803 PMCID: PMC7440830 DOI: 10.1136/bmjgh-2020-002437] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/02/2020] [Accepted: 07/08/2020] [Indexed: 01/13/2023] Open
Abstract
Introduction Improving the quality of care during childbirth is essential for reducing neonatal and maternal mortality. One barrier to improving quality of care is understanding the appropriate level to target interventions. We examine quality of care data during labour and delivery from multiple countries to assess whether quality varies primarily from nurse to nurse within the same facility, or primarily between facilities. Methods To assess the relative contributions of nurses and facilities to variance in quality of care, we performed a variance decomposition analysis using a linear mixed effect model on two data sources: (1) the number of vital signs assessed for women in labour from a study of nurse practices in Uttar Pradesh, India; 2) broad-scale indices of respectful and competent care generated from Service Provision Assessments in Kenya and Malawi. We used unsupervised clustering, a data mining technique that groups objects together based on similar characteristics, to identify groups of facilities that displayed distinct patterns of vital signs assessment behaviour. Results We found 3–10 times more variance in quality of care was explained by the facility where a patient received care than by the nurse who provided it. The unsupervised clustering analysis revealed groups of facilities with highly distinct patterns of vital signs assessment, even when overall rates of vital signs assessments were similar (eg, some facilities consistently test fetal heart rate, but not other vitals, others only blood pressure). Conclusion Facilities within a region can vary substantially in the quality of care they provide to women in labour, but within a facility, nurses tend to provide similar care. This holds true both for care that can be influenced by equipment availability and technical training (eg, vital signs assessment), as well as cultural aspects (eg, respectful care).
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Affiliation(s)
| | | | - Banadakoppa Manjappa Ramesh
- India Health Action Trust, Lucknow, Uttar Pradesh, India.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Blanchard
- Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Vikas Gothalwal
- India Health Action Trust, Lucknow, Uttar Pradesh, India.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Vasanthakumar Namasivayam
- India Health Action Trust, Lucknow, Uttar Pradesh, India.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Pankaj Kumar
- National Health Mission, Government of Uttar Pradesh, Lucknow, Uttar Pradesh, India
| | - Sema K Sgaier
- Surgo Foundation, Washington, DC, USA .,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
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Gabrani J, Schindler C, Wyss K. Perspectives of Public and Private Primary Healthcare Users in Two Regions of Albania on Non-Clinical Quality of Care. J Prim Care Community Health 2021; 11:2150132720970350. [PMID: 33243061 PMCID: PMC7705804 DOI: 10.1177/2150132720970350] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Aiming to tackle the rise of non-communicable diseases and an ageing population, Albania is engaged in boosting primary healthcare services and quality of care. The patients’ perspectives on their experience with public and private providers are, however, missing, although their viewpoints are critical while shaping the developing services. Consequently, we analyze perceptions of users of primary healthcare as it relates to non-clinical quality of care and the association to sociodemographic characteristics of patients and the type of provider. Methods: A facility-based survey was conducted in 2018 using the World Health Organization responsiveness questionnaire which is based on a 4-point scale along with 8 non-clinical domains of quality of care. The data of 954 patients were analyzed through descriptive statistics and linear mixed regression models. Results: Similar mean values were reported on total scale of the quality of care for private and public providers, also after sociodemographic adjustments. The highest mean score was reported for the domain “communication” (3.75) followed by “dignity” (3.65), while the lowest mean scores were given for “choice” (2.89) and “prompt attention” (3.00). Urban governmental PHC services were rated significantly better than private outpatient clinics in “coordination of care” (2.90 vs 2.12, P < .001). In contrast, private outpatient clinics were judged significantly better than urban PHC clinics in “confidentiality” (3.77 vs 3.38, P = .04) and “quality of basic amenities” (3.70 vs 3.02, P < .001). “Autonomy” was reported as least important attribute of quality. Conclusion: While the perception of non-clinical care quality was found to be high and similar for public and private providers, promptness and coordination of care require attention to meet patient’s expectations on good quality of care. There is a need to raise the awareness on autonomy and the involvement of patients’ aspects concerning their health.
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Affiliation(s)
- Jonila Gabrani
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Kaspar Wyss
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Development of a Secure Website to Facilitate Information Sharing in Families at High Risk of Bowel Cancer-The Familyweb Study. Cancers (Basel) 2021; 13:cancers13102404. [PMID: 34065728 PMCID: PMC8155923 DOI: 10.3390/cancers13102404] [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: 02/28/2021] [Revised: 05/04/2021] [Accepted: 05/10/2021] [Indexed: 11/22/2022] Open
Abstract
Simple Summary Families with an inherited high risk of bowel cancer may struggle to share information about their diagnosis. This means that relatives are not always aware of their increased risk of cancer or able to access screening for the early detection of cancer. Through this study, we aimed to help such families by creating a website where patients could share confidential information with their relatives securely online. Following a survey and telephone interviews with affected individuals, the content of the website was developed to suit the needs of families. Website function was tested with patients to check feasibility and acceptability. Most participants wanted more information to support their adaptation to the diagnosis and help inform their relatives. This study demonstrates how health professionals can improve access to genetic testing and cancer screening in families at high risk of cancer, thus reducing morbidity and mortality. Abstract Individuals with pathogenic variants in genes predisposing to bowel cancer are encouraged to share this information within their families. Close relatives at 50% risk can have access to bowel cancer surveillance. However, many relatives remain unaware of their vulnerability or have insufficient information. We investigated the feasibility and acceptability of using a secure website to support information sharing within families at high risk of bowel cancer. Patients (n = 286) answered an anonymous cross-sectional survey, with 14 participating in telephone interviews. They reported that the diagnosis had a profound effect on them and their family relationships, and consequently desired more support from health professionals. Website content was created in response to the preferences of survey and interview participants. Reactions to the website from 12 volunteers were captured through remote usability testing to guide further refinement of the website. Participants welcomed the opportunity to store and share personal information via the website and wanted more information and help informing their relatives about the diagnosis. Important website topics were: healthy lifestyle; genetic testing; and how to talk to children about the diagnosis. A website providing online access to confidential documents was both feasible and acceptable and could translate into increased uptake of cancer surveillance, resulting in lower morbidity and mortality in these families.
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Dung DT, Binh VTL, Worrell CM, Brady M, Walsh V, Yajima A, Sifri Z, Fox LM. Evaluation of a facility-based inspection tool to assess lymphedema management services in Vietnam. PLoS Negl Trop Dis 2020; 14:e0008773. [PMID: 33075056 PMCID: PMC7595627 DOI: 10.1371/journal.pntd.0008773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 10/29/2020] [Accepted: 09/04/2020] [Indexed: 01/24/2023] Open
Abstract
Assuring availability of services for patients with lymphedema is required for countries to be validated as having achieved elimination of lymphatic filariasis (LF). A direct inspection protocol (DIP) tool, designed to measure the readiness to provide quality lymphedema management services, has recently been developed. The DIP tool includes 14 indicators across six quality themes: trained staff, case management and education materials, water infrastructure, medicines and commodities, patient tracking system, and staff knowledge. We evaluated the use of the tool in Vietnam, where data were needed to inform validation efforts. To apply the tool in Vietnam, we compiled a list of 219 commune health stations (CHS) with known lymphedema patients and conducted a cross-sectional survey in 32 CHS; including 24 in Red River Delta region, 2 in the North Central region, and 6 in the South Central Coast region. The mean facility score, calculated by assigning 1 point per indicator, was 8.8 of 14 points (63%, range 4[29%]-13[93%]). Percentage of surveyed facilities with staff trained in last two years was 0%; availability of lymphedema management guidelines (56%); availability of information, education, and communication materials (16%); reliable improved water infrastructure (94%); availability of antiseptics (81%), antifungals (44%), analgesics or anti-inflammatories (97%), antibiotics (94%); supplies for lymphedema and acute attack management (100%); lymphedema patients recorded in last 12 months (9%); staff knowledge about lymphedema signs/symptoms (63%), lymphedema management strategies (72%), signs/symptoms of acute attacks (81%), and acute attack management strategies (75%). The tool allowed standardized assessment of readiness to provide quality services. Lack of trained health staff, limited patient tracking, and depletion of education materials were identified as challenges and addressed by the national program. Survey data were included in the validation dossier, providing evidence necessary for WHO to validate Vietnam as having eliminated lymphatic filariasis in 2018. Lymphedema, a chronic swelling of the limbs, is a consequence of a debilitating and disfiguring neglected parasitic infection known as lymphatic filariasis (LF). In places where LF is common, the World Health Organization (WHO) recommends a simple and effective hygiene program to improve the quality of life of people living with lymphedema. In places where persons with lymphedema are found, health facilities should have the ability to teach these simple techniques and manage complications. Further, WHO recommends that countries evaluate their lymphedema care services to ensure quality and requires information about lymphedema care when deciding whether to acknowledge that a country has eliminated LF. We developed a tool for use in assessing readiness of health facilities to provide quality lymphedema care, then evaluated the tool in health facilities across three regions of Vietnam, collecting information on 14 factors related to lymphedema care quality. Most facilities had needed supplies and the staff generally understood how to care for persons with lymphedema; however, facilities often lacked patient tracking systems or health education materials. Vietnam used this information to improve lymphedema care services throughout the country and received acknowledgement of LF elimination from WHO in 2018.
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Affiliation(s)
- Do Trung Dung
- National Institute of Malariology, Parasitology, and Entomology, Hanoi, Vietnam
| | - Vu Thi Lam Binh
- National Institute of Malariology, Parasitology, and Entomology, Hanoi, Vietnam
| | - Caitlin M. Worrell
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
| | - Molly Brady
- RTI International, Washington, D.C., United States of America
| | - Victoria Walsh
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Aya Yajima
- World Health Organization Western Pacific Regional Office, Manila, Philippines
| | - Zeina Sifri
- Helen Keller International, Washington, D.C., United States of America
| | - LeAnne M. Fox
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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22
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Deribew A, Dejene T, Defar A, Berhanu D, Biadgilign S, Tekle E, Asheber K, Deribe K. Health system capacity for tuberculosis care in Ethiopia: evidence from national representative survey. Int J Qual Health Care 2020; 32:306-312. [PMID: 32232364 DOI: 10.1093/intqhc/mzaa024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/02/2019] [Accepted: 01/29/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the tuberculosis (TB) health system capacity and its variations by location and types of health facilities in Ethiopia. DESIGN We used the Service Provision Assessment plus (SPA+) survey data that were collected in 2014 in all hospitals and randomly selected health centers and private facilities in all regions of Ethiopia. We assessed structural, process and overall health system capacity based on the Donabedian quality of care model. Multiple linear regression and spatial analysis were done to assess TB capacity score variation across regions. SETTING The study included 873 public and private health facilities all over Ethiopia. PARTICIPANTS None. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) None. RESULTS A total of 873 health facilities were included in the analysis. The overall TB care capacity score was 76.7%, 55.9% and 37.8% in public hospitals, health centers and private facilities, respectively. The health system capacity score for TB was higher in the urban (60.4%) facilities compared to that of the rural (50.0%) facilities (β = 8.0, 95% CI: 4.4, 11.6). Health centers (β = -16.2, 95% CI: -20.0, -12.3) and private health facilities (β = -38.3, 95% CI: -42.4, -35.1) had lower TB care capacity score than hospitals. Overall TB care capacity score were lower in Western and Southwestern Ethiopia and in Benishangul-Gumuz and Gambella regions. CONCLUSIONS The health system capacity score for TB care in Ethiopia varied across regions. Health system capacity improvement interventions should focus on the private sectors and health facilities in the rural and remote areas to ensure equity and improve quality of care.
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Affiliation(s)
- Amare Deribew
- St. Paul Millennium Medical College, Addis Ababa, Ethiopia.,Nutrition International, Ethiopia
| | - Tariku Dejene
- Center for Population Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Atkure Defar
- Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Della Berhanu
- Ethiopia Public Health Institute, Addis Ababa, Ethiopia.,London School of Hygiene and Tropical Medicine, London, UK
| | - Sibhatu Biadgilign
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, USA
| | - Ephrem Tekle
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Kebede Deribe
- Wellcome Trust Brighton & Sussex Centre for Global Health Research, Brighton & Sussex Medical School, Falmer, Brighton, UK.,College of Health Science, School of Public Health, Addis Ababa University, Ethiopia
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23
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Towards improved health service quality in Tanzania: contribution of a supportive supervision approach to increased quality of primary healthcare. BMC Health Serv Res 2019; 19:848. [PMID: 31747932 PMCID: PMC6865029 DOI: 10.1186/s12913-019-4648-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 10/16/2019] [Indexed: 11/26/2022] Open
Abstract
Background Universal Health Coverage only leads to the desired health outcomes if quality of health services is ensured. In Tanzania, quality has been a major concern for many years, including the problem of ineffective and inadequate routine supportive supervision of healthcare providers by council health management teams. To address this, we developed and assessed an approach to improve quality of primary healthcare through enhanced routine supportive supervision. Methods Mixed methods were used, combining trends of quantitative quality of care measurements with qualitative data mainly collected through in-depth interviews. The former allowed for identification of drivers of quality improvements and the latter investigated the perceived contribution of the new supportive supervision approach to these improvements. Results The results showed that the new approach managed to address quality issues that could be solved either solely by the healthcare provider, or in collaboration with the council. The new approach was able to improve and maintain crucial primary healthcare quality standards across different health facility level and owner categories in various contexts. Conclusion Together with other findings reported in companion papers, we could show that the new supportive supervision approach not only served to assess quality of primary healthcare, but also to improve and maintain crucial primary healthcare quality standards. The new approach therefore presents a powerful tool to support, guide and drive quality improvement measures within council. It can thus be considered a suitable option to make routine supportive supervision more effective and adequate.
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24
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Darney BG, Kapp N, Andersen K, Baum SE, Blanchard K, Gerdts C, Montagu D, Chakraborty NM, Powell B. Definitions, measurement and indicator selection for quality of care in abortion. Contraception 2019; 100:354-359. [DOI: 10.1016/j.contraception.2019.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/09/2019] [Accepted: 07/15/2019] [Indexed: 11/25/2022]
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25
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King R, Jones L. Key factors deterring women's engagement with skilled birth attendants in three districts of Timor-Leste. A qualitative descriptive study. Midwifery 2019; 79:102555. [PMID: 31634757 DOI: 10.1016/j.midw.2019.102555] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/25/2019] [Accepted: 10/08/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To describe the barriers to women's access to maternity services in three districts of Timor-Leste. Research design/setting: Focused ethnography with data collection methods commensurate with a qualitative research design. SETTING AND PARTICIPANTS Data was collected in three districts in Timor-Leste. Participants included seventeen stakeholders, health professionals and managers providing skilled birth attendance (SBA) in Timor-Leste and thirty women who have given birth and are competent to give consent. FINDINGS Access to SBA services is seriously impeded by poor roads and lack of transportation, the poor condition and amenity of services, restricted hours of opening, the lack of availability of skilled SBA professionals and medical resources. Participants also commented upon the lack of privacy and multiple caregivers. Timorese patriarchal family structures, intergenerational decision-making and cultural attitudes towards reproductive health information and services potentially reduce women's access to reproductive health services. CONCLUSION This data provides a comprehensive record of the multiple structural barriers to women's access to SBA services. The modified AAAQA framework provides categories and an organisational structure to these barriers to SBA services. IMPLICATIONS FOR PRACTICE Maternity care in Timor-Leste is extremely poorly resourced. Midwives and other SBA will need to provide innovative low cost solutions if they are to consistently provide respectful culturally safe midwifery care. This includes the provision of privacy and a one to one midwifery relationship `with woman'. In addition, many women are unable to access SBA, where possible the MoH can consider strategies to improve the provision of SBA services to women birthing in community.
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Affiliation(s)
- Rosemary King
- Federation University, 61353279861 P.O. Box 665, Ballarat, Victoria 3353, Australia.
| | - Linda Jones
- Federation University, 1800 333 864 100 Clyde Rd, Berwick, Victoria 3806, Australia.
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26
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Moresky RT, Razzak J, Reynolds T, Wallis LA, Wachira BW, Nyirenda M, Carlo WA, Lin J, Patel S, Bhoi S, Risko N, Wendle LA, Calvello Hynes EJ. Advancing research on emergency care systems in low-income and middle-income countries: ensuring high-quality care delivery systems. BMJ Glob Health 2019; 4:e001265. [PMID: 31406599 PMCID: PMC6666806 DOI: 10.1136/bmjgh-2018-001265] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 02/07/2023] Open
Abstract
Emergency care systems (ECS) address a wide range of acute conditions, including emergent conditions from communicable diseases, non-communicable diseases, pregnancy and injury. Together, ECS represent an area of great potential for reducing morbidity and mortality in low-income and middle-income countries (LMICs). It is estimated that up to 54% of annual deaths in LMICs could be addressed by improved prehospital and facility-based emergency care. Research is needed to identify strategies for enhancing ECS to optimise prevention and treatment of conditions presenting in this context, yet significant gaps persist in defining critical research questions for ECS studies in LMICs. The Collaborative on Enhancing Emergency Care Research in LMICs seeks to promote research that improves immediate and long-term outcomes for clients and populations with emergent conditions. The objective of this paper is to describe systems approaches and research strategies for ECS in LMICs, elucidate priority research questions and methodology, and present a selection of studies addressing the operational, implementation, policy and health systems domains of health systems research as an approach to studying ECS. Finally, we briefly discuss limitations and the next steps in developing ECS-oriented interventions and research.
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Affiliation(s)
- Rachel T Moresky
- sidHARTe-Strengthening Emergency Systems Program, Columbia University Heilbrunn Department of Population and Family Health, New York, New York, USA.,Department of Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Junaid Razzak
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Teri Reynolds
- Department for Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland
| | - Lee A Wallis
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Mulinda Nyirenda
- Adult Emergency and Trauma Centre, Queen Elizabeth Central Hospital, Ministry of Health, Blantyre, Malawi.,Emergency Medicine Section, Internal Medicine Department, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Waldemar A Carlo
- Department of Pediatrics, Division of Neonatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Janet Lin
- Department of Emergency Medicine and Center for Global Health, University of Illinois at Chicago, College of Medicine, Chicago, Illinois, USA
| | - Shama Patel
- Department of Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Sanjeev Bhoi
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Nicholas Risko
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lily A Wendle
- sidHARTe-Strengthening Emergency Systems Program, Columbia University Heilbrunn Department of Population and Family Health, New York, New York, USA
| | - Emilie J Calvello Hynes
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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27
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Makowiecka K, Marchant T, Betemariam W, Chaturvedi A, Jana L, Liman A, Mathewos B, Muhammad FB, Semrau K, Wunnava SS, Sibley LM, Berhanu D, Gautham M, Umar N, Spicer N, Schellenberg J. Characterising innovations in maternal and newborn health based on a common theory of change: lessons from developing and applying a characterisation framework in Nigeria, Ethiopia and India. BMJ Glob Health 2019; 4:e001405. [PMID: 31406587 PMCID: PMC6666810 DOI: 10.1136/bmjgh-2019-001405] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/25/2019] [Accepted: 05/28/2019] [Indexed: 11/23/2022] Open
Abstract
Government leadership is key to enhancing maternal and newborn survival. In low/middle-income countries, donor support is extensive and multiple actors add complexity. For policymakers and others interested in harmonising diverse maternal and newborn health efforts, a coherent description of project components and their intended outcomes, based on a common theory of change, can be a valuable tool. We outline an approach to developing such a tool to describe the work and the intended effect of a portfolio of nine large-scale maternal and newborn health projects in north-east Nigeria, Ethiopia and Uttar Pradesh in India. Teams from these projects developed a framework, the 'characterisation framework', based on a common theory of change. They used this framework to describe their innovations and their intended outcomes. Individual project characterisations were then collated in each geography, to identify what innovations were implemented where, when and at what scale, as well as the expected health benefit of the joint efforts of all projects. Our study had some limitations. It would have been enhanced by a more detailed description and analysis of context and, by framing our work in terms of discrete innovations, we may have missed some synergistic aspects of the combination of those innovations. Our approach can be valuable for building a programme according to a commonly agreed theory of change, as well as for researchers examining the effectiveness of the combined work of a range of actors. The exercise enables policymakers and funders, both within and between countries, to enhance coordination of efforts and to inform decision-making about what to fund, when and where.
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Affiliation(s)
- Krystyna Makowiecka
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Tanya Marchant
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Wuleta Betemariam
- The Last Ten Kilometers Project, JSI Research and Training Institute, Addis Ababa, Ethiopia
| | - Anuraag Chaturvedi
- Public Health and Nutrition, Public Health Foundation of India, Gurgaon, Haryana, India
| | | | - Audu Liman
- Atiku Centre for Development, American University of Nigeria, Yola, Adamawa, Nigeria (formerly with PACT Nigeria)
| | | | | | - Katherine Semrau
- Ariadne Labs, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Global Health Equity and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sita Shankar Wunnava
- Public Health Consultant, Coimbatore, Tamilnadu, India (formerly with PATH, New Delhi)
| | | | - Della Berhanu
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Meenakshi Gautham
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Nasir Umar
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Neil Spicer
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
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Stewart S, Moholdt TT, Burrell LM, Sliwa K, Mocumbi AO, McMurray JJ, Keates AK, Hawley JA. Winter Peaks in Heart Failure: An Inevitable or Preventable Consequence of Seasonal Vulnerability? Card Fail Rev 2019; 5:83-85. [PMID: 31179017 PMCID: PMC6546000 DOI: 10.15420/cfr.2018.40.2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 03/12/2019] [Indexed: 01/03/2023] Open
Abstract
Climate change is a major contributor to annual winter peaks in cardiovascular events across the globe. However, given the paradoxical observation that cardiovascular seasonality is observed in relatively mild as well as cold climates, global warming may not be as positive for the syndrome of heart failure (HF) as some predict. In this article, we present our Model of Seasonal Flexibility to explain the spectrum of individual responses to climatic conditions. We have identified distinctive phenotypes of resilience and vulnerability to explain why winter peaks in HF occur. Moreover, we identify how better identification of climatic vulnerability and the use of multifaceted interventions focusing on modifiable bio-behavioural factors may improve HF outcomes.
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Affiliation(s)
- Simon Stewart
- Hatter Institute for Cardiovascular Research in Africa, University of Cape Town Cape Town, South Africa
| | - Trine T Moholdt
- Norwegian University of Science and Technology Trondheim, Norway
| | | | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, University of Cape Town Cape Town, South Africa.,Australian Catholic University Melbourne, Australia
| | - Ana O Mocumbi
- Mozambique Institute for Health Education and Research Maputo, Mozambique
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29
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Brizuela V, Leslie HH, Sharma J, Langer A, Tunçalp Ö. Measuring quality of care for all women and newborns: how do we know if we are doing it right? A review of facility assessment tools. LANCET GLOBAL HEALTH 2019; 7:e624-e632. [DOI: 10.1016/s2214-109x(19)30033-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 12/10/2018] [Accepted: 01/17/2019] [Indexed: 12/27/2022]
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30
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Syed SB, Leatherman S, Mensah-Abrampah N, Neilson M, Kelley E. Improving the quality of health care across the health system. Bull World Health Organ 2019; 96:799. [PMID: 30505024 PMCID: PMC6249706 DOI: 10.2471/blt.18.226266] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Shamsuzzoha B Syed
- Department of Service Delivery & Safety, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Sheila Leatherman
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, United States of America
| | - Nana Mensah-Abrampah
- Department of Service Delivery & Safety, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Matthew Neilson
- Department of Service Delivery & Safety, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Edward Kelley
- Department of Service Delivery & Safety, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
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31
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Renggli S, Mayumana I, Mboya D, Charles C, Mshana C, Kessy F, Glass TR, Pfeiffer C, Schulze A, Aerts A, Lengeler C. Towards improved health service quality in Tanzania: appropriateness of an electronic tool to assess quality of primary healthcare. BMC Health Serv Res 2019; 19:55. [PMID: 30670011 PMCID: PMC6341708 DOI: 10.1186/s12913-019-3908-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 01/15/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Progress in health service quality is vital to reach the target of Universal Health Coverage. However, in order to improve quality, it must be measured, and the assessment results must be actionable. We analyzed an electronic tool, which was developed to assess and monitor the quality of primary healthcare in Tanzania in the context of routine supportive supervision. The electronic assessment tool focused on areas in which improvements are most effective in order to suit its purpose of routinely steering improvement measures at local level. METHODS Due to the lack of standards regarding how to best measure quality of care, we used a range of different quantitative and qualitative methods to investigate the appropriateness of the quality assessment tool. The quantitative methods included descriptive statistics, linear regression models, and factor analysis; the qualitative methods in-depth interviews and observations. RESULTS Quantitative and qualitative results were overlapping and consistent. Robustness checks confirmed the tool's ability to assign scores to health facilities and revealed the usefulness of grouping indicators into different quality dimensions. Focusing the quality assessment on processes and structural adequacy of healthcare was an appropriate approach for the assessment's intended purpose, and a unique key feature of the electronic assessment tool. The findings underpinned the accuracy of the assessment tool to measure and monitor quality of primary healthcare for the purpose of routinely steering improvement measures at local level. This was true for different level and owner categories of primary healthcare facilities in Tanzania. CONCLUSION The electronic assessment tool demonstrated a feasible option for routine quality measures of primary healthcare in Tanzania. The findings, combined with the more operational results of companion papers, created a solid foundation for an approach that could lastingly improve services for patients attending primary healthcare. However, the results also revealed that the use of the electronic assessment tool outside its intended purpose, for example for performance-based payment schemes, accreditation and other systematic evaluations of healthcare quality, should be considered carefully because of the risk of bias, adverse effects and corruption.
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Affiliation(s)
- Sabine Renggli
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, 4002 Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Iddy Mayumana
- Ifakara Health Institute, Dar es Salaam/Ifakara, United Republic of Tanzania
| | - Dominick Mboya
- Ifakara Health Institute, Dar es Salaam/Ifakara, United Republic of Tanzania
| | - Christopher Charles
- Ifakara Health Institute, Dar es Salaam/Ifakara, United Republic of Tanzania
| | - Christopher Mshana
- Ifakara Health Institute, Dar es Salaam/Ifakara, United Republic of Tanzania
| | - Flora Kessy
- Ifakara Health Institute, Dar es Salaam/Ifakara, United Republic of Tanzania
| | - Tracy R. Glass
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, 4002 Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Constanze Pfeiffer
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, 4002 Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Ann Aerts
- Novartis Foundation, Basel, Switzerland
| | - Christian Lengeler
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, 4002 Basel, Switzerland
- University of Basel, Basel, Switzerland
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32
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Ramaswamy G, Chinnakali P, Selvaraju S, Nair D, Thekkur P, Selvaraj K, Shivashankar R, Singh AR, Vrushabhendra HN. High prevalence of prediabetes among the family members of individuals with diabetes. Findings from targeted screening program from south India. Diabetes Metab Syndr 2019; 13:866-872. [PMID: 30641823 DOI: 10.1016/j.dsx.2018.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 12/07/2018] [Indexed: 11/29/2022]
Abstract
AIM We aimed to screen for prediabetes, diabetes and other cardiovascular risk factors among family members of people with diabetes registered for care in a primary health centre in South India. METHODS During 2017-2018, we screened eligible family members of individuals with diabetes at their homes. We measured fasting capillary blood glucose (FCBG); for those with FCBG≥126 mg/dl, we confirmed the diagnosis of diabetes with fasting plasma glucose (FPG). We defined prediabetes as FCBG between 100 and 125 mg/dl; diabetes as both FCBG and FPG ≥126 mg/dl. We assessed non-communicable disease risk factors using WHO STEPS questionnaire. RESULTS Of total 884 participants, 873 (99%) underwent screening; 280 (32%) had prediabetes, and 19 (2.2%) were confirmed with diabetes. Of newly diagnosed, 17 (90%) were initiated on treatment. Of 873 participants, 180 (20.6%) were newly diagnosed with hypertension. Of the total, 7.3%, 5.2% and 16% reported tobacco use, alcohol use and high salt intake respectively. Nearly half (48%) had overweight. CONCLUSION Though the yield for diabetes is modest (3%), the house to house approach was able to screen 99% of eligible population. High prevalence of prediabetes and undiagnosed hypertension emphasize the need for screening and life style modifications.
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Affiliation(s)
- Gomathi Ramaswamy
- M.D. Community Medicine, Assistant Professor, Department of Community Medicine, Sri Venkateshwaraa Medical College Hospital and Research Center (SVMCH&RC), (Current Position: Research Officer, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, Puducherry, India.
| | - Palanivel Chinnakali
- M.D. Community Medicine, Associate Professor, Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
| | - Sriram Selvaraju
- MPH, Scientist C, National Institute for Research in Tuberculosis, Chennai, India.
| | - Divya Nair
- M.D. Community Medicine, Program Officer, The INCLEN Trust International, New Delhi, India.
| | - Pruthu Thekkur
- M.D. Community Medicine, Monitoring and Evaluation Officer, The Union, South East Asia Office, New Delhi, India.
| | - Kalaiselvi Selvaraj
- M.D. Community Medicine, Assistant Professor, Department of Community Medicine, Pondicherry Institute of Medical Sciences (PIMS), Puducherry, India.
| | - Roopa Shivashankar
- M.D. Community Medicine, Centre for Chronic Disease Control, New Delhi, India.
| | - Akash Ranjan Singh
- M.D. Community Medicine, Senior Resident, Department of Community Medicine, All India Institute of Medical Sciences, Bhopal, India.
| | - Halevoor Nanjundappa Vrushabhendra
- M.D. Community Medicine, Assistant Professor, Department of Community Medicine, Sri Venkateshwaraa Medical College Hospital and Research Center (SVMCH&RC), (Current Position: Research Officer, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, Puducherry, India.
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Mishra V, Samuel C, Sharma SK. Patient’s Utility for Various Attributes of Diabetes Care Services. IIM KOZHIKODE SOCIETY & MANAGEMENT REVIEW 2019. [DOI: 10.1177/2277975218798134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Diabetes is rising like an epidemic in India. The prevalence of diabetes in India has reached an alarming level of 72.95 millions. The purpose of this article is to assess the relative importance of various health care service attributes in diabetes care. Our study uses secondary research and focus group discussion to identify the attributes of a diabetes specialty clinic. The attributes included in the questionnaire were the quality of the care provide by the health care givers, spend per visit, hospitalization expense, waiting time and the distance to the hospital. Conjoint analysis was used to assess the relative importance of the attributes. It was found that the hospital’s quality was the most important attribute while the distance to the hospital was the attribute with the least importance. Although the quality of the hospital is the most important criterion in selecting a hospital in diabetes care, factors like waiting time, spend per visit, and hospitalization expense play an important role in the selection. We assess the relative importance of these factors for the diabetic patients in India. The study is first of its kind and could help policy makers in designing better health care services in diabetes care.
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Affiliation(s)
| | | | - S. K. Sharma
- Indian Institute of Technology (BHU), Varanasi, India
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Kuper H, Mactaggart I, Dionicio C, Cañas R, Naber J, Polack S. Can we achieve universal health coverage without a focus on disability? Results from a national case-control study in Guatemala. PLoS One 2018; 13:e0209774. [PMID: 30589885 PMCID: PMC6307777 DOI: 10.1371/journal.pone.0209774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 12/11/2018] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To compare access to healthcare services for people with disabilities to those without disabilities, within a national case-control study in Guatemala. METHODS We undertook a population-based case-control study, nested within a national survey in Guatemala. Cases with disabilities were people with self-reported difficulties in functioning. One control without disabilities was selected per case, matched by age, gender and cluster. Information was collected on: health status, access to health services and rehabilitation, and socioeconomic status. RESULTS The study included 707 people with disabilities, and 465 controls. People with disabilities were more likely to report a serious health problem (aOR 2.8, 2.2-3.7) or doctor-diagnosis of one of 17 general health conditions (aOR 2.9, 2.2-3.8) as compared to controls without disabilities. People with disabilities were twice as likely as controls to have received treatment for a diagnosed condition (aOR 2.2, 1.7-2.8). Coverage of treatment for impairment-related health conditions was low, as was awareness and access to rehabilitation services. People with disabilities were more likely than controls to report being disrespected (aOR 1.9, 1.0-3.7) or finding it difficult to understand information given (aOR 1.6, 1.1-1.4). CONCLUSION Efforts are needed to raise awareness about rehabilitation services and improve quality of health services for people with disabilities in Guatemala, to ensure that their rights are fulfilled and to assist in the achievement of Universal Health Coverage. Better tools are needed to measure healthcare access, including consideration of geographic access, quality and affordability, to allow the generation of comparable data on access to healthcare among people with disabilities.
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Affiliation(s)
- Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Islay Mactaggart
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Rafael Cañas
- National Council on Disability, Guatemala City, Guatemala
| | - Jonathan Naber
- National Council on Disability, Guatemala City, Guatemala
| | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Geldsetzer P, Haakenstad A, James EK, Atun R. Non-technical health care quality and health system responsiveness in middle-income countries: a cross-sectional study in China, Ghana, India, Mexico, Russia, and South Africa. J Glob Health 2018; 8:020417. [PMID: 30356805 PMCID: PMC6189548 DOI: 10.7189/jogh.08.020417] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND While there is increasing recognition that the non-technical aspects of health care quality - particularly the inter-personal dimensions of care - are important components of health system performance, evidence from population-based studies on these outcomes in low- and middle-income countries is sparse. This study assesses these non-technical aspects of care using two measures: health system responsiveness (HSR), which quantifies the degree to which the health system meets the expectations of the population, and non-technical health care quality (QoC), for which we 'filtered out' these expectations. Pooling data from six large middle-income countries, this study therefore aimed to determine how HSR and QoC vary between countries and by individuals' sociodemographic characteristics within countries. METHODS We pooled individual-level data, collected between 2007 and 2010, from nationally representative household surveys of (primarily) adults aged 50 years and older in China, Ghana, India, Mexico, Russia, and South Africa. The outcome measure was a binary indicator for a 'bad' rating (HSR: "very bad" or "bad" on a five-point Likert scale; QoC: a worse rating of one's own visit than that of the character in an anchoring vignette) on at least one of seven dimensions for the most recent primary care visit. RESULTS 23 749 adults who reported to have sought primary care during the preceding 12 months were includedin the analysis. The proportion of participants who gave a bad rating for their last primary care visit on at least one of seven dimensions varied from 4.3% (95% confidence interval (CI) = 2.8-6.7) in China to 33.1% (95% CI = 23.6-44.2) in South Africa for HSR, and from 17.0% (95% CI = 11.4-24.5) in Russia to 50.8% (95% CI = 46.0-55.6) in Ghana for QoC. There was a strong negative association between increasing household wealth and both bad HSR and QoC in India and South Africa. CONCLUSIONS Achieving universal health coverage (UHC) with good-quality health services ("effective UHC") will require efforts to improve HSR and QoC across the population in Ghana and South Africa. Additionally, a particular focus on raising HSR and QoC for the poorest population groups is needed in India and South Africa.
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Affiliation(s)
- Pascal Geldsetzer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Annie Haakenstad
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Erin Kinsella James
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Gergen J, Josephson E, Vernon C, Ski S, Riese S, Bauhoff S, Madhavan S. Measuring and paying for quality of care in performance-based financing: Experience from seven low and middle-income countries (Democratic Republic of Congo, Kyrgyzstan, Malawi, Mozambique, Nigeria, Senegal and Zambia). J Glob Health 2018; 8:021003. [PMID: 30574295 PMCID: PMC6286672 DOI: 10.7189/jogh.08.021003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Performance-based financing (PBF) both measures and determines payments based on the quality of care delivered and is emerging as a potential tool to improve quality. METHODS Comparative case study methodology was used to analyze common challenges and lessons learned in quality of care across seven PBF programs (Democratic Republic of Congo, Kyrgyzstan, Malawi, Mozambique, Nigeria, Senegal and Zambia). The eight case studies, across seven PBF programs, compared were commissioned by the USAID-funded Translating Research into Action (TRAction) project (n = 4), USAID's Health Finance and Government project (n = 3), and from the Global Delivery Initiative (n = 1). RESULTS The programs show similar design features to assess quality, but significant heterogeneity in their application. The seven programs included 18 unique quality checklists, containing over 1400 quality of care indicators, with an average per checklist of 116 indicators (ranging from 26-228). The quality checklists share a focus on structural components of quality (representing 80% of indicators on average, ranging from 38%-91%). Process indicators constituted an average of 20% across all checklists (ranging from 8.4% to 61.5%), with the majority measuring the correct application of care protocols for MCH services including child immunization. The sample included only one example of an outcome indicator from Kyrgyzstan. Performance data demonstrated a modest upward improvement over time in checklist scores across schemes, however, achievements plateaued at 60%-70%, with small or rural clinics reporting difficulty achieving payment thresholds due to limited resources and poor infrastructure. Payment allocations (distribution) and thresholds (for payments), data transparency, and approaches to measuring (verification) of quality differ across schemes. CONCLUSIONS Similarities exist in the processes that govern the design of PBF mechanisms, yet substantial heterogeneity in the experiences of implementing quality of care components in PBF programs are evident. This comparison suggests tailoring further the quality component of PBF programs to local and country contexts, and a need to better understand how quality is measured in practice. The growing operational experiences with PBF programs in different settings offer opportunities to learn from best practices, improve ongoing and future programs, and inform research to alleviate current challenges.
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Affiliation(s)
| | | | | | - Samantha Ski
- University Research Co., LLC (URC), Chevy Chase, Maryland, USA
| | - Sara Riese
- University Research Co., LLC (URC), Chevy Chase, Maryland, USA
| | | | - Supriya Madhavan
- United States Agency for International Development (USAID), Washington, D.C., USA
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Exley JL, Umar N, Moxon S, Usman AU, Marchant T. Newborn resuscitation in Gombe State, northeastern Nigeria. J Glob Health 2018; 8:020420. [PMID: 30410739 PMCID: PMC6207101 DOI: 10.7189/jogh.08.020420] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background Basic newborn resuscitation for babies not breathing at birth is a highly effective intervention and its scale-up identified as a top research priority. However, tracking progress on the scale-up and coverage of this intervention is compromised by limitations in measuring both the number of newborns receiving the intervention and the number of newborns requiring the intervention. Using data from a facility and birth attendant survey in Gombe State, Nigeria, we aimed to advance the measurement agenda by developing a proxy indicator defined as the "percent of newborns born in a facility with the potential to provide newborn resuscitation". Methods The indicator's denominator was defined as: the total number of births in facilities during a defined time period (facility records). The numerator was constructed from the number of those births that occurred in appropriately equipped facilities (facility inventory), where a birth attendant demonstrated basic resuscitation competence (assessed by a simulation exercise). The proportion of facility-births that took place in a setting with the potential to provide newborn resuscitation was then calculated. Results The analysis included 17 383 births that occurred during May-October 2015 in 117 primary and referral facilities surveyed in November 2015. Overall 81% of the facilities did not have all items of essential equipment required for resuscitation; the items of equipment least frequently present included a timing device and resuscitation bag with two sizes of neonatal face mask. Only 3% of 117 birth attendants interviewed demonstrated competence to undertake resuscitation, all of whom were classified as skilled attendants and worked in referral facilities. We found that 20% of the 17 383 births took place in a facility with the potential to provide lifesaving resuscitation care. Conclusions The indicator definition of neonatal resuscitation presented here responds to the need to advance the measurement agenda for newborn care and importantly adjusts for the volume of births occurring in different facilities. Its application in this setting revealed substantial missed opportunities to providing lifesaving care and highlights the need for a greater focus on input as well as process quality in all levels of health facilities.
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Affiliation(s)
- Josephine Lr Exley
- Centre for Evaluation and Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medical, London, UK
| | - Nasir Umar
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre and Department for Disease Control, London School of Hygiene & Tropical Medical, London, UK
| | - Sarah Moxon
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medical, London, UK
| | | | - Tanya Marchant
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre and Department for Disease Control, London School of Hygiene & Tropical Medical, London, UK
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Sheffel A, Karp C, Creanga AA. Use of Service Provision Assessments and Service Availability and Readiness Assessments for monitoring quality of maternal and newborn health services in low-income and middle-income countries. BMJ Glob Health 2018; 3:e001011. [PMID: 30555726 PMCID: PMC6267320 DOI: 10.1136/bmjgh-2018-001011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/15/2018] [Accepted: 09/07/2018] [Indexed: 12/03/2022] Open
Abstract
Improving the quality of maternal and newborn health (MNH) services is key to reducing adverse MNH outcomes in low-income and middle-income countries (LMICs). The Service Provision Assessment (SPA) and Service Availability and Readiness Assessment (SARA) are the most widely employed, standardised tools that generate health service delivery data in LMICs. We ascertained the use of SPA/SARA surveys for assessing the quality of MNH services using a two-step approach: a SPA/SARA questionnaire mapping exercise in line with WHO's Quality of Care (QoC) Framework for pregnant women and newborns and the WHO quality standards for care around the time of childbirth; and a scoping literature review, searching for articles that report SPA/SARA data. SPA/SARA surveys are well suited to assess the WHO Framework's cross-cutting dimensions (physical and human resources); SPA also captures elements in the provision and experience of care domains for antenatal care and family planning. Only 4 of 31 proposed WHO quality indicators around the time of childbirth can be fully generated using SPA and SARA surveys, while 19 and 23 quality indicators can be partially obtained from SARA and SPA surveys, respectively; most of these are input indicators. Use of SPA/SARA data is growing, but there is considerable variation in methods employed to measure MNH QoC. With SPA/SARA data available in 30 countries, MNH QoC assessments could benefit from guidance for creating standard metrics. Adding questions in SPA/SARA surveys to assess the WHO QoC Framework's provision and experience of care dimensions would fill significant data gaps in LMICs.
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Affiliation(s)
- Ashley Sheffel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Celia Karp
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andreea A Creanga
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Moller AB, Newby H, Hanson C, Morgan A, El Arifeen S, Chou D, Diaz T, Say L, Askew I, Moran AC. Measures matter: A scoping review of maternal and newborn indicators. PLoS One 2018; 13:e0204763. [PMID: 30300361 PMCID: PMC6177145 DOI: 10.1371/journal.pone.0204763] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/13/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A variety of global-level monitoring initiatives have recommended indicators for tracking progress in maternal and newborn health. As a first step supporting the work of WHO's Mother and Newborn Information for Tracking Outcomes and Results (MoNITOR) Technical Advisory Group, we aimed to compile and synthesize recommended indicators in order to document the landscape of maternal and newborn measurement and monitoring. METHODS We conducted a scoping review of indicators proposed by global multi-stakeholder groups to suggest next steps to further support maternal and newborn measurement and monitoring. Indicators pertaining to pregnancy, childbirth, and postpartum/postnatal and newborn care were extracted and included in the indicator compilation, together with key indicator metadata. We examined patterns and relationships across the compiled indicators. RESULTS We identified 140 indicators linked to maternal and newborn health topics across the continuum of service provision. Fifty-five indicators relate to inputs and processes, 30 indicators relate to outputs, outcomes comprise 37 indicators in the database, and 18 impact indicators. A quarter of indicators proposed by global groups is either under development/discussion or is considered "aspirational", highlighting the currently evolving monitoring landscape. Although considerable efforts have been made to harmonize indicator recommendations, there are still relatively few indicators shared across key monitoring initiatives and some of those that are shared may have definitional variation. CONCLUSION Rapid, wide-ranging work by a number of multi-stakeholder groups has resulted in a substantial number of indicators, many of which partially overlap and many are not supported with adequate documentation or guidance. The volume of indicators, coupled with the number of initiatives promoting different indicator lists, highlight the need for strengthened coordination and technical leadership to harmonize recommendations for improved measurement and monitoring of data related to maternal and newborn heath.
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Affiliation(s)
- Ann-Beth Moller
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
- * E-mail:
| | | | - Claudia Hanson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Alison Morgan
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Doris Chou
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Theresa Diaz
- Department of Maternal, Newborn, Child and Adolescent Health World Health Organization, Geneva, Switzerland
| | - Lale Say
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ian Askew
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Allisyn C. Moran
- Department of Maternal, Newborn, Child and Adolescent Health World Health Organization, Geneva, Switzerland
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Topp SM, Sheikh K. Are We Asking All the Right Questions About Quality of Care in Low- and Middle-Income Countries? Int J Health Policy Manag 2018; 7:971-972. [PMID: 30316253 PMCID: PMC6186461 DOI: 10.15171/ijhpm.2018.48] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/15/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
- Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia.,Public Health Foundation of India, New Delhi, India
| | - Kabir Sheikh
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia.,Public Health Foundation of India, New Delhi, India
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Koulidiati JL, De Allegri M, Souares A, Ouedraogo S, Hien H, Robyn PJ, Brenner S. Factors associated with effective coverage of child health services in Burkina Faso. Trop Med Int Health 2018; 23:1188-1199. [DOI: 10.1111/tmi.13140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | - Aurelia Souares
- Institute of Public Health; Heidelberg University; Heidelberg Germany
| | | | - Hervé Hien
- Centre Muraz; Bobo-Dioulasso Burkina Faso
- Institut de recherche en science de la santé; Bobo-Dioulasso Burkina Faso
| | | | - Stephan Brenner
- Institute of Public Health; Heidelberg University; Heidelberg Germany
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Allen E, Schellenberg J, Berhanu D, Cousens S, Marchant T. Associations between increased intervention coverage for mothers and newborns and the number and quality of contacts between families and health workers: An analysis of cluster level repeat cross sectional survey data in Ethiopia. PLoS One 2018; 13:e0199937. [PMID: 30071026 PMCID: PMC6071969 DOI: 10.1371/journal.pone.0199937] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/15/2018] [Indexed: 11/25/2022] Open
Abstract
Background Survival of mothers and newborns depends on life-saving interventions reaching those in need. Recent evidence suggests that indicators of contact with health services are poor proxies for measures of coverage of life saving care and attention has shifted towards the quality of care provided during contacts. Methods and findings Regression analysis using data from representative cluster-based household surveys and surveys of the frontline health workers and primary health facilities in four regions of Ethiopia in 2012 and 2015 was used to explore associations between increased numbers of contacts or improvements in quality and any change in the coverage of interventions (intervention coverage). In pregnancy, in multiple regression, an increase in the quality indicator ‘focused ANC behaviours’ was associated with a change in both the coverage of iron supplementation and syphilis prevention ((regression coefficients (95% CI)) 0·06 (0·01, 0·11); 0·07 (0·04, 0·10)). This equates to a 0.6% increase in the proportion of women taking iron supplementation and a 0.7% in women receiving syphilis prevention for a 10% increase in the quality indicator ‘focused ANC behaviours’. At delivery, in multiple regression the quality indicator ‘availability of uterotonic supplies amongst birth attendants’ was associated with improved coverage of prophylactic uterotonics (0·72 (0·50, 0·94)). No evidence of any relationships between contacts, quality and intervention coverage were observed within the early postnatal period. Conclusions Increases in both contacts and in quality of care are needed to increase the coverage of life saving interventions. For interventions that need to be delivered at multiple visits, such as antenatal vaccination, increasing the number of contacts had the strongest association with coverage. For those relying on a single point of contact, such as those delivered at birth, we found strong evidence to support current commitments to invest in both input and process quality.
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Affiliation(s)
- Elizabeth Allen
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | | | - Della Berhanu
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Simon Cousens
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tanya Marchant
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016. Lancet 2018; 391:2236-2271. [PMID: 29893224 PMCID: PMC5986687 DOI: 10.1016/s0140-6736(18)30994-2] [Citation(s) in RCA: 512] [Impact Index Per Article: 85.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/23/2018] [Accepted: 04/18/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. METHODS Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. FINDINGS In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8-98·1) in Iceland, followed by 96·6 (94·9-97·9) in Norway and 96·1 (94·5-97·3) in the Netherlands, to values as low as 18·6 (13·1-24·4) in the Central African Republic, 19·0 (14·3-23·7) in Somalia, and 23·4 (20·2-26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1-93·6) in Beijing to 48·0 (43·4-53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6-68·8) in Goa to 34·0 (30·3-38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. INTERPRETATION GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations. FUNDING Bill & Melinda Gates Foundation.
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Doubova SV, Pérez-Cuevas R. Going further to measure improvements in health-care access and quality. Lancet 2018; 391:2190-2192. [PMID: 29803588 DOI: 10.1016/s0140-6736(18)30987-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 04/23/2018] [Indexed: 10/16/2022]
Affiliation(s)
- Svetlana V Doubova
- Epidemiology and Health Services Research Unit, CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico 06725.
| | - Ricardo Pérez-Cuevas
- Health System Research Center, National Institute of Public Health, Cuernavaca City, Mexico
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Murphy GAV, Gathara D, Abuya N, Mwachiro J, Ochola S, Ayisi R, English M. What capacity exists to provide essential inpatient care to small and sick newborns in a high mortality urban setting? - A cross-sectional study in Nairobi City County, Kenya. PLoS One 2018; 13:e0196585. [PMID: 29702700 PMCID: PMC5922525 DOI: 10.1371/journal.pone.0196585] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 04/16/2018] [Indexed: 01/25/2023] Open
Abstract
Introduction Appropriate demand for, and supply of, high quality essential neonatal care is key to improving newborn survival but evaluating such provision has received limited attention in low- and middle-income countries. Moreover, specific local data are needed to support healthcare planning for this vulnerable population. Methods We conducted health facility assessments between July 2015-April 2016, with retrospective review of admission events between 1st July 2014 and 30th June 2015, and used estimates of population-based incidence of neonatal conditions in Nairobi to explore access and evaluate readiness of public, private not-for-profit (mission), and private-for-profit (private) sector facilities providing 24/7 inpatient neonatal care in Nairobi City County. Results In total, 33 (4 public, 6 mission, and 23 private) facilities providing 24/7 inpatient neonatal care in Nairobi City County were identified, 31 were studied in detail. Four public sector facilities, including the only three facilities in which services were free, accounted for 71% (8,630/12,202) of all neonatal admissions. Large facilities (>900 annual admissions) with adequate infrastructure tended to have high bed occupancy (over 100% in two facilities), high mortality (15%), and high patient to nurse ratios (7–15 patients per nurse). Twenty-one smaller, predominantly private, facilities were judged insufficiently resourced to provide adequate care. In many of these, nurses provided newborn and maternity care simultaneously using resources shared across settings, newborn care experience was likely to be limited (<50 cases per year), there was often no resident clinician, and sick babies were often referred onwards. Results suggest 44% (9,764/21,966) of Nairobi’s small and sick newborns may not access any of the identified facilities and a further 9% (2,026/21,966) access facilities judged to be inadequately equipped. Conclusion Over 50% of Nairobi’s sick newborns may not access a facility with adequate resources to provide essential care. A very high proportion of care accessed is provided by four public and one low cost mission facility; these face major challenges of high patient acuity (high mortality), high patient to nurse ratios, and often overcrowding. Reducing high neonatal mortality in this urban, predominantly poor, population will require effective long-term, multi-sectoral planning and investment.
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Affiliation(s)
- Georgina A V Murphy
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - David Gathara
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Nancy Abuya
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya.,Nairobi City County Government, Nairobi, Kenya
| | - Jacintah Mwachiro
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Sam Ochola
- Nairobi City County Government, Nairobi, Kenya
| | | | - Mike English
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
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Krzyżaniak N, Pawłowska I, Bajorek B. Quality pharmacy services and key performance indicators in Polish NICUs: a Delphi approach. Int J Clin Pharm 2018; 40:533-542. [PMID: 29605949 DOI: 10.1007/s11096-018-0623-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/15/2018] [Indexed: 01/12/2023]
Abstract
Background Currently, there is no literature describing what a quality level of practice entails in Polish neonatal intensive care units (NICUs), nor are there any means of currently measuring the quality of pharmaceutical care provided to NICU patients. Objective To identify a set of essential pharmacist roles and pharmacy-relevant key performance indicators (KPI's) suitable for Polish neonatal intensive units (NICUs). Setting Polish hospital pharmacies and NICUs. Method Using a modified Delphi technique, potential KPI's structured along Donabedian's domains as well as pharmacy services were presented to an expert panel of stakeholders. Two online, consecutive Delphi rounds, were completed by panellists between August and September 2017. Main outcome measure To identify the minimum level of pharmacy services that should be consistently provided to NICU patients. Results A total of 16 panellists contributed to the expert panel. Overall, consensus of 75% was reached for 23 indicators and for 28 roles. When considering pharmacy services for the NICU, the experts were found to highly value traditional pharmacy roles, such as dispensing and extemporaneous compounding, however, they were still eager for roles in the other domains, such as educational and clinical services, to be listed as essential for NICU practice. Panellists were found to positively value the list of indicators presented, and excluded only 9 out of the total list. Conclusion There is a need for future research to establish a minimum standard of practice for Polish pharmacists to encourage the progression and standardisation of hospital pharmacy services to meet the level of practice seen in NICUs worldwide.
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Affiliation(s)
- Natalia Krzyżaniak
- Graduate School of Health (Pharmacy), University of Technology Sydney, PO Box 123, Broadway, Ultimo, NSW, 2007, Australia.
| | - Iga Pawłowska
- Department of Pharmacology, Medical University of Gdansk, Dębowa Str. 23, 80-204, Gdańsk, Poland
| | - Beata Bajorek
- Graduate School of Health (Pharmacy), University of Technology Sydney, PO Box 123, Broadway, Ultimo, NSW, 2007, Australia
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Sarkar NDP, Bunders-Aelen J, Criel B. The complex challenge of providing patient-centred perinatal healthcare in rural Uganda: A qualitative enquiry. Soc Sci Med 2018; 205:82-89. [PMID: 29674017 DOI: 10.1016/j.socscimed.2018.03.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 03/07/2018] [Accepted: 03/16/2018] [Indexed: 11/28/2022]
Abstract
RATIONALE Increasing research and reflections on quality of healthcare across the perinatal period slowly propels the global community to lobby for improved standards of quality perinatal healthcare, especially in low- and middle-income countries. OBJECTIVE The purpose of this qualitative study was to obtain a deeper understanding of how interpersonal dimensions of the quality of care relate to real-life experiences of perinatal care, in a resource-constrained local health system. METHODS In total, 41 in-depth interviews and five focus group discussions (N = 34) were conducted with perinatal women and local health system health professionals living and working in rural Uganda. Data analysis used an emergent and partially inductive, thematic framework based on the grounded theory approach. RESULTS The results indicated that interpersonal aspects of quality of perinatal care and service delivery are largely lacking in this low-resource setting. Thematic analysis showed three interrelated process aspects of quality of perinatal care: negative reported patient-provider interactions, the perceptions shaping patient-provider interactions, and emergent consequences arising out of these processes of care. Further reflections expose the central, yet often-unheeded, role of perinatal women's agency in their own health seeking behaviours and overall well-being, as well as that of underlying practical norms surrounding health worker attitudes and behaviours. CONCLUSION These findings highlight the complexity of patient-centred perinatal healthcare provision in rural Uganda and point to the relevance of linking the interpersonal dimensions of quality of care to the larger systemic and structural dimensions of perinatal healthcare.
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Affiliation(s)
- Nandini D P Sarkar
- Equity and Health Unit, Department of Public Health, Institute of Tropical Medicine at Antwerp, Belgium; Athena Institute, Faculty of Earth and Life Sciences, Vrije Universiteit Amsterdam, The Netherlands; ISGlobal, University of Barcelona, Spain.
| | - Joske Bunders-Aelen
- Athena Institute, Faculty of Earth and Life Sciences, Vrije Universiteit Amsterdam, The Netherlands
| | - Bart Criel
- Equity and Health Unit, Department of Public Health, Institute of Tropical Medicine at Antwerp, Belgium
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Adeniran A, Likaka A, Knutsson A, Costello A, Daelmans B, Maliqi B, Burssa D, Freer J, Askew I, Bowen L, Kak L, McDougall L, Zaka N, Tunçalp Ö, Tenhoope-Bender P, Syed SB, Peterson SS, Luchesi T, Zeck W, Were W, Barker P, Naimy Z. Leadership, action, learning and accountability to deliver quality care for women, newborns and children. Bull World Health Organ 2018. [PMID: 29531422 PMCID: PMC5840625 DOI: 10.2471/blt.17.197939] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Abosede Adeniran
- Child Health Division, Federal Ministry of Health, Abuja, Nigeria
| | | | - Anneka Knutsson
- United Nations Population Fund, New York, United Sates of America (USA)
| | - Anthony Costello
- Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Bernadette Daelmans
- Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Blerta Maliqi
- Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | | | - Joseph Freer
- Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Ian Askew
- Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | | | - Lily Kak
- United States Agency for International Development, Washington DC, USA
| | - Lori McDougall
- The Partnership for Maternal, Newborn & Child Health, World Health Organization, Geneva, Switzerland
| | - Nabila Zaka
- United Nations Children's Fund, New York, USA
| | - Özge Tunçalp
- Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | | | - Shamsuzzoha Babar Syed
- Department of Service Delivery and Safety, World Health Organization, Geneva, Switzerland
| | | | | | | | - Wilson Were
- Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Pierre Barker
- Institute for Healthcare Improvement, Cambridge, USA
| | - Zainab Naimy
- Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
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Colbourn T. Achieving progress for mothers, babies, and children in Kenya. LANCET GLOBAL HEALTH 2017; 5:e732-e733. [PMID: 28716340 DOI: 10.1016/s2214-109x(17)30261-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 06/28/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Tim Colbourn
- University College London (UCL) Institute for Global Health, UCL, London, WC1N 1EH, UK.
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