Insights of undergraduate health sciences students about a French interprofessional training initiative

BACKGROUND

Incorporating interprofessional collaboration within healthcare is critical to delivery of patient-centered care. Interprofessional Education (IPE) programs are key to promoting such collaboration. The 'Public Health Service' (PHS) in France is a mandatory IPE initiative that embodies this collaborative spirit, bringing together students from varied health undergraduate training programs-nursing, physiotherapy, pharmacy, midwifery, and medicine- in a common training program focused on primary prevention. The aim of the study was to assess the experience and attitudes of students in the five health training programs regarding the interest of IPEs in the PHS.

METHODS

A cross-sectional survey was administered to 823 students from the 2022-2023 cohort at a French university. The questionnaire was designed with 12 Likert-scale questions specifically created to evaluate the students' experiences, knowledge, and attitudes focused on IPE during the practical seminars, school interventions, and the overall PHS. Additionally, an open-ended question was utilized to gather qualitative data. Statistical analyses assessed satisfaction levels across undergraduate training programs, while thematic analysis was applied to the qualitative responses.

RESULTS

Within the surveyed cohort, 344 students responded to the survey. The findings showed that students were satisfied with the interprofessional collaboration, both in practical teaching sessions (75% satisfaction) and in primary prevention projects conducted in schools (70% satisfaction), despite their having faced challenges with coordination. Pharmacy students, in particular, highlighted the need for adjustments in program scheduling. The qualitative feedback underscored the positive value of IPE, notwithstanding the organizational difficulties stemming from different academic timetables.

CONCLUSION

The student feedback indicated a high level of satisfaction with the interprofessional work carried out in both the practical teaching and the primary prevention projects. To further enhance the educational impact and address the scheduling complexities, it is recommended that program refinements be made based on student feedback and pedagogical best practices.

Process evaluation of an integrated community-based intervention for promoting health equity in children in a new residential development area

BACKGROUND

Reducing health inequities for children from a disadvantaged background is an important task in public health. While intersectoral partnerships are a promising way to achieve this, few studies have examined the factors influencing the success of these interventions. In this study, we conducted a process evaluation of the integrated community-based intervention Präventionskette Freiham that the city of Munich, Germany, has implemented in a new residential development area. The aim was to investigate the implementation process as well as barriers and facilitators.

METHODS

Following a mixed methods approach, we collected data from different core groups making up Präventionskette Freiham from April 2020 to August 2022, exploring their perspective on the implementation process. We conducted repeated qualitative interviews with the network coordinators and eleven local professionals from institutions engaged with or relevant for the intervention. We also undertook a focus group with four members of the advisory group representing the three municipal departments guiding the intervention. Ego-centered network maps were drawn by the network coordinators to chart the development of the network. Subsequently, we also conducted an online survey with local network members.

RESULTS

At the early stage of the implementation process, the intervention was able to integrate actors from different sectors, serving as a platform for mutual exchange. However, the network produced limited output. According to the interviews, this may be mainly attributable to the early development status of the area. We identified seven topics that may act as facilitators or barriers to implementation of Präventionskette Freiham: (1) availability of resources, (2) political and administrative support, (3) the network coordinators, (4) network-internal processes, (5) trans-institutional cooperation, (6) perceived benefits of engagement, and (7) the output of the network.

CONCLUSIONS

The early development status of the area was a challenge for the intervention. This emphasizes the need to carefully consider context when planning and implementing integrated community-based public health interventions in new residential development areas.

The urban-rural disparities and factors associated with the utilization of public health services among diabetes patients in China

BACKGROUND

Basic public health services for diabetes play an essential role in controlling glycemia in patients with diabetes. This study was conducted to understand the urban-rural disparities in the utilization of basic public health services for people with diabetes and the factors influencing them.

METHODS

The data were obtained from the 2018 China Health and Retirement Longitudinal Study (CHARLS) with 2976 diabetes patients. Chi-square tests were used to examine the disparities in the utilization of diabetes physical examination and health education between urban and rural areas. Logistic regression was performed to explore the factors associated with the utilization of diabetes public health services.

RESULTS

Among all participants, 8.4% used diabetes physical examination in the past year, and 28.4% used diabetes health education services. A significant association with age (OR = 0.64, 95% CI:0.49-0.85; P < 0.05) was found between patients' use of health education services. Compared with diabetes patients living in an urban area, diabetes patients living in a rural area used less diabetes health education. (χ2= 92.39, P < 0.05). Patients' self-reported health status (OR = 2.04, CI:1.24-3.35; P < 0.05) and the use of glucose control (OR = 9.33, CI:6.61-13.16; P < 0.05) were significantly positively associated with the utilization of diabetes physical examination. Patients with higher education levels were more likely to use various kinds of health education services than their peers with lower education levels (OR = 1.64, CI:1.21-2.22; P < 0.05).

CONCLUSION

Overall, urban-rural disparities in the utilization of public health services existed. Vulnerable with diabetes, such as those in rural areas, are less available to use diabetes public health services. Providing convenient health service infrastructure facilitates the utilization of basic public health services for diabetes in older patients with diabetes, especially in rural areas.

Pandemic management: Analysis of availability and relevance of surveillance indicators by COVID-Task-Forces in the German federal state of Lower Saxony

Background

Locally, the introduction of measures during times of a pandemic emergency is embodied in a pandemic containment plan created by the Robert Koch Institute in 2017. In addition to central indicators such as incidence rates and number of deaths, various indicators are used at the local level to assess the pandemic situation. So far, there hasn't been analyses of the availability and perceived relevance of the surveillance indicators used to manage the SARS-CoV-2 pandemic by the local German pandemic task forces.

Aim

This study examined whether local decision-makers had access to surveillance-related indicators in a way that they could be used to make informed decisions in response to the pandemic situation.

Methods

A cross sectional study was conducted, using an online questionnaire developed by experts of The Public Health Agency of Lower Saxony and The University Medical Center Göttingen (UMG). All local COVID-19 task forces of the German state of Lower-Saxony were enrolled in the study.

Findings

The surveillance indicators assessed by survey respondents as most available and relevant are included under the German Infection Protection Act (IfSG). In contrast, the indicators that are not bound by the IfSG have a significantly lower availability and an inconsistent assessment of relevance.

Conclusion

Against the background of efficiency, it seems central to be able to reliably provide the highly weighted surveillance indicators. Nevertheless, the relevance assessment gap between the indicators embedded in the IfSG and the ones that are not may be explained by cognitive processes such as anchoring bias. The collection and use of indicators to assess the pandemic situation and to evaluate measures should be the subject of continuous multidisciplinary discussions.

Equality of public health service and family doctor contract service utilisation among migrants in China

China initiated the equalisation of an essential public health service programme in 2009 with the goal of developing a more equitable and effective public health system for all people. This study employs data from the China Migrants Dynamic Survey to examine regional-level and household-level income-related inequalities in public health service utilisation and its determinants. Wagstaff concentration indices indicate that essential public health services and family doctor contract services are concentrated among less developed prefectures and poorer households. Decomposition analysis based on recentered influence function regression shows that education contributes to pro-poor inequality in health records and health education utilisation. China's policies of essential public health services and family doctor contract services reduce income-related inequalities in health service utilisation, which has important implications for developing countries striving to achieve universal health service coverage and equal health outcomes.

Catastrophic out-of-pocket payments for dental treatment: regional evidence from Spain

BACKGROUND

To estimate the incidence and concentration of catastrophic out-of-pocket payments for healthcare and dental treatment, by region in Spain (calculated as the proportion of households needing to exceed a given threshold of their income to make these payments) in 2008, 2011 and 2015.

METHODS

The data analysed were obtained from the Spanish Family Budget Survey reports for the years in question. The study method was that proposed by Wagstaff and van Doorslaer (2003), contrasting payments for dental treatment versus household income and considering thresholds of 10%, 20%, 30% and 40%, thus obtaining incidence rates. In addition, relevant sociodemographic variables were obtained for each household included in the study.

RESULTS

With some regional heterogeneity, on average 4.75% of Spanish households spend more than 10% of their income on dental treatment, and 1.23% spend more than 40%. Thus, 38.67% of catastrophic out-of-pocket payments for dental services in Spain corresponds to payments at the 10% threshold. This value rises to 55.98% for a threshold of 40%.

CONCLUSIONS

An important proportion of catastrophic out-of-pocket payments for health care in Spain corresponds to dental treatment, a service that has very limited availability under the Spanish NHS. This finding highlights the need to formulate policies aimed at enhancing dental cover, in order to reduce inequalities in health care and, consequently, enhance the population's quality of life and health status.

[The maturity model for the public health service-a tool for assessing and improving the digital maturity level of German public health agencies]

The COVID 19 crisis has highlighted the key role of the public health service (PHS), with its approximately 375 municipal health offices involved in the pandemic response. Here, in addition to a lack of human resources, the insufficient digital maturity of many public health departments posed a hurdle to effective and scalable infection reporting and contact tracing. In this article, we present the maturity model (MM) for the digitization of health offices, the development of which took place between January 2021 and February 2022 and was funded by the German Federal Ministry of Health. It has been applied since the beginning of 2022 with the aim of strengthening the digitization of the PHS. The MM aims to guide public health departments step by step to increase their digital maturity to be prepared for future challenges. The MM was developed and evaluated based on qualitative interviews with employees of public health departments and other experts in the public health sector as well as in workshops and with a quantitative survey. The MM allows the measurement of digital maturity in eight dimensions, each of which is subdivided into two to five subdimensions. Within the subdimensions a classification is made on five different maturity levels. Currently, in addition to recording the digital maturity of individual health departments, the MM also serves as a management tool for planning digitization projects. The aim is to use the MM as a basis for promoting targeted communication between the health departments to exchange best practices for the different dimensions.

[What are the effects of different places of death of old people?]

Background

Inadequate quality of medical postmortem examinations has been discussed in the forensic medical literature for many years. It is known that older deceased persons are less likely to have a non-natural cause of death certified and autopsies are performed less frequently compared to younger deceased persons.

Methods

Death certificates of all deaths that occurred in Munich with an age of ≥ 75 years during the death period 01/01/2013-31/12/2014 were analyzed. Standardized, anonymized data entry was performed. The collected data were analyzed descriptively.

Results

A total of 26,303 persons died during the study period. Of these deaths, 16,146 (60.7%) were ≥ 75 years. Most common places of death for the aged were hospital (56.1%), private address (21.8%), and nursing home (20.0%). A natural mode of death was reported in 88.5%, unexplained in 8.8%, and non-natural in 2.7%. Most common immediate causes of death were diseases of the circulatory system (23.5%), inaccurately designated or unknown causes of death (20.0%), and diseases of the respiratory system (16.3%). Autopsies were performed on 4.9%, largely judicial. The parameters studied showed large differences in the analyses depending on the place of death.

Discussion

This study again shows considerable quality deficiencies in the issuance of death certificates. Despite the dual approach of the Munich health authority (control, training), the quality of death certificates could not be sustainably improved in recent years. Types and causes of death showed partly considerable differences depending on the place of death and the doctor who issued the certificate. The deficits identified in the information provided under the heading "Causes of death" are also likely to have a negative impact on the cause of death statistics.

[COVID-19- and influenza-associated deaths in Munich as of March 2020-a standardized analysis of death certificates]

INTRODUCTION

In light of the current COVID-19 pandemic, the idea arose to conduct a study to comparatively evaluate deaths from two respiratory transmissible infectious diseases (pandemic COVID-19 and seasonal influenza) by means of death certificates received by the health department.

METHODS

Death certificates of all deaths in Munich in the death period from 1 March-31 December 2020 were analyzed. The predefined inclusion criteria were the indication of "Corona, COVID-19, SARS-CoV‑2, Influenza (A/B)" on the death certificates. Standardized data entry was performed. The collected data were analyzed descriptively in aggregated form.

RESULTS

A total of 12,441 persons died during the study period, 1029 (8.3%) from confirmed COVID-19 and 22 (0.1%) from influenza. The two collectives matched well in the parameters studied. The mean age at death was approximately 80 years and the most common site of death was in hospital. Infectious disease was the cause of death in more than 90% of cases. The most common causes of death were acute respiratory distress syndrome/respiratory failure and multiorgan failure. An average of two previous illnesses were reported, most commonly diseases of the circulatory system and nervous system. There was no influenza death in the second pandemic wave.

DISCUSSION

In this study, COVID-19- and influenza-associated deaths were compared for the first time. The deaths of both collectives matched well in the parameters studied, but still require verification in a larger study given the small numbers of influenza cases. An English full-text version of this article is available at SpringerLink as Supplementary Information.

The voice of patients in Israel's general hospitals

PURPOSE

The purpose of this study is to capture the variety of issues that concern patients and to examine the extent to which personal characteristics of patients, such as education, ethnicity, age, gender and conditions of hospitalisation, influence the tendency to "express (negative) voice" and raise "critical views".

DESIGN/METHODOLOGY/APPROACH

Using data obtained from the 2014 Survey of Health Satisfaction in Israel, the study focuses on patients' responses to an open-ended question regarding the medical care experience in hospitals.

FINDINGS

The analysis reveals that "the voice of patients" spreads across a wide variety of issues, including the physical condition of the hospital and caregiver behaviour. Multivariate regression models show that subgroups with greater access to social and economic resources (i.e. in Israel, individuals who are Jewish), academics, women and younger patients are more likely to express critical voice regarding the hospitalisation experience. Likewise, inferior hospitalisation conditions are likely to increase expression of negative "voice" and criticism.

ORIGINALITY/VALUE

The findings underscore the importance and value of open-ended questions in evaluating healthcare satisfaction, suggesting that the likelihood of expressing critical voice is higher among patients of high socio-economic status - perhaps because they are more likely to expect, demand and feel entitled to high-quality care. Likewise, inferior hospitalisation conditions increase the critical voice.

[COVID-19-associated deaths]

INTRODUCTION

In December 2019, the new infectious coronavirus disease 2019 (COVID-19) first appeared in China. So far, no systematic evaluation of death certificates of COVID-19-associated deaths has been presented.

METHODS

The death certificates of all deaths in Munich during the period from 1 March to 31 July 2020 were analyzed. The previously defined inclusion criteria were the indication of corona, COVID-19 and SARS-CoV‑2 in the death certificates. The variables were entered anonymously according to a developed key. The collected data were evaluated descriptively.

RESULTS

In the period under investigation, a total of 5840 people died in the Munich City area. Of these deaths 332 (5.7%) were COVID-19-associated. In 281 deaths (84.6%) there was a definite COVID-19 and in 51 deaths (15.4%) the suspicion of this disease. The most frequent causes of death were acute respiratory distress syndrome or respiratory insufficiency (59.1%), multiple organ failure (21.4%) and sepsis (10%). An average of 1.8 pre-existing illnesses were reported in the death certificates. Most frequently mentioned were diseases of the circulatory system (54.8%), the nervous system (22.8%) and metabolic diseases (18.9%). The average age at death was 79 years and the most frequent place of death was a hospital (85%). An autopsy was attempted by the doctors who issued the death certificates for 18.1% of the collective, most frequently in the case of unexplained or unnatural causes of death and young age of the deceased. Clinical pathological autopsies were performed on 11% of the collective and judicial autopsies on 1%.

DISCUSSION

This study is the first evaluation of death certificates with respect to the novel infectious COVID-19. Number and essential characteristics of COVID-19-associated deaths in Munich during the so-called first wave could be mapped. The interest of physicians in autopsies was rather low despite the appearance of a new infectious disease.

Evaluating the national multisite implementation of dialectical behaviour therapy in a community setting: a mixed methods approach

BACKGROUND

The implementation of evidence-based interventions for borderline personality disorder in community settings is important given that individuals with this diagnosis are often extensive users of both inpatient and outpatient mental health services. Although work in this area is limited, previous studies have identified facilitators and barriers to successful DBT implementation. This study seeks to expand on previous work by evaluating a coordinated implementation of DBT in community settings at a national level. The Consolidated Framework for Implementation Research (CFIR) (Damschroder et al., Implementation Sci. 4:50, 2009) provided structural guidance for this national level coordinated implementation.

METHODS

A mixed methods approach was utilised to explore the national multisite implementation of DBT from the perspective of team leaders and therapists who participated in the coordinated training and subsequent implementation of DBT. Qualitative interviews with DBT team leaders (n = 8) explored their experiences of implementing DBT in their local service and was analysed using content analysis. Quantitative surveys from DBT therapists (n = 74) examined their experience of multiple aspects of the implementation process including orienting the system, and preparations and support for implementation. Frequencies of responses were calculated. Written qualitative feedback was analysed using content analysis.

RESULTS

Five themes were identified from the interview data: team formation, implementation preparation, client selection, service level challenges and team leader role. Participants identified team size and support for the team leader as key points for consideration in DBT implementation. Key challenges encountered were the lack of system support to facilitate phone coaching and a lack of allocated time to focus on DBT. Implementation facilitators included having dedicated team members and support from management.

CONCLUSIONS

The barriers and facilitators identified in this study are broadly similar to those reported in previous research. Barriers and facilitators were identified across several domains of the CFIR and are consistent with a recently published DBT implementation Framework (Toms et al., Borderline Personal Disord Emot Dysregul. 6: 2, 2019). Future research should pay particular attention to the domain of characteristics of individuals involved in DBT implementation. The results highlight the importance of a mandated service plan for the coordinated implementation of an evidence-based treatment in a public health service.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT03180541; Registered June 7th 2017 'retrospectively registered'.

[Death certificates-an underestimated source of information for statistics, judicature, public health, and science]

The thorough external examination of a corpse and the correct completion of the death certificate are medical duties with far-reaching consequences. Data obtained from the death certificates are the basis for mortality statistics and for scientific research. They can be helpful in uncovering criminal offences or for the surveillance of medical facilities. For many years the deficiencies of external post-mortem examinations and death certificates have been discussed in professional journals.The important task of analysing all death certificates is performed by the local health authorities. This is the only opportunity for quality control and, if necessary, the doctors who issued the death certificate must be asked for corrections. This also improves the quality of the mortality statistics and contributes to the administration of justice.Additionally, important information for routine duties of the public health authorities can be obtained from the death certificates concerning the monitoring of narcotics, the supervision of medical facilities and the adherence to notification requirements for infectious diseases. Furthermore, death certificates contain relevant data for selected medical research projects.The high information content of death certificates is widely unknown and should be used by the health authorities comprehensively and systematically. Enough qualified staff needs to be allocated to further secure the important task of quality control of death certificates.

BeWell: quality assurance health promotion pilot

PURPOSE

The purpose of this paper is to determine the experience participating in a health promotion program for refugee and asylum seekers and torture survivors in a safety net clinical setting.

DESIGN/METHODOLOGY/APPROACH

Refugee and asylum seeker torture survivors participated in a seven-week health promotion program at a safety-net clinic. Participants interviewed before, during and after the program was designed to improve and maintain health promotion program quality.

FINDINGS

Six major themes emerged: social networks; tools/techniques/skills; wellness planning; spiritualism; health maintenance; and social/group interaction. Preliminary results suggest that this multi-pronged approach is feasible and acceptable to foreign-born torture survivors.

RESEARCH LIMITATIONS/IMPLICATIONS

Torture impacts many facets of one's life. A program which addresses health from a multidisciplinary perspective has promise to facilitate healing.

PRACTICAL IMPLICATIONS

The impact of torture and human rights violations significantly affects many facets of peoples' lives including emotional, social, physical and spiritual dimensions. Therefore a program which utilizes a multidisciplinary integrated bio-psychosocial and spiritual approach has the potential to simultaneously address many domains facilitating healing.

ORIGINALITY/VALUE

BeWell, a bio-psychosocio-spiritual health promotion strategy aimed at improving health service quality and increasing patient satisfaction to support positive health outcomes by implementing in-classroom/person modules for patients, to the authors' knowledge is unique in its efforts to encompass multiple domains simultaneously and fully integrate an approach to wellbeing.

Patients' satisfaction as a dimension of quality: a survey on outpatients' care in Dubai

PURPOSE

The last few years have seen a stronger emphasis on patient-centred care within the international healthcare setting. Patient-centred care is clearly perceived to be important to optimise the satisfaction and well-being of patients. The purpose of this paper is to review current patient-centred practices for outpatients in both private clinics and public hospitals in Dubai. Such a comparison contributes to the identification of best management practices as a means of enhancing healthcare delivery.

DESIGN/METHODOLOGY/APPROACH

This study is based on an independent survey consisting of self-administered questionnaires, in which patients were asked to rate several aspects of private clinics or government hospitals in Dubai. The questionnaire used has been drawn from the Consumer Assessment of Healthcare Providers and Systems Clinician and Group Survey, Version 3.0. Responses from 420 patients form a data set that is analysed quantitatively.

FINDINGS

In total, 420 respondents took part in this survey. The results of the survey show that there is a considerable difference between the expectation levels of patients from government hospitals and patients from private clinics. Patients from government hospitals consistently show that time is a critical aspect of the service received, with 68 per cent of the respondents reporting this issue. Additionally, poor customer care, as reported by 14 per cent of the respondents, is also a critical issue. Timely service and appointments are among the main factors that contribute to patient satisfaction. Patients in private clinics, instead, particularly value clear explanations from doctors and nurses - this is corroborated by the fact that 11 per cent of the respondents reported appreciation of this type of service.

PRACTICAL IMPLICATIONS

This paper draws attention to a patient-centric perspective of healthcare, and highlights the importance of educating patients through clear explanations.

ORIGINALITY/VALUE

Little evidence exists on the standards of healthcare in Dubai. The authors explore this area and present direct evidence on quality standard implementation, identify implementation shortcomings and make recommendations for future research and practice.

Managing the essential medicines stock at rural healthcare systems in India

PURPOSE

The purpose of this paper is to eliminate the medicine stock-out problem by building an optimum medicine stock in rural healthcare centers in India.

DESIGN/METHODOLOGY/APPROACH

Data associated with inflow and outflow of a specific medicine (folic acid tablets) arer collected from all consecutive supply chain stages during the survey. While conducting the survey, it is found that several medicines are out of stock owing to uncertain lead time and demand. Integrating with quantity discount and min-max ( s, S) inventory policy, two models are developed using system dynamics: one is Model 1 with constant lead time and uncertain demand, and the other is Model 2 with both uncertain lead time and demand.

FINDINGS

Both models are simulated for a period of one year on Stella 9.1 platform. The results are compared with actual data, and the comparison shows significant improvement of the medicine stock at all downstream stages, while maintaining a certain safety stock. Further, Model 2 suggests a larger stock than Model 1 at each point of time.

PRACTICAL IMPLICATIONS

Despite numerous issues, the stocks of medicine in rural healthcare systems can be improved as suggested by the models. The models depict the behavior of inventory stock at each stage of the supply chain and act as a function of time that could be used in the form of a prediction tool for the policymakers.

ORIGINALITY/VALUE

This paper is one of the first papers that had developed the model of the medicine supply chain in rural parts of a developing country. It provides a generic framework for the stock assessment and improvement throughout the supply chain.

India's rural healthcare systems: structural modeling

PURPOSE

The purpose of this paper is to identify factors related to rural healthcare services and establish a hierarchical model for the effective rural healthcare management in India.

DESIGN/METHODOLOGY/APPROACH

A questionnaire survey identified and correlated numerous factors related to the Uttarakhand rural healthcare systems. Experts opinion were translated into a reachability matrix and an interpretive structural model. A fuzzy matriced impacts croises-multiplication applique and classment (FMICMAC) analysis arranged the factors as hierarchical stages using their driving power.

FINDINGS

The interpretive structural and FMICMAC hierarchical models suggest four key driving factors: diseases, climatic conditions, population growth and political pressure.

PRACTICAL IMPLICATIONS

Despite numerous issues, rural healthcare services can be improved by considering key driving factors that could be used as a prediction tool for policy makers.

ORIGINALITY/VALUE

Results demonstrate that population control, coordinating services with local bodies and rural health center annual maintenance can be game changers toward better healthcare services.

Infant mortality rate in India: mediating causes

PURPOSE

The purpose of this paper is to develop a new approach to health service quality assurance.

DESIGN/METHODOLOGY/APPROACH

Data were collected using a structured, eight-section questionnaire. Stratified random samples were drawn from four villages based in four Indian regions.

FINDINGS

Psychological discomfort is an infant mortality rate (IMR) mediating factor. The root mean square error of approximation fit statistic for the model was 0.08, which was considered the best fit.

PRACTICAL IMPLICATIONS

Addressing mediating causes can reduce IMR in developing countries.

ORIGINALITY/VALUE

The model that the authors described helps health institution managers to map quality assurance health management and economics.

[Clostridium difficile-associated deaths from 2013-2016 in Munich and Nuremberg : Reporting behavior and patient characteristics]

BACKGROUND

A number of risk factors for C. difficile infection (CDI) are described in the literature, in particular an antibiotic therapy 4-6 weeks before disease, an age of >65 years, immunosuppression and living in a long-term care facility. Increasing incidence rates have been reported for Germany. CDI is the fourth most common nosocomial infection with 6.4%.

AIM

Due to the amendment of the Infection Protection Act of 01.05.2016, the proportion of all deaths that are C. difficile-associated deaths should be investigated to determine the extent to which the obligation to report is fulfilled in the case of a severe CDI. The epidemiological situation in Munich and Nuremberg should also be investigated and the characteristics of the deceased should be analyzed.

MATERIAL AND METHODS

A review of all death certificates for the period from 1 January 2013 to 30 June 2016 was carried out according to defined inclusion criteria for clostridia infection. All data were anonymized, standardized and statistically evaluated.

RESULTS

Almost every hundredth death is associated with C. difficile. Medical and outbreak reports are very poor and do not reflect the real situation. The age of the deceased and increased factors for the acquisition of a CDI correspond to the literature. The collected data from both cities show a good congruence.

CONCLUSION

For the first time, data from the health authorities can be submitted on the proportion of all deaths that are C. difficile-associated deaths, reporting behavior and patient characteristics in cases of severe CDI. This is a serious disease, especially for older people with regard to the existence of risk factors, and its frequency and effects are significantly underestimated.

Service quality and satisfaction in healthcare sector of Pakistan- the patients' expectations

Purpose The purpose of this paper is to assess the influence of patients' expectations from healthcare service quality on their satisfaction with nursing in public and private hospitals of Pakistan. Design/methodology/approach Data ( n=456) were collected from three public sector hospitals and three private sector hospitals of Lahore, the capital of Pakistan's most populous province. Male and female patients who have experience of both sectors were surveyed using a self-administered questionnaire developed using the original SERVQUAL approach. Data were analyzed using the statistical techniques and the Laplace criterion. Findings This paper attempts to explain degree of influences of five service quality constructs (empathy, responsiveness, tangibility, reliability and assurance) on Pakistani patients' expectations from the private and public sector hospitals and thus patient satisfaction. Further, this work can offer several intuitions into the effect of five constructs of service quality on patients' expectations of healthcare service quality and patient satisfaction with the service providers/nursing. The results reveal that the patient satisfaction is most strongly related to empathy in public sector and to responsiveness in private sector. Research limitations/implications In light of the previous studies and the current research findings, the study anticipates no apparently significant improvement in healthcare sector of Pakistan in near future considering various factors discussed in the study. The study will also help the service providers and the policy makers in understanding the deteriorating situation of the Pakistani healthcare sector and will guide them in identifying the areas by improving which not only the healthcare service quality in the country can be improved but also the image of healthcare sector among the masses and competitiveness of the healthcare sector can be enhanced. Originality/value The value of the study rests in its critical analysis of the current status of the healthcare sector of Pakistan with a view to suggest the areas that need to be worked on by the service providers and policy makers. Also, the study tries to settle a controversy within Pakistani healthcare literature concerning the question that who is producing more satisfied patients: private hospitals or their public counterparts?

Cluster analysis of psychiatric profile, its correlates, and using mental health services among the young people aged 15-34: findings from the first phase of Iranian youth cohort in Ravansar

PURPOSES

(1) Cluster analysis of psychiatric disorders and partitioning the youth; (2) determining socio-demographic correlates and parental histories for each one of the clusters; and (3) comparing clusters based on the extent and type of using psychotherapeutic services.

METHODS

The current cross-sectional study is a part of the first phase of PERSIAN Youth Cohort. The sample of the study includes 2991 participants aged 15-34 (27 ± 5.1 years, 55.6% female) from Ravansar district in western Iran. Enrollment and data collection for this phase were performed from October, 2014 to January, 2017. The data were collected through structured interviews, including the Composite International Diagnostic Interview (CIDI; version 2.1), mental health-related Sheehan Disability Scale, and Service Use Questionnaire. The obtained data were analyzed using two-step cluster analysis, multinomial logistic regression, and Chi-square test.

RESULTS

Our model proposed three clusters: a clinical cluster with significant mental disability; a healthy cluster with significant disability; and a healthy cluster with mild disability. There is a direct relationship between widow/divorced marital status and psychiatric maternal history with the clinical cluster (P < 0.05). Clinical and non-clinical clusters with medium to severe disability used services for mental health more often that the healthy cluster with mild functional disability (P < 0.05).

CONCLUSIONS

The results of the study show that 28.7% of the youth in the general population of western Iran are suffering from psychiatric disorders and nearly two-thirds of the total population reported a medium-severe functional disability. Considering the wide range of mental disorders and the functional disability levels created by these disorders, cluster analysis could provide invaluable information regarding the partitioning of the youth population.

Residents' educational attainment and preventive care utilization in China

Purpose China launched a comprehensive health reform in 2009 to improve healthcare quality. Because preventive care utilization in China has not been frequently discussed, the purpose of this paper is to focus on the association between education level and preventive care before and after the initiation of the reform. Education has been referred to as the best health outcome indicator and China's educational reform has been progressive, such as the health reform. Design/methodology/approach The authors analyzed data from four China Health and Nutrition Surveys (CHNS): 2004 ( n=9,617); 2006 ( n=9,527); 2009 ( n=9,873); and 2011 ( n=9,430). Variables were selected based on Andersen's healthcare utilization model (predisposing, enabling and need factors). Multivariable logistic regression models, odds ratios (ORs) and 95 percent confidence intervals (95 percent CI) were conducted and reported. Findings In the adjusted multivariable logistic regression models, the authors found that general education was associated ( p<0.05) with access to preventive care in 2004, 2009 and 2011, but not in 2006. Individuals with higher education had higher ORs for utilizing preventive care, compared with lower education (primary school education or none). Practical implications Policy implications include providing educational protocols regarding preventive care's significance to residents educated at lower level schools, especially younger individuals. Originality/value To the authors' knowledge, this is the first comparative assessment on education level and preventive care utilization before and after the implementation of the Chinese health reform.

Strengthening the public health workforce: An estimation of the long-term requirements for public health specialists in Serbia

At the beginning of the 21st century, planning the public health workforce requirements came into the focus of policy makers. The need for improved provision of essential public health services, driven by a challenging non-communicable disease and causes of death and disability within Serbia, calls for a much needed estimation of the requirements of the public health professionals. Mid and long-term public health specialists' supply and demand estimations out to 2025were developed based on national staffing standards and regional distribution of the workforce in public health institutes of Serbia. By 2025, the supply of specialists, taking into account attrition rate of -1% reaches the staffing standard. However, a slight increase in attrition rates has the impact of revealing supply shortage risks. Demand side projections show that public health institutes require an annual input of 10 specialists or 2.1% annual growth rate in order for the four public health fields to achieve a headcount of 487 by 2025 as well as counteract workforce attrition rates. Shortage and poor distribution of public health specialists underline the urgent need for workforce recruitment and retention in public health institutes in order to ensure the coordination, management, surveillance and provision of essential public health services over the next decade.

Dialectical behaviour therapy for treating adults and adolescents with emotional and behavioural dysregulation: study protocol of a coordinated implementation in a publicly funded health service

BACKGROUND

In the Republic of Ireland, borderline personality disorder (BPD) is a feature of approximately 11-20% of clinical presentations to outpatient clinics within mental health services. These estimates are similar to other countries including the UK and USA. Dialectical behaviour therapy (DBT) is an intervention with a growing body of evidence that demonstrates its efficacy in treating individuals diagnosed with BPD. While a number of randomised controlled trials (RCTs) have demonstrated the efficacy of DBT, there is limited research which evaluates the effectiveness of this model when applied to real world settings. Funding was secured to co-ordinate DBT training in public community-based mental health services across Ireland. As no other study has evaluated a co-ordinated national implementation of DBT, the current study proposes to investigate the effectiveness of DBT in both adult and child/adolescent community mental health services across Ireland, evaluate the coordinated implementation of DBT at a national level, and complete a comprehensive economic evaluation comparing DBT versus treatment-as-usual.

METHODS/ DESIGN

This study takes the form of a quasi-experimental design. Individuals attending community mental health services who meet criteria for participation in the DBT programme will be allocated to the intervention group. Individuals who live in areas in Ireland where DBT is not yet available, and individuals who choose not to participate in the intervention, will be invited to participate in a treatment-as-usual comparison group. Self-report clinical measures and health service use questionnaires for DBT participants (and parent/guardians as appropriate) will be administered at pre-, mid- and post-intervention, as well as follow-up for participants who complete the intervention. Survey and interview data for DBT therapists will be gathered at three time points: prior to DBT training, 6 months after teams begin delivery of the intervention, and 2 years following training completion.

DISCUSSION

It is anticipated that the results of this study will provide evidence for the effectiveness of DBT for patients, and report on recommendations regarding best practice guidelines for implementation of DBT and its economic merit in a publicly funded service.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT03180541 ; Registered June 7th 2017 'retrospectively registered'.

Measuring healthcare productivity - from unit to system level

Purpose - Healthcare productivity is a growing issue in most Western countries where healthcare expenditure is rapidly increasing. Therefore, accurate productivity metrics are essential to avoid sub-optimization within a healthcare system. The purpose of this paper is to focus on healthcare production system productivity measurement. Design/methodology/approach - Traditionally, healthcare productivity has been studied and measured independently at the unit, organization and system level. Suggesting that productivity measurement should be done in different levels, while simultaneously linking productivity measurement to incentives, this study presents the challenges of productivity measurement at the different levels. The study introduces different methods to measure productivity in healthcare. In addition, it provides background information on the methods used to measure productivity and the parameters used in these methods. A pilot investigation of productivity measurement is used to illustrate the challenges of measurement, to test the developed measures and to prove the practical information for managers. Findings - The study introduces different approaches and methods to measure productivity in healthcare. Practical implications - A pilot investigation of productivity measurement is used to illustrate the challenges of measurement, to test the developed measures and to prove the practical benefits for managers. Originality/value - The authors focus on the measurement of the whole healthcare production system and try to avoid sub-optimization. Additionally considering an individual patient approach, productivity measurement is examined at the unit level, the organizational level and the system level.

[Health care provisions for asylum-seekers : A nationwide survey of public health authorities in Germany]

BACKGROUND

Nation-wide studies on the health care situation of asylum-seekers in Germany are lacking, but decision-makers increasingly need such information.

OBJECTIVES

The aim of the study was to assess structures, processes and needs related to the health care provision for asylum-seekers along the continuum of reception centres to community dwellings from the perspective of the German public health authorities.

MATERIALS AND METHODS

A nation-wide cross-sectional mixed-methods survey was carried out. All heads of public health authorities in Germany (N = 389) were invited to complete a standardized questionnaire related to: (1) medical procedures and screening; (2) prevention and health promotion; (3) communication; (4) documentation and information; (5) coordination; (6) structural resources and needs. The quantitative survey was complemented by qualitative semi-structured interviews.

RESULTS

In total, 123 heads of public health authorities (response rate: 31,6 %) completed the questionnaire, and 29 were interviewed. Priority areas to improve the health care situation were better coordination and standardisation of care, enhancing vaccination capacities, standardised documentation, better health information exchange (in line with data protection laws), and a stronger focus on a few relevant infectious diseases in the scope of compulsory health entry examinations.

CONCLUSION

The instruments proved useful to assess the health care situation of asylum-seekers in a decentralized health care system. Repeated surveys with a focus on selected domains of the questionnaire could help monitor the health care situation on a regular basis.

Discharge against medical advice from a Tehran emergency department

PURPOSE

The purpose of this paper is to identify the main reasons for discharge against medical advice (DAMA) in the emergency department (ED) of a teaching hospital in Tehran, Iran.

DESIGN/METHODOLOGY/APPROACH

This cross-sectional study was conducted on all the patients who left the ED of a referral teaching hospital against medical advice (AMA) in 2008. A questionnaire was filled out for each patient to determine the reasons behind patient leaving AMA.

FINDINGS

In total, 12.8 percent of the patients left the hospital AMA. Dissatisfaction with being observed in the ED, having a feeling of recovery and hospital personnel encouraging patients to leave the hospital were the main reasons for leaving the hospital AMA.

PRACTICAL IMPLICATIONS

Like many other centers, the results showed that poor communication skill and work overload were the main contributing factors to DAMA. The center managed to improve patient satisfaction and thus lowered DAMA rates following this study. Considering the similarities reported in the reports and that of other studies, it could be concluded that policy makers in other centers can also benefit from the results to adopt effective approaches to reduce DAMA rate.

ORIGINALITY/VALUE

To the knowledge no study has evaluated the rate and the reasons behind DAMA in the Iranian EDs.

Standard 12 month dialectical behaviour therapy for adults with borderline personality disorder in a public community mental health setting

BACKGROUND

Dialectical behaviour therapy (DBT) is noted to be an intervention with a growing body of evidence that demonstrates its efficacy in treating individuals diagnosed with borderline personality disorder (BPD). Evidence for the effectiveness of DBT in publicly funded community mental health settings is lacking however. No study to our knowledge has been published on the effectiveness of a 12 month standard DBT programme without adaptations for individuals with BPD in a publicly funded community mental health setting and no study has included data across multiple time-points. The main objective of the current study was to determine if completion of a 12 month DBT programme is associated with improved outcomes in terms of borderline symptoms, anxiety, hopelessness, suicidal ideation, depression and quality of life. A secondary objective includes assessing client progress across multiple time-points throughout the treatment.

METHODS

Fifty-four adult participants with BPD completed the standard DBT programme across four sites in community mental health settings in the Republic of Ireland. Data was collected by the DBT therapists working with participants and took place at 8 week intervals across the 12 month programme. To explore the effects of the intervention for participants, linear mixed-effects models were used to estimate change utilising data available from all time-points.

RESULTS

At the end of the 12 month programme, significant reductions in borderline symptoms, anxiety, hopelessness, suicidal ideation and depression were observed. Increases in overall quality of life were also noted. In particular, gains were made during the first 6 months of the programme. There was a tendency for scores to slightly regress after the six-month mark which marks the start of the second delivery of the group skills cycles.

CONCLUSIONS

The current study provides evidence for the effectiveness of standard DBT in publicly funded community mental health settings. As participants were assessed at the end of every module, it was possible to observe trends in symptom reduction during each stage of the intervention. Despite real-world limitations of applying DBT in community settings, the results of this study are comparable with more tightly controlled studies.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT03166579; Registered May 24th 2017 'retrospectively registered'.

Managing healthcare information: analyzing trust

Purpose - The purpose of this paper is to analyze two case studies with a trust matrix tool, to identify trust issues related to electronic health records. Design/methodology/approach - A qualitative research approach is applied using two case studies. The data analysis of these studies generated a problem list, which was mapped to a trust matrix. Findings - Results demonstrate flaws in current practices and point to achieving balance between organizational, person and technology trust perspectives. The analysis revealed three challenge areas, to: achieve higher trust in patient-focussed healthcare; improve communication between patients and healthcare professionals; and establish clear terminology. By taking trust into account, a more holistic perspective on healthcare can be achieved, where trust can be obtained and optimized. Research limitations/implications - A trust matrix is tested and shown to identify trust problems on different levels and relating to trusting beliefs. Future research should elaborate and more fully address issues within three identified challenge areas. Practical implications - The trust matrix's usefulness as a tool for organizations to analyze trust problems and issues is demonstrated. Originality/value - Healthcare trust issues are captured to a greater extent and from previously unchartered perspectives.

Are We Really Impacting Duration of Untreated Psychosis and Does It Matter?: Longitudinal Perspectives on Early Intervention from the Irish Public Health Services

Although early intervention in psychosis is clinically intuitive and theoretically feasible, the reality is that over recent decades the evidence base to support it has not advanced as much as might have been anticipated. Material benefits of early intervention in established psychosis have not been universally demonstrated and much uncertainty continues to surround the field of treatment in the prodromal phase. Undoubtedly methodological differences between studies are relevant and better understanding of different treatment models and the effectiveness of their constituent parts may yield the most benefit, particularly from a public health perspective.

Food production and service in UK hospitals

PURPOSE

The purpose of this paper is to apply value stream mapping holistically to hospital food production/service systems focused on high-quality food.

DESIGN/METHODOLOGY/APPROACH

Multiple embedded case study of three (two private-sector and one public-sector) hospitals in the UK.

FINDINGS

The results indicated various issues affecting hospital food production including: the menu and nutritional considerations; food procurement; food production; foodservice; patient perceptions/expectations.

RESEARCH LIMITATIONS/IMPLICATIONS

Value stream mapping is a new approach for food production systems in UK hospitals whether private or public hospitals.

PRACTICAL IMPLICATIONS

The paper identifies opportunities for enhancing hospital food production systems.

ORIGINALITY/VALUE

The paper provides a theoretical basis for process enhancement of hospital food production and the provision of high-quality hospital food.