Perspectives on Communication Technology Use for Alleviating the Impact of COVID-19 on Hospitalized Patients' Well-Being and Transitions in Care

BACKGROUND

The COVID-19 pandemic created many challenges for in-patient care including patient isolation and limitations on hospital visitation. Although communication technology, such as video calling or texting, can reduce social isolation, there are challenges for implementation, particularly for older adults.

OBJECTIVE/METHODS

This study used a mixed methodology to understand the challenges faced by in-patients and to explore the perspectives of patients, family members, and health care providers (HCPs) regarding the use of communication technology. Surveys and focus groups were used.

FINDINGS

Patients who had access to communication technology perceived the COVID-19 pandemic to have more adverse impact on their well-beings but less on hospitalization outcomes, compared to those without. Most HCPs perceived that technology could improve programs offered, connectedness of patients to others, and access to transitions of care supports. Focus groups highlighted challenges with technology infrastructure in hospitals.

DISCUSSION

Our study findings may assist efforts in appropriately adopting communication technology to improve the quality of in-patient and transition care.

[Foot reflexology for caregivers in palliative care]

Foot reflexology is the use of massage and acupressure techniques on the feet, which represent each organ of the human body. The reflexologist knows precisely the anatomy of the body and the reflex points on the feet in order to relieve and treat the person's problems. A team from the University Hospital of Clermont-Ferrand shares a very positive experience, unfortunately interrupted by the Covid-19 health crisis.

[Quality of Medical Imaging examination requests in Bouaké (Cote d'Ivoire): about 3129 requests]

OBJECTIVE

Assess the quality of medical imaging exam requests in order to facilitate their successful completion.

MATERIAL AND METHODS

This was a prospective study, carried out at the Bouaké UniversityHospital over a period of 4 months. This study covered 3129 requests for examination. The aim was to evaluate the conformity of the different requests established by the CDEI indicator. Data analysis was carried out using Epi Info 7 software.

RESULTS

Requests for medical imaging exams were under-informed in 98.66% of cases by prescribers as defined by the CDEI indicator. The requests included the patient's name in 99.78% of cases, first name(s) in 98.91% of cases, age in 51.45%, and sex in 60.95% of cases. 84.79% of the reports came from the Bouaké CHU and 98.43% were dated. The patient's hospitalized status was not specified in 99.97% of the requests for analysis. The indication was included in 92.78% of the reports and diagnostic hypotheses were mentioned in only 94.76%. The imaging medium requested was specified in 99.78% with conventional radiography predominating in 80.88%. The anatomical region was mentioned in 92.49%. The identity and contact information of the prescribers represented 92% and 48% of the requestsrespectively.

CONCLUSION

The quality of writing of medical imaging examination requests was unsatisfactory overall with a high rate of non-compliance. Much effort to be made by the different actors.

[Advocacy for food and wine in palliative care]

In the palliative care unit, the care and treatment provided are aimed at optimizing the quality of life and not the quantity of life. Food is adjusted to the patient's condition and is primarily oriented towards pleasure food.

Clinical practice standards for colonoscopy

Colonoscopy is considered as the most effective tool for preventing, screening, and diagnosing colorectal lesions. Effectiveness of colonoscopy was identified as a major priority, and it strictly depends on quality measures. Therefore, international guidelines were formulated on quality indicators for colonoscopy, aiming to reduce the rate of interval cancers related to missed lesions during colonoscopy. Quality indicators are divided into 3 time periods: preprocedure, intraprocedure, and postprocedure.  The main pre-procedural indicators are the assessment of the appropriateness of indication of colonoscopy and the prescription of adequate bowel preparation during a consultation prior to colonoscopy. Per-procedural criteria include all technical aspects of the procedure, which are "endoscopist-dependent" factors, particularly cecal intubation, detection of adenomas and withdrawal time. The main post-procedure indicators are the rate of complications, patient experience and optimal surveillance intervals following removal of colorectal polyps. The implementation of key performance measures in endoscopy practice is increasingly important as it can help improving our care of patients and optimize outcomes. In this review, the "Club d'endoscopie digestive" (CED) presented a summary of the main colonoscopy quality indicators, and suggested recommendations that took into account the particularities of our local conditions.

[Temporality in nursing research: a metronome for the benefit of quality?]

Time is a key element of the nursing research process, notably because it is lacking in daily life and is subject to strict regulations. Engage in a nursing research project thereby forces the researcher to review the time available, to rethink nursing practice. It can therefore prove to be a useful tool in the organisation of are and the improvement of practices.

Determinants of multidrug-resistant tuberculosis in São Paulo-Brazil: a multilevel Bayesian analysis of factors associated with individual, community and access to health services

Objective

Multidrug‐resistant tuberculosis (MDR‐TB) remains a serious public health problem worldwide. Accordingly, this study sought to identify individual, community and access to health services risk factors for MDR‐TB.

Methods

Retrospective cohort of all TB cases diagnosed between 2006 and 2016 in the state of São Paulo. A Bayesian spatial hierarchical analysis with a multilevel design was carried out.

Results

It was identified that the history of previous TB treatment (Odds Ratios [OR]:13.86, 95% credibility interval [95% CI]:12.06–15.93), positive sputum culture test (OR: 5.26, 95% CI: 4.44–6.23), diabetes mellitus (OR: 2.34, 95% CI: 1.87–2.91), residing at a standard address (OR: 2.62, 95% CI: 1.91–3.60), positive sputum smear microscopy (OR: 1.74, 95% CI: 1.44–2.12), cavitary pulmonary TB (OR: 1.35, 95% CI: 1.14–1.60) and diagnosis performed due to spontaneous request (OR: 1.26; 95% CI: 1.10–1.46) were associated with MDR‐TB. Furthermore, municipalities that performed HIV tests in less than 42.65% of patients with TB (OR: 1.50, 95% CI: 1.25–1.79), that diagnosed TB cases only after death (OR: 1.50, 95% CI: 1.17–1.93) and that had more than 20.16% of their population with income between ¼ and ½ of one minimum wage (OR: 1.56, 95% CI: 1.30–1.87) were also related to the MDR‐TB.

Conclusions

Knowledge of these predictive factors may help to develop more comprehensive disease prevention strategies for MDR‐TB, avoiding the risks expressed regarding drug resistance expansion.

Patterns, quality and appropriateness of surgical referrals in Malawi

OBJECTIVES

Reliable referral systems are essential to the functionality and efficiency of the wider health care system in low- and middle-income countries (LMICs), particularly in surgery as the disease burden is growing while resources remain constrained and unevenly distributed. Yet, this is a critically under-researched area. This study aimed to provide a comprehensive assessment of surgical referral systems in a LMIC, Malawi, with a view to shedding light on this important aspect of public health and share lessons learned.

METHODS

We conducted a prospective analysis of all inter-hospital referrals received at Queen Elizabeth Central Hospital (QECH) in 2014-2015. A subsample of 255 referrals was assessed by three independent surgical experts against necessity and quality of the transfer to identify any inefficiencies in the referral process.

RESULTS

1317 patients were referred to QECH during the study period (average 53/month), 80% sent by government district hospitals. One in 3 cases were referred unnecessarily, many of which could have been managed locally. In 82% of cases, there was no communication with QECH prior to referral, 41% had incorrect/incomplete diagnosis by the referring clinicians and 39% of referrals were not timely.

CONCLUSIONS

Our findings provide the first evidence on the state of the surgical referral system in Malawi and contribute to building the body of knowledge necessary to inform system improvements. Responses should include reducing inappropriate use of specialist care and ensuring better care pathways for surgical patients, especially in rural areas, where access to specialist expertise is not available at present.

Variation in competent and respectful delivery care in Kenya and Malawi: a retrospective analysis of national facility surveys

Objective

Although substantial progress has been made in increasing access to care during childbirth, reductions in maternal and neonatal mortality have been slower. Poor‐quality care may be to blame. In this study, we measure the quality of labour and delivery services in Kenya and Malawi using data from observations of deliveries and explore factors associated with levels of competent and respectful care.

Methods

We used data from nationally representative health facility assessment surveys. A total of 1100 deliveries in 392 facilities across Kenya and Malawi were observed and quality was assessed using two indices: the quality of the process of intrapartum and immediate postpartum care (QoPIIPC) index and a previously validated index of respectful maternity care. Data from standardised observations of care were analysed using descriptive statistics and multivariable random‐intercept regression models to examine factors associated with variation in quality of care. We also quantified the variance in quality explained by each domain of covariates (patient‐, provider‐ and facility‐level and subnational divisions).

Results

Only 61–66% of basic elements of competent and respectful care were performed. In adjusted models, better‐staffed facilities, private hospitals and morning deliveries were associated with higher levels of competent and respectful care. In Malawi, younger, primipara and HIV‐positive women received higher‐quality care. Quality also differed substantially across regions in Kenya, with a 25 percentage‐point gap between Nairobi and the Coast region. Quality was also higher in higher‐volume facilities and those with caesarean section capacity. Most of the explained variance in quality was due to regions in Kenya and to facility, and patient‐level characteristics in Malawi.

Conclusions

Our findings suggest considerable scope for improvement in quality. Increasing staffing and shifting births to higher‐volume facilities – along with promotion of respectful care in these facilities – should be considered in sub‐Saharan Africa to improve outcomes for mothers and newborns.

Quantity vs. quality: an assessment of the current pipeline for rabies

OBJECTIVES

To gain insight in the potential of the current pipeline for rabies to decrease the burden of disease by evaluating its relevance to high-risk countries.

METHODS

Rabies-related patent documents and clinical trials were retrieved from Espacenet and the WHO ICTRP, respectively. Data were cleaned, modulated and categorised into a pre-defined set of indicators those were used for (statistical) analyses on the number of patent applications, patent quality and type of stakeholders involved for different geographical areas.

RESULTS

Analysis of 583 unique patent families applied for in the period 1954-2017 showed a steep growth in the yearly number of patent applications. A significant portion of new patent applications concern Chinese patents with relatively low quality that are filed by a dispersed group of applicants. Excluding these patents, the number of patent applications has been virtually stable over the years. A shift is seen in public stakeholders becoming more prolific as patent applicants. This shift is also reflected in clinical trials; key sponsors of clinical trials include public and private stakeholders originating from high-risk rabies countries. The majority of clinical trials investigate adjustments to existing vaccines that may improve accessibility.

CONCLUSION

The results show a discrepancy between the quantity and quality of rabies patent applications that reflects national patent regulations rather than real progress in decreasing the burden of disease. This is in contrast to clinical trials, which focus on incremental innovations that are tested in clinical trials but may nevertheless have a potentially strong impact in high-risk countries.

Examining program quality in early childhood home visiting: From infrastructure to relationships

Although there are many examples of evidence-based early childhood home-visiting programming, the field itself struggles with modest outcomes and variable levels of program effectiveness. This article documents the experience of creating a statewide monitoring system to assess home-visiting program quality and compliance to identified standards, integrating multiple sources of information across different domains of functioning. Monitoring results from 57 programs are summarized, with variable but promising levels of quality. Programs generally report satisfaction and benefit from the process. In addition, the relationship between direct observations of home visits and home-visitor report of their approach to working with families is analyzed. Results suggest significant, albeit small, associations. Although there are trade-offs between comprehensiveness of information gathering and practical application, the use of monitoring findings to support home-visiting programs holds potential for quality improvement.

Effect of a maternal and newborn health system quality improvement project on the use of facilities for childbirth: a cluster-randomised study in rural Tanzania

Objectives

Reduction in maternal and newborn mortality requires that women deliver in high quality health facilities. However, many facilities provide sub‐optimal quality of care, which may be a reason for less than universal facility utilisation. We assessed the impact of a quality improvement project on facility utilisation for childbirth.

Methods

In this cluster‐randomised experiment in four rural districts in Tanzania, 12 primary care clinics and their catchment areas received a quality improvement intervention consisting of in‐service training, mentoring and supportive supervision, infrastructure support, and peer outreach, while 12 facilities and their catchment areas functioned as controls. We conducted a census of all deliveries within the catchment area and used difference‐in‐differences analysis to determine the intervention's effect on facility utilisation for childbirth. We conducted a secondary analysis of utilisation among women whose prior delivery was at home. We further investigated mechanisms for increased facility utilisation.

Results

The intervention led to an increase in facility births of 6.7 percentage points from a baseline of 72% (95% Confidence Interval: 0.6, 12.8). The intervention increased facility delivery among women with past home deliveries by 18.3 percentage points (95% CI: 10.1, 26.6). Antenatal quality increased in intervention facilities with providers performing an additional 0.5 actions across the full population and 0.8 actions for the home delivery subgroup.

Conclusions

We attribute the increased use of facilities to better antenatal quality. This increased utilisation would lead to lower maternal mortality only in the presence of improvement in care quality.

Magnitude and pattern of improvement in processes of care for hospitalised children with diarrhoea and dehydration in Kenyan hospitals participating in a clinical network

OBJECTIVE

WHO recommends optimisation of available interventions to reduce deaths of under-five children with diarrhoea and dehydration (DD). Clinical networks may help improve practice across many hospitals but experience with such networks is scarce. We describe magnitude and patterns of changes in processes of care for children with DD over the first 3 years of a clinical network.

METHODS

Observational study involving children aged 2-59 months with DD admitted to 13 hospitals participating in the clinical network. Processes of individual patient care including agreement of assessment, diagnosis and treatment according to WHO guidelines were combined using the composite Paediatric Admission Quality of Care (PAQC) score (range 0-6).

RESULTS

Data from 7657 children were analysed and improvements in PAQC scores were observed. Predicted mean PAQC score for all the hospitals at enrolment was 59.8% (95% CI: 54.7, 64.9) but showed a wide variation (variance 10.7%, 95% CI: 5.8, 19.6). Overall mean PAQC score increased by 13.8% (95% CI: 8.7-18.9, SD between hospitals: ±8.2) in the first 12 months, with an average 0.9% (95% CI: 0.3-1.5, SD ± 1.0) increase per month and plateaued thereafter, and changes were similar in two groups of hospitals joining the network at different times.

CONCLUSION

Adherence to guidelines for children admitted with DD can be improved through participation in a clinical network but improvement is limited, not uniform for all aspects of care and contexts and occurs early. Future research should address these issues.

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TOWARDS A NEW CERTIFICATION OF HEALTHCARE FACILITIES FOR 2020.: The accreditation process, now a certification process for healthcare facilities, has constantly evolved since 1999 in order to improve the quality and safety of care provided to patients. In order to meet demographic, epidemiological and social challenges, it needs to be revised again. The French National Health Authority board has fixed three main objectives for the 2020 version: to medicalise certification, simplify it and adapt it to hospital groups in the public and private sector.

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The certification visit by the French National Health Authority requires a high level of commitment and collaboration on the part of the teams of the healthcare facility concerned. Professionals from a hospital at home unit having obtained its Level A certification describe the process and explain how the approach helped to give meaning to collective action when caring for patients in their home.

[Not Available]

E-SATIS NATIONAL SURVEY, MEASURING PATIENT SATISFACTION AND EXPERIENCE.: Since 2015, the French National Health Authority has been managing and rolling out the national programme for measuring patient satisfaction and experience, called 'e-Satis'. Thanks to this evaluation, it has produced, for all participating healthcare facilities, detailed and continuous results, in order to guide the improvement of the quality of practices and the organisation of care. The National Health Authority must now look to consolidate the programme, notably through greater patient participation and the appropriation of the results by professionals.

[Not Available]

INTEGRATION OF THE QUALITY APPROACH INTO NURSING PRACTICES, CHALLENGES AND IMPROVEMENT LEVERS.: The deployment of the care quality and safety approach is integrated into the strategic policies of healthcare facilities. Despite significant investment by management and a desire on the part of caregivers to provide quality care, certain tools and practices are still not widely used. A qualitative survey carried out with nurses and healthcare managers reveals the obstacles to the long-term survival of such an approach and the levers which can be used to develop this quality culture.

[Not Available]

Care quality and safety indicators, piloted by the national health authority, are tools forming part of a global programme of improvement of quality and safety of care. The national scheme for measuring the quality and safety of care provides, for all healthcare facilities, dashboards for managing care quality and safety. Currently focused on the public and private hospital sector, it needs to evolve to widen its scope to include community care and the medical-social sector.

[Not Available]

The internal/external audit method in a nursing home is a lever for improving quality which varies greatly depending on the homes' management and contexts. It remains a useful quality management tool but does not necessarily respond to the specific nature of these facilities. The guidelines and populations are evolving towards the medicalisation of nursing homes and a risk prevention policy similar to that found in hospitals.

[Reception, the first element of care in emergency departments]

The mission of an emergency department is to attend to any person arriving, at any time, whatever their condition, with the aim of treating them or transferring them to the most appropriate department. The approach often requires the provision of technical care meaning that relational care frequently takes a back seat. When the patient first arrives, the care is different, the patient-nurse interaction is essential. The role and the missions accorded to the triage nurse are fundamental in ensuring the patient receives quality care at this stage.

[Quality, an ethical dimension in nursing care]

Care cannot simply be summed up as a standardised practice. It constitutes an ethical obligation which drives us to respond actively to the call for help from a person suffering and in need. A real call to action, this practice, both relational and technical, strives to care about others, first and foremost in terms of their ability to be in the world.

Quality of omeprazole purchased via the Internet and personally imported into Japan: comparison with products sampled in other Asian countries

OBJECTIVE

To evaluate the quality of omeprazole personally imported into Japan via the Internet and to compare the quality of these samples with previously collected samples from two other Asian countries.

METHODS

The samples were evaluated by observation, authenticity investigation and pharmacopoeial quality analysis. Quality comparison of some selected samples was carried out by dissolution profiling, Raman spectroscopy and principle component analysis (PCA).

RESULTS

Observation of the Internet sites and samples revealed some discrepancies including the delivery of a wrong sample and the selling of omeprazole without a prescription, although it is a prescription medicine. Among the 28 samples analysed, all passed the identification test, 26 (93%) passed the quantity and content uniformity tests and all passed the dissolution test. Dissolution profiling confirmed that all the personally imported omeprazole samples remained intact in the acid medium. On the other hand, six samples from two of the same manufacturers, previously collected during surveys in Cambodia and Myanmar, frequently showed premature omeprazole release in acid. Raman spectroscopy and PCA showed significant variation between omeprazole formulations in personally imported samples and the samples from Cambodia and Myanmar.

CONCLUSIONS

Our results indicate that the pharmaceutical quality of omeprazole purchased through the Internet was sufficient, as determined by pharmacopeial tests. However, omeprazole formulations distributed in different market segments by the same manufacturers were of diverse quality. Measures are needed to ensure consistent quality of products and to prevent entry of substandard products into the legitimate supply chain.

[Managing the cold chain in healthcare facilities]

The storage of temperature-sensitive healthcare products requires control of the cold chain. Healthcare facilities must have the appropriate equipment at their disposal and ensure the traceability and monitoring of temperatures.

[Simulation in health to improve the delivery of care]

Simulation in health care is a very effective training tool. Using mannequins, 'standardised patients' or virtual care environments, it encourages participants to reflect on nursing practices while practising in a safe and controlled space.

[Sleep and nocturnal incontinence in hospital or institutional care]

A survey carried out in 2004 studied the link between quality of sleep and the nocturnal management of incontinence. This same survey was repeated 10 years later. The results reveal the impact on quality of sleep, the deteriorating management of incontinence with the lenghtening of waiting time and the causes of waking. This discussion process on the quality of sleep must continue.

[Web TV, a tool favouring collaboration for quality care]

The Web TV of the EPSM Lille-Métropole is an innovative communication tool in mental health. Aiming to change the image of psychiatry among users as well as professionals, these programmes, posted online, enable viewers to see the care provided by mental health professionals. They are also an opportunity for those involved to get to know each other better to improve the way they work together.

[The respect of the right to freedom of movement, an indicator of good quality patient management]

Freedom of movement is at the centre of contradictory challenges for the different people working in psychiatry, faced with a society demanding social regulation and safety, and the desire of institutions to provide high quality care. This freedom, and more globally the respect of patients' civil rights, are an indicator of the expected quality of care. Taking these rights into consideration does not mean neglecting safety, but attempts to put it into perspective. This article presents the clinical case of a patient.

[Adverse event sheets, a quality improvement tool]

The declaration of adverse events comprises a written nurse report which helps to improve the quality and safety of care. Submitted to professionals from the quality department, this report will be used to perform an analysis of the causes and must therefore be descriptive and objective.

[Electronic nursing records]

A community hospital team describes how they have set up, over several years, a system of electronic nursing records. Thanks to the work of the nurses of the hospital information system, the screen has replaced paper in line with the specific needs of the professionals.

Determining the effective coverage of maternal and child health services in Kenya, using demographic and health survey data sets: tracking progress towards universal health coverage

OBJECTIVES

Effective coverage (EC) is a measure of health systems' performance that combines need, use and quality indicators. This study aimed to assess the extent to which the Kenyan health system provides effective and equitable maternal and child health services, as a means of tracking the country's progress towards universal health coverage.

METHODS AND RESULTS

The Demographic Health Surveys (2003, 2008-2009 and 2014) and Service Provision Assessment surveys (2004, 2010) were the main sources of data. Indicators of need, use and quality for eight maternal and child health interventions were aggregated across interventions and economic quintiles to compute EC. EC has increased from 26.7% in 2003 to 50.9% in 2014, but remains low for the majority of interventions. There is a reduction in economic inequalities in EC with the highest to lowest wealth quintile ratio decreasing from 2.41 in 2003 to 1.65 in 2014, but maternal health services remain highly inequitable.

CONCLUSIONS

Effective coverage of key maternal and child health services remains low, indicating that individuals are not receiving the maximum possible health gain from existing health services. There is an urgent need to focus on the quality and reach of maternal and child health services in Kenya to achieve the goals of universal health coverage.

[Collaboration between nursing teams and users to improve the quality of the care provision]

The place of users in the health care system has evolved towards their greater involvement in health institutions. International models have led France to recognise patients' experience and to develop a partnership with caregivers. Adapted methods favour the emergence and consideration of the opinion of those receiving the care, help to open up the debate and develop actions more in line with patients' needs.

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Zusammenfassung. Die Qualitätssicherung zu Gunsten der Patienten ist im Alltag nicht mehr wegzudenken. Diese Arbeit beschreibt wichtige Aspekte bezüglich Sicherstellung von Standards zur Qualitätssicherung und Qualitätsverbesserung im diagnostischen und interventionellen rheumatologischen Ultraschall in der Schweiz durch die Arbeitsgruppe QIR («Quality in Rheumatology»). Qualitätsindikatoren in der Rheumatologie und Qualitätsstandards in der Arthrosonografie werden hervorgehoben und vorgestellt.

[Internal and external assessment of nursing home residents' satisfaction]

Quality improvement procedures and measuring the satisfaction of nursing home residents is a major priority. A study assessed the differences between the results of a survey conducted by internal staff and of one carried out by an external service provider to evaluate the satisfaction of the residents of a nursing home.

[Quality of care and risk management in hospital at home services]

Hospital at home structures are healthcare institutions in their own right, with the same obligations in terms of governance with regard to quality of care and risk management. However, hospital at home services are characterised by the remote management of the activity and the nursing staff, with specific constraints.

Performance Measures in the Management of Chronic Obstructive Pulmonary Disease in Primary Care--A Retrospective Analysis

RATIONALE

Adherence to recommendations regarding quality of care for chronic obstructive pulmonary disease (COPD) improves outcome of patients. Performance measures (PM) reflect the quality of care but information about documentation of PM in primary care, is scant.

AIM

To investigate the documentation of COPD PM in primary care practices of the Canton Zurich.

METHOD

Twelve months retrospective medical chart review with physician of patients diagnosed COPD. PM were assessed by calculating the percentages of documented performance parameters. In addition, PM were compared with a practice running a structured COPD program.

RESULTS

Data from 14 practices, total 115 patients, 57% male, mean age 68 (44–93) years, 46% active smokers, median pack-years 56 (range 22–150) were analyzed. Comorbidities were documented in 73%, GOLD grading in 70% (GOLD I 11%, GOLD II 64%, GOLD III 21%, GOLD IV 4%). On average, patients were reported to have 1,4 exacerbations/year. Documentation of PM ranged between 16% (written action plan for exacerbations) and 95% (smoking status). Documentation was identified for smoking cessation advice (74%), influenza vaccination/recommendation (49%), adequate pharmacotherapy (65%), inhalation instruction (57%), pulmonary rehabilitation advice (27%), collaborative care (60%) and proactive follow up (51%). The practice running the COPD program showed significant better documentation for all PM (p<0,01) but for influenza vaccination.

CONCLUSION

In Swiss primary care gaps in documentation and tracking of COPD performance exist. Identifying and bridging these gaps is central for health care quality.

Mutuelles de santé en Afrique : caractéristiques et relations contractuelles avec les prestataires de soins pour la prise en charge de la qualité des soins

En Afrique, une part importante de la population est encore confrontée à plusieurs barrières pour accéder aux soins. Les mutuelles de santé (MS) sont mises en place pour réduire la barrière financière et assurer à leurs membres un accès à des soins de qualité. Les MS établissent des relations avec les prestataires de soins sous forme de contrat, dont certaines clauses peuvent contenir des notions de qualité des soins (QS). A travers une vue d'ensemble de la typologie de 180 MS de 14 pays (dans Afrique Ouest et Centrale), cet article vise à analyser dans quelle mesure les caractéristiques des MS influencent la mise en œuvre de mécanismes contractuels susceptibles de faciliter la discussion sur la QS. L'hypothèse de cette association a été étudiée avec trois types de caractéristiques (taille, utilisation des services et volume des soins achetés) et huit variables relatives à la contractualisation et la QS (existence d'un contrat, organisation de rencontres, fréquence de ces rencontres, présence de notions de QS dans le contrat, négociation du contrat, révision du contrat, révision des clauses spécifiques à la QS et organisation de rencontres pour discuter de QS). Les MS de type communautaire représentent 80% des mutuelles étudiées (60% d'entre elles sont localisées en zone rurale). Les MS professionnelles représentent 17% et se concentrent principalement au Mali et en Côte d'Ivoire. La quasi-totalité des MS disposent de contrats écrits et contenant des notions relatives à la QS. Bien que les MS de grande taille ayant des résultats financiers importants négocient plus les aspects liés à la qualité des soins lors de l'élaboration de la convention, les MS de taille et aux performances financières plus modestes mettent en œuvre des mécanismes plus réguliers de concertation avec les prestataires. Ces rencontres sont susceptibles de créer un espace de prise en charge de la QS.

[Quality of involuntary hospital administration in Switzerland]

SUBJECT

This study aims at investigating the formal and content-related quality of medical certificates directing compulsory hospital admissions before the scheduled alteration of the Swiss civil legislation in January 2013. A comparison between physicians with different professional backgrounds concerning certificates and patients was conducted.

METHODS

Retrospective investigation of medical records of involuntary inpatients at the University Hospital of Psychiatry in Zurich during a period of six months (N=489).

RESULTS

Considerable deficits concerning formal and particularly content-related aspects of the certificates were found. Psychiatrists issued certificates of the highest quality followed by emergency physicians, hospital doctors and general practitioners. Patients differed with respect to several sociodemographic and clinical variables.

CONCLUSIONS

The quality of certificates directing involuntary hospital admission has to be improved considering the impact on the individual concerned. The consequences of the new legislation on the quality of the admission practices should be inquired in order to improve professional training on the issue.

[Pain and conflicts: a comparative approach and implications for end-of-life quality of care]

Are conflicts to an organization what pain is to an organism?

OBJECTIVES

To explore the similarities and the differences between pain and conflicts in palliative care settings, and to better understand the potential importance of conflicts in end of life quality of care.

METHODS

Comparative and reflective methods focusing on how conflicts and pain are taken care of in health structures.

RESULTS

Pain and conflicts present numerous similarities such as identity, typology, prevalence, warning function, economic and social costs, denial, occultation and hurdles to appropriate management. Differences also exist regarding pain - there are prevention programs on local and international levels; there are specific research and training programs; and there is also some social visibility. This does not yet exist on a larger scale regarding conflicts.

CONCLUSION

Decision makers at clinical and public health levels should probably push to label conflicts as indicators of quality of care and develop appropriate health policy programs.