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Mulaku MN, Nyagol B, Owino EJ, Ochodo E, Young T, Steingart KR. Factors contributing to pre-treatment loss to follow-up in adults with pulmonary tuberculosis: a qualitative evidence synthesis of patient and healthcare worker perspectives. Glob Health Action 2023; 16:2148355. [PMID: 36548521 PMCID: PMC9788701 DOI: 10.1080/16549716.2022.2148355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 11/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Since 2018, over 14 million people have been treated for tuberculosis (TB) globally. However, pre-treatment loss to follow-up (PTLFU) has been shown to contribute substantially to patient losses in the TB care cascade with subsequent high community transmission and mortality rates. OBJECTIVE To identify, appraise, and synthesise evidence on the perspectives of patients and healthcare workers on factors contributing to PTLFU in adults with pulmonary TB. METHODS We registered the title with PROSPERO (CRD42021253212). We searched nine relevant databases up to 24 May 2021 for qualitative studies. Two review authors independently reviewed records for eligibility and extracted data. We assessed methodological quality with the Evidence for Policy and Practice Information Centre tool and synthesised data using the Supporting the Use of Research Evidence framework. We assessed confidence in our findings using Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual). RESULTS We reviewed a total of 1239 records and included five studies, all from low- and middle-income countries. Key themes reported by patients and healthcare workers were communication challenges among healthcare workers and between healthcare workers and patients; knowledge, attitudes, and behaviours about TB and its management; accessibility and availability of facilities for TB care; and human resource and financial constraints, weakness in management and leadership in TB programmes. Patients' change of residence, long waiting times, and poor referral systems were additional factors that contributed to patients disengaging from care. We had moderate confidence in most of our findings. CONCLUSION Findings from our qualitative evidence synthesis highlight multiple factors that contribute to PTLFU. Central to addressing these factors will be the need to strengthen health systems and offer people-centred care.
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Affiliation(s)
- Mercy Namuma Mulaku
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Pharmacy, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Bruce Nyagol
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Eddy Johnson Owino
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Eleanor Ochodo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Taryn Young
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Karen R Steingart
- Honorary Research Fellow, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Henderson L, Bain H, Allan E, Kennedy C. An Exploratory Multi-Case Study of the Health and Wellbeing Needs, Relationships and Experiences of Health and Social Care Service Users and the People who Support them at Home. Int J Integr Care 2023; 23:11. [PMID: 36845871 DOI: 10.5334/ijic.7003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 02/02/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction International policies and legislation set a precedence of person-centred sustainable integrated Health and Social Care (HSC) that meets the health and wellbeing needs of service users through improved experiences. However, current research focuses on service models, with fewer studies investigating experiences and needs. Methods This qualitative multi-case [n = 7] study was co-designed with key stakeholders and aimed to explore experiences and needs of people who access and provide HSC at home. Data were collected in a regional area of Scotland (UK) via single [n = 10] or dyad [n = 4] semi-structured interviews with service users [n = 6], informal carers [n = 5] and HSC staff [n = 7] and synthesised using Interpretive Thematic Analysis. Findings Interpersonal connections and supportive relationships were instrumental in helping all participant groups feel able to cope with their changing HSC needs and roles. They promoted reassurance, information sharing and reduced anxiety; when they were lacking, it negatively impacted upon experiences of HSC. Discussion Promoting inter-personal connections that encourage supportive relationships between people who access and provide HSC and their communities, could promote person-centred Relationship-based care and improve HSC experiences. Conclusions This study identifies indicators for improved HSC, advocating co-produced community-driven services to meet the self-defined needs of those who access and provide care.
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Abstract
Introduction: The implementation of people-centred care requires strategies that respond to local conditions and contexts, with the participation of local stakeholders in collaborative approaches such as co-design. Within this framework, the authors performed a literature review to identify the most implemented practices in health and social care services for co-designing digital solutions. Methods: The literature review was conducted following five steps: (i) Definition of the Keywords and their relations; (ii) Definition of the selection criteria; (iii) Search in PubMed; (iv) Selection of papers; and (v) Analysis of the selected papers. Results: 20 papers addressed to co-design health digital solutions with stakeholders were analysed in terms of the activities implemented and participants involved. Discussion: Previous studies using co-design methods for the deployment of health digital solutions employed a wide range of activities, most of them combining activities and/or mixed target groups. Conclusion: Co-design is the key to deliver people-centred care as it allows to involve stakeholders in the development of health digital solutions. Implementing one or more of the co-design methods identified in this literature review should be considered to better address the needs and specific projects and target groups.
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Nakayama G, Masumoto S, Haruta J, Maeno T. Measuring family caregivers' experience of interprofessional care for patients and families: development of the Japanese version of the Caregivers' Experience Instrument. Fam Pract 2020; 37:854-861. [PMID: 32589192 DOI: 10.1093/fampra/cmaa059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Improving individuals' experience of care is now a critical goal of health care systems. Although a number of instruments have been developed to measure experience of care, few instruments measure family caregivers' experience of interprofessional care for patients and families. OBJECTIVE To develop the Japanese version of the Caregivers' Experience Instrument (J-IEXPAC CAREGIVERS) and to investigate its validity in assessing quality of integrated care for both patients with chronic conditions and their family caregivers, from the caregivers' perspective, in Japan. METHODS We used a cross-sectional questionnaire survey to test the validity and internal consistency of J-IEXPAC CAREGIVERS. Four hundred family caregivers were recruited in three municipalities. We evaluated the feasibility, structural validity, internal consistency and hypothesis testing for construct validity of the scale. RESULTS A total of 274 (68.5%) questionnaires were analysed. Confirmatory factor analysis showed acceptable model fit for the hypothesized two-factor model according to fit indices, as identified for the original version: attention for the patient and attention for the caregiver. Cronbach's alpha for score in J-IEXPAC CAREGIVERS with 12 items was high (0.92). Spearman's rank correlation coefficient between overall caregiver satisfaction and J-IEXPAC CAREGIVERS score was 0.71. Family caregivers who experienced home-visit services had significantly (P = 0.001) higher total scores than those who did not. CONCLUSIONS This pilot study showed that the J-IEXPAC CAREGIVERS is valid and reliable. This scale can be useful for evaluating quality of integrated care, with focus on family caregivers and patients with chronic conditions in Japan.
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Affiliation(s)
- Gen Nakayama
- Department of Primary Care and Medical Education, Graduate School of Comprehensive Human Sciences, Tsukuba, Japan
| | - Shoichi Masumoto
- Department of Family Medicine, General Practice and Community Health, Faculty of Medicine, Tsukuba, Japan
| | - Junji Haruta
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Medical Education Center, School of Medicine, Keio University, Tokyo, Japan
| | - Tetsuhiro Maeno
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Lionis C, Symvoulakis EK, Markaki A, Petelos E, Papadakis S, Sifaki-Pistolla D, Papadakakis M, Souliotis K, Tziraki C. Integrated people-centred primary health care in Greece: unravelling Ariadne's thread. Prim Health Care Res Dev 2019; 20:e113. [PMID: 31668150 DOI: 10.1017/S1463423619000446] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The 40th anniversary of the World Health Organization Alma-Ata Declaration in Astana offered the impetus to discuss the extent to which integrated primary health care (PHC) has been successfully implemented and its impact on research and practice. This paper focuses on the experiences from Greece in implementing primary health care reform and lessons learned from the conduct of evidence-based research. It critically examines what appears to be impeding the effective implementation of integrated PHC in a country affected by the financial and refugee crisis. The key challenges for establishing integrated people-centred primary care include availability of family physicians, information and communication technology, the prevention and management of chronic disease and migrant and refugees' health. Policy recommendations are formulated to guide the primary health care reform in Greece, while attempting to inform efforts in other countries with similar conditions.
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Maurits EEM, de Veer AJE, Groenewegen PP, Francke AL. Attractiveness of people-centred and integrated Dutch Home Care: A nationwide survey among nurses. Health Soc Care Community 2018; 26:e523-e531. [PMID: 29508473 DOI: 10.1111/hsc.12564] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/31/2018] [Indexed: 06/08/2023]
Abstract
The World Health Organization is calling for a fundamental change in healthcare services delivery, towards people-centred and integrated health services. This includes providing integrated care around people's needs that is effectively co-ordinated across providers and co-produced by professionals, the patient, the family and the community. At the same time, healthcare policies aim to scale back hospital and residential care in favour of home care. This is one reason for the home-care nursing staff shortages in Europe. Therefore, this study aimed to examine whether people-centred, integrated home care appeals to nurses with different levels of education in home care and hospitals. A questionnaire survey was held among registered nurses in Dutch home-care organisations and hospitals in 2015. The questionnaire addressed the perceived attractiveness of different aspects of people-centred, integrated home care. In total 328 nurses filled in the questionnaire (54% response rate). The findings showed that most home-care nurses (70% to 97%) and 36% to 76% of the hospital nurses regard the different aspects of people-centred, integrated home care as attractive. Specific aspects that home-care nurses find attractive are promoting the patient's self-reliance and having a network in the community. Hospital nurses are mainly attracted to health-related prevention and taking control in complex situations. No clear differences between the educational levels were found. It is concluded that most home-care nurses and a minority of hospital nurses feel attracted to people-centred, integrated home care, irrespective of their educational level. The findings are relevant to policy makers and home-care organisations who aim to expand the home-care nursing workforce.
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Affiliation(s)
- Erica E M Maurits
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Anke J E de Veer
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Peter P Groenewegen
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Department of Sociology and Department of Human Geography, Utrecht University, Utrecht, The Netherlands
| | - Anneke L Francke
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Centre, Utrecht, The Netherlands
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Abreu L, Nunes JA, Taylor P, Silva S. The Role of Distributed Health Literacy in Asthma Integrated Care: A Public Medical Context from Portugal. Int J Integr Care 2018; 18:18. [PMID: 30127702 PMCID: PMC6095081 DOI: 10.5334/ijic.3301] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 05/14/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Improvements in asthma integrated care might be achieved through in-depth knowledge about how health literacy is dispersed through a group. This study intends to map out health literacy mediators (those who makes his/her literacy skills available to others for them to accomplish specific literacy purposes) and how they enable self-management skills in patients with asthma. METHODS Twenty interviews were conducted in a Primary Care Center of Porto using the McGill Illness Narrative Interview. Data were thematically analyzed as case-based and process-tracing-oriented. RESULTS Interviewees with a dense network of mediators revealed a low impact of asthma on their lives, dependence on primary care physician for instrumental support and dependence on family members to provide emotional/pragmatic support. Interviewees who relied on a restricted network of mediators (belonging to formal sources of health services and providing informational support) described episodes of crisis as disruptive and demonstrated a reactive approach to self-management skills. CONCLUSIONS The roles performed by core health mediators (health professionals, family/friends, media) in support of asthma management varied according to patients' narratives of minimization/disruption, connected to dense/restricted social networks. To clarify the boundaries of responsibility-shifting and to enrich support provided by formal sources of health services and peer education groups is needed.
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Affiliation(s)
- Liliana Abreu
- ISPUP-EPI Unit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n˚ 135, 4050-600 Porto, PT
- i3S – Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen, Porto, PT
- Faculdade de Medicina, Universidade do Porto, Porto, PT
| | - João Arriscado Nunes
- Center for Social Studies and School of Economics of the University of Coimbra, PT
| | - Peter Taylor
- Science, Technology and Values Program, University of Massachusetts, Boston, US
| | - Susana Silva
- ISPUP-EPI Unit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n˚ 135, 4050-600 Porto, PT
- Faculdade de Medicina, Universidade do Porto, Porto, PT
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Ferrer APS, Brentani AVM, Sucupira ACSL, Navega ACB, Cerqueira ES, Grisi SJFE. The effects of a people-centred model on longitudinality of care and utilization pattern of healthcare services--Brazilian evidence. Health Policy Plan 2016; 29 Suppl 2:ii107-13. [PMID: 25274635 PMCID: PMC4202922 DOI: 10.1093/heapol/czu077] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Brazil is experiencing a time of change in pattern of care: from ‘traditional’ to Family Health Strategy (FHS), a model guided by the principles of people, family and community-centred medicine. The heterogeneity in care currently offered affects the primary care impact. This study aims to evaluate the longitudinality of care and correlate this primary care principle to the utilization pattern of care among patients hospitalized due to preventable conditions, comparing the two care models currently offered in Brazil. It is a cross-sectional, analytical and descriptive study with a quantitative approach. The sample consisted of 501 patients from 0 to 14 years old. Data was collected in 2011 and the Primary Care Assessment Tool (PCATool-Brazil) child version was used. Bivariate and multivariate analyses were performed including patient-related variables (age, maternal education, income and type of diagnosis) and care model. From the hospitalizations occurred during the period, 65.2% were Ambulatory Care Sensitive Conditions. Patients evaluated ‘longitudinality’ as regular. Both the care continuity dimension and the utilization pattern of care services showed a link with the care model offered. Findings suggest that the FHS care model, based on the assumptions of people-centred medicine, was associated with better ratings of care continuity, which was reflected in a more appropriate utilization pattern of care services.
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Affiliation(s)
- Ana Paula Scoleze Ferrer
- Department of Pediatrics, School of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 647., 05403-000 São Paulo, SP, Brazil
| | - Alexandra Valéria Maria Brentani
- Department of Pediatrics, School of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 647., 05403-000 São Paulo, SP, Brazil
| | - Ana Cecília Silveira Lins Sucupira
- Department of Pediatrics, School of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 647., 05403-000 São Paulo, SP, Brazil
| | - Ana Carolina Barsaglini Navega
- Department of Pediatrics, School of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 647., 05403-000 São Paulo, SP, Brazil
| | - Elisa Scanavini Cerqueira
- Department of Pediatrics, School of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 647., 05403-000 São Paulo, SP, Brazil
| | - Sandra Josefina Ferraz Ellero Grisi
- Department of Pediatrics, School of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 647., 05403-000 São Paulo, SP, Brazil
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