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Khan N, Gilliar W, Bamrah JS, Dave S. Post-COVID-19: can digital solutions lead to a more equitable global healthcare workforce? BJPsych Int 2023; 20:18-23. [PMID: 36812032 PMCID: PMC9909439 DOI: 10.1192/bji.2022.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 04/07/2022] [Indexed: 11/23/2022] Open
Abstract
An unintended consequence of the COVID-19 pandemic has been the exponential growth of telemedicine, with automation of healthcare becoming more common. Face-to-face meetings and training events have been replaced relatively seamlessly with online versions, taking clinical or academic expertise to distant parts of the world and making them more accessible and affordable. The wide reach of digital platforms offering remote healthcare offers the opportunity of democratising access to high-quality healthcare, However, certain challenges remain: (a) clinical guidance developed in one geographical area may need adaptation for use in others; (b) regulatory mechanisms from one jurisdiction need to offer patient safety across other jurisdictions; (c) barriers created by disparity in technology infrastructure and the variation in pay for services across different economies, leading to brain drain and an inequitable workforce. The World Health Organization's Global Code of Practice on the International Recruitment of Health Personnel could offer the preliminary framework on which solutions to these challenges could be built.
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Affiliation(s)
- Nagina Khan
- BHSc, PGCert, PhD, Senior Research Associate, College of Osteopathic Medicine, Touro University Nevada, Henderson, Nevada, USA.
| | - Wolfgang Gilliar
- DO, FAAPMR, Dean, College of Osteopathic Medicine, Touro University Nevada, Henderson, Nevada, USA
| | - J. S. Bamrah
- FRCPSYCH, MHSM, FIIOPM, Consultant Psychiatrist, Greater Manchester Mental Health NHS Foundation Trust, Park House, North Manchester General Hospital, UK
| | - Subodh Dave
- FRCPsych, MMed, Consultant Psychiatrist and Deputy Director of Undergraduate Medical Education, Derbyshire Healthcare Foundation Trust, University of Bolton, UK.
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Aboelkhir HAB, Elomri A, ElMekkawy TY, Kerbache L, Elakkad MS, Al-Ansari A, Aboumarzouk OM, El Omri A. A Bibliometric Analysis and Visualization of Decision Support Systems for Healthcare Referral Strategies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16952. [PMID: 36554837 PMCID: PMC9778793 DOI: 10.3390/ijerph192416952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/24/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The referral process is an important research focus because of the potential consequences of delays, especially for patients with serious medical conditions that need immediate care, such as those with metastatic cancer. Thus, a systematic literature review of recent and influential manuscripts is critical to understanding the current methods and future directions in order to improve the referral process. METHODS A hybrid bibliometric-structured review was conducted using both quantitative and qualitative methodologies. Searches were conducted of three databases, Web of Science, Scopus, and PubMed, in addition to the references from the eligible papers. The papers were considered to be eligible if they were relevant English articles or reviews that were published from January 2010 to June 2021. The searches were conducted using three groups of keywords, and bibliometric analysis was performed, followed by content analysis. RESULTS A total of 163 papers that were published in impactful journals between January 2010 and June 2021 were selected. These papers were then reviewed, analyzed, and categorized as follows: descriptive analysis (n = 77), cause and effect (n = 12), interventions (n = 50), and quality management (n = 24). Six future research directions were identified. CONCLUSIONS Minimal attention was given to the study of the primary referral of blood cancer cases versus those with solid cancer types, which is a gap that future studies should address. More research is needed in order to optimize the referral process, specifically for suspected hematological cancer patients.
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Affiliation(s)
| | - Adel Elomri
- College of Science and Engineering, Hamad Bin Khalifa University, Doha 34110, Qatar
| | - Tarek Y. ElMekkawy
- Department of Mechanical and Industrial Engineering, College of Engineering, Qatar University, Doha 2713, Qatar
| | - Laoucine Kerbache
- College of Science and Engineering, Hamad Bin Khalifa University, Doha 34110, Qatar
| | - Mohamed S. Elakkad
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Abdulla Al-Ansari
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Omar M. Aboumarzouk
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
- College of Medicine, QU-Health, Qatar University, Doha 2713, Qatar
- School of Medicine, Dentistry and Nursing, The University of Glasgow, Glasgow G12 8QQ, UK
| | - Abdelfatteh El Omri
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
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Teklu AM, Litch JA, Tesfahun A, Wolka E, Tuamay BD, Gidey H, Cheru WA, Senturia K, Gezahegn W. Referral systems for preterm, low birth weight, and sick newborns in Ethiopia: a qualitative assessment. BMC Pediatr 2020; 20:409. [PMID: 32861246 PMCID: PMC7456368 DOI: 10.1186/s12887-020-02311-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 08/21/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND A responsive and well-functioning newborn referral system is a cornerstone to the continuum of child health care; however, health system and client-related barriers negatively impact the referral system. Due to the complexity and multifaceted nature of newborn referral processes, studies on newborn referral systems have been limited. The objective of this study was to assess the barriers for effective functioning of the referral system for preterm, low birth weight, and sick newborns across the primary health care units in 3 contrasting regions of Ethiopia. METHODS A qualitative assessment using interviews with mothers of preterm, low birth weight, and sick newborns, interviews with facility leaders, and focus group discussions with health care providers was conducted in selected health facilities. Data were coded using an iteratively developed codebook and synthesized using thematic content analysis. RESULTS Gaps and barriers in the newborn referral system were identified in 3 areas: transport and referral communication; availability of, and adherence to newborn referral protocols; and family reluctance or refusal of newborn referral. Specifically, the most commonly noted barriers in both urban and rural settings were lack of ambulance, uncoordinated referral and return referral communications between providers and between facilities, unavailability or non-adherence to newborn referral protocols, family fear of the unknown, expectation of infant death despite referral, and patient costs related to referral. CONCLUSIONS As the Ethiopian Federal Ministry of Health focuses on averting early child deaths, government investments in newborn referral systems and standardizing referral and return referral communication are urgently needed. A complimentary approach is to lessen referral overload at higher-level facilities through improvements in the scope and quality of services at lower health system tiers to provide basic and advanced newborn care.
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Affiliation(s)
- Alula M. Teklu
- St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - James A. Litch
- Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), 19009 33rd Avenue W, Suite 200, Lynnwood, Seattle, WA 98036 USA
| | - Alemu Tesfahun
- Defence University, College of Health Sciences, Addis Ababa, Ethiopia
| | | | | | | | | | - Kirsten Senturia
- Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), 19009 33rd Avenue W, Suite 200, Lynnwood, Seattle, WA 98036 USA
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Moi Trevisol D, Melz G, Dias de Castro Filho E, Nascimento Fontanive V. Referências médicas evitáveis em unidade de saúde de Porto Alegre. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2020. [DOI: 10.5712/rbmfc15(42)2129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introdução: A análise das referências médicas de pacientes da Atenção Primária à Saúde (APS) para especialidades focais traz questões relevantes para a formulação e administração de políticas do sistema de saúde. A detecção de encaminhamentos potencialmente evitáveis pode permitir um aprimoramento dos processos de trabalho, assim como otimizar a alocação de recursos. Objetivo: Descrever as referências secundárias geradas por médicos de uma Unidade de APS vinculada ao Grupo Hospitalar Conceição (GHC), no ano de 2017, e construir critérios para classificá-las, discutindo sua evitabilidade. Métodos: Estudo descritivo-exploratório, baseado em documentação. Os dados foram obtidos no sistema GERCON® (Sistema de Gerenciamento de Consultas da Secretaria Municipal de Saúde de Porto Alegre/RS). Os encaminhamentos foram classificados conforme seu motivo e também conforme sua evitabilidade. Resultados: Foram gerados 799 encaminhamentos, a 110 especialidades médicas no período. Após a exclusão das especialidades de dermatologia e de pré-natal de alto risco (por mudança nos critérios e fluxos de encaminhamento, durante 2017), restaram 733 referenciamentos. Destes, 582 foram categorizados pelas pesquisadoras como não evitáveis e 151 como evitáveis. Os motivos de encaminhamentos predominantes foram: terapêuticas não disponíveis na APS (34%), recursos diagnósticos não disponíveis em APS (26,5%) e dúvida diagnóstica ou terapêutica (23,2%). Em relação à evitabilidade, foram identificados 20,6% de referenciamentos evitáveis, predominando aqueles que envolviam carência de conhecimentos/habilidades/ atitude do médico. Quanto aos encaminhamentos categorizados como não evitáveis (79,4%), predominaram aqueles efetivados por necessidade de conhecimentos/habilidades/procedimentos não próprios à APS. Conclusão: A construção de um conceito para referências evitáveis, a partir de estudos empíricos, pode enriquecer a gestão de serviços de APS, tendo em vista sua resolutividade. O presente estudo encontrou, nessa Unidade de APS, um baixo percentual de encaminhamentos potencialmente evitáveis.
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Liddy C, Moroz I, Mihan A, Nawar N, Keely E. A Systematic Review of Asynchronous, Provider-to-Provider, Electronic Consultation Services to Improve Access to Specialty Care Available Worldwide. Telemed J E Health 2019; 25:184-198. [DOI: 10.1089/tmj.2018.0005] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Clare Liddy
- C.T. Lamont Primary Health Care Research Center, Bruyère Research Institute, Ottawa, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - Isabella Moroz
- C.T. Lamont Primary Health Care Research Center, Bruyère Research Institute, Ottawa, Canada
| | - Ariana Mihan
- C.T. Lamont Primary Health Care Research Center, Bruyère Research Institute, Ottawa, Canada
| | - Nikhat Nawar
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Erin Keely
- Department of Medicine, University of Ottawa, Ottawa, Canada
- Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, Canada
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Tackling low back pain in Brazil: a wake-up call. Braz J Phys Ther 2018; 23:189-195. [PMID: 30337255 DOI: 10.1016/j.bjpt.2018.10.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 09/28/2018] [Accepted: 10/03/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Low back pain is the leading cause of years lived with disability in Brazil based upon Global Burden of Disease estimates. Since 1990, the number of years lived with disability has increased by 79.7%, and this number is expected to continue to rise due to population growth and ageing. Yet, similarly to other countries, little attention has been given to it in both the public and private health systems, arguably making it an overlooked epidemic in Brazil. There is evidence that Brazil has adopted unwarranted practices in the management of low back pain in a similar manner to what has been observed in high-income countries. To tackle the burden of low back pain in Brazil, we need highly coordinated efforts from government, the private sector, universities, health workers and civil society. OBJECTIVE This masterclass intends to provide an overview of the challenges faced by Brazil in relation to low back pain management and propose potential solutions that could potentially be implemented based on experiences reported in the literature.
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Bomfim RA, de Souza LB, Corrente JE. Tooth loss and its relationship with protein intake by elderly Brazilians-A structural equation modelling approach. Gerodontology 2017; 35:51-58. [PMID: 29214669 DOI: 10.1111/ger.12317] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study aimed at assessing the relationship between self-perceived tooth loss and wearing dentures, on the one hand, and the consumption of protein, on the other hand, among the elderly population of Botucatu, SP. Food consumption tends to decrease with ageing, especially protein intake, and one of the causes could be the precariousness of oral health. Several risk factors associated with deficient dietary protein intake have been identified, namely greater physical dependence, reduced caloric intake and food insecurity, but no studies have analysed whether tooth loss and prostheses interfere with protein intake. METHODS An interview was conducted among 365 elderly individuals, in which we examined oral health-related quality of life (OHRQoL) as the only latent variable, in a 24-hour nutritional assessment dietary recall repeated 3 times, conducted in person by a trained nutritionist and also performed an analysis of nutritional needs using the Nutrition Data System Research (NDSR) Program. RESULTS The structural equation model, performed using Stata v.14, showed that lack of teeth (standardised coefficient [SC] = 0.21, P < .001), and prosthesis use (SC = -0.21, P < .001) was associated with OHRQoL. Lack of teeth had a direct effect on the consumption of animal protein (SC = 0.08, P = .02), a strong total effect on animal protein intake (SC = 0.51, P = .04) and a medium effect on total protein intake (SC = 0.20, P = .03), adjusted for confounders (depression and medical problems). CONCLUSION Tooth loss had a strong and significant total effect on animal protein intake and a medium effect on total protein intake among elderly Brazilians.
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Affiliation(s)
- Rafael A Bomfim
- School of Dentistry, Department of Community Health, Federal University of Mato Grosso do Sul (UFMS), Campo Grande, Brazil
| | - Luciana B de Souza
- School of Nutrition, Department of Community Health, Federal University of Mato Grosso do Sul (UFMS), Campo Grande, Brazil
| | - José E Corrente
- Bioscience Institute, University of São Paulo State (UNESP), Botucatu, São Paulo, Brazil
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