Kolltveit, Beate-Christin Hope; Gjengedal, Eva; Graue, Marit; Iversen, Marjolein. M.; Thorne, Sally; Kirkevold, Marit
Background Introducing new technology in health care is inevitably a challenge. More knowledge is needed to better plan future telemedicine interventions. Our aim was therefore to explore health care professionals’ experience in the initial phase of introducing telemedicine technology in caring for people with diabetic foot ulcers. Methods Our methodological strategy was Interpretive Description. Data were collected between 2014 and 2015 using focus groups (n = 10). Participants from home-bas...
Howard, Steven W; Bernell, Stephanie L; Yoon, Jangho; Luck, Jeff; Ranit, Claire M
To control Medicaid costs, improve quality, and drive community engagement, the Oregon Health Authority introduced a new system of coordinated care organizations (CCOs). While CCOs resemble traditional Medicaid managed care, they have differences that have been deliberately designed to improve care coordination, increase accountability, and incorporate greater community governance. Reforms include global budgets integrating medical, behavioral, and oral health care and public health functions; risk-adjusted payments rewarding outcomes and evidence-based practice; increased transparency; and greater community engagement. The CCO model faces several implementation challenges. If successful, it will provide improved health care delivery, better health outcomes, and overall savings. PMID:25480844
Borah, G L; Hagberg, N; Jakubiak, C; Temple, J
Until 1989, the Commonwealth of Massachusetts operated a mandated care program known as Services for Handicapped Children (SHC) for children with cleft lip/palate or craniofacial anomalies. During the mid 1980s, the federal government reduced its block grant funds and encouraged the Commonwealth of Massachusetts to develop Project SERVE to address this changing fiscal reality. The principal outcome of Project SERVE was the recommendation that the SHC direct care programs, including all craniofacial and cleft palate clinics, should be dismantled over a number of years. However, due to the economic recession, all government funding was suddenly withdrawn from cleft palate teams and the state-run SHC clinics were abruptly dissolved. To treat patients left without coordinated care, former team members reassembled and began a new craniofacial team based at the University of Massachusetts Medical Center. Difficulties with the transition of the clinic included recruiting and retaining team members; remuneration procedures for team members; maintenance of patient records previously kept by the state; coordination of clinical/clerical responsibilities; identifying a physical locale to hold the clinics; and solicitation of referring health care provider referrals and follow-up. All these issues required specific interventions that are presented in this paper. Project SERVE, begun under federal auspices, in the Commonwealth of Massachusetts, has recently been promoted as a model for a new and improved approach to the management of cleft palate and craniofacial care delivery nationwide. Awareness of the potential for abrupt, radical change in funding for federally mandated cleft/craniofacial care is essential, and a successful transition to a medical center-based model is possible using the procedures established at our center. PMID:8338866
Qummry Ali Hindi
Full Text Available Objectives: To determine the cesarean section (CS rate in a consecutive series of pregnant women with Diabetes Mellitus. Material and Methods: This retrospective patients’ files review of deliveries happened to diabetic mothers was carried out from 1st January, 2005 to 31st December, 2006 in the department of Obstetrics and Gynecology of Alnoor Specialist Hospital, Makkah, Saudi Arabia. Results: Among all subjects (118, Saudi national women predominated 101(86%. Majority belonged to the age group of 36-40 years, i.e., 38(32% and 52(44% was diagnosed as gestational diabetes mellitus. However, 89(75% of pregnancies were terminated through CS. Conclusion: Majority were delivered by CS.
Entwistle, Vikki; Firnigl, Danielle; Ryan, Mandy; Francis, Jillian; Kinghorn, Philip
Objective Patients' experiences are often treated as health care quality indicators. Our aim was to identify the range of experiences of health care delivery that matter to patients and to produce a conceptual map to facilitate consideration of why they matter. Methods Broad-based review and critical interpretive synthesis of research literature on patients' perspectives of health care delivery. We recorded experiences reported by a diverse range of patients on ‘concept cards’, considered why...
Full Text Available Abstract Background In 2003, the Ethiopian Ministry of Health launched the Health Extension Programme (HEP, which was intended to increase access to reproductive health care. Despite enormous effort, utilization of maternal health services remains limited, and the reasons for the low utilization of the services offered through the HEP previously have not been explored in depth. This study explores women’s experiences and perceptions regarding delivery care in Tigray, a northern region of Ethiopia, and enables us to make suggestions for better implementation of maternal health care services in this setting. Methods We used six focus group discussions with 51 women to explore perceptions and experiences regarding delivery care. The data were analysed by means of grounded theory. Results One core category emerged, ‘making pragmatic choices’, which connected the categories ‘aiming for safer deliveries’, ‘embedded in tradition’, and ‘medical knowledge under constrained circumstances’. In this setting, women – aiming for safer deliveries – made choices pragmatically between the two available models of childbirth. On the one hand, choice of home delivery, represented by the category ‘embedded in tradition’, was related to their faith, the ascendancy of elderly women, the advantages of staying at home and the custom of traditional birth attendants (TBAs. On the other, institutional delivery, represented by the category ‘medical knowledge under constrained circumstances’, and linked to how women appreciated medical resources and the support of health extension workers (HEWs but were uncertain about the quality of care, emphasized the barriers to transportation. In Tigray women made choices pragmatically and seemed to not feel any conflict between the two available models, being supported by traditional birth attendants, HEWs and husbands in their decision-making. Representatives of the two models were not as open to
Stevens, F; Zee, J. van der
A health care delivery system is the organized response of a society to the health problems of its inhabitants. Societies choose from alternative health care delivery models and, in doing so, they organize and set goals and priorities in such a way that the actions of different actors are effective, meaningful, and socially accepted. From a sociological point of view, the analysis of health care delivery systems implies recognition of their distinct history over time, their specific values an...
Stevens, F.; Zee, J. van der
A health care delivery system is the organized response of a society to the health problems of its inhabitants. Societies choose from alternative health care delivery models and, in doing so, they organize and set goals and priorities in such a way that the actions of different actors are effective,
Witter, Sophie; Arhinful, Daniel Kojo; Kusi, Anthony; Zakariah-Akoto, Sawudatu
In resource-poor countries, the high cost of user fees for deliveries limits access to skilled attendance, and contributes to maternal and neonatal mortality and the impoverishment of vulnerable households. A growing number of countries are experimenting with different approaches to tackling financial barriers to maternal health care. This paper describes an innovative scheme introduced in Ghana in 2003 to exempt all pregnant women from payments for delivery, in which public, mission and private providers could claim back lost user fee revenues, according to an agreed tariff. The paper presents part of the findings of an evaluation of the policy based on interviews with 65 key informants in the health system at national, regional, district and facility level, including policymakers, managers and providers. The exemption mechanism was well accepted and appropriate, but there were important problems with disbursing and sustaining the funding, and with budgeting and management. Staff workloads increased as more women attended, and levels of compensation for services and staff were important to the scheme's acceptance. At the end of 2005, a national health insurance scheme, intended to include full maternal health care cover, was starting up in Ghana, and it was not yet clear how the exemptions scheme would fit into it. PMID:17938071
Conclusions: Neonatal outcome did not depend on mode of delivery though maternal morbidity and cost of care is increased following Caesarean Section. Proper selection of cases and by improving skill and confidence in new generation obstetrician, vaginal delivery of singleton fetuses in breech presentation at term remains a safe option that can be offered to a woman in a tertiary care centre. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 562-565
Maeng, Daniel D; Snyder, Susan R; Baumgart, Charles; Minnich, Amy L; Tomcavage, Janet F; Graf, Thomas R
Many states in the United States, including Pennsylvania, have opted to rely on private managed care organizations to provide health insurance coverage for their Medicaid population in recent years. Geisinger Health System has been one such organization since 2013. Based on its existing care management model involving data-driven population management, advanced patient-centered medical homes, and targeted case management, Geisinger's Medicaid management efforts have been redesigned specifically to accommodate those with complex health care issues and social service needs to facilitate early intervention, effective and efficient care support, and ultimately, a positive impact on health care outcomes. An analysis of Geisinger's claims data suggests that during the first 19 months since beginning Medicaid member enrollment, Geisinger's Medicaid members, particularly those eligible for the supplemental security income benefits, have incurred lower inpatient, outpatient, and professional costs of care compared to expected levels. However, the total cost savings were partially offset by the higher prescription drug costs. These early data suggest that an integrated Medicaid care management effort may achieve significant cost of care savings. (Population Health Management 2016;19:257-263). PMID:26565693
Kim, Hongsoo; Jung, Young-Il; Kwon, Soonman
Little is known about health and social care provision for people with long-term care (LTC) needs under multiple insurances. The aim of this study is to compare the profile, case-mix, and service provision to older people at long-term care hospitals (LTCHs) covered by the national health insurance (NHI) with those of older people at long-term care facilities (LTCFs) covered by the public long-term care insurance (LTCI) in Korea. A national LTC survey using common functional measures and a case-mix classification system was conducted with a nationally representative sample of older people at LTCFs and LTCHs in 2013. The majority of older people in both settings were female and frail, with complex chronic diseases. About one fourth were a low-income population with Medical-Aid. The key functional status was similar between the two groups. As for case-mix, more than half of the LTCH population were categorized as having lower medical care needs, while more than one fourth of the LTCF residents had moderate or higher medical care needs. Those with high medical care needs at LTCFs were significantly more likely to be admitted to acute-care hospitals than their counterparts at LTCHs. The current delivery of institutional LTC under the two insurances in Korea is not coordinated well. It is necessary to redefine the roles of LTCHs and strengthen health care in LTCFs. A systems approach is critical to establish person-centered, integrated LTC delivery across different financial sources. PMID:26305121
Hameed, Khaled Abdel
satisfaction. In addition, monitoring the improvement of such plans is an integral part of the quality process. Importantly, the facility provides comprehensive care with professionals available 24 hours/7 days. On-call teams assigned to manage pain and other treatment modalities comprises of staff supervised by the primary cancer clinicians; this arrangement facilitates reaching this goal. This study will illustrate our experience through 25 years, trying to provide the highest care of patients with cancer pain on an outpatient basis. PMID:21448029
Full Text Available In order to develop patient-centered care we need to know what patients want and how changing socio-demographic factors shape their preferences.We fielded a structured questionnaire that included a discrete choice experiment to investigate women's preferences for place of delivery care in four rural districts of Pwani Region, Tanzania. The discrete choice experiment consisted of six attributes: kind treatment by the health worker, health worker medical knowledge, modern equipment and medicines, facility privacy, facility cleanliness, and cost of visit. Each woman received eight choice questions. The influence of potential supply- and demand- side factors on patient preferences was evaluated using mixed logit models.3,003 women participated in the discrete choice experiment (93% response rate completing 23,947 choice tasks. The greatest predictor of health facility preference was kind treatment by doctor (β = 1.13, p<0.001, followed by having a doctor with excellent medical knowledge (β = 0.89 p<0.001 and modern medical equipment and drugs (β = 0.66 p<0.001. Preferences for all attributes except kindness and cost were changed with changes to education, primiparity, media exposure and distance to nearest hospital.Care quality, both technical and interpersonal, was more important than clinic inputs such as equipment and cleanliness. These results suggest that while basic clinic infrastructure is necessary, it is not sufficient for provision of high quality, patient-centered care. There is an urgent need to build an adequate, competent, and kind health workforce to raise facility delivery and promote patient-centered care.
Singh D; Choudhury Roy D; Rao Pralhad N; Nayar S
An attempt was made to study the personality traits influencing the performance of 17 primary school teachers selected under ICMR project in Wardha district, to investigate feasibility and effectiveness of their involvement as primary health care workers vis-Ã -vis the 19 community health volunteers introduced by the State Government in the non-teacher villages of the project at the same time. The results indicated that both the teachers and community health volunteers preferred preven...
Full Text Available An attempt was made to study the personality traits influencing the performance of 17 primary school teachers selected under ICMR project in Wardha district, to investigate feasibility and effectiveness of their involvement as primary health care workers vis-Ã -vis the 19 community health volunteers introduced by the State Government in the non-teacher villages of the project at the same time. The results indicated that both the teachers and community health volunteers preferred preventive and promotive health tasks and they showed no significant difference on the motivation and leadership orientation scale. The teachers, because of their job security and promotional avenues were satisfied with their achievements and were full of hopes and aspirations but the same was not true with the community health volunteers. This was due to their comparatively poor economic conditions and unstable sources of livelihood.
Bohmer, Richard M J; Lawrence, David M
Without significant operational reform within the nation's health care delivery organizations, new financing models, payment systems, or structures are unlikely to realize their promise. Adapting insights from high-performing companies in other high-risk, high-cost, science- and technology-based industries, we propose the "care platform" as an organizing framework for internal operations in diversified provider organizations to increase the quality, reliability, and efficiency of care delivery. A care platform organizes "care production" around similar work, rather than organs or specialties; integrates standard and custom care processes; and surrounds them with specifically configured information and business systems. Such organizational designs imply new roles for physicians. PMID:18780920
Heather B Neuman
Full Text Available The 2013 Institute of Medicine report investigating cancer care concluded that the cancer care delivery system is in crisis due to an increased demand for care, increasing complexity of treatment, decreasing work force and rising costs. Engaging patients and incorporating evidence-based care into routine clinical practice are essential components of a high quality cancer delivery system. However, a gap currently exists between the identification of beneficial research findings and application in clinical practice. Implementation research strives to address this gap. In this review, we discuss key components of high quality implementation research. We then apply these concepts to a current cancer care delivery challenge in women’s health, specifically the implementation of a surgery decision aid for women newly diagnosed with breast cancer.
Ramezani, Monir; Ahmadi, Fazlollah; Mohammadi, Eesa; Kazemnejad, Anoshirvan
Background: Despite the paramount importance and direct relationship of spirituality and spiritual care with health and well-being, they are relatively neglected aspects of nursing care. Objectives: The aim of this study is to explore Iranian nurses’ perceptions and experiences of the facilitators of spiritual care delivery. Materials and Methods: For this qualitative content analysis study, a purposive maximum-variation sample of 17 nurses was recruited from teaching and private hospitals in...
Niclasen, Birgit; Mulvad, Gert
Objectives. To describe the health care system and health care delivery in Greenland. Study design and method. This was a literature study that included literature and articles searched in PubMed published from 1989 to 2009 about health care in Greenland. Results. The health care system is a publicly financed governmental responsibility. Its major challenges are limited economic resources, Greenland’s demographic structure, rapid epidemiological changes, increased public demand for specialize...
Wennberg, J; Gittelsohn
Health information about total populations is a prerequisite for sound decision-making and planning in the health care field. Experience with a population-based health data system in Vermont reveals that there are wide variations in resource input, utilization of services, and expenditures among neighboring communities. Results show prima facie inequalities in the input of resources that are associated with income transfer from areas of lower expenditure to areas of higher expenditure. Variations in utilization indicate that there is considerable uncertainty about the effectiveness of different levels of aggregate, as well as specific kinds of, health services. Informed choices in the public regulation of the health care sector require knowledge of the relation between medical care systems and the population groups being served, and they should take into account the effect of regulation on equality and effectiveness. When population-based data on small areas are available, decisions to expand hospitals, currently based on institutional pressures, can take into account a community's regional ranking in regard to bed input and utilization rates. Proposals by hospitals for unit price increases and the regulation of the actuarial rate of insurance programs can be evaluated in terms of per capita expenditures and income transfer between geographically defined populations. The PSRO's can evaluate the wide variations in level of services among residents of different communities. Coordinated exercise of the authority vested in these regulatory programs may lead to explicit strategies to deal directly with inequality and uncertainty concerning the effectiveness of health care delivery. Population-based health information systems, because they can provide information on the performance of health care systems and regulatory agencies, are an important step in the development of rational public policy for health. PMID:4750608
Marked regional differences in HIV-related clinical outcomes exist across Europe. Models of outpatient HIV care, including HIV testing, linkage and retention for positive persons, also differ across the continent, including examples of sub-optimal care. Even in settings with reasonably good...... outcomes, existing models are scrutinized for simplification and/or reduced cost. Outpatient HIV care models across Europe may be centralized to specialized clinics only, primarily handled by general practitioners (GP), or a mixture of the two, depending on the setting. Key factors explaining...... this diversity include differences in health policy, health insurance structures, case load and the prevalence of HIV-related morbidity. In clinical stable populations, the current trend is to gradually extend intervals between HIV-specific visits in a shared care model with GPs. A similar shared-model approach...
Full Text Available Marked regional differences in HIV-related clinical outcomes exist across Europe. Models of outpatient HIV care, including HIV testing, linkage and retention for positive persons, also differ across the continent, including examples of sub-optimal care. Even in settings with reasonably good outcomes, existing models are scrutinized for simplification and/or reduced cost. Outpatient HIV care models across Europe may be centralized to specialized clinics only, primarily handled by general practitioners (GP, or a mixture of the two, depending on the setting. Key factors explaining this diversity include differences in health policy, health insurance structures, case load and the prevalence of HIV-related morbidity. In clinical stable populations, the current trend is to gradually extend intervals between HIV-specific visits in a shared care model with GPs. A similar shared-model approach with community clinics for injecting drug-dependent persons is also being implemented. Shared care models require oversight to ensure that primary responsibility is defined for the persons overall health situation, for screening of co-morbidities, defining indication to treat comorbidities, prescription of non-HIV medicines, etc. Intelligent bioinformatics platforms (i.e. generation of alerts if course of care deviates from a prior defined normality are being developed to assist in providing this oversight and to provide measure of quality. Although consensus exists to assess basic quality indicators of care, a comprehensive set of harmonized indicators are urgently needed to define best practise standards via benchmarking. Such a tool will be central to guide ongoing discussions on restructuring of models, as quality of care should not be compromised in this process.
Sanders, Jay H.
The Interactive Telemedicine Systems (ITS) system was specifically developed to address the ever widening gap between our medical care expertise and our medical care delivery system. The frustrating reality is that as our knowledge of how to diagnose and treat medical conditions has continued to advance, the system to deliver that care has remained in an embryonic stage. This has resulted in millions of people being denied their most basic health care needs. Telemedicine utilizes an interactive video system integrated with biomedical telemetry that allows a physician at a base station specialty medical complex or teaching hospital to examine and treat a patient at multiple satellite locations, such as rural hospitals, ambulatory health centers, correctional institutions, facilities caring for the elderly, community hospital emergency departments, or international health facilities. Based on the interactive nature of the system design, the consulting physician at the base station can do a complete history and physical examination, as if the patient at the satellite site was sitting in the physician's office. This system is described.
August, D A; Faubion, W C; Ryan, M L; Haggerty, R H; Wesley, J R
The financial, entrepreneurial, administrative, and legal forces acting within the home care arena make it difficult for clinicians to develop and operate home care initiatives within an academic setting. HomeMed is a clinician-initiated and -directed home care delivery system wholly owned by the University of Michigan. The advantages of a clinician-directed system include: Assurance that clinical and patient-based factors are the primary determinants of strategic and procedural decisions; Responsiveness of the system to clinician needs; Maintenance of an important role for the referring physician in home care; Economical clinical research by facilitation of protocol therapy in ambulatory and home settings; Reduction of lengths of hospital stays through clinician initiatives; Incorporation of outcome analysis and other research programs into the mission of the system; Clinician commitment to success of the system; and Clinician input on revenue use. Potential disadvantages of a clinician-based system include: Entrepreneurial, financial, and legal naivete; Disconnection from institutional administrative and data management resources; and Inadequate clinician interest and commitment. The University of Michigan HomeMed experience demonstrates a model of clinician-initiated and -directed home care delivery that has been innovative, profitable, and clinically excellent, has engendered broad physician, nurse, pharmacist, and social worker enthusiasm, and has supported individual investigator clinical protocols as well as broad outcomes research initiatives. It is concluded that a clinician-initiated and -directed home care program is feasible and effective, and in some settings may be optimal. PMID:8242586
American Psychologist, 2013
Psychologists practice in an increasingly diverse range of health care delivery systems. The following guidelines are intended to assist psychologists, other health care providers, administrators in health care delivery systems, and the public to conceptualize the roles and responsibilities of psychologists in these diverse contexts. These…
Hanyabui, Akpabli; Ossai, Uche
ABSTRACT COURSE: Bachelor Thesis in Business Administration 15 ECTS AUTHORS: Ossai Uche, (21st March 1980), Västerås. Prosper Akpabli Hanyabui, (17th March 1980), Västerås. PROBLEM STATEMENT How can Labadi Beach Hotel improve on customer care activities in order to create a positive customer experiences in the hotel? PURPOSE: The purpose of this study is to describe what Labadi Beach Hotel is doing and what they could do to improve customer care. Furthermore we shall also find out the problem...
Mayara Caroline Barbieri
Full Text Available The aim of the study was to analyze the guidelines considering breastfeeding given by health professionals to women during prenatal care, delivery and postpartum care. Quantitative and descriptive work developed at Regional Pinheiros, Maringá-PR, from the registry in SisPreNatal, from May to August 2009. Data were collected through interviews conducted with parents at home, using a structured instrument. Participants were 36 mothers, most of whom received counseling for breastfeeding during prenatal (58.3%, maternity (87.6% and in nursing visits to newborn (84.6%. The prevalence of exclusive breastfeeding was 37.5%, even with the end of maternity leave. The rate is still below the recommended by the World Health Organization for exclusive breastfeeding. The present results may contribute to the monitoring of health actions and development of new strategies in the maintenance of exclusive breastfeeding.
A contextual review of models for chronic care was doneto develop a context-adapted chronic care model-basedservice delivery model for chronic conditions includingdiabetes. The Philippines was used as the setting ofa low-to-middle-income country. A context-basednarrative review of existing models for chronic carewas conducted. A situational analysis was done at thegrassroots level, involving the leaders and members ofthe community, the patients, the local health system andthe healthcare providers. A second analysis making useof certain organizational theories was done to explore onimproving feasibility and acceptability of organizing carefor chronic conditions. The analyses indicated that carefor chronic conditions may be introduced, consideringthe needs of people with diabetes in particular andthe community in general as recipients of care, andthe issues and factors that may affect the healthcareworkers and the health system as providers of thiscare. The context-adapted chronic care model-basedservice delivery model was constructed accordingly.Key features are incorporation of chronic care in thehealth system＇s services; assimilation of chronic caredelivery with the other responsibilities of the healthcareworkers but with redistribution of certain tasks; andensuring that the recipients of care experience thewhole spectrum of basic chronic care that includes educationand promotion in the general population, riskidentification, screening, counseling including self-caredevelopment, and clinical management of the chroniccondition and any co-morbidities, regardless of level ofcontrol of the condition. This way, low-to-middle incomecountries can introduce and improve care for chronicconditions without entailing much additional demand ontheir limited resources.
A presentation of a case and a theoretical discussion concerning what characterizes the sozialisation and formation taking place in educations related to care work inside the Danish welfare system presently. The article presents an analysis of the relation between curriculum,didactics and...... clash between competing rationalities, that cause dilemmas in care....
Too often health care executives state the need for more research, knowledge, and information in staffing. Perhaps what we really need is education and support for innovation in operations. In looking for the holy grail of staffing solutions, focused attention will need to be placed on creating innovative care delivery models. Leaders who are tasked with developing innovative care delivery models must have a supportive environment and given time to be successful. PMID:27265951
Gregory, Debbie; Buckner, Martha
The growing complexity of technology, equipment, and devices involved in patient care delivery can be staggering and overwhelming. Technology is intended to be a tool to help clinicians, but it can also be a frustrating hindrance if not thoughtfully planned and strategically aligned. Critical care nurses are key partners in the collaborations needed to improve safety and quality through health information technology (IT). Nurses must advocate for systems that are interoperable and adapted to the context of care experiences. The involvement and collaboration between clinicians, information technology specialists, biomedical engineers, and vendors has never been more relevant and applicable. Working together strategically with a shared vision can effectively provide a seamless clinical workflow, maximize technology investments, and ultimately improve patient care delivery and outcomes. Developing a strategic integrated clinical and IT roadmap is a critical component of today's health care environment. How can technology strategy be aligned from the executive suite to the bedside caregiver? What is the model for using clinical workflows to drive technology adoption? How can the voice of the critical care nurse strengthen this process? How can success be assured from the initial assessment and selection of technology to a sustainable support model? What is the vendor's role as a strategic partner and "co-caregiver"? PMID:24896558
Hung, Dorothy; Chung, Sukyung; Martinez, Meghan; Tai-Seale, Ming
This study examined relationships between organizational culture and patient-centered outcomes in primary care. Generalized least squares regression was used to analyze patient access, care continuity, and reported experiences of care among 357 physicians in 41 primary care departments. Compared with a "Group-oriented" culture, a "Rational" culture type was associated with longer appointment wait times, and both "Hierarchical" and "Developmental" culture types were associated with less care continuity, but better patient experiences with care. Understanding the unique effects of organizational culture can enhance the delivery of more patient-centered care. PMID:27232685
R Majdzadeh; Rostamigooran, N; H Esmailzadeh; Rajabi, F.; L Doshmangir
Background: The aim of this study was to determine the impact of important social and technological trends on health care delivery, in the context of developing “Iran’s Health System Reform Plan by 2025”. Methods: A detailed review of the national and international literature was done to identify the main trends affecting health system. To collect the experts’ opinions about important trends and their impact on health care delivery, Focus Group Discussions (FGDs) and semi-structured in-depth ...
Cowing, Michelle; Davino-Ramaya, Carrie M; Ramaya, Krishnan; Szmerekovsky, Joseph
As competition intensifies within the health care industry, patient satisfaction and service quality are providing the evidentiary basis for patient outcomes. We propose a conceptual model of three interrelated areas, service, health outcomes, and resource stewardship, all affected by the clinician-patient relationship. Our model considers the perspectives of the health care organization, the clinician, and the patient to define a more comprehensive measure of health care delivery performance...
Steele, Joseph Rodgers; Jones, A Kyle; Clarke, Ryan K; Shoemaker, Stowe
The patient experience has moved to the forefront of health care-delivery research. The University of Texas MD Anderson Cancer Center Department of Diagnostic Radiology began collaborating in 2011 with the University of Houston Conrad N. Hilton College of Hotel and Restaurant Management, and in 2013 with the University of Nevada, Las Vegas, William F. Harrah College of Hotel Administration, to explore the application of service science to improving the patient experience. A collaborative pilot study was undertaken by these 3 institutions to identify and rank the specific needs and expectations of patients undergoing imaging procedures in the MD Anderson Department of Diagnostic Radiology. We first conducted interviews with patients, providers, and staff to identify factors perceived to affect the patient experience. Next, to confirm these factors and determine their relative importance, we surveyed more than 6,000 patients by e-mail. All factors considered important in the interviews were confirmed as important in the surveys. The surveys showed that the most important factors were acknowledgment of the patient's concerns, being treated with respect, and being treated like a person, not a "number"; these factors were more important than privacy, short waiting times, being able to meet with a radiologist, and being approached by a staff member versus having one's name called out in the waiting room. Our work shows that it is possible to identify and rank factors affecting patient satisfaction using techniques employed by the hospitality industry. Such factors can be used to measure and improve the patient experience. PMID:25533732
U.S. Department of Health & Human Services — The Affordable Care Act includes tools to improve the quality of health care that can also lower costs for taxpayers and patients. This means avoiding costly...
Blanton, W B
"These trends represent the obvious call from society for health change: enlarged access to the system; reduction in the rate of rise in cost; equity in care; and increased quality in care. All of these elements except the cost objective requires not lessened but additional and redistributed resources. If this is pleasing, exert influence to reinforce the trends toward it. If not, speak now to modify the otherwise inevitable." PMID:706646
Rossi, Filippo; Masi, Maurizio
This book offers a state-of-the-art overview of controlled drug delivery systems, covering the most important innovative applications. The principles of controlled drug release and the mechanisms involved in controlled release are clearly explained. The various existing polymeric drug delivery systems are reviewed, and new frontiers in material design are examined in detail, covering a wide range of polymer modification techniques. The concluding chapter is a case study focusing on use of a drug-eluting stent. The book is designed to provide the reader with a complete understanding of the mechanisms and design of controlled drug delivery systems, and to this end includes numerous step-by-step tutorials. It illustrates how chemical engineers can advance medical care by designing polymeric delivery systems that achieve either temporal or spatial control of drug delivery and thus ensure more effective therapy that eliminates the potential for both under-and overdosing.
Singer, S.J.; Burgers, J.S.; Friedberg, M.; Rosenthal, M.B.; Leape, L.; Schneider, E.
Integration of care is emerging as a central challenge of health care delivery, particularly for patients with multiple, complex chronic conditions. The authors argue that the concept of "integrated patient care" would benefit from further clarification regarding (a) the object of integration and (b
This and the preceding article (Nursing Mirror, Sept. 1, 1978) form a slightly shortened version of Chap. 5 from Vol. 2 of the book 'Oncology for Nurses and Health Care Professionals', ed. R. Tiffany, (Allen and Unwin, Oct. 1978). Teletherapy was dealt with in part 1. Part 2 is concerned with radiotherapy using radioisotope implants and applicators and unsealed sources, and with surgery and chemotherapy, including side effects of anti-tumour drugs. The physical and psychological effects on the patient of these forms of treatment are discussed, and nursing care and radiological safety precautions for both patients and nursing staff are described. (author)
Olawale Ibrahim Olateju
Full Text Available We examine the TQM Strategies and health care delivery in Nigeria, and the various means of measuring service quality. Nigeria continues to suffer outbreaks of various diseases cholera, malaria, cerebrospinal meningitis, measles, yellow fever, Bird flu e.t.c., all these diseases combine to cause high morbidity and mortality in the population. To assess the situation this paper looks at the relevant indicators like Annual Budgets by Government, Individual’s income, the role of Nigerian Medical Association (NMA and various health care agencies vested with the sole responsibility for elaborating standards for products and processes in Health care Delivery.The paper also examines the implication of Government Budget estimates on the Life expectancy of an average Nigerian. The findings necessitated the need for the government to seek support from WHO to assist in strengthening the health care system by advocating and providing technical support to health sector reforms.
Full Text Available Abstract Background Delivery by a skilled birth attendant (SBA in a hospital is advocated to improve maternal health; however, hospital expenses for delivery care services are a concern for women and their families, particularly for women who pay out-of-pocket. Although health insurance is now implemented in Lao PDR, it is not universal throughout the country. The objectives of this study are to estimate the total health care expenses for vaginal delivery and caesarean section, to determine the association between health insurance and family income with health care expenditure and assess the effect of health insurance from the perspectives of the women and the skilled birth attendants (SBAs in Lao PDR. Methods A cross-sectional study was carried out in two provincial hospitals in Lao PDR, from June to October 2010. Face to face interviews of 581 women who gave birth in hospital and 27 SBAs was carried out. Both medical and non-medical expenses were considered. A linear regression model was used to assess influencing factors on health care expenditure and trends of medical and non-medical expenditure by monthly family income stratified by mode of delivery were assessed. Results Of 581 women, 25% had health care insurance. Health care expenses for delivery care services were significantly higher for caesarean section (270 USD than for vaginal delivery (59 USD. After adjusting for the effect of hospital, family income was significantly associated with all types of expenditure in caesarean section, while it was associated with non-medical and total expenditures in vaginal delivery. Both delivering women and health providers thought that health insurance increased the utilisation of delivery care. Conclusions Substantially higher delivery care expenses were incurred for caesarean section compared to vaginal delivery. Three-fourths of the women who were not insured needed to be responsible for their own health care payment. Women who had higher family
Objectives. Describe the Alaska Native Health Care delivery system and some of the historical elements that shaped it. Study Design. Retrospective program review. Methods. Retrospective review of existing administrative and clinical programs. Results. Over the last 10,000 -15,000 years the Alaska Native Health System developed from at traditional tribal based self-care system to a complex system that is interdependent on local, state, federal, and private insurance payers. The Alaska Tribal H...
Lack of sleep has well established effects on physiological, cognitive and behavioural functionality. Sleep deprivation can adversely affect clinical performance as severely as alcohol according to some sources. Sleep deficiency may be due to loss of one night’s sleep or repeated interruptions of sleep. Chronic sleep degrades the ability to recognise one’s ability to recognise the impairments induced by sleep loss. The problem of sleep deprivation has vexed acute medical practice for decades. Improvement has been painfully slow. The problem is that all 168 hours throughout every week of every year have to be covered and there are a finite number of doctors to shoulder the burden. There are many strongly held views about how best to provide night-time and week-end care. Constructive innovations are thin on the ground. The biggest gap is between administration and doctors with financial considerations being the limiting factor. It is, however, generally accepted on all sides that sleep loss and fatigue can have adverse effects on both patients and doctors.
Full Text Available Background: The aim of this study was to determine the impact of important social and technological trends on health care delivery, in the context of developing “Iran's Health System Reform Plan by 2025”.Methods: A detailed review of the national and international literature was done to identify the main trends affecting health system. To collect the experts’ opinions about important trends and their impact on health care delivery, Focus Group Discussions (FGDs and semi-structured in-depth interviews techniques were used. The study was based on the STEEP model. Final results were approved in an expert’s panel session.Results: The important social and technological trends, affecting health system in Iran in the next 15 years are demographic transition, epidemiologic transition, increasing bio-environmental pollution, increasing slums, increasing private sector partnership in health care delivery, moving toward knowledge-based society, development of information and communication technology, increasing use of high technologies in health system, and development of traditional and alternative medicine. The opportunities and threats resulting from the above mentioned trends were also assessed in this study.Conclusion: Increasing healthcare cost due tosome trends like demographic and epidemiologic transition and uncontrolled increase in using new technologies in health care is one of the most important threats that the health system will be facing. The opportunities that advancement in technology and moving toward knowledge-based society create are important and should not be ignored.
Entwistle, Vikki A; Watt, Ian S
Health services internationally struggle to ensure health care is “person-centered” (or similar). In part, this is because there are many interpretations of “person-centered care” (and near synonyms), some of which seem unrealistic for some patients or situations and obscure the intrinsic value of patients’ experiences of health care delivery. The general concern behind calls for person-centered care is an ethical one: Patients should be “treated as persons.” We made novel use of insights fro...
Darr, A. R.
This thesis is about the experience of Muslim British Pakistani families coping with thalassaemia (a chronic, inherited blood disorder) and the implications for service delivery. Its central concern is to illustrate that simplistic and culturally-biased assumptions are an unsatisfactory base on which to devise health service delivery for minority populations, and that with careful study it is possible to deliver culturally sensitive and appropriate services. The the...
Milani, Richard V; Lavie, Carl J
Chronic disease has become the great epidemic of our times, responsible for 75% of total health care costs and the majority of deaths in the US. Our current delivery model is poorly constructed to manage chronic disease, as evidenced by low adherence to quality indicators and poor control of treatable conditions. New technologies have emerged that can engage patients and offer additional modalities in the treatment of chronic disease. Modifying our delivery model to include team-based care in concert with patient-centered technologies offers great promise in managing the chronic disease epidemic. PMID:25460529
Marzieh Akbarzadeh; Zahra Masoudi; Mohammad Javad Hadianfard; Maryam Kasraeian; Najaf Zare
Delivery is considered as one of the most painful experiences of women's life. The present study aimed to compare the effects of supportive care and acupressure on the pregnant women's pain intensity and delivery outcome. In this experimental study, 150 pregnant women were randomly divided into supportive care, acupressure, and control groups. The intensity of pain was measured using Visual Analogue Scale (VAS). The supportive care group received both physical and emotional cares. In the acup...
Yusuf Abdu Misau
Full Text Available Migration of health workers ‘Brain drain’ is defined as the movement of health personnel in search of a better standard of living and life quality, higher salaries, access to advanced technology and more stable political conditions in different places worldwide. The debate about migration of health workers from the developing to the developed world has remained pertinent for decades now. Regardless of the push and pull factors, migration of health care workers from developing countries to developed ones, have done more harm than good on the health care deliveries in the developing countries. This article reviews the literature on the effects of cross-border migration of health care professionals.
Bundy, David G; Muschelli, John; Clemens, Gwendolyn D; Strouse, John J; Thompson, Richard E; Casella, James F; Miller, Marlene R
Preventive services can reduce the morbidity of sickle cell disease (SCD) in children but are delivered unreliably. We conducted a retrospective cohort study of children aged 2 to 5 years with SCD, evaluating each child for 14 months and expecting that he/she should receive ≥75% of days covered by antibiotic prophylaxis, ≥1 influenza immunization, and ≥1 transcranial Doppler ultrasound (TCD). We used logistic regression to quantify the relationship between ambulatory generalist and hematologist visits and preventive services delivery. Of 266 children meeting the inclusion criteria, 30% consistently filled prophylactic antibiotic prescriptions. Having ≥2 generalist, non-well child care visits or ≥2 hematologist visits was associated with more reliable antibiotic prophylaxis. Forty-one percent of children received ≥1 influenza immunizations. Children with ≥2 hematologist visits were most likely to be immunized (62% vs. 35% among children without a hematologist visit). Only 25% of children received ≥1 TCD. Children most likely to receive a TCD (42%) were those with ≥2 hematologist visits. One in 20 children received all 3 preventive services. Preventive services delivery to young children with SCD was inconsistent but associated with multiple visits to ambulatory providers. Better connecting children with SCD to hematologists and strengthening preventive care delivery by generalists are both essential. PMID:26950087
Pines, Jesse M; McStay, Frank; George, Meaghan; Wiler, Jennifer L; McClellan, Mark
Current alternative payment models (APMs) that move away from traditional fee-for-service payment often have explicit goals to reduce utilization in episodic settings, such as emergency departments (ED). We apply the new HHS payment reform taxonomy to illustrate a pathway to success for EDs in APMs. Despite the unique challenges faced by EDs, a variety of category 2 and 3 APMs may be applicable to EDs in the short- and long term to improve efficiency and value. Full and partially capitated models create incentives for longitudinal and episodic ED providers and payers to unite to create interventions to reduce costs. However, prospective attribution remains a challenge for EDs because of exogenous demand, which makes it important for EDs to be one of the components of capitated payment along with longitudinal providers who can exert greater control on overall care demands. The goal of payment and delivery reforms in ED care is to improve population health across the continuum of acute and longitudinal care. In order to deliver cost-conscious care, ED providers will need additional resources, expanded information, and new processes and metrics to facilitate cost-conscious decisions. Improved availability of electronic information across settings, evidence generated from developing and testing acute care-specific payment models, and engaging acute care providers directly in reform efforts will help meet these goals. PMID:27541697
Peltokorpi, Antti; Linna, Miika; Malmström, Tomi; Torkki, Paulus; Lillrank, Paul Martin
Purpose - The focused factory is one of the concepts that decision-makers have adopted for improving health care delivery. However, disorganized definitions of focus have led to findings that cannot be utilized systematically. The purpose of this paper is to discuss strategic options to focus health care operations. Design/methodology/approach - First the literature on focus in health care is reviewed revealing conceptual challenges. Second, a definition of focus in terms of demand and requisite variety is defined, and the mechanisms of focus are explicated. A classification of five focus strategies that follow the original idea to reduce variety in products and markets is presented. Finally, the paper examines managerial possibilities linked to the focus strategies. Findings - The paper proposes a framework of five customer-oriented focus strategies which aim at reducing variety in different characteristics of care pathways: population; urgency and severity; illnesses and symptoms; care practices and processes; and care outcomes. Research limitations/implications - Empirical research is needed to evaluate the costs and benefits of the five strategies and about system-level effects of focused units on competition and coordination. Practical implications - Focus is an enabling condition that needs to be exploited using specific demand and supply management practices. It is essential to understand how focus mechanisms differ between strategies, and to select focus that fits with organization's strategy and key performance indicators. Originality/value - Compared to previous more resource-oriented approaches, this study provides theoretically solid and practically relevant customer-oriented framework for focusing in health care. PMID:26959897
Logan, J. S.; Stewart, G. R.
NASA's Space Station is viewed as the beginning of man's permanent presence in space. This paper presents the guidelines being developed by NASA's medical community in preparing a quality, permanent health care delivery system for Space Station. The guidelines will be driven by unique Space Station requirements such as mission duration, crew size, orbit altitude and inclination, EVA frequency and rescue capability. The approach will emphasize developing a health care system that is modular and flexible. It will also incorporate NASA's requirements for growth capability, commonality, maintainability, and advanced technology development. Goals include preventing unnecessary rescue attempts, as well as maintaining the health and safety of the crew. Proper planning will determine the levels of prevention, diagnosis, and treatment necessary to achieve these goals.
Wald, J. S.
Summary Objectives Address current topics in consumer health informatics. Methods Literature review. Results Current health care delivery systems need to be more effective in the management of chronic conditions as the population turns older and experiences escalating chronic illness that threatens to consume more health care resources than countries can afford. Most health care systems are positioned poorly to accommodate this. Meanwhile, the availability of ever more powerful and cheaper information and communication technology, both for professionals and consumers, has raised the capacity to gather and process information, communicate more effectively, and monitor the quality of care processes. Conclusions Adapting health care systems to serve current and future needs requires new streams of data to enable better self-management, improve shared decision making, and provide more virtual care. Changes in reimbursement for health care services, increased adoption of relevant technologies, patient engagement, and calls for data transparency raise the importance of patient-generated health information, remote monitoring, non-visit based care, and other innovative care approaches that foster more frequent contact with patients and better management of chronic conditions. PMID:25123739
Kohn, Elise C; Ivy, S Percy
Understanding the biology of cancer at the cellular and molecular levels, and the application of such knowledge to the patient, has opened new opportunities and uncovered new obstacles to quality cancer care delivery. Benefits include our ability to now understand that many, if not most, cancers are not one-size-fits-all. Cancers are a variety of diseases for which intervention may be very different. This approach is beginning to bear fruit in gynecologic cancers where we are investigating therapeutic optimization at a more focused level, that while not yet precision care, is perhaps much improved. Obstacles to quality care for patients come from many directions. These include incomplete understanding of the role of the mutant proteins in the cancers, the narrow spectrum of agents, broader mutational profiles in solid tumors, and sometimes overzealous application of the findings of genetic testing. This has been further compromised by the unbridled use of social media by all stakeholders in cancer care often without scientific qualification, where anecdote sometimes masquerades as a fact. The only current remedy is to wave the flag of caution, encourage all patients who undergo genetic testing, either germline or somatic, to do so with the oversight of genetic counselors and physician scientists knowledgeable in the pathways involved. This aspiration is accomplished with well-designed clinical trials that inform next steps in this complex and ever evolving process. PMID:27200294
Chiu, H C
Taiwan reached the World Health Organization (WHO) benchmark of 7% aged 65 and over for defining an aging population only as recently as 1993. With this proportion projected to double to 14% by 2020, Taiwan faces a rapid increase in need for long-term care. This article presents an account of the current service delivery system, which is divided between health and social affairs administrations, with a substantial role also taken by the Veteran Administration, and growing provision of facilities that operate outside the government-registered system. While a basic level of both institutional and community care services has developed, they are not organized into an integrated service system. Problems arising from the divisions and overlaps in responsibility are identified in relation to competition for resources, differences in regulation and eligibility, funding arrangements and misallocation of resources, and divergent views about the philosophical basis of long-term care. Other aspects of services fall under each jurisdiction, but there is also some overlap. A case study of Taiwan's second largest city, Kaohsiung City, reports the outcomes of these divisions as a thin spread of a range of services rather than a coordinated service network. Several planning exercises have been undertaken in recent years to address these problems, and although at an early stage of implementation, the outcomes of these plans are seen as shaping the future directions of long-term care in Taiwan. PMID:12216358
Neergaard, Mette Asbjørn; Olesen, Frede; Jensen, Anders Bonde;
Background: Knowledge about the quality and organisation of care to terminally ill cancer patients with a relatives' view in a primary health care setting is limited. The aim of the study is to analyse experiences and preferences of bereaved relatives to terminally ill cancer patients in a primary...... care setting to explore barriers and facilitators for delivery of good palliative home care. Methods: Three focus group interviews with fourteen bereaved relatives in Aarhus County, Denmark. Results: Three main categories of experience were identified: 1) The health professionals' management, where a...... need to optimize was found. 2) Shared care, which was lacking. 3) The relatives' role, which needs an extra focus. Conclusion: Relatives experience insufficient palliative care mainly due to organizational and cultural problems among professionals. Palliative care in primary care in general needs...
Ford, Bryan Keith; Ingersoll-Dayton, Berit; Burgio, Kathryn
This study's main objective was to examine care transition experiences of older veterans and their caregivers. Fifty patients age 65 years and older, discharged from a Veterans Affairs Medical Center hospital, completed the Care Transitions Measure-15 survey three to four weeks postdischarge. Seven patients and six caregivers participated in semistructured interviews. Overall, the quality of care transitions was rated as good; however, some items were indicated as problematic for veterans. Themes that emerged included agreeableness, frustration with complex information, caregiver education, and the timing and methods of information delivery. These findings have implications for all clinical staff working with veterans, and particularly for social workers facilitating care transitions for veterans and their caregivers. PMID:27263203
Essary, Alison C; Wade, Nathaniel L
According to the most recent statistics from the National Center for Education Statistics, disparities in enrollment in undergraduate and graduate education are significant and not improving commensurate with the national population. Similarly, only 12% of graduating medical students and 13% of graduating physician assistant students are from underrepresented racial and ethnic groups. Established in 2012 to promote health care transformation at the organization and system levels, the School for the Science of Health Care Delivery is aligned with the university and college missions to create innovative, interdisciplinary curricula that meet the needs of our diverse patient and community populations. Three-year enrollment trends in the program exceed most national benchmarks, particularly among students who identify as Hispanic and American Indian/Alaska Native. The Science of Health Care Delivery program provides students a seamless learning experience that prepares them to be solutions-oriented leaders proficient in the business of health care, change management, innovation, and data-driven decision making. Defined as the study and design of systems, processes, leadership and management used to optimize health care delivery and health for all, the Science of Health Care Delivery will prepare the next generation of creative, diverse, pioneering leaders in health care. PMID:27262477
Shahshahani, Maryam Sadat; Salehi, Shayesteh; Rastegari, Mohammad; Rezayi, Abdollah
BACKGROUND: In the recent decade, due to the overwhelming importance of health and prevention of diseases, nurses, the greatest part of the health care system, are acting in any position of the health care delivery system; because nursing have a key role in promotion of health and health care everywhere. The objective of this research was to study the desired positions of nursing in the health care delivery system in Iran. METHODS: This was a triangulation study done on three steps during 200...
Jarvis, W. R.
In the past, health care was delivered mainly in acute-care facilities. Today, health care is delivered in hospital, outpatient, transitional care, long-term care, rehabilitative care, home, and private office settings. Measures to reduce health-care costs include decreasing the number of hospitals and the length of patient stays, increasing outpatient and home care, and increasing long-term care for the elderly. The home-care industry and managed care have become major providers of health ca...
Egerod, Ingrid; Bergbom, Ingegerd; Lindahl, Berit;
BACKGROUND: Sedation practices in the intensive care unit have evolved from deep sedation and paralysis toward lighter sedation and better pain management. The new paradigm of sedation has enabled early mobilization and optimized mechanical ventilator weaning. Intensive care units in the Nordic c...... state, where they face the choice of life or death. Caring nurses and family members play an important role in assisting the patient to transition back to life.......BACKGROUND: Sedation practices in the intensive care unit have evolved from deep sedation and paralysis toward lighter sedation and better pain management. The new paradigm of sedation has enabled early mobilization and optimized mechanical ventilator weaning. Intensive care units in the Nordic...... countries have been particularly close to goals of lighter or no sedation and a more humane approach to intensive care. OBJECTIVES: The aim of our study was to systematically review and reinterpret newer Nordic studies of the patient experience of intensive care to obtain a contemporary description of human...
Full Text Available Else Cathrine Rustad,1–4 Bodil Furnes,1 Berit Seiger Cronfalk,2,5,6 Elin Dysvik1 1Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway; 2Faculty of Health and Caring Sciences, Stord Haugesund University College, Stord, Norway; 3Research Network on Integrated Health Care in Western Norway, Helse Fonna Local Health Authority, Haugesund, Norway; 4Department of Clinical Medicine, Helse Fonna Local Health Authority, Haugesund, Norway; 5Palliative Research Center, Ersta Sköndal University College, Stockholm, Sweden; 6Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden Background: A fragmented health care system leads to an increased demand for continuity of care across health care levels. Research indicates age-related differences during care transition, with the oldest patients having experiences and needs that differ from those of other patients. To meet the older patients’ needs and preferences during care transition, professionals must understand their experiences.Objective: The purpose of the study was to explore how patients ≥80 years of age experienced the care transition from hospital to municipal health care services.Methods: The study has a descriptive, explorative design, using semistructured interviews. Fourteen patients aged ≥80 participated in the study. Qualitative content analysis was used to describe the individuals’ experiences during care transition.Results: Two complementary themes emerged during the analysis: “Participation depends on being invited to plan the care transition” and “Managing continuity of care represents a complex and challenging process”.Discussion: Lack of participation, insufficient information, and vague responsibilities among staff during care transition seemed to limit the continuity of care. The patients are the vulnerable part of the care transition process, although they possess important
Henriques, J; Golding, J; Thomas, P
Information on 934 never married mothers (Single) were compared with 301 who were widowed, divorced or separated (Once-married) and 15 225 who were married at the time of delivery and were part of the 1970 British Births Survey. Once the maternal age and parity differences had been taken into account the major findings concerned the mothers' health behaviour and the obstetric care they received. Single and Once-married mothers were markedly less likely than the Married group to have used contraceptives in the 18 months before conception, to know accurately the date of the last menstrual period, to commence antenatal care before the third trimester, and to attend antenatal or parentcraft classes. Both groups were more likely to smoke, the Once-married group having an especially high rate of heavy smokers. Single mothers were more likely to be anaemic during pregnancy and the Once-married to have a history of bleeding. Both groups were more likely to be delivered in a consultant unit. Relatively high proportions of Single and Once-married mothers had delivered without any pain relief. PMID:3803266
Volpe, F J
Continuity of health care is a goal to be achieved. Most are for it. Many claim to provide it. But how do we know we have it? What are the key features of continuity? While dictionaries do not define the phrase "continuity of health care," we do find definitions of "continuity." The Oxford English Dictionary, Second Edition, includes in its definitions: "the state or quality of being uninterrupted in sequence or succession, or in essence or idea; connectedness, coherence, unbroken..." Stedman's Medical Dictionary includes: "absence of interruption, a succession of parts intimately united..." These definitions stress an uninterrupted succession and include the concept that there needs to be a connection to the parts. Without that connection, continuity, in health care delivery or elsewhere, does not exist. PMID:10139074
Kimmel, April D; Martin, Erika G; Galadima, Hadiza; Bono, Rose S; Tehrani, Ali Bonakdar; Cyrus, John W; Henderson, Margaret; Freedberg, Kenneth A; Krist, Alexander H
With over 1 million people living with HIV, the US faces national challenges in HIV care delivery due to an inadequate HIV specialist workforce and the increasing role of non-communicable chronic diseases in driving morbidity and mortality in HIV-infected patients. Alternative HIV care delivery models, which include substantial roles for advanced practitioners and/or coordination between specialty and primary care settings in managing HIV-infected patients, may address these needs. We aimed to systematically review the evidence on patient-level HIV-specific and primary care health outcomes for HIV-infected adults receiving outpatient care across HIV care delivery models. We identified randomized trials and observational studies from bibliographic and other databases through March 2016. Eligible studies met pre-specified eligibility criteria including on care delivery models and patient-level health outcomes. We considered all available evidence, including non-experimental studies, and evaluated studies for risk of bias. We identified 3605 studies, of which 13 met eligibility criteria. Of the 13 eligible studies, the majority evaluated specialty-based care (9 studies). Across all studies and care delivery models, eligible studies primarily reported mortality and antiretroviral use, with specialty-based care associated with mortality reductions at the clinician and practice levels and with increased antiretroviral initiation or use at the clinician level but not the practice level. Limited and heterogeneous outcomes were reported for other patient-level HIV-specific outcomes (e.g., viral suppression) as well as for primary care health outcomes across all care delivery models. No studies addressed chronic care outcomes related to aging. Limited evidence was available across geographic settings and key populations. As re-design of care delivery in the US continues to evolve, better understanding of patient-level HIV-related and primary care health outcomes, especially
Full Text Available Rosemin Kassam1, John B Collins2, Jonathan Berkowitz31School of Population and Public Health, Faculty of Medicine, 2Department of Educational Studies, Faculty of Education, 3Sauder School of Business, University of British Columbia, Vancouver, British Columbia, CanadaBackground: The purpose of this study was to validate previously published satisfaction scales in larger and more diversified patient populations; to expand the number of community pharmacies represented; to test the robustness of satisfaction measures across a broader demographic spectrum and a variety of health conditions; to confirm the three-factor scale structure; to test the relationships between satisfaction and consultation practices involving pharmacists and pharmacy students; and to examine service gaps and establish plausible norms.Methods: Patients completed a 15-question survey about their expectations regarding pharmaceutical care-related activities while shopping in any pharmacy and a parallel 15 questions about their experiences while shopping in this particular pharmacy. The survey also collected information regarding pharmaceutical care consultation received by the patients and brief demographic data.Results: A total of 628 patients from 55 pharmacies completed the survey. The pilot study’s three-factor satisfaction structure was confirmed. Overall, satisfaction measures did not differ by demographics or medical condition, but there were strong and significant store-to-store differences and consultation practice advantages when pharmacists or pharmacists-plus-students participated, but not for consultations with students alone.Conclusion: Patient satisfaction can be reliably measured by surveys structured around pharmaceutical care activities. The introduction of pharmaceutical care in pharmacies improves patient satisfaction. Service gap details indicated that pharmacy managers need to pay closer attention to various consultative activities involving patients
Objective: The aim of this study is to explore the experiences and views of midwives regarding third- and fourth-degree perineal tears. Method: Focus group interviews with midwives from a university hospital. Qualitative analysis using principles from ‘grounded theory’. Findings: The participants mentioned several factors that they considered important for the prevention of tears that may cause injury to the anal sphincter. A crucial aspect was the way in which the midwife deals with the phys...
Novick, Gina; Sadler, Lois S; Kennedy, Holly Powell; Cohen, Sally S; Groce, Nora E; Knafl, Kathleen A
Group prenatal care (GPNC) is an innovative alternative to individual prenatal care. In this longitudinal study we used ethnographic methods to explore African American and Hispanic women's experiences of receiving GPNC in two urban clinics. Methods included individual, in-depth, semistructured interviews of women and group leaders in GPNC, participant observation of GPNC sessions, and medical record review. GPNC offered positive experiences and met many of women's expressed preferences regarding prenatal care. Six themes were identified, which represented separate aspects of women's experiences: investment, collaborative venture, a social gathering, relationships with boundaries, learning in the group, and changing self. Taken together, the themes conveyed the overall experience of GPNC. Women were especially enthusiastic about learning in groups, about their relationships with group leaders, and about having their pregnancy-related changes and fears normalized; however, there were also important boundaries on relationships between participants, and some women wished for greater privacy during physical examinations. PMID:20693516
Villanueva, N E
Grounded theory methodology was utilized to explore the experiences of critical care nurses caring for patients who were unable to respond due to a traumatic brain injury or receiving neuromuscular blocking agents. The registered nurses participating in the study worked in a neuroscience intensive care unit. Saturation of the categories was achieved with 16 interviews. The core category that emerged from the study is Giving the Patient a Chance. The subcategories of Learning about My Patient, Maintaining and Monitoring, Talking to My Patient, Working with Families, Struggling with Dilemmas and Personalizing the Experience all centered upon the focus of doing everything to help the patient attain the best possible outcome. Factors influencing each of the subcategories were identified such as the acuity of the patient, experience level of the nurse and the presence or absence of family members or significant others. These factors accounted for the variations in the nurses' experience. Several reasons accounting for the variations were determined. The study identified areas that need to be addressed in both general nursing education and nursing practice, such as instruction on talking to comatose patients, working with families and orientation information for nurses new to caring for these populations. Recommendations for improvement in these areas, as well as for future studies are discussed. PMID:10553569
Differences in the experience of pregnancy and birth after ART compared to spontaneous conception are of interest for the developmental pyschologist. Studies performed to date have compared mainly the psychological aspects of experiencing the singleton pregnancy and the single birth. Couples after ART are at higher anxiety levels compared to those who have conceived naturally in the early stages of pregnancy. Individual experiences with infertility in those affected have often led to states of anxiety, low self-esteem and low confidence, but this does not seem to persist in pregnancy. Higher anxiety symptoms occur primarily. Increased symptoms of anxiety are found in pregnant women and their partners who have undergone the high stress of infertility. Pregnant women after ART are less concerned about the physical changes during pregnancy. Couples with previous ART mediated more harmony on the first impression, however, on the other hand being less communicative. A long duration of infertility (7 years or more) was associated with the expression of a large birth anxiety. Postpartum disorders such as depression are influenced by the interaction of several risk factors, particularly prematurity, multiple births and caesarean sections reinforce the emotional problems. Studies have confirmed an emotional well-being and a happy pregnancy with a satisfying mother-child relationship. However, where fears about the foetal surival are higher, postpartum difficulties are greater and self-esteem is lower after ART. Fears about the foetal survival and postnatal educational difficulties were greater after the application of assisted reproduction and the self-esteem lower. Pregnancy and parenthood after assisted reproduction may be idealised and is associated with a difficult transition to parenthood. PMID:22028057
Busari, Jamiu O
Quality assurance (QA) in higher medical education involves the development, sustenance, improvement, and evaluation of the standard of training of medical professionals. In health care delivery, QA focuses on guaranteeing and maintaining a high standard of the service provided in different health care systems. When the service delivered by the care provider is in accordance with what the recipients of health care expect, then quality in health care is considered to be present. There are seve...
Fiori, Kevin; Schechter, Jennifer; Dey, Monica; Braganza, Sandra; Rhatigan, Joseph; Houndenou, Spero; Gbeleou, Christophe; Palerbo, Emmanuel; Tchangani, Elfamozo; Lopez, Andrew; Bensen, Emily; Hirschhorn, Lisa R
Providing quality care for all children living with HIV/AIDS remains a global challenge and requires the development of new healthcare delivery strategies. The care delivery value chain (CDVC) is a framework that maps activities required to provide effective and responsive care for a patient with a particular disease across the continuum of care. By mapping activities along a value chain, the CDVC enables managers to better allocate resources, improve communication, and coordinate activities. We report on the successful application of the CDVC as a strategy to optimize care delivery and inform quality improvement (QI) efforts with the overall aim of improving care for Pediatric HIV patients in Togo, West Africa. Over the course of 12 months, 13 distinct QI activities in Pediatric HIV/AIDS care delivery were monitored, and 11 of those activities met or exceeded established targets. Examples included: increase in infants receiving routine polymerase chain reaction testing at 2 months (39-95%), increase in HIV exposed children receiving confirmatory HIV testing at 18 months (67-100%), and increase in patients receiving initial CD4 testing within 3 months of HIV diagnosis (67-100%). The CDVC was an effective approach for evaluating existing systems and prioritizing gaps in delivery for QI over the full cycle of Pediatric HIV/AIDS care in three specific ways: (1) facilitating the first comprehensive mapping of Pediatric HIV/AIDS services, (2) identifying gaps in available services, and (3) catalyzing the creation of a responsive QI plan. The CDVC provided a framework to drive meaningful, strategic action to improve Pediatric HIV care in Togo. PMID:27391996
Egerod, Ingrid; Bagger, Christine
had a triangulated approach and group dynamics were described as the focus group was used to explore agreement and disagreement among the participants. Little is known about the content of intensive care diaries and their usefulness and meaning for the patients. The participants in our study agreed......The aim of the study was to explore patients' experiences and perceptions of receiving intensive care diaries. A focus group and intensive care diaries for four former ICU patients were analysed to understand what works and what needs further development for patients who receive a diary. The study...
Pronovost, Peter J.; Goeschel, Christine A.
The need for health services research is likely to rise rapidly as the population ages, health care costs soar, and therapeutic and diagnostic choices proliferate. Building an effective and efficient health care delivery system is a national priority. Yet the national health care quality report concludes that we lack the ability to monitor progress toward even basic quality and patient safety goals effectively.
Iyengar, Sharad D; Iyengar, Kirti; Suhalka, Virendra; Agarwal, Kumaril
A retrospective cross-sectional survey was conducted to assess key practices and costs relating to home- and institutional delivery care in rural Rajasthan, India. One block from each of two sample districts was covered (estimated population--279,132). Field investigators listed women who had delivered in the past three months and contacted them for structured case interview. In total, 1947 (96%) of 2031 listed women were successfully interviewed. An average of 2.4 and 1.7 care providers attended each home- and institutional delivery respectively. While 34% of the women delivered in health facilities, modem care providers attended half of all the deliveries. Intramuscular injections, intravenous drips, and abdominal fundal pressure were widely used for hastening delivery in both homes and facilities while post-delivery injections for active management of the third stage were administered to a minority of women in both the venues. Most women were discharged prematurely after institutional delivery, especially by smaller health facilities. The cost of accessing home-delivery care was Rs 379 (US$ 8) while the mean costs in facilities for elective, difficult vaginal deliveries and for caesarean sections were Rs 1336 (US$ 30), Rs 2419 (US$ 54), and Rs 11,146 (US$ 248) respectively. Most families took loans at high interest rates to meet these costs. It is concluded that widespread irrational practices by a range of care providers in both homes and facilities can adversely affect women and newborns while inadequate observance of beneficial practices and high costs are likely to reduce the benefits of institutional delivery, especially for the poor. Government health agencies need to strengthen regulation of delivery care and, especially, monitor perinatal outcomes. Family preference for hastening delivery and early discharge also require educational efforts. PMID:19489423
Lavis, J N; Anderson, G M
A major focus of the current health care debate is the notion that a substantial proportion of the health care delivered in Canada is inappropriate. There are two types of appropriateness: appropriateness of a service and appropriateness of the setting in which care is provided (i.e., inpatient v. outpatient or home care). Measuring both types objectively requires the comparison of observed patterns of care with explicit criteria for appropriate care. The few studies of appropriateness conduc...
Story William T; Burgard Sarah A; Lori Jody R; Taleb Fahmida; Ali Nabeel; Hoque DM Emdadul
Abstract Background A primary cause of high maternal mortality in Bangladesh is lack of access to professional delivery care. Examining the role of the family, particularly the husband, during pregnancy and childbirth is important to understanding women's access to and utilization of professional maternal health services that can prevent maternal mortality. This qualitative study examines husbands' involvement during childbirth and professional delivery care utilization in a rural sub-distric...
Wade, Joanne E; Ledbetter, David H; Williams, Marc S
The United States health care system is undergoing significant change and is seeking innovations in care delivery and reimbursement models that will lead to improved value for patients, providers, payers, and employers. Genomic medicine has the potential to be a disruptive innovation that if implemented intelligently can improve value. The article presents the perspective of the leaders of a large integrated healthcare delivery system regarding the decision to invest in implementation of genomic medicine. PMID:24619641
Mumtaz, Zubia; O’Brien, Beverley; Higginbottom, Gina
Background Immigration to Canada has significantly increased in recent years, particularly in the Prairie Provinces. There is evidence that pregnant newcomer women often encounter challenges when attempting to navigate the health system. Our aim was to explore newcomer women’s experiences in Canada regarding pregnancy, delivery and postpartum care and to assess the degree to which Canada provides equitable access to pregnancy and delivery services. Methods Data were obtained from the Canadian...
An overview is presented of the system of health care delivery to the personnel of nuclear power plants in Temelin and Dukovany, Czechoslovakia. The system of curative and preventivd care is described in detail, including preventive examinations, rehabilitation and spa treatment. The organisational structure is also described of health care institutions and the tasks are outlined of the works health care centres. (L.O.)
This study explores the different approaches to service delivery in fragile states by surveying donors' own evaluations of their existing fragile states policies. Because there is limited understanding of what works in risky environments, monitoring and evaluation are critical components of effective assistance. By highlighting trends in the strategies that donors have developed to implement acknowledged good practices, we can better understand how these experiences might contribute to future...
Full Text Available Background: In Tanzania, a country of 42 million, access to oral morphine is rare.Aim: To demonstrate the effectiveness of palliative care teams in reducing patients’ pain and in increasing other positive life qualities in the absence of morphine; and to document the psychological burden experienced by their clinical providers, trained in morphine delivery, as they observed their patients suffering and in extreme pain.Setting: One hundred and forty-fie cancer patients were included from 13 rural hospitals spread across Tanzania.Method: A mixed method study beginning with a retrospective quantitative analysis of cancer patients who were administered the APCA African POS tool four times. Bivariate analyses of the scores at time one and four were compared across the domains. The qualitative arm included an analysis of interviews with six nurses, each with more than fie years’ palliative care experience and no access to strong opioids.Results: Patients and their family caregivers identifid statistically signifiant (p < 0.001 improvements in all of the domains. Thematic analysis of nurse interviews described the patient and family benefis from palliative care but also their great distress when ‘bad cases’ arose who would likely benefi only from oral morphine.Conclusion: People living with chronic cancer-related pain who receive palliative care experience profound physical, spiritual and emotional benefis even without oral morphine. These results demonstrate the need for continued advocacy to increase the availability of oral morphine in these settings in addition to palliative care services.
Full Text Available Jamiu O BusariDepartment of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, The NetherlandsAbstract: Quality assurance (QA in higher medical education involves the development, sustenance, improvement, and evaluation of the standard of training of medical professionals. In health care delivery, QA focuses on guaranteeing and maintaining a high standard of the service provided in different health care systems. When the service delivered by the care provider is in accordance with what the recipients of health care expect, then quality in health care is considered to be present. There are several factors in higher medical education and health care that are responsible for the emergence of QA. These include externally imposed obligations requiring demonstration of public accountability and responsibility from educational institutions, as well as the need for activity-specific information by policy makers as an aid for important decision-making within educational institutions. In health care delivery on the other hand, the emergence of QA is linked to the need for containing rising health care costs in the face of limited resources and to guaranteeing high quality patient care in a changing health care environment where the power relationship between doctors and patients is shifting towards patients. Although medical education can be regarded as a distinct entity in the health care industry, it still remains an inherent part of the health care delivery system. As a result, different strategies aimed at guaranteeing and assuring high standards of health care and education in many countries tend to overlap. This paper reflects on whether quality assurance in health care delivery and medical education should be seen as separate entities.Keywords: quality assurance, health care, higher medical education
Jensen, Hanne Irene; Gerritsen, Rik T; Koopmans, Matty;
PURPOSE: The purpose of the study is to adapt and provide preliminary validation for questionnaires evaluating families' experiences of quality of care for critically ill patients in the intensive care unit (ICU). MATERIALS AND METHODS: This study took place in 2 European ICUs. Based on literature...... and qualitative interviews, we adapted 2 previously validated North American questionnaires: "Family Satisfaction with the ICU" and "Quality of Dying and Death." Family members were asked to assess relevance and understandability of each question. Validation also included test-retest reliability and construct...... validity. RESULTS: A total of 110 family members participated. Response rate was 87%. For all questions, a median of 97% (94%-99%) was assessed as relevant, and a median of 98% (97%-100%), as understandable. Median ceiling effect was 41% (30%-47%). There was a median of 0% missing data (0%-1%). Test...
Darrel J. Weinkauf; Boris Kralj
Reductions in health care funding by both the federal and provincial governments in recent years have focused attention on the cost-effectiveness of health care delivery, particularly on the delivery of primary care services. We use data extracted from the Ontario Health Insurance Plan (OHIP) claims database to assess differences between walk-in clinics and other primary care delivery settings in initial visit costs, follow-up visit costs, service duplication, and diagnoses treated. Our analy...
We are building the EPR trademark reactor fleet. Together. With four EPR trademark projects under construction in the world, AREVA has unrivalled experience in the delivery of large-scale nuclear projects, including more than a thousand lessons learned captured from Olkiluoto 3 and Flamanville 3 projects. This book of knowledge as well as the return of experience of AREVA's and EDF's teams are now being fully leveraged on ongoing projects, especially on Flamanville 3 and Taishan, and will be incorporated in all future EPRTM projects.
Full Text Available Delivery is considered as one of the most painful experiences of women’s life. The present study aimed to compare the effects of supportive care and acupressure on the pregnant women’s pain intensity and delivery outcome. In this experimental study, 150 pregnant women were randomly divided into supportive care, acupressure, and control groups. The intensity of pain was measured using Visual Analogue Scale (VAS. The supportive care group received both physical and emotional cares. In the acupressure group, on the other hand, BL32 acupoint was pressed during the contractions. Then, the data were analyzed using descriptive and inferential statistics. The results revealed significant difference among the three groups regarding the intensity of pain after the intervention (P<0.001. Besides, the highest rate of natural vaginal delivery was observed in the supportive care group (94% and the acupressure group (92%, while the highest rate of cesarean delivery was related to the control group (40% and the difference was statistically significant (P<0.001. The results showed that maternal supportive care and acupressure during labor reduced the intensity of pain and improved the delivery outcomes. Therefore, these methods can be introduced to the medical team as effective strategies for decreasing delivery pain. This trial is registered with the Iranian Registry of Clinical Trial Code IRCT2014011011706N5.
Van Beek, Ken; Duchemin, Steve; Gersh, Geniene; Pettigrew, Susanne; Silva, Pamela; Luskin, Barb
Introduction: The continuity and coordination of care between medical and behavioral health services is a major issue facing our health care delivery system. Barriers to basic communication between providers of medical services and providers of behavioral health services, include: no coordination of services, and poor recognition of the relationship between medical and behavioral issues.
Cortis, J D
The population of the United Kingdom reflects rich cultural diversity. Hence, nursing must respond to the challenges of meeting the needs of different ethnic groups and fulfilL the requirements of the Code of Professional Conduct. This article presents the findings of a study using grounded theory to explore the lived experience of Pakistani (Urdu-speaking) communities that received nursing care in a hospital setting in the United Kingdom. The study reflects national initiatives toward "consumer led" health care delivery. The findings illustrate a lack of congruence between the group's expectations and their experiences. Nurses were perceived to have a poor understanding of ethnic needs, portraying ethnocentric attitudes and behaviour. The participants attributed the lack of congruence mainly to the presence of racism in British health care systems. The author suggests possible changes at the strategic, managerial, and educational levels of health care delivery. PMID:11982043
Conclusions Patients and HCPs welcomed the introduction of agent technology to the delivery of health care. Widespread use will depend more on the trust patients place in their own GP than on technological issues.
Story William T
Full Text Available Abstract Background A primary cause of high maternal mortality in Bangladesh is lack of access to professional delivery care. Examining the role of the family, particularly the husband, during pregnancy and childbirth is important to understanding women's access to and utilization of professional maternal health services that can prevent maternal mortality. This qualitative study examines husbands' involvement during childbirth and professional delivery care utilization in a rural sub-district of Netrokona district, Bangladesh. Methods Using purposive sampling, ten households utilizing a skilled attendant during the birth of the youngest child were selected and matched with ten households utilizing an untrained traditional birth attendant, or dhatri. Households were selected based on a set of inclusion criteria, such as approximate household income, ethnicity, and distance to the nearest hospital. Twenty semi-structured interviews were conducted in Bangla with husbands in these households in June 2010. Interviews were transcribed, translated into English, and analyzed using NVivo 9.0. Results By purposefully selecting households that differed on the type of provider utilized during delivery, common themes--high costs, poor transportation, and long distances to health facilities--were eliminated as sufficient barriers to the utilization of professional delivery care. Divergent themes, namely husbands' social support and perceived social norms, were identified as underlying factors associated with delivery care utilization. We found that husbands whose wives utilized professional delivery care provided emotional, instrumental and informational support to their wives during delivery and believed that medical intervention was necessary. By contrast, husbands whose wives utilized an untrained dhatri at home were uninvolved during delivery and believed childbirth should take place at home according to local traditions. Conclusions This study provides
Wickizer, T M; Franklin, G; Plaeger-Brockway, R; Mootz, R D
This article has summarized research and policy activities undertaken in Washington State over the past several years to identify the key problems that result in poor quality and excessive disability among injured workers, and the types of system and delivery changes that could best address these problems in order to improve the quality of occupational health care provided through the workers' compensation system. Our investigations have consistently pointed to the lack of coordination and integration of occupational health services as having major adverse effects on quality and health outcomes for workers' compensation. The Managed Care Pilot Project, a delivery system intervention, focused on making changes in how care is organized and delivered to injured workers. That project demonstrated robust improvements in disability reduction; however, worker satisfaction suffered. Our current quality improvement initiative, developed through the Occupational Health Services Project, synthesizes what was learned from the MCP and other pilot studies to make delivery system improvements. This initiative seeks to develop provider incentives and clinical management processes that will improve outcomes and reduce the burden of disability on injured workers. Fundamental to this approach are simultaneously preserving workers' right to choose their own physician and maintaining flexibility in the provision of individualized care based on clinical need and progress. The OHS project then will be a "real world" test to determine if aligning provider incentives and giving physicians the tools they need to optimize occupational health delivery can demonstrate sustainable reduction in disability and improvements in patient and employer satisfaction. Critical to the success of this initiative will be our ability to: (1) enhance the occupational health care management skills and expertise of physicians who treat injured workers by establishing community-based Centers of Occupational
Killett, A; Burns, D.; F. Kelly; Brooker, D.; Bowes, A.; La Fontaine, J.; Latham, I.; Wilson, M; O'Neill, M
Organisational culture of institutions providing care for older people is increasingly recognised as influential in the quality of care provided. There is little research, however, that specifically examines the processes of care home culture and how these may be associated with quality of care. In this paper we draw from an empirical study carried out in the United Kingdom (UK) investigating the relationship between care home culture and residents' experience of care. Eleven UK care homes we...
Jafar S Tabrizi; Samira Askari; Zahra Fardiazar; Hossein Koshavar; Kamal Gholipour
Background: Our aim was to determine the service quality of delivered care for people with Caesarean Section and Normal Delivery. Methods: A cross-sectional study was conducted among 200 people who had caesarean section and normal delivery in Al-Zahra Teaching Hospital in Tabriz, north western Iran. Service quality was calculated using: Service Quality = 10 – (Importance × Performance) based on importance and performance of service quality aspects from the postpartum women‟s...
Ellner, Andrew L; Stout, Somava; Sullivan, Erin E; Griffiths, Elizabeth P; Mountjoy, Ashlin; Phillips, Russell S
Challenged by demands to reduce costs and improve service delivery, the U.S. health care system requires transformational change. Health systems innovation is defined broadly as novel ideas, products, services, and processes-including new ways to promote healthy behaviors and better integrate health services with public health and other social services-which achieve better health outcomes and/or patient experience at equal or lower cost. Academic health centers (AHCs) have an opportunity to focus their considerable influence and expertise on health systems innovation to create new approaches to service delivery and to nurture leaders of transformation. AHCs have traditionally used their promotions criteria to signal their values; creating a health systems innovator promotion track could be a critical step towards creating opportunities for innovators in academic medicine. In this Perspective, the authors review publicly available promotions materials at top-ranked medical schools and find that while criteria for advancement increasingly recognize systems innovation, there is a lack of specificity on metrics beyond the traditional yardstick of peer-reviewed publications. In addition to new promotions pathways and alternative evidence for the impact of scholarship, other approaches to fostering health systems innovation at AHCs include more robust funding for career development in health systems innovation, new curricula to enable trainees to develop skills in health systems innovation, and new ways for innovators to disseminate their work. AHCs that foster health systems innovation could meet a critical need to contribute both to the sustainability of our health care system and to AHCs' continued leadership role within it. PMID:25738387
Vaks, Katrin; Sjöström, Rita
The purpose of this qualitative study was to understand and examine how patients with rheumatoid arthritis (RA) experience climate care and its effects. A qualitative approach was chosen for the study. Two men and six women were interviewed according to a semistructured interview guide. The text was analyzed using a manifest content analysis. The analysis resulted in four categories and 10 subcategories. The interviewees experienced climate care positively. The training was perceived increasing gradually. The patients felt that they performed to a maximum capacity during training and were impressed by the staff's enthusiasm and encouragement. The patients felt that they were involved in the goal setting and the choice of treatment, and the staff noticed individual needs. There was a feeling among the patients of being acknowledged by the staff. Information about the disease was perceived as individualized. The climate and beautiful surroundings were viewed as encouraging physical activity and a feeling of well-being. Patients made new friends, had fun together and also shared experiences about their disease. Furthermore, the patients described a sense of belonging to a group as well as a feeling of not being the only one that was sick among the healthy. Not having to do everyday tasks and having time to themselves were perceived positively. Several factors contributed to the positive experiences of climate care; climate, environment, physical activity, social context, staff involvement, and information about the disease were described as interacting together and resulting in a sense of well-being. A proposal for future research would be to examine if/how the various factors might interact and affect the RA patients' illness and quality of life. PMID:26730385
AIM: To describe the lived experience of family members of patients in the intensive care unit. BACKGROUND: Admission of a critically ill relative to an intensive care unit causes anxiety and stress to family members. Nursing care is initially focused on maintaining the physiological stability of the patient and less on the needs and concerns of family members. Understanding how families make sense of this experience may help nurses focus on the delivery of family centred care. METHODOLOGY: A phenomenological method was used to describe the lived experiences of family members of patients in an intensive care unit. In-depth interviews were conducted with six family members and analysed using qualitative thematic analysis. RESULTS: Four main themes emerged from the data: the need to know, making sense of it all, being there with them and caring and support. Family members needed honest information about the patient\\'s progress and outcome to make the situation more bearable for them. Making sense of the situation was a continuous process which involved tracking and evaluating care given. Being with their relative sustained their family bond and was a way to demonstrate love and support. Caring reassurance provided by the nurses enabled a sense of security. Support was needed by family members to assist them in coping. CONCLUSION: The research provided an insight into how family members viewed the impact of the admission and how they subsequently found ways of dealing with the situation. RELEVANCE TO CLINICAL PRACTICE: Using a holistic approach to nursing assessment and care delivery in intensive care necessitates that nurses interact with and care for family members of patients. Development of a philosophy of family centred care is necessary, with formal assessment of families to take place soon after admission and an appropriate plan of care drawn up at this time.
McGlade, Michael S.; Saha, Somnath; Dahlstrom, Marie E.
Latina mothers in the United States enjoy surprisingly favorable birth outcomes despite their social disadvantages. This “Latina paradox” is particularly evident among Mexican-born women. The social and cultural factors that contribute to this paradox are maintained by community networks—informal systems of prenatal care that are composed of family, friends, community members, and lay health workers. This informal system confers protective factors that provide a behavioral context for healthy births. US-born Latinas are losing this protection, although it could be maintained with the support of community-based informal care systems. We recommend steps to harness the benefits of informal systems of prenatal care in Latino communities to meet the increasing needs of pregnant Latina women. PMID:15569952
Full Text Available Interprofessional education (IPE is an activity that involves two or more professions who learn interactively together to improve collaboration and the quality of care. Research has continually revealed that health and social care professionals encounter a range of problems with interprofessional coordination and collaboration which impact on the quality and safety of care. This empirical work resulted in policymakers across health care education and practice to invest in IPE to help resolve this collaborative failures. It is anticipated that IPE will provide health and social care professionals with the abilities required to work together effectively in providing safe high quality care to patients. Through a discussion of a range of key professional, educational and organization issues related to IPE, this paper argues that this form of education is an important strategy to improve the delivery of safe and effective care
Schmidt, LA; Rittenhouse, DR; Wu, KJ; Wiley, JA
Background: The patient-centered medical home (PCMH) is a key service delivery innovation in health reform. However, there are growing questions about whether the changes in clinics promoted by the PCMH model lead to improvements in the patient experience. Objective: To test the hypothesis that PCMH improvements in safety-net primary care clinics are associated with a more positive patient experience. Research Design: Multilevel cross-sectional analysis of patients nested within the primary c...
Augusto, Vincent; Xie, Xiaolan
This paper addresses a pharmacy delivery design problem with two types of human resources: pharmacy assistants and transporters within a hospital. Each medical unit of the hospital has a mobile medicine closet which is conveyed each week by transporters to the central pharmacy for inventory assessment and refill by assistants. Transportation is carried out by foot, by tractor or by truck depending on the location. The problem consists in creating a transportation and supply planning for each day of the week in order to balance workloads for both transporters and assistants while ensuring the availability of medicine to each medical service. A two-step approach using mixed-integer linear programming formulation is proposed to determine a near optimal schedule. Numerical results are given to assess its efficiency. The proposed approach is then combined with a simulation model to redesign the delivery process of the pharmacy department of a French university teaching hospital. Methodology of this real-life reengineering study is presented and discussed. PMID:19469456
Full Text Available Abstract Background About 98% of newborn deaths occur in developing countries, where most newborns deaths occur at home. In Nepal, approximately, 90% of deliveries take place at home. Information about reasons for delivering at home and newborn care practices in urban areas of Nepal is lacking and such information will be useful for policy makers. Methods A cross-sectional survey was carried out in the immunisation clinics of Pokhara city, western Nepal during January and February, 2006. Two trained health workers administered a semi-structured questionnaire to the mothers who had delivered at home. Results A total of 240 mothers were interviewed. Planned home deliveries were 140 (58.3% and 100 (41.7% were unplanned. Only 6.2% of deliveries had a skilled birth attendant present and 38 (15.8% mothers gave birth alone. Only 46 (16.2% women had used a clean home delivery kit and only 92 (38.3% birth attendants had washed their hands. The umbilical cord was cut after expulsion of placenta in 154 (64.2% deliveries and cord was cut using a new/boiled blade in 217 (90.4% deliveries. Mustard oil was applied to the umbilical cord in 53 (22.1% deliveries. Birth place was heated throughout the delivery in 88 (64.2% deliveries. Only 100 (45.8% newborns were wrapped within 10 minutes and 233 (97.1% were wrapped within 30 minutes. Majority (93.8% of the newborns were given a bath soon after birth. Mustard oil massage of the newborns was a common practice (144, 60%. Sixteen (10.8% mothers did not feed colostrum to their babies. Prelacteal feeds were given to 37(15.2% newborns. Initiation rates of breast-feeding were 57.9% within one hour and 85.4% within 24 hours. Main reasons cited for delivering at home were 'preference' (25.7%, 'ease and convenience' (21.4% for planned deliveries while 'precipitate labor' (51%, 'lack of transportation' (18% and 'lack of escort' during labor (11% were cited for the unplanned ones. Conclusion High-risk home delivery and
Wickizer, Thomas M.; Franklin, Gary; Plaeger-Brockway, Roy; Mootz, Robert D.
Researchers and health policy analysts in Washington State set out to determine the extent to which administrative process changes and delivery system interventions within workers' compensation affect quality and health outcomes for injured workers. This research included a pilot project to study the effects of providing occupationally focused health care through managed care arrangements on health outcomes, worker and employer satisfaction, and medical and disability costs. Based on the resu...
Jamiu O BusariDepartment of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, The NetherlandsAbstract: Quality assurance (QA) in higher medical education involves the development, sustenance, improvement, and evaluation of the standard of training of medical professionals. In health care delivery, QA focuses on guaranteeing and maintaining a high standard of the service provided in different health care systems. When the...
Darega, Birhanu; Dida, Nagasa; Tafese, Fikru; Ololo, Shimeles
Background Delivery at health institutions under the care of trained health-care providers and utilization of postnatal cares services plays vital roles in promoting child survival and reducing the risk of maternal mortality. More than 80 % of maternal deaths can be prevented if pregnant women access to essential maternity cares like antenatal care, institutional delivery and postnatal care services. Thus, this study aimed to assess institutional delivery and postnatal care services utilizati...
Perceived patient value is often not aligned with the emerging expenses for health care services. In other words, the costs are often supposed as rising faster than the actual value for the patients. This fact is causing major concerns to governments, health plans, and individuals. Attempts to solve the problem have habitually been on the operational effectiveness side: increasing patient volume, minimizing costs, rationing, or closing hospitals, usually resulting in a zero-sum game. Only few...
Full Text Available BACKGROUND: As part of the mid-term evaluation of a Women's Health Care Project, a study was conducted to compare the utilization of maternal and neonatal health (MNH services in two areas with different levels of service in Punjab, Pakistan. METHODS: A cross-sectional survey was conducted to interview Married Women of Reproductive Age (MWRA. Information was collected on MWRA knowledge regarding danger signs during pregnancy, delivery, postnatal periods, and MNH care seeking behavior. After comparing MNH service utilization, the two areas were compared using a logistic regression model, to identify the association of different factors with the intervention after controlling for socio-demographic, economic factors and distance of the MWRA residence to a health care facility. RESULTS: The demographic characteristics of women in the two areas were similar, although socioeconomic status as indicated by level of education and better household amenities, was higher in the intervention area. Consequently, on univariate analysis, utilization of MNH services: antenatal care, TT vaccination, institutional delivery and use of modern contraceptives were higher in the intervention than control area. Nonetheless, multivariable analysis controlling for confounders such as socioeconomic status revealed that utilization of antenatal care services at health centers and TT vaccination during pregnancy are significantly associated with the intervention. CONCLUSIONS: Our findings suggest positive changes in health care seeking behavior of women and families with respect to MNH. Some aspects of care still require attention, such as knowledge about danger signs and neonatal care, especially umbilical cord care. Despite overall success achieved so far in response to the Millennium Development Goals, over the past two decades decreases in maternal mortality are far from the 2015 target. This report identifies some of the key factors to improving MNH and serves as an
Singer, S J
The health care delivery system is made up of providers--hospitals and doctors--increasingly organized into medical groups. Medical groups interact with payors, primarily health maintenance organizations, that increasingly pass through both risk and prices from increasingly demanding purchasers. This article summarizes the present and future prospects for each of these groups.
... 45 Public Welfare 1 2010-10-01 2010-10-01 false Waivers for the delivery of health care service. 50.5 Section 50.5 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION U.S. EXCHANGE VISITOR PROGRAM-REQUEST FOR WAIVER OF THE TWO-YEAR FOREIGN RESIDENCE REQUIREMENT § 50.5...
Full Text Available Health and social care systems are implementing fundamental changes to organizational structures and work practices in an effort to achieve integrated care. While some integration initiatives have produced positive outcomes, many have not. We reframe the concept of integration as a learning process fueled by knowledge exchange across diverse professional and organizational communities. We thus focus on the cognitive and social dynamics of learning in complex adaptive systems, and on learning behaviours and conditions that foster collective learning and improved collaboration. We suggest that the capacity to learn how to learn shapes the extent to which diverse professional groups effectively exchange knowledge and self-organize for integrated care delivery.
This paper outlines the role of quality audit within the framework of quality assurance, presenting the concurrent and retrospective approaches available. The literature survey provides a review of the limited audit tools available and their application to continence services and care delivery, as well as attempts to produce tools from national and local standard setting. Audit is part of a process; it can involve staff, patients and their relatives and the team of professionals providing care, as well as focusing on organizational and management levels. In an era of market delivery of services there is a need to justify why audit is important to continence advisors and managers. Effectiveness, efficiency and economics may drive the National Health Service, but quality assurance, which includes standards and audit tools, offers the means to ensure the quality of continence services and care to patients and auditing is also required in the purchaser/provider contracts for patient services. An overview and progress to date of published and other a projects in auditing continence care and service is presented. By outlining and highlighting the audit of continence service delivery and care as a basis on which to build quality assurance programmes, it is hoped that this knowledge will be shared through the setting up of a central auditing clearing project. PMID:7551434
Calvello, Emilie J B; Tenner, Andrea G; Broccoli, Morgan C; Skog, Alexander P; Muck, Andrew E; Tupesis, Janis P; Brysiewicz, Petra; Teklu, Sisay; Wallis, Lee; Reynolds, Teri
A major barrier to successful integration of acute care into health systems is the lack of consensus on the essential components of emergency care within resource-limited environments. The 2013 African Federation of Emergency Medicine Consensus Conference was convened to address the growing need for practical solutions to further implementation of emergency care in sub-Saharan Africa. Over 40 participants from 15 countries participated in the working group that focused on emergency care delivery at health facilities. Using the well-established approach developed in the WHO's Monitoring Emergency Obstetric Care, the workgroup identified the essential services delivered-signal functions-associated with each emergency care sentinel condition. Levels of emergency care were assigned based on the expected capacity of the facility to perform signal functions, and the necessary human, equipment and infrastructure resources identified. These consensus-based recommendations provide the foundation for objective facility capacity assessment in developing emergency health systems that can bolster strategic planning as well as facilitate monitoring and evaluation of service delivery. PMID:26202673
Full Text Available This paper presents the implementation of a smart environment that employs Ambient Intelligence technologies in order to augment a typical hospital room with smart features that assist both patients and medical staff. In this environment various wireless and wired sensor technologies have been integrated, allowing the patient to control the environment and interact with the hospital facilities, while a clinically oriented interface allows for vital sign monitoring. The developed applications are presented both from a patient’s and a doctor’s perspective, offering different services depending on the user’s role. The results of the evaluation process illustrate the need for such a service, leading to important conclusions about the usefulness and crucial role of AmI in health care.
Full Text Available Abstract The United States pediatric population with chronic health conditions is expanding. Currently, this demographic comprises 12-18% of the American child and youth population. Affected children often receive fragmented, uncoordinated care. Overall, the American health care delivery system produces modest outcomes for this population. Poor, uninsured and minority children may be at increased risk for inferior coordination of services. Further, the United States health care delivery system is primarily organized for the diagnosis and treatment of acute conditions. For pediatric patients with chronic health conditions, the typical acute problem-oriented visit actually serves as a barrier to care. The biomedical model of patient education prevails, characterized by unilateral transfer of medical information. However, the evidence basis for improvement in disease outcomes supports the use of the chronic care model, initially proposed by Dr. Edward Wagner. Six inter-related elements distinguish the success of the chronic care model, which include self-management support and care coordination by a prepared, proactive team. United States health care lacks a coherent policy direction for the management of high cost chronic conditions, including rheumatic diseases. A fundamental restructure of United States health care delivery must urgently occur which places the patient at the center of care. For the pediatric rheumatology workforce, reimbursement policies and the actions of health plans and insurers are consistent barriers to chronic disease improvement. United States reimbursement policy and overall fragmentation of health care services pose specific challenges for widespread implementation of the chronic care model. Team-based multidisciplinary care, care coordination and self-management are integral to improve outcomes. Pediatric rheumatology demand in the United States far exceeds available workforce supply. This article reviews the career
White, Catherine Roller; O'Brien, Kirk; Pecora, Peter J.; English, Diana; Williams, Jason R.; Phillips, Chereese M.
The Northwest Foster Care Alumni Study examined the relation between experiences in foster care and depression among young adults who spent at least a year in foster care as adolescents. Results indicate that preparation for leaving foster care, nurturing supports from the foster family, school stability, access to tutoring, access to therapeutic…
Kinder, Karen; Kristensen, Troels; Abrams, Chad
Objectives The aim of this workshop is to provide an insight into how information gained through applications of risk stratification in the primary health care sector, from integrated care networks to primary care clinics and finally at the individual clinician level can improve the delivery...... of primary care. Background As has been demonstrated in both public and private healthcare systems around the globe, risk stratification contributes to improved clinical management of populations. This includes the ability to: – Predict high-risk individuals for inclusion in population health management......, pharmacy management, and disease management programs. – Identify individuals at risk of hospitalization and re-hospitalization. – Identify patients whose pharmacy expenditures are greater than what is predicted based upon their morbidity profile alone. – Identify those at risk of uncoordinated care...
Logan, J. S.; Shulman, E. L.; Johnson, P. C.
Specific requirements for medical support of a long-duration manned facility in a low earth orbit derive from inflight medical experience, projected medical scenarios, mission related spacecraft and environmental hazards, health maintenance, and preventive medicine. A sequential buildup of medical capabilities tailored to increasing mission complexity is proposed. The space station health maintenance facility must provide preventive, diagnostic, and therapeutic medical support as immediate rescue capability may not exist.
Elwyn, Glyn; Thompson, Rachel; John, Roshen; Grande, Stuart W
BACKGROUND: Efforts have been made to measure integration in health care delivery, but few existing instruments have adopted a patient perspective, and none is sufficiently generic and brief for administration at scale. We sought to develop a brief and generic patient-reported measure of integration in health care delivery. METHODS: Drawing on both existing conceptualisations of integrated care and research on patients' perspectives, we chose to focus on four distinct domains of integration: ...
Warner, Echo L; Wu, Yelena P; Hacking, Claire C; Wright, Jennifer; Spraker-Perlman, Holly L; Gardner, Emmie; Kirchhoff, Anne C
Current guidelines recommend all pediatric cancer survivors receive a survivor care plan (SCP) for optimal health management, yet clinical delivery of SCPs varies. We evaluated oncology providers' familiarity with and preferences for delivering SCPs to inform the implementation of a future SCP program at our institution. From November 2013 to April 2014, oncology providers from the Primary Children's Hospital in Salt Lake City, UT, completed a survey (n=41) and a 45-min focus group (n=18). Participants reported their familiarity with and training in SCP guidelines, opinions on SCPs, and barriers to delivering SCPs. As a secondary analysis, we examined differences in survey responses between physicians and nurses with Fisher's exact tests. Focus group transcripts and open-ended survey responses were content analyzed. Participants reported high familiarity with late effects of cancer treatment (87.8%) and follow-up care that cancer survivors should receive (82.5%). Few providers had delivered an SCP (oncologists 35.3% and nurses 5.0%; p=0.03). Barriers to providing SCPs included lack of knowledge (66.7%), SCP delivery is not expected in their clinic (53.9%), and no champion (48.7%). In qualitative comments, providers expressed that patient age variation complicated SCP delivery. Participants supported testing an SCP intervention program (95.1%) and felt this should be a team-based approach. Strategies for optimal delivery of SCPs are needed. Participants supported testing an SCP program to improve the quality of patient care. Team-based approaches, including nurses and physicians, that incorporate provider training on and support for SCP delivery are needed to improve pediatric cancer care. PMID:25893925
Gilmartin, M J
Market transformations occurring within the health care industry require new patterns of organization and management to meet the increasing complexity of service delivery. A greater understanding of the innovation and entrepreneurial dynamic allows administrators, managers, and leaders to create a new vision of service delivery. Central management and leadership objectives include the development of service technologies that capitalize upon the inherent knowledge of workers to meet consumer needs. A strong sense of innovation and entrepreneurship leading to the introduction of new or improved nursing technologies is a primary component in the evolution of professional nursing practice for the 21st century. PMID:9505707
This thesis explores the care experiences of looked-after, dual heritage young people with one white and one black African Caribbean parent. These young people have a history of spending longer periods in care than others and the assumption is that they experience identity confusion because they are neither white nor black. Given that very little is actually known in this domain, it has been necessary to examine their care experiences in order to unpack the myths and assumption...
Davis, Deborah Winders; Honaker, Sarah M; Jones, V Faye; Williams, P Gail; Stocker, Frederick; Martin, Elaine
This study describes the experiences of and barriers for pediatricians in Kentucky in providing behavioral/mental health (B-MH) services in primary care settings. These data will serve as a foundation for improving service delivery. An online survey was completed by 70 pediatricians. Descriptive data are presented. More than 90% of the respondents said that they saw at least one patient a month with 1 of 10 specific B-MH diagnoses. Physicians' comfort with diagnosing and treating disorders varied widely by diagnosis, age-group, and drug classification. Major barriers to providing optimal care were inaccessibility of mental health professionals for consultation and referral, lack of communication, and lack of knowledge. Respondents were more likely to favor consultation and co-location models over an integration model of care delivery. Overall, the authors found that pediatricians are dealing with patients with B-MH problems for which they may not have been adequately trained. Communication and collaboration needs were identified. PMID:22514194
The pre-surgery nursing practice model derived from Newman's theory was developed to change the delivery of nursing care in a pre-surgical clinic. Guided by the theoretical knowledge of health as expanding consciousness, transpersonal caring, and reflective practice, key practice changes included a) incorporating Newman's praxis process, b) changing the physical space, and c) providing opportunities to reflect on practice. The purpose of this study was to utilize a phenomenological approach to evaluate a new model of care among 31 patients and 4 nurses. PMID:19342715
Kaggal, Vinod C; Elayavilli, Ravikumar Komandur; Mehrabi, Saeed; Pankratz, Joshua J; Sohn, Sunghwan; Wang, Yanshan; Li, Dingcheng; Rastegar, Majid Mojarad; Murphy, Sean P; Ross, Jason L; Chaudhry, Rajeev; Buntrock, James D; Liu, Hongfang
The concept of optimizing health care by understanding and generating knowledge from previous evidence, ie, the Learning Health-care System (LHS), has gained momentum and now has national prominence. Meanwhile, the rapid adoption of electronic health records (EHRs) enables the data collection required to form the basis for facilitating LHS. A prerequisite for using EHR data within the LHS is an infrastructure that enables access to EHR data longitudinally for health-care analytics and real time for knowledge delivery. Additionally, significant clinical information is embedded in the free text, making natural language processing (NLP) an essential component in implementing an LHS. Herein, we share our institutional implementation of a big data-empowered clinical NLP infrastructure, which not only enables health-care analytics but also has real-time NLP processing capability. The infrastructure has been utilized for multiple institutional projects including the MayoExpertAdvisor, an individualized care recommendation solution for clinical care. We compared the advantages of big data over two other environments. Big data infrastructure significantly outperformed other infrastructure in terms of computing speed, demonstrating its value in making the LHS a possibility in the near future. PMID:27385912
Full Text Available Abstract Background In recognition of the critical shortage of human resources within health services, community health workers have been trained and deployed to provide primary health care in developing countries. However, very few studies have investigated whether these health workers can provide good quality of care. This study investigated the knowledge and performance of health extension workers (HEWs on antenatal and delivery care. The study also explored the barriers and facilitators for HEWs in the provision of maternal health care. Methods In conducting this research, a cross-sectional study was performed. A total of 50 HEWs working in 39 health posts, covering a population of approximately 195,000 people, were interviewed. Descriptive statistics was used and a composite score of knowledge of HEWs was made and interpreted based on the Ethiopian education scoring system. Results Almost half of the respondents had at least 5 years of work experience as a HEW. More than half (27 (54% of the HEWs had poor knowledge on contents of antenatal care counseling, and the majority (44 (88% had poor knowledge on danger symptoms, danger signs, and complications in pregnancy. Health posts, which are the operational units for HEWs, did not have basic infrastructures like water supply, electricity, and waiting rooms for women in labor. On average within 6 months, a HEW assisted in 5.8 births. Only a few births (10% were assisted at the health posts, the majority (82% were assisted at home and only 20% of HEWs received professional assistance from a midwife. Conclusion Considering the poor knowledge of HEWs, poorly equipped health posts, and poor referral systems, it is difficult for HEWs to play a key role in improving health facility deliveries, skilled birth attendance, and on-time referral through early identification of danger signs. Hence, there is an urgent need to design appropriate strategies to improve the performance of HEWs by enhancing their
Silver, Julie K; Raj, Vishwa S; Fu, Jack B; Wisotzky, Eric M; Smith, Sean Robinson; Kirch, Rebecca A
Palliative care and rehabilitation practitioners are important collaborative referral sources for each other who can work together to improve the lives of cancer patients, survivors, and caregivers by improving both quality of care and quality of life. Cancer rehabilitation and palliative care involve the delivery of important but underutilized medical services to oncology patients by interdisciplinary teams. These subspecialties are similar in many respects, including their focus on improving cancer-related symptoms or cancer treatment-related side effects, improving health-related quality of life, lessening caregiver burden, and valuing patient-centered care and shared decision-making. They also aim to improve healthcare efficiencies and minimize costs by means such as reducing hospital lengths of stay and unanticipated readmissions. Although their goals are often aligned, different specialized skills and approaches are used in the delivery of care. For example, while each specialty prioritizes goal-concordant care through identification of patient and family preferences and values, palliative care teams typically focus extensively on using patient and family communication to determine their goals of care, while also tending to comfort issues such as symptom management and spiritual concerns. Rehabilitation clinicians may tend to focus more specifically on functional issues such as identifying and treating deficits in physical, psychological, or cognitive impairments and any resulting disability and negative impact on quality of life. Additionally, although palliative care and rehabilitation practitioners are trained to diagnose and treat medically complex patients, rehabilitation clinicians also treat many patients with a single impairment and a low symptom burden. In these cases, the goal is often cure of the underlying neurologic or musculoskeletal condition. This report defines and describes cancer rehabilitation and palliative care, delineates their
Buist, Diana SM; Chang, Eva; Handley, Matt; Pardee, Roy; Gundersen, Gabrielle; Cheadle, Allen; Reid, Robert J
Context: Perceptions about low-value care (eg, medical tests and procedures that may be unnecessary and/or harmful) among clinicians with capitated salaries are unknown. Objective: Explore clinicians’ perceived use of and responsibility for reducing low-value care by focusing on barriers to use, awareness of the Choosing Wisely campaign, and response to reports of peer-comparison resource use and practice patterns. Methods: Electronic, cross-sectional survey, distributed in 2013, to 304 salaried primary care physicians and physician assistants at Group Health Cooperative. Main Outcome Measures: Attitudes, awareness, and barriers of low-value care strategies and initiatives. Results: A total of 189 clinicians responded (62% response rate). More than 90% believe cost is important to various stakeholders and believe it is fair to ask clinicians to be cost-conscious. Most found peer-comparison resource-use reports useful for understanding practice patterns and prompting peer discussions. Two-thirds of clinicians were aware of the Choosing Wisely campaign; among them, 97% considered it a legitimate information source. Although 88% reported being comfortable discussing low-value care with patients, 80% reported they would order tests or procedures when a patient insisted. As key barriers in reducing low-value care, clinicians identified time constraints (45%), overcoming patient preferences/values (44%), community standards (43%), fear of patients’ dissatisfaction (41%), patients’ knowledge about the harms of low-value care (38%), and availability of tools to support shared decision making (37%). Conclusions: Salaried clinicians are aware of rising health care costs and want to be stewards of limited health care resources. Evidence-based initiatives such as the Choosing Wisely campaign may help motivate clinicians to be conscientious stewards of limited health care resources. PMID:26562308
Haagen, E.C.; Hermens, R.P.M.G.; Nelen, W.L.D.M.; Braat, D.D.; Kremer, J.A.M.; Grol, R.P.T.M.
OBJECTIVE: To identify subfertile couples' experiences with specific aspects of intrauterine insemination (IUI) care and to determine which patient and hospital characteristics affect their experiences. DESIGN: Cross-sectional survey with written questionnaires. SETTING: One large tertiary hospital
Full Text Available To The Editor: There is an increasing need to incorporate the use of electronic medical records EMR in our healthcare delivery. The advancement in information technology and its impact in all sectors including healthcare has accelerated this need amidst the ever growing challenges facing healthcare today. These challenges include; reducing preventable errors, improving communication among health care providers and facilities, and controlling the cost of medical care. I may argue that employing an electronic medical record system may be the one solution that will addresses all of these issues. The literature shows that Innovations in electronic record keeping have dramatically improved communication and patient safety without increasing costs.
Schmitz, M F; Ryan, P; Walker, J L; Sokolov, J J
One of the most significant lessons learned from this process is that setting objectives with performance standards is the key to continuous quality improvement. The critical differences between health administration and health management are threefold: (1) performance standards are developed with clarity, (2) care delivery is monitored and measured against these standards, and (3) improvements are made based on information from these measurements. PMID:10130057
Kwedza Ru K
Full Text Available Abstract Background Australia's Aboriginal and Torres Strait Islander (Indigenous populations have disproportionately high rates of adverse perinatal outcomes relative to other Australians. Poorer access to good quality maternal health care is a key driver of this disparity. The aim of this study was to describe patterns of delivery of maternity care and service gaps in primary care services in Australian Indigenous communities. Methods We undertook a cross-sectional baseline audit for a quality improvement intervention. Medical records of 535 women from 34 Indigenous community health centres in five regions (Top End of Northern Territory 13, Central Australia 2, Far West New South Wales 6, Western Australia 9, and North Queensland 4 were audited. The main outcome measures included: adherence to recommended protocols and procedures in the antenatal and postnatal periods including: clinical, laboratory and ultrasound investigations; screening for gestational diabetes and Group B Streptococcus; brief intervention/advice on health-related behaviours and risks; and follow up of identified health problems. Results The proportion of women presenting for their first antenatal visit in the first trimester ranged from 34% to 49% between regions; consequently, documentation of care early in pregnancy was poor. Overall, documentation of routine antenatal investigations and brief interventions/advice regarding health behaviours varied, and generally indicated that these services were underutilised. For example, 46% of known smokers received smoking cessation advice/counselling; 52% of all women received antenatal education and 51% had investigation for gestational diabetes. Overall, there was relatively good documentation of follow up of identified problems related to hypertension or diabetes, with over 70% of identified women being referred to a GP/Obstetrician. Conclusion Participating services had both strengths and weaknesses in the delivery of maternal
The thesis researched the views and experiences of nursing staff of psychiatric special care ward on psychiatric care of depressed patients. Because caring is patient/client oriented profession, it is essential to include patients and nursing staff in the development work. This assumption was basis for the thesis. The thesis aimed to add knowledge on the views of the nursing staff and to show how this knowledge can be used in development of psychiatric care. The thesis also pursue...
Vargens, O; Berterö, Carina
This study was made by a qualitative approach based on symbolic interactionism and grounded theory. The subject was defined as what mutilation means for nurses who take care of women submitted to gynaecological surgery. The aim was to identify the interaction relationship of nurses as female with the phenomenon of mutilation in gynaecological surgeries and how it affects their relationship with female patients in this situation. Data were obtained by interviews with 16 nurses who work in gyna...
Full Text Available Abstract Background Increasingly, women in India attend health facilities for childbirth, partly due to incentives paid under government programs. Increased use of health facilities can alleviate the risks of infections contracted in unhygienic home deliveries, but poor infection control practices in labour and delivery units also cause puerperal sepsis and other infections of childbirth. A needs assessment was conducted to provide information on procedures and practices related to infection control in labour and delivery units in Gujarat state, India. Methods Twenty health care facilities, including private and public primary health centres and referral hospitals, were sampled from two districts in Gujarat state, India. Three pre-tested tools for interviewing and for observation were used. Data collection was based on existing infection control guidelines for clean practices, clean equipment, clean environment and availability of diagnostics and treatment. The study was carried out from April to May 2009. Results Seventy percent of respondents said that standard infection control procedures were followed, but a written procedure was only available in 5% of facilities. Alcohol rubs were not used for hand cleaning and surgical gloves were reused in over 70% of facilities, especially for vaginal examinations in the labour room. Most types of equipment and supplies were available but a third of facilities did not have wash basins with "hands-free" taps. Only 15% of facilities reported that wiping of surfaces was done immediately after each delivery in labour rooms. Blood culture services were available in 25% of facilities and antibiotics are widely given to women after normal delivery. A few facilities had data on infections and reported rates of 3% to 5%. Conclusions This study of current infection control procedures and practices during labour and delivery in health facilities in Gujarat revealed a need for improved information systems
Young children's experiences outside of both home and school are important for their development. As women have entered the labor force, child care has become an increasingly important context for child development. Child care experiences prior to school entry have been well-documented as important influences on children's academic and…
Else Cathrine Rustad,1–4 Bodil Furnes,1 Berit Seiger Cronfalk,2,5,6 Elin Dysvik1 1Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway; 2Faculty of Health and Caring Sciences, Stord Haugesund University College, Stord, Norway; 3Research Network on Integrated Health Care in Western Norway, Helse Fonna Local Health Authority, Haugesund, Norway; 4Department of Clinical Medicine, Helse Fonna Local Health Authority, Haugesund, Norway; 5Pal...
Rustad EC; Furnes B; Cronfalk BS; Dysvik E
Else Cathrine Rustad,1–4 Bodil Furnes,1 Berit Seiger Cronfalk,2,5,6 Elin Dysvik1 1Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway; 2Faculty of Health and Caring Sciences, Stord Haugesund University College, Stord, Norway; 3Research Network on Integrated Health Care in Western Norway, Helse Fonna Local Health Authority, Haugesund, Norway; 4Department of Clinical Medicine, Helse Fonna Local Health Authority, Haugesund, Norway; 5Palliat...
Mushi Adiel K
Full Text Available Abstract Background Although antenatal care coverage in Tanzania is high, worrying gaps exist in terms of its quality and ability to prevent, diagnose or treat complications. Moreover, much less is known about the utilisation of postnatal care, by which we mean the care of mother and baby that begins one hour after the delivery until six weeks after childbirth. We describe the perspectives and experiences of women and health care providers on the use of antenatal and postnatal services. Methods From March 2007 to January 2008, we conducted in-depth interviews with health care providers and village based informants in 8 villages of Lindi Rural and Tandahimba districts in southern Tanzania. Eight focus group discussions were also conducted with women who had babies younger than one year and pregnant women. The discussion guide included information about timing of antenatal and postnatal services, perceptions of the rationale and importance of antenatal and postnatal care, barriers to utilisation and suggestions for improvement. Results Women were generally positive about both antenatal and postnatal care. Among common reasons mentioned for late initiation of antenatal care was to avoid having to make several visits to the clinic. Other concerns included fear of encountering wild animals on the way to the clinic as well as lack of money. Fear of caesarean section was reported as a factor hindering intrapartum care-seeking from hospitals. Despite the perceived benefits of postnatal care for children, there was a total lack of postnatal care for the mothers. Shortages of staff, equipment and supplies were common complaints in the community. Conclusion Efforts to improve antenatal and postnatal care should focus on addressing geographical and economic access while striving to make services more culturally sensitive. Antenatal and postnatal care can offer important opportunities for linking the health system and the community by encouraging women to
Titaley Christiana R; Hunter Cynthia L; Dibley Michael J; Heywood Peter
Abstract Background Trained birth attendants at delivery are important for preventing both maternal and newborn deaths. West Java is one of the provinces on Java Island, Indonesia, where many women still deliver at home and without the assistance of trained birth attendants. This study aims to explore the perspectives of community members and health workers about the use of delivery care services in six villages of West Java Province. Methods A qualitative study using focus group discussions ...
Description of situation concerning care of pregnancy, childbirth and childbed in Wageningen, the Netherlands. Diagnosis of pregnancy / supervision of pregnancy ( zwangerschapsbegeleiding ) / place of delivery / maternity home / controls of pregnancy / gymnastics course for parents / evaluation of p
Dornhoefer, J D
This essay explores an illness in a health care professional through lenses of role flexibility and professional accountability. It highlights the process of contemplation about the dual identifications implicit in the experience of being both a professional and a patient within one health care delivery system. This can be a position of standing on the borders of possibility. Thus, the dilemma of a "wounded healer" may challenge some assumptions inherent in the giving and receiving of care as well as grant us some regard for the power shifts within the management of our patients and of ourselves. The experience that one's ailment can be an opportunity-to explore notions of sickness and health or to help to tease out the limits or the potential impact of our responsibility toward that which we name disease and cure-may be the more salient message. PMID:11760112
Lin, Jin-Ding; Sung, Chang-Lin; Lin, Lan-Ping; Liu, Ta-Wen; Lin, Pei-Ying; Chen, Li-Mei; Chu, Cordia M.; Wu, Jia-Ling
This study aims to establish evidence-based data to explore the perceptions and experience of primary care physicians in the Pap smear screening provision for women with intellectual disabilities (ID), and to analyze the associated factors in the delivery of screening services to women with ID in Taiwan. Data obtained by a cross-sectional survey…
Coyle, Yvonne M.; Miller, Alan M.; Paulson, R. Steven
Cancer care is expensive due to the high costs of treatment and preventable utilization of resources. Government, employer groups, and insurers are seeking cancer care delivery models that promote both cost-efficiency and quality care. Baylor University Medical Center at Dallas (BUMC), a large tertiary care hospital, in collaboration with Texas Oncology, a large private oncology practice, established two independent centers that function cooperatively within the Baylor Charles A. Sammons Canc...
Full Text Available Abstract Background Recent years have seen an unprecedented increase in funds for procurement of health commodities in developing countries. A major challenge now is the efficient delivery of commodities and services to improve population health. With this in mind, we documented staffing levels and productivity in peripheral health facilities in southern Tanzania. Method A health facility survey was conducted to collect data on staff employed, their main tasks, availability on the day of the survey, reasons for absenteeism, and experience of supervisory visits from District Health Teams. In-depth interview with health workers was done to explore their perception of work load. A time and motion study of nurses in the Reproductive and Child Health (RCH clinics documented their time use by task. Results We found that only 14% (122/854 of the recommended number of nurses and 20% (90/441 of the clinical staff had been employed at the facilities. Furthermore, 44% of clinical staff was not available on the day of the survey. Various reasons were given for this. Amongst the clinical staff, 38% were absent because of attendance to seminar sessions, 8% because of long-training, 25% were on official travel and 20% were on leave. RCH clinic nurses were present for 7 hours a day, but only worked productively for 57% of time present at facility. Almost two-third of facilities had received less than 3 visits from district health teams during the 6 months preceding the survey. Conclusion This study documented inadequate staffing of health facilities, a high degree of absenteeism, low productivity of the staff who were present and inadequate supervision in peripheral Tanzanian health facilities. The implications of these findings are discussed in the context of decentralized health care in Tanzania.
Lokich, J J; Silvers, S; Brereton, H; Byfield, J; Bick, R
Free-standing cancer centers (FSCC) represent a growing trend in cancer care delivery within community practice. The critical components to FSCC are multidisciplinary cancer care, a complete menu of direct care and support services, a commitment to clinical trials and clinical investigation, and a comprehensive program for quality assurance. The advantages of FSCC to the community, to hospital programs, to the practicing surgical, medical, and radiation oncologists, and to the third-party carriers, including health maintenance organizations, are detailed. The development of an FSCC depends on the resolution of issues of (a) competition (between hospitals, hospitals and physicians, therapeutic disciplines, regional comprehensive cancer centers and FSCCs) and (b) concerns about conflict of interest. The ideal model of FSCC may well be represented by the joint venture of community hospital(s) and the community oncologists. PMID:2801600
Full Text Available Objectives. To describe the application of teleophthalmology in rural and underserved areas of India. Study Design. This paper describes the major teleophthalmology projects in India and its benefits. Results. Teleophthalmology is the use of telecommunication for electronic transfer of health-related data from rural and underserved areas of India to specialities in urban cities. The MDRF/WDF Rural Diabetes Project has proved to be very beneficial for improvement of quality health care in Tamilnadu and can be replicated at the national level. This community outreach programme using telemedicine facilities has increased awareness of eye diseases, improved access to specialized health care, helped in local community empowerment, and provided employment opportunities. Early detection of sight threatening disorders by teleophthalmology and prompt treatment can help decrease visual impairment. Conclusion. Teleophthalmology can be a very effective model for improving eye care delivery system in rural and underserved areas of India.
Clift, Kathryn; Scott, Luther; Johnson, Michael; Gonzalez, Carlos
A handful of the many changes resulting from the Affordable Care Act underscore the need for a geographic understanding of existing and prospective member communities. Health exchanges require that health provider networks are geographically accessible to underserved populations, and nonprofit hospitals nationwide are required to conduct community health needs assessments every three years. Beyond these requirements, health care providers are using maps and spatial analysis to better address health outcomes that are related in complex ways to social and economic factors.Kaiser Permanente is applying geographic information systems, with spatial analytics and map-based visualizations, to data sourced from its electronic medical records and from publicly and commercially available datasets. The results are helping to shape an understanding of the health needs of Kaiser Permanente members in the context of their communities. This understanding is part of a strategy to inform partnerships and interventions in and beyond traditional care delivery settings. PMID:24694317
McWhinney, I R; Stewart, M A
Family physicians were asked about their recent experience with caring for dying patients at home and for their evaluation of a recently established Palliative Care Home Support Team. Ninety-four percent of the respondents had cared for at least one dying patient at home during the previous 2 years. About two thirds felt comfortable, competent, confident, supported, and in control. One quarter felt personally drained by the experience, but almost as many found it personally renewing. Of those...
Background It is recognised that prisoners suffer varying health problems on initial imprisonment and are at risk from a range of health problems over their sentence duration. These health problems are contributing to the increased prevalence of prisoners in secondary care, last recorded as annually 47,857. Research currently fails to address the topic of nurses’ experiences and views of caring for prisoners in secondary care. The aim of this study was to gain knowledge of nurses’ experiences...
Strydom, Corinne; Wessels, Cornelia; Van Der Walt, Engela; Greeff, Minrie
For several years the School of Nursing Science and the School of Psychosocial Behavioural Science, of a specific university, have been offering health care services in response to some of the health needs of a disadvantaged community as part of their students' experiential learning. However, these health care services were rendered independently by these two schools, implying that no feedback system existed to evaluate the worth and quality of these student-rendered health care services. The...
Stineman, Margaret G.; Kwong, Pui L.; Kurichi, Jibby E.; Prvu-Bettger, Janet A.; Vogel, W Bruce; Maislin, Greg; Bates, Barbara E.; Reker, Dean M.
Stineman MG, Kwong PL, Kurichi JE, Prvu-Bettger JA, Vogel WB, Maislin G, Bates BE, Reker DM. The effectiveness of inpatient rehabilitation in the acute postoperative phase of care after transtibial or transfemoral amputation: study of an integrated health care delivery system. Arch Phys Med Rehabil 2008;89:1863-72.
Cohen, M A
A number of key trends are emerging in long-term care related to financing, new models of service delivery, and shifts in consumer expectations and preferences. Taken together, changes occurring in these areas point to a rapidly transforming long-term care landscape. Financing responsibility is shifting away from the federal government to states, individuals, and their families; providers are integrating and managing acute and long-term care services and adding new services to the continuum of care; and consumers are thinking more seriously about how to plan and pay for their future care needs, as well as how to independently navigate the long-term care system. PMID:9499656
van der Wal, C J; Smithwick, C L
This paper discusses some basic economic principles and concepts and how they relate to the analysis of dental care delivery. The fundamental theories of consumer behavior, profit maximization, information and transaction costs, and agency are considered. It is asserted that the information gap existing between patients and providers gives rise to a principal-agent problem, the operative element of this paper. The authors conclude that while under managed fee-for-service (MFFS) delivery systems, third-party administrators use financial, administrative, and utilization management tools to guide consumer and provider behavior, to reduce the size of the information gap, and achieve a more efficient allocation of resources, this does not occur under direct reimbursement (DR). PMID:9420386
ROLANDO R. CRUZADA, JR.
Full Text Available This study focused on the determination of the delivery of services of day care workers in the municipality of Sta. Maria, Province of Laguna during the first semester of school year 2012-2013. Descriptive research was used in this study. Among the key findings were that Day Care Workers with respect to interactional relationship accomplished the functions with outstanding adequacy such as constantly giving feedback and praises on the performance of children, along with workers and parents coordination and cooperation, with verbal interpretation of Always Observe. In terms of instructional quality both group of respondents perceived that day care workers in-charge had adequate abilities and competencies concerning their education and trainings in connection with teaching small children with verbal interpretation of Always Observe. The parents had confidence to the day care workers in-charge of their children aside from regularly consulting the day care workers about their children’s progress with verbal interpretation of Always Observe. There were only 871 households who availed of the services of day care centers in which 27 workers were employed and each of them assigned to handle an average of 33 children. Notable along with other findings was the day care workers and parents had the same perception as to the extent of services provided by the Day Care Center with respect to interactional relationship, instructional quality and parental participation. Subsequently the study ensued with these five factual remarks: Children’s interactions with parents in the centers were the direct mechanisms through which children learn. The educational qualification and the capability of the day care workers to handle small children were the primary essentials in children’s learning. Parents’ participation in the day care centers premises brought harmonious relationship between the Day Care Workers and children as well. The capacity of day care worker
Frey, Rosemary; Boyd, Michal; Foster, Sue; Robinson, Jackie; Gott, Merryn
Organisational culture has been shown to impact on resident outcomes in residential aged care (RAC). This is particularly important given the growing number of residents with high palliative care needs. The study described herein (conducted from January 2013 to March 2014) examined survey results from a convenience sample of 46 managers, alongside interviews with a purposively selected sample of 23 bereaved family members in order to explore the perceptions of organisational culture within New Zealand RAC facilities in one large urban District Health Board. Results of the Organisational Culture Assessment Instrument (OCAI) completed by managers indicated a preference for a 'Clan' and the structured 'Hierarchy' culture. Bereaved family interviews emphasised both positive and negative aspects of communication, leadership and teamwork, and relationship with residents. Study results from both managers' OCAI survey scores and next of kin interviews indicate that while the RAC facilities are culturally oriented towards providing quality care for residents, they may face barriers to adopting organisational processes supportive of this goal. PMID:25808936
Trujillo, Juan C; Carrillo, Bladimir; Iglesias, Wilman J
The determinants of maternal and child health have been the recurrent topics of study in developing countries. Using the Demographic and Health Survey (2010) of Colombia, this study aimed to identify the determinants for professional antenatal care and institutional delivery, taking into account the interdependence of these two decisions, which we consider using a bivariate probit model. This study found that when certain factors affecting both the decision to seek prenatal care and giving birth in a hospital are neglected, the results of the estimates are inefficient. Estimates show that the effects of education, parity, regional location and economic status on institutional delivery tend to be underestimated in a univariate probit model. The results indicate that economic status, level of education, parity and medical-insurance affiliation influenced the joint likelihood of accessing professional antenatal care and delivering in a health facility. An important finding is that mothers with a higher level of education are 9 percentage points more likely to access these two health services compared with mothers who are illiterate. Another observed finding is the regional disparities. The evidence indicates that mothers in the Pacific Region, the poorest region of Colombia, are 6 percentage points less likely to access such services. Thus, the results indicate that the Colombian health policy should emphasize increasing the level of schooling of mothers and establish health facilities in the poorest regions of the country to ensure that women in need are provided with social health insurance. PMID:23735737
Covill, Carl; Batt, Sarah
Currently the emphasis on primary care is that of pro-active management and patient participation (South 2005). In a rights based health system it is argued that the patient has the right to expect, high quality and accountable nursing care, delivered by health care professionals who have the skills and experience to underpin this philosophy as advocates of professional practice (Barnes 1997). With the widening participation of patient involvement as promoted by the DoH( 2002), the prominence...
Kimerling, Rachel; Pavao, Joanne; Wong, Ava
We utilized a nationally representative survey of women veteran primary care users to examine associations between patient activation and mental health care experiences. A dose–response relationship was observed, with odds of high quality ratings significantly greater at each successive level of patient activation. Higher activation levels were also significantly associated with preference concordant care for gender-related preferences (use of female providers, women-only settings, and women-...
Thomson, Sarah; Dixon, Anna
This paper examines some policies to increase or restrict consumer choice in western European health systems as regards four decisions: choice between public and private insurance; choice of public insurance fund; choice of first contact care provider and choice of hospital. Choice between public and private insurance is limited and arose for historical reasons in Germany. Owing to significant constraints, few people choose the private option. Choice of public insurance fund tends to be exercised by younger and healthier people, the decision to change fund is mainly associated with price and, despite complex risk adjustment mechanisms, it has led to risk selection by funds. Choice of first contact care provider is widespread in Europe. In countries where choice has traditionally been restricted, reforms aim to make services more accessible and convenient to patients. Reforms to restrict direct access to specialists aim to reduce unnecessary and inappropriate care but have been unpopular with the public and professionals. Patients' take up of choice of hospital has been surprisingly low, given their stated willingness to travel. Only where choice is actively supported in the context of long waiting times is take up higher. The objectives, implementation and impact of policies about choice have varied across western Europe. Culture and embedded norms may be significant in determining the extent to which patients exercise choice. PMID:16824264
Chin, Chee Wei Winston; Phua, Kai-Hong
Singapore, like many developed countries, is facing the challenge of a rapidly aging population and the increasing need to provide long-term care (LTC) services for elderly in the community. The Singapore government's philosophy on care for the elderly is that the family should be the first line of support, and it has relied on voluntary welfare organizations (VWOs) or charities for the bulk of LTC service provision. For LTC financing, it has emphasized the principles of co-payment and targeting of state support to the low-income population through means-tested government subsidies. It has also instituted ElderShield, a national severe disability insurance scheme. This paper discusses some of the challenges facing LTC policy in Singapore, particularly the presence of perverse financial incentives for hospitalization, the pitfalls of over-reliance on VWOs, and the challenges facing informal family caregivers. It discusses the role of private LTC insurance in LTC financing, bearing in mind demand- and supply-side failures that have plagued the private LTC insurance market. It suggests the need for more standardized needs assessment and portable LTC benefits, with reference to the Japanese Long-Term Care Insurance program, and also discusses the need to provide more support to informal family caregivers. PMID:26808468
Full Text Available Quality service delivery to the consumer of health is a legal reality as it is emphasised in the White Paper on the Transformation of Public Service delivery (South Africa, 1997. The guiding philosophy adopted within this framework is that of Batho Pele, which means placing the consumer at the centre of healthcare service delivery. Increasing attention has been paid to hospital processes from a quality perspective. By analogy, outpatient departments can be viewed as industrial plants where technological know-how is transferred to patients through service delivery, which is a cornerstone of a hospital’s business. Outpatients, as consumers of healthcare, draw conclusions about the quality of service delivery based on their experiences of such services. In this vein, an outpatient’s experience of a particular service is an indicator of his/her level of satisfaction with the quality of that service. No South African study can be found in the literature on out-patients’ experiences of quality service delivery. This study’s purpose is to explore and describe outpatients’ experiences of the quality of service delivery at a teaching hospital in Gauteng. A qualitative, explorative, descriptive study that was contextual in nature was conducted to achieve this aim. Focus group interviews were conducted with outpatients who met the selection criteria. Open coding was used to analyse the contents from the transcripts and field notes typed verbatim. Strategies for trustworthiness, namely co-coding, prolonged engagement, triangulation and adequate referencing, were employed to ensure the credibility of the study and research findings. The results reflect themes that were reduced into two main categories, namely positive and negative experiences. The positive experiences reflect outpatients’ experience of their relationship with medical staff and their satisfaction with the quality of medical care. Negative experiences relate predominantly to a lack
Kuehn, Mary Beth
The purpose of this qualitative, phenomenological study was to describe how nursing faculty are cared for in the workplace. Participants were interviewed individually or in a focus group to understand their experience. Following data analysis, the following themes were created: the process of being cared for included connecting, openly sharing,…
Using spiritual and religious resources gives patients and families strength to cope during a crisis, but nurses often do not offer spiritual care (Kloosterhouse & Ames, 2002). The purpose of this phenomenological study was to explore nurses" lived experience of giving spiritual care. A descriptive phenomenological approach was used to interview 4…
Care delivery for the child to grow up despite the pain: the family's experience Cuidando para que el niño crezca a pesar del dolor: la experiencia de la familia Cuidando para a criança crescer apesar da dor: a experiência da família
Lisabelle Mariano Rossato
Full Text Available This study aimed to understand the meaning of the experience of families having a child experiencing pain due to Juvenile Rheumatoid Arthritis and to construct a theoretical model representing this experience. Grounded Theory and Symbolic Interactionism were used as methodological framework and theoretical framework, respectively. Data were collected by semistructured interviews with 12 families. Data analysis allowed for the construction of the theoretical model Caring for the child to grow despite the pain, which describes an experience based on motivational elements: wanting to see the child without pain and wanting to see the child live a normal life, reviewing how the family lives the transition in its development cycles, retaking and integrating them in the family dynamic with the appearance of the disease and pain in the child. This theoretical model provides a framework for teaching, research and care, permitting advances in terms of theoretical nursing knowledge.Este trabajo tuvo como objetivos comprender el cotidiano de la familia del niño que vivencia la situación de dolor consecuente de la Artritis Reumatoidea Juvenil y construir un modelo teórico representativo de esa experiencia. La Teoría Fundamentada en los Datos y el Interacionismo Simbólico fueron utilizados como referenciales metodológico y teórico, respectivamente. Los datos fueron obtenidos por intermedio de entrevistas semi-estructuradas a 12 familias. El análisis de los datos permitió construir el modelo teórico Cuidando para que el niño crezca a pesar del dolor, que describe una experiencia estructurada en torno a los elementos motivadores: queriendo ver el niño libre del dolor y queriendo ver el niño llevar una vida normal, revelando como la familia vivencia las transiciones en sus ciclos de desarrollo, integrándolos en la dinámica familiar con la llegada de la enfermedad y del dolor en el niño. Este modelo proporciona un referencial que ayuda a la ense
attributed to incentive payments offered to physicians within FHGs and FHNs. However, these primary care delivery models need to be compared with other delivery models and fee for service practices in order to describe more specifically what aspects of model delivery and incentives affect care.
Titaley Christiana R
Full Text Available Abstract Background Trained birth attendants at delivery are important for preventing both maternal and newborn deaths. West Java is one of the provinces on Java Island, Indonesia, where many women still deliver at home and without the assistance of trained birth attendants. This study aims to explore the perspectives of community members and health workers about the use of delivery care services in six villages of West Java Province. Methods A qualitative study using focus group discussions (FGDs and in-depth interviews was conducted in six villages of three districts in West Java Province from March to July 2009. Twenty FGDs and 165 in-depth interviews were conducted involving a total of 295 participants representing mothers, fathers, health care providers, traditional birth attendants and community leaders. The FGD and in-depth interview guidelines included reasons for using a trained or a traditional birth attendant and reasons for having a home or an institutional delivery. Results The use of traditional birth attendants and home delivery were preferable for some community members despite the availability of the village midwife in the village. Physical distance and financial limitations were two major constraints that prevented community members from accessing and using trained attendants and institutional deliveries. A number of respondents reported that trained delivery attendants or an institutional delivery were only aimed at women who experienced obstetric complications. The limited availability of health care providers was reported by residents in remote areas. In these settings the village midwife, who was sometimes the only health care provider, frequently travelled out of the village. The community perceived the role of both village midwives and traditional birth attendants as essential for providing maternal and health care services. Conclusions A comprehensive strategy to increase the availability, accessibility, and
Kaiser, L R
There is no logical, linear way to approach a future in which knowledge and technology explode and new opportunities go hand-in-hand with rapid obsolescence. Teams and task groups will replace the vertical command structures of the past, making teamwork, flexibility, and imagination more important that absolute knowledge. Maximum downward task delegation and decentralization will empower workers at all levels while challenging the assumptions of licensure. As the health-care organization grows more ephemeral, management will become an increasingly subtle art. Visionary skills are essential in a dynamic, rapidly changing society where the past is no longer a guide for the future. PMID:1958819
Novick, Gina; Sadler, Lois S.; Kennedy, Holly Powell; Cohen, Sally S.; Groce, Nora E.; Knafl, Kathleen A.
Group prenatal care (GPNC) is an innovative alternative to individual prenatal care. In this longitudinal study we used ethnographic methods to explore African American and Hispanic women’s experiences of receiving GPNC in two urban clinics. Methods included individual, in-depth, semistructured interviews of women and group leaders in GPNC, participant observation of GPNC sessions, and medical record review. GPNC offered positive experiences and met many of the women’s expressed preferences r...
Objective:To study the effect of noninvasive delivery for reducing episiotomy rate.Methods:126 cases of vaginal delivery women from July to September 2013 were divided into the observation group and the control group, with 63 cases in each. The observation group were given noninvasive delivery technology,while the control group were given traditional delivery technology.The curative effect of two groups were compared.Results:The difference of perineum complete and episiotomy of two groups was statistically significant(P0.05).The bleeding was similar between the two groups,with no statistical significance(P>0.05).The difference of postpartum perineum wound healing and perineal pain after 3 days was statistically significant(P<0.05).Conclusion:Noninvasive childbirth can reduce episiotomy rate and reduce the perineal pain postpartum.It is favorable for perineum wound healing and improving the quality of life.It makes maternal women no longer fear episiotomy,so that it reduces the rate of cesarean delivery.%目的：探讨无创分娩对于减少会阴侧切率的效果。方法：2013年7-9月收治经阴道分娩产妇126例，分成观察组和对照组，各63例。观察组采用无创分娩技术，对照组采用传统分娩技术。比较两组效果。结果：两组会阴完整、会阴侧切比较差异有统计学意义(P＜0.05)，会阴裂伤程度差异无统计学意义(P＞0.05)，两组出血比较差异无统计学意义(P＞0.05)，产后3 d 会阴伤口愈合及会阴疼痛差异有统计学意义(P＜0.05)。结论：无创分娩降低会阴侧切率，减轻会阴产后疼痛，有利会阴伤口愈合，改善产妇生活质量，使产妇不再惧怕侧切而行剖宫产，降低了剖宫产率。
Edoh, Thierry Oscar; Teege, Gunnar
One of the problems in health care in developing countries is the bad accessibility of medicine in pharmacies for patients. Since this is mainly due to a lack of organization and information, it should be possible to improve the situation by introducing information and communication technology. However, for several reasons, standard solutions are not applicable here. In this paper, we describe a case study in Benin, a West African developing country. We identify the problem and the existing obstacles for applying standard ECommerce solutions. We develop an adapted system approach and describe a practical test which has shown that the approach has the potential of actually improving the pharmaceutical care delivery. Finally, we consider the security aspects of the system and propose an organizational solution for some specific security problems. PMID:21519942
Thomsen, Thordis; Vester-Andersen, Morten; Nielsen, Martin Vedel;
patients experience postoperative care. The patient population is generally older with multiple comorbidities, and the short-term postoperative mortality rate is 15-20%. Thus, vigilant surgeon and nursing attention is essential. The present study is a qualitative sub-study of a randomised trial evaluating......AIMS AND OBJECTIVES: To elicit knowledge of patient experiences of postoperative intermediate care in an intensive care unit and standard postoperative care in a surgical ward after emergency abdominal surgery. BACKGROUND: Emergency abdominal surgery is common, but little is known about how...... postoperative intermediate care after emergency abdominal surgery, the InCare trial. DESIGN: A qualitative study with individual semi-structured interviews. METHODS: We analysed interviews using Systematic Text Condensation. RESULTS: Eighteen patients (nine intervention/nine controls) were strategically sampled...
Patricia Del Grosso; Amy Brown; Sandra Silva; Jamila Henderson; Naomi Tein; Diane Paulsell
This volume highlights service delivery approaches and strategies that show promise for improving the oral health care delivery system and promoting oral health. It includes descriptions and examples of implementation in different program settings and with different target populations.
Tahrani, Abd A.; McCarthy, Mary; Godson, Jojo; Taylor, Sarah; Slater, Helen; Capps, Nigel; Moulik, Probal; Macleod, Andrew F
General practice characteristics are important for healthcare providers to maximise outcomes. Although different aspects of general practice characteristics have been studied previously, the impact of practice size on the delivery of care has been sparsely studied, particularly in relation to diabetes care. This brief report presents a longitudinal study in Shropshire (66 practices, 16 858 patients with diabetes) to assess the impact of practice size on diabetes care before and after implemen...
Mulley, Albert G.
This paper addresses the fourth theme of the Indiana Global Health Research Working Conference, Clinical Effectiveness and Health Systems Research. It explores geographic variation in health care delivery and health outcomes as a source of learning how to achieve better health outcomes at lower cost. It focuses particularly on the relationship between investments made in capacities to deliver different health care services to a population and the value thereby created by that care for individ...
Abstract Background Many western countries have policies of dispersal and direct provision accommodation (state-funded accommodation in an institutional centre) for asylum seekers. Most research focuses on its effect on the asylum seeking population. Little is known about the impact of direct provision accommodation on organisation and delivery of local primary care and social care services in the community. The aim of this research is to explore this issue. Methods In 2005 a direct provision accommodation centre was opened in a rural area in Ireland. A retrospective qualitative case study was designed comprising in-depth interviews with 37 relevant stakeholders. Thematic analysis following the principles of framework analysis was applied. Results There was lack of advance notification to primary care and social care professionals and the community about the new accommodation centre. This caused anxiety and stress among relevant stakeholders. There was insufficient time to plan and prepare appropriate primary care and social care for the residents, causing a significant strain on service delivery. There was lack of clarity about how primary care and social care needs of the incoming residents were to be addressed. Interdisciplinary support systems developed informally between healthcare professionals. This ensured that residents of the accommodation centre were appropriately cared for. Conclusions Direct provision accommodation impacts on the organisation and delivery of local primary care and social care services. There needs to be sufficient advance notification and inter-agency, inter-professional dialogue to manage this. Primary care and social care professionals working with asylum seekers should have access to training to enhance their skills for working in cross-cultural consultations.
Heidenreich, Mary T; Koo, Fung Kuen; White, Kate
The Chinese community, a heterogeneous, highly visible non-English speaking ethnic group in Australia, remains mostly hidden and underrepresented in palliative care service delivery along with participation in health research despite being the fastest growing such group in the country. There is a lack of Australian research information concerning the impact of migration on the caregiving experience of women carers within the Chinese cultural framework and the Australian palliative care context. This paper aims to explore the influence of Chinese cultural norms and immigration on the experience of immigrant women of Chinese ancestry caring for a terminally ill family member at home in Sydney. This study also seeks to identify factors that may present access barriers to palliative care support services. A qualitative approach was used in this study. Data were collected from semi-structured interviews with five home-based Chinese women carers and were analysed using thematic analysis. Findings identified that the participants found being a carer is a lonely and isolating experience. Sources of isolation and loneliness included social isolation experienced as a solitary carer without meaningful family and social relationships; loss of familiar cultural understandings and family values; and emotional isolators expressed in response to the physical and emotional role commitment and other constraints. The study results suggest the need for palliative care educational programmes designed to help nurses to understand the impact of cultural background within the palliative care context. Results also indicate that health care professionals should provide culturally appropriate and competent palliative care services, sensitive to the diverse socio-cultural influences and individual needs of Chinese migrants. PMID:25632724
Full Text Available Abstract Background Negative events are abusive, potentially dangerous or life-threatening health care events, as perceived by the patient. Patients' perceptions of negative events are regarded as a potentially important source of information about the quality of health care. We explored negative events in hospital care as perceived by immigrant patients. Methods Semi-structured individual and group interviews were conducted with respondents about negative experiences of health care. Interviews were transcribed and analyzed using a framework method. A total of 22 respondents representing 7 non-Dutch ethnic origins were interviewed; each respondent reported a negative event in hospital care or treatment. Results Respondents reported negative events in relation to: 1 inadequate information exchange with care providers; 2 different expectations between respondents and care providers about medical procedures; 3 experienced prejudicial behavior on the part of care providers. Conclusions We identified three key situations in which negative events were experienced by immigrant patients. Exploring negative events from the immigrant patient perspective offers important information to help improve health care. Our results indicate that care providers need to be trained in adequately exchanging information with the immigrant patient and finding out specific patient needs and perspectives on illness and treatment.
An anthropological study has been carried out in order to evaluate the need expressed by patients undergoing radiotherapy treatment. The study was mostly qualitative and based on the radiotherapy experiences of 13 women with breast cancer and six men with head and neck cancer. A 24-year-old female anthropologist spent one year in the department of radiotherapy at the Bergonie Institute in Bordeaux. She collected data on patients' needs through the observation of their experience of treatment and personal interviews. These were put in context, analyzed both by qualitative and quantitative methods. The results pointed out the need for more information on the different steps of treatment and the patient's need 'for a smile'front the medical team; in other words, emphatic support. (author)
Otolorin, Emmanuel; Gomez, Patricia; Currie, Sheena; Thapa, Kusum; Dao, Blami
Approximately 15% of expected births worldwide will result in life-threatening complications during pregnancy, delivery, or the postpartum period. Providers skilled in emergency obstetric and newborn care (EmONC) services are essential, particularly in countries with a high burden of maternal and newborn mortality. Jhpiego and its consortia partners have implemented three global programs to build provider capacity to provide comprehensive EmONC services to women and newborns in these resource-poor settings. Providers have been educated to deliver high-impact maternal and newborn health interventions, such as prevention and treatment of postpartum hemorrhage and pre-eclampsia/eclampsia and management of birth asphyxia, within the broader context of quality health services. This article describes Jhpiego's programming efforts within the framework of the basic and expanded signal functions that serve as indicators of high-quality basic and emergency care services. Lessons learned include the importance of health facility strengthening, competency-based provider education, global leadership, and strong government ownership and coordination as essential precursors to scale-up of high impact evidence-based maternal and newborn interventions in low-resource settings. PMID:26115858
This qualitative study focused on counseling psychology doctoral students' perspectives regarding their practicum training experience in primary care psychology. The four participants included three females and one male. Semi-structured individual and focus group interviews were used to explore participants' experiences. The participants described…
McWilliams, J. Michael; Landon, Bruce E.; Chernew, Michael E.; Zaslavsky, Alan M.
BACKGROUND Incentives for accountable care organizations (ACOs) to limit health care use and improve quality may enhance or hurt patients’ experiences with care. METHODS Using Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data covering 3 years before and 1 year after the start of Medicare ACO contracts in 2012 as well as linked Medicare claims, we compared patients’ experiences in a group of 32,334 fee-for-service beneficiaries attributed to ACOs (ACO group) with those in a group of 251,593 beneficiaries attributed to other providers (control group), before and after the start of ACO contracts. We used linear regression and a difference-in-differences analysis to estimate changes in patients’ experiences in the ACO group that differed from concurrent changes in the control group, with adjustment for the sociodemographic and clinical characteristics of the patients. RESULTS After ACO contracts began, patients’ reports of timely access to care and their primary physicians’ being informed about specialty care differentially improved in the ACO group, as compared with the control group (P = 0.01 and P = 0.006, respectively), whereas patients’ ratings of physicians, interactions with physicians, and overall care did not differentially change. Among patients with multiple chronic conditions and high predicted Medicare spending, overall ratings of care differentially improved in the ACO group as compared with the control group (P = 0.02). Differential improvements in timely access to care and overall ratings were equivalent to moving from average performance among ACOs to the 86th to 98th percentile (timely access to care) and to the 82nd to 96th percentile (overall ratings) and were robust to adjustment for group differences in trends during the preintervention period. CONCLUSIONS In the first year, ACO contracts were associated with meaningful improvements in some measures of patients’ experience and with unchanged performance in
Paul A Bourne
Full Text Available Paul A Bourne1, Chloe Morris1, Christopher AD Charles2, Maureen D Kerr-Campbell3, Denise Eldemire-Shearer11Department of Community Health and Psychiatry and 2King Graduate School, Monroe College, Bronx, and Center for Victim Support, Harlem Hospital Center, New York; 3Systems Development Unit, Main Library, Faculty of Humanities and Education, The University of the West Indies, Mona, JamaicaAbstract: Patient satisfaction and quality of life are becoming increasingly important among the more traditional clinical outcomes in the monitoring and evaluation of health care delivery. This study explored patient’s self-rated health and patient satisfaction with health care providers, and examined whether health care providers are a barrier to patient care. The sample consisted of 2000 men aged 55 years and older in the parish of St Catherine, Jamaica. A 132-item questionnaire was used to collect the data. Descriptive statistics was used to provide information about their satisfaction with the health care system. Seventy-four percent of the sample indicated good self-rated health status (excellent, 19.0%. Forty-seven percent of the sample had sought advice from a health care provider in the last 12 months; 14.1% understood the advice of the clinician, community health aide (19.9%, pharmacist (15.4%, nurse (2.1% and nurse aide (4.6%. The respondents indicated that community health aides contributed more to improving their health (43.4% when compared with nurses (34.8%, clinicians (17.5%, and herbalists (3.7%. Furthermore, 31.7% indicated that their medical doctors were hospitable and 4.2% were knowledgeable. Negative self-rated health, perceived lack of knowledge among doctors, lack of understanding of advice from health care providers, are just some of the factors associated with dissatisfaction of patients with chronic conditions. These findings provide a framework and foundation from which further studies on effective intervention aimed at
Full Text Available Katharine C Garvey,1 Jonathan A Finkelstein,2,3 Lori M Laffel,1,4 Victoria Ochoa,1 Joseph I Wolfsdorf,1 Erinn T Rhodes1 1Division of Endocrinology, Boston Children's Hospital, 2Division of General Pediatrics, Boston Children's Hospital, 3Department of Population Medicine, Harvard Pilgrim Health Care Institute, 4Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, MA, USA Background: The purpose of this study was to describe the current status of adult diabetes care in young adults with type 1 diabetes and examine associations between health care transition experiences and care utilization. Methods: We developed a survey to assess transition characteristics and current care in young adults with type 1 diabetes. We mailed the survey to the last known address of young adults who had previously received diabetes care at a tertiary pediatric center. Results: Of 291 surveys sent, 83 (29% were undeliverable and three (1% were ineligible. Of 205 surveys delivered, 65 were returned (response rate 32%. Respondents (mean age 26.6 ± 3.0 years, 54% male, 91% Caucasian transitioned to adult diabetes care at a mean age of 19.2 ± 2.8 years. Although 71% felt mostly/completely prepared for transition, only half received recommendations for a specific adult provider. Twenty-six percent reported gaps exceeding six months between pediatric and adult diabetes care. Respondents who made fewer than three diabetes visits in the year prior to transition (odds ratio [OR] 4.5, 95% confidence interval [CI] 1.2–16.5 or cited moving/relocation as the most important reason for transition (OR 6.3, 95% CI 1.3–31.5 were more likely to report gaps in care exceeding six months. Patients receiving current care from an adult endocrinologist (79% were more likely to report at least two diabetes visits in the past year (OR 6.0, 95% CI 1.5–24.0 compared with those receiving diabetes care from a general internist/adult primary care doctor (17%. Two
Chandran, Devyani; Corbin, J Hope; Shillam, Casey
Palliative care is specialized health care to improve quality of life for patients with serious illness and their families through prevention and relief of suffering. A Palliative Care Institute was held in western Washington to capture community voices about diverse needs, strengths, and opportunities for improvement of palliative care. Researchers employed qualitative methods to obtain thematic data, provide real-time analysis, and engage in a multivoting technique to reflect stakeholder interest in individual themes and prioritize larger group interests. Bronfenbrenner's ecological systems framework was used to explore caregiver experiences. Within the microsystem, caregivers reported difficulties in interactions with medical providers as a key challenge. Within the mesosysytem, interactions between patients and medical providers and the impact on caregivers were explored. Within the exosystem, caregivers reported lack of control over the schedules of personal care staff. Macrosystem influences included impact of local culture on the development of palliative care services. Chronosystem influences include de-medicalization of childbirth and its impact on perceptions of palliative care. Implications include the need for social workers to be proactive in fostering trust and effective communication between care providers and caregivers, and the demand for health care provider training in communication with patients and families. PMID:27143579
Himmelstein, David U; Woolhandler, Steffie
The United States has four decades of experience with the combination of public funding and private health care management and delivery, closely analogous to reforms recently enacted or proposed in many other nations. Extensive research, herein reviewed, shows that for-profit health institutions provide inferior care at inflated prices. The U.S. experience also demonstrates that market mechanisms nurture unscrupulous medical businesses and undermine medical institutions unable or unwilling to tailor care to profitability. The commercialization of care in the United States has driven up costs by diverting money to profits and by fueling a vast increase in management and financial bureaucracy, which now consumes 31 percent of total health spending. The Veterans Health Administration system--a network of government hospitals and clinics--has emerged as the leader in quality improvement and information technology, indicating the potential for public sector excellence and innovation. The poor performance of U.S. health care is directly attributable to reliance on market mechanisms and for-profit firms, and should warn other nations from this path. PMID:18724573
Hans Justus Amukugo
Full Text Available The purpose of this study is to explore and describe the perceptions of nursing students regarding the delivery of quality nursing care in Katutuura Health Centre, Windhoek, and Khomas Region. A qualitative, exploratory, descriptive and contextual research designs were used in this study. An individual interview was conducted on ten (10 4th year nursing students at UNAM main campus with regard to the delivery of quality nursing care. The data showed that most students expressed shortage of staff, high number of patient attendance, insufficient equipment and insufficient time as factors that affect the delivery of quality nursing care. Possible interventions regarding resource management should be put into consideration, where extra nursing staffs needed to be trained and distributed among hospitals and clinics in Namibia.
With implementation of the Patient Protection and Affordable Care Act, more Americans are gaining insurance coverage but often have high deductibles and significant out-of-pocket cost sharing. Deductibles routinely exceed $1,000 and often approach $5,000. In this essay, I share our family's experience attempting to navigate urgent medical decisions in a high-deductible health plan. In accessing urgent care for our child's fracture, we unknowingly encountered a 10-fold variation for what should be routine, low-cost technology (ie, plain film x-ray). Though the financial consequences for our family were minimal, for many families with high-deductible plans the financial implications are enormous. Through this experience, I learned that the principles of consumer-directed health care-that patients can and should price shop for care-are flawed in urgent and emergent situations. PMID:27184999
Larsen, Anna; Exavery, Amon; Phillips, James F; Tani, Kassimu; Kanté, Almamy M
Objectives Four antenatal visits, delivery in a health facility, and three postnatal visits are the World Health Organization recommendations for women to optimize maternal health outcomes. This study examines maternal compliance with the full recommended maternal health visits in rural Tanzania with the goal of illuminating interventions to reduce inequalities in maternal health. Methods Analysis included 907 women who had given birth within two years preceding a survey of women of reproductive age. Multinomial logistic regression was used to assess the influence of maternal, household, and community-level characteristics on four alternative classes defining relative compliance with optimal configuration of maternal health care seeking behavior. Results Parity, wealth index, timeliness of ANC initiation, nearest health facility type, religion, and district of residence were significant predictors of maternal health care seeking when adjusted for other factors. Multiparous women compared to primiparous were less likely to seek care at the high level [RRR 0.16, 95 % confidence interval (CI) 0.06-0.46], at the mid-level (RRR 0.22, 95 % CI 0.09-0.58), and the mid-low level (RRR 0.27, 95 % CI 0.09-0.80). Women in the highest wealth index compared to those in the poorest group were almost three times more likely to seek the highest two levels of care versus the lowest level (high RRR 2.92, 95 % CI 1.27-6.71, mid-level RRR 2.71, 95 % 1.31-5.62). Conclusion Results suggest that efforts to improve the overall impact of services on the continuum of care in rural Tanzania would derive particular benefit from strategies that improve maternal health coverage among multiparous and low socioeconomic status women. PMID:27194528
Full Text Available Abstract Background Weight stigma is pervasive in Western society and in healthcare settings, and has a negative impact on victims’ psychological and physical health. In the context of an increasing focus on the management of overweight and obese women during and after pregnancy in research and clinical practice, the current studies aimed to examine the presence of weight stigma in maternity care. Addressing previous limitations in the weight stigma literature, this paper quantitatively explores the presence of weight stigma from both patient and care provider perspectives. Methods Study One investigated associations between pre-pregnancy body mass index (BMI and experiences of maternity care from a state-wide, self-reported survey of 627 Australian women who gave birth in 2009. Study Two involved administration of an online survey to 248 Australian pre-service medical and maternity care providers, to investigate their perceptions of, and attitudes towards, providing care for pregnant patients of differing body sizes. Both studies used linear regression analyses. Results Women with a higher BMI were more likely to report negative experiences of care during pregnancy and after birth, compared to lower weight women. Pre-service maternity care providers perceived overweight and obese women as having poorer self-management behaviours, and reported less positive attitudes towards caring for overweight or obese pregnant women, than normal-weight pregnant women. Even care providers who reported few weight stigmatising attitudes responded less positively to overweight and obese pregnant women. Conclusions Overall, these results provide preliminary evidence that weight stigma is present in maternity care settings in Australia. They suggest a need for further research into the nature and consequences of weight stigma in maternity care, and for the inclusion of strategies to recognise and combat weight stigma in maternity care professionals’ training.
Timonen, Virpi; O'Dwyer, Ciara
Insights into daily living in residential care settings are rare. This article draws on a qualitative dataset (semi-structured interviews and recordings of residents' council meetings) that gives a glimpse of the experiences and coping strategies of (older) people living in residential care. The data highlight the range of unmet needs of the residents, similar to the categories of physiological, safety, love, esteem, and self-actualization needs in Maslow's hierarchy of needs theory. Our analysis indicates that "higher" and "lower" needs are closely intertwined and mutually reinforcing and should therefore be accorded equal emphasis by professionals (including social workers) employed within residential care settings. PMID:19860294
Weled, Barry J; Adzhigirey, Lana A; Hodgman, Tudy M; Brilli, Richard J; Spevetz, Antoinette; Kline, Andrea M; Montgomery, Vicki L; Puri, Nitin; Tisherman, Samuel A; Vespa, Paul M; Pronovost, Peter J; Rainey, Thomas G; Patterson, Andrew J; Wheeler, Derek S
In 2001, the Society of Critical Care Medicine published practice model guidelines that focused on the delivery of critical care and the roles of different ICU team members. An exhaustive review of the additional literature published since the last guideline has demonstrated that both the structure and process of care in the ICU are important for achieving optimal patient outcomes. Since the publication of the original guideline, several authorities have recognized that improvements in the processes of care, ICU structure, and the use of quality improvement science methodologies can beneficially impact patient outcomes and reduce costs. Herein, we summarize findings of the American College of Critical Care Medicine Task Force on Models of Critical Care: 1) An intensivist-led, high-performing, multidisciplinary team dedicated to the ICU is an integral part of effective care delivery; 2) Process improvement is the backbone of achieving high-quality ICU outcomes; 3) Standardized protocols including care bundles and order sets to facilitate measurable processes and outcomes should be used and further developed in the ICU setting; and 4) Institutional support for comprehensive quality improvement programs as well as tele-ICU programs should be provided. PMID:25803647
Prinja, Shankar; Bahuguna, Pankaj; Gupta, Rakesh; Sharma, Atul; Rana, Saroj Kumar; Kumar, Rajesh
Background India aims to achieve universal access to institutional delivery. We undertook this study to estimate the universality of institutional delivery care for pregnant women in Haryana state in India. To assess the coverage of institutional delivery, we analyze service coverage (coverage of public sector institutional delivery), population coverage (coverage among different districts and wealth quintiles of the population) and financial risk protection (catastrophic health expenditure and impoverishment as a result of out-of-pocket expenditure for delivery). Methods We analyzed cross-sectional data collected from a randomly selected sample of 12,191 women who had delivered a child in the last one year from the date of data collection in Haryana state. Five indicators were calculated to evaluate coverage and financial risk protection for institutional delivery—proportion of public sector deliveries, out-of-pocket expenditure, percentage of women who incurred no expenses, prevalence of catastrophic expenditure for institutional delivery and incidence of impoverishment due to out-of-pocket expenditure for delivery. These indicators were calculated for the public and private sectors for 5 wealth quintiles and 21 districts of the state. Results The coverage of institutional delivery in Haryana state was 82%, of which 65% took place in public sector facilities. Approximately 63% of the women reported no expenditure on delivery in the public sector. The mean out-of-pocket expenditures for delivery in the public and private sectors in Haryana were INR 771 (USD 14.2) and INR 12,479 (USD 229), respectively, which were catastrophic for 1.6% and 22% of households, respectively. Conclusion Our findings suggest that there is considerably high coverage of institutional delivery care in Haryana state, with significant financial risk protection in the public sector. However, coverage and financial risk protection for institutional delivery vary substantially across
Gisele Nepomuceno de Andrade
Full Text Available Objective: Understanding the experiences of health professionals in primary care with the Child Health Booklet in child health care. Method: A qualitative study with a phenomenological approach, in which participated nurses and doctors from six teams of the Family Health Strategy (FHS in Belo Horizonte, MG. In total, were carried out 12 non-directive interviews, using two guiding questions. Results: A comprehensive analysis of the speeches enabled the construction of three categories that signal the experiences of the professionals with the booklet. The experiments revealed difficulties arising from the limitations of knowledge about the instrument; incomplete filling out of the booklet by many professionals that care for children; the daily confrontations of the process and the organization of work teams; disinterest of families with the instrument. Conclusion: The research points possible and necessary ways to improve the use of booklets as an instrument of full child health surveillance.
Brauer, D J; Schmidt, B J; Pearson, V
This article describes a model we developed to guide the selection and design of nursing activities that will facilitate the health of persons with stroke and their families. Care in the context of stroke has been structured by the medical model's focus on functional ability. As a result, nursing is viewed as ancillary to other professions; yet, studies of the stroke experience from the patient's view suggest that distinctive nursing interventions are needed. Current models of illness do not sufficiently address the nature of stroke and thus cannot serve as a framework for nursing care. Our model conceptualizes stroke as a progressive, holistic experience with physiological, psychological, and social dimensions. It was developed from a synthesis of research articles identified through searches of CINAHL, MEDLINE, and PSYCHLIT (1980-1999) indexes using the terms "stroke," "stress," "coping," "chronic illness," and "transitions and growth" and from our clinical experiences. Our research established that the stroke experience involves the deterioration of the whole person and the development of a new person through discovery and resynthesis. Each of these processes progressively dominates the experience and together they form a three-phase model. This model of the stroke experience suggests that nursing care should focus initially on limiting deterioration and then concentrate on facilitating growth. Selection of specific interventions requires an understanding of the uniqueness of each stroke experience, as well as the commonalities, among these experiences. PMID:12035694
Yekefallah, Leili; Ashktorab, Tahereh; Manoochehri, Houman; Hamid, Alavi Majd
The concept and meaning of futile care depends on the existing culture, values, religion, beliefs, medical achievements and emotional status of a country. We aimed to define the concept of futile care in the viewpoints of nurses working in intensive care units (ICUs). In this phenomenological study, the experiences of 25 nurses were explored in 11 teaching hospitals affiliated to Social Security Organization in Ghazvin province in the northwest of Iran. Personal interviews and observations were used for data collection. All interviews were recorded as well as transcribed and codes, subthemes and themes were extracted using Van Manen's analysis method. Initially, 191 codes were extracted. During data analysis and comparison, the codes were reduced to 178. Ultimately, 9 sub-themes and four themes emerged: uselessness, waste of resources, torment, and aspects of futility.Nurses defined futile care as "useless, ineffective care giving with wastage of resources and torment of both patients and nurses having nursing and medical aspects" As nurses play a key role in managing futile care, being aware of their experiences in this regard could be the initial operational step for providing useful care as well as educational programs in ICUs. Moreover, the results of this study could help nursing managers adopt supportive approaches to reduce the amount of futile care which could in turn resolve some of the complications nurses face at these wards such as burnout, ethical conflicts, and leave. PMID:25946928
Full Text Available Abstract Background Dentistry in Australia combines business and health care service, that is, the majority of patients pay money for tangible dental procedures such as fluoride applications, dental radiographs, dental fillings, crowns, and dentures among others. There is evidence that patients question dentists’ behaviours and attitudes during a dental visit when those highly technical procedures are performed. However, little is known about how patients’ experience dental care as a whole. This paper illustrates the findings from a qualitative study recently undertaken in general dental practice in Australia. It focuses on patients’ experiences of dental care, particularly on the relationship between patients and dentists during the provision of preventive care and advice in general dental practices. Methods Seventeen patients were interviewed. Data analysis consisted of transcript coding, detailed memo writing, and data interpretation. Results Patients described their experiences when visiting dental practices with and without a structured preventive approach in place, together with the historical, biological, financial, psychosocial and habitual dimensions of their experience. Potential barriers that could hinder preventive activities as well as facilitators for prevention were also described. The offer of preventive dental care and advice was an amazing revelation for this group of patients as they realized that dentists could practice dentistry without having to “drill and fill” their teeth. All patients, regardless of the practice they came from or their level of clinical risk of developing dental caries, valued having a caring dentist who respected them and listened to their concerns without “blaming” them for their oral health status. These patients complied with and supported the preventive care options because they were being “treated as a person not as a patient” by their dentists. Patients valued dentists who made
Manuela Aguirre Ulloa
Full Text Available Adapted from a review on the same book published by The Design Observer Group on April 4th, 2014. You can access the original publication online at http://designobserver.com/feature/design-for-care/38382/ Peter Jones´ recently published book represents a timely and comprehensive view of the value design brings to healthcare innovation. The book uses an empathic user story that conveys emotions and life to a structure that embraces the different meanings of Design for Care: Spanning from caring at the personal level to large-scale caring systems. The author has a main objective for each of its three main target audiences: Designers, companies and healthcare teams. Firstly, it allows designers to understand healthcare in a holistic and patient-centered way, breaking down specialized silos. Secondly, it shows how to design better care experiences across care continuums. Consequently, for companies serving the healthcare sector, the book presents how to humanize information technology (IT and services and meet the needs of health seekers. Finally, the book aims to inform healthcare teams (clinical practitioners and administrators the value design brings in research, co-creation and implementation of user and organizational experiences. It also proposes that healthcare teams learn and adopt design and systems thinking techniques so their innovation processes can be more participatory, holistic and user-centered.
Shaw, Kate M.; Handler, Joel; Wall, Hilary K.; Kanter, Michael H
The Kaiser Permanente Southern California (Kaiser) health care system succeeded in improving hypertension control in a multiethnic population by adopting a series of changes in health care delivery. Data from the Healthcare Effectiveness Data and Information Set (HEDIS) was used to assess blood pressure control from 2004 through 2012. Hypertension control increased overall from 54% to 86% during that period, and 80% or more in every subgroup, regardless of race/ethnicity, preferred language, ...
Nyamathi, Adeline M.; Sinha, Sanjeev; Ganguly, Kalyan K.; William, Ravi Raj; Heravian, Anisa; Ramakrishnan, Padma; Greengold, Barbara; Ekstrand, Maria; Rao, Pantangi Venkata Rama
Researchers explored the barriers to AIDS care for rural women living with AIDS, and investigated alternative delivery models to increase the women’s adherence to anti-retroviral therapy. Community-based participatory research focus groups were conducted by the researchers with a convenience sample of 39 women living with AIDS from a Primary Health Center near Chennai, India and with nurses, physicians and Accredited Social Health Activists (Ashas), lay health care workers. The most prevalent...
Glazier Richard H; White Heather L
Abstract Background Despite more than a decade of research on hospitalists and their performance, disagreement still exists regarding whether and how hospital-based physicians improve the quality of inpatient care delivery. This systematic review summarizes the findings from 65 comparative evaluations to determine whether hospitalists provide a higher quality of inpatient care relative to traditional inpatient physicians who maintain hospital privileges with concurrent outpatient practices. M...
Introduction: Research suggests that parents of disabled children are dissatisfied with inpatient care delivery to their children. Objectives: - To explore the inpatient care of disabled children - To determine the rewards and challenges of working with disabled children and young people and those with complex health needs - To analyse contemporary nursing curricula in order to ascertain areas of teaching pertinent to disabled children and young people and those with comple...
Duncombe, Chris; Rosenblum, Scott; Hellmann, Nicholas; Holmes, Charles; Wilkinson, Lynne; Biot, Marc; Bygrave, Helen; Hoos, David; Garnett, Geoff
The delivery of HIV care in the initial rapid scale-up of HIV care and treatment was based on existing clinic-based models, which are common in highly resourced settings and largely undifferentiated for individual needs. A new framework for treatment based on variable intensities of care tailored to the specific needs of different groups of individuals across the cascade of care is proposed here. Service intensity is characterised by four delivery components: (i) types of services delivered, (ii) location of service delivery, (iii) provider of health services and (iv) frequency of health services. How these components are developed into a service delivery framework will vary across countries and populations, with the intention being to improve acceptability and care outcomes. The goal of getting more people on treatment before they become ill will necessitate innovative models of delivering both testing and care. As HIV programmes expand treatment eligibility, many people entering care will not be ‘patients’ but healthy, active and productive members of society 1. To take the framework to scale, it will be important to: (i) define which individuals can be served by an alternative delivery framework; (ii) strengthen health systems that support decentralisation, integration and task shifting; (iii) make the supply chain more robust; and (iv) invest in data systems for patient tracking and for programme monitoring and evaluation. La délivrance des soins du VIH dans le déploiement initial rapide des soins et du traitement du VIH a été basée sur des modèles existants dans les cliniques, qui sont courants dans les régions bénéficiant d’importantes ressources et largement indifférenciées pour les besoins individuels. Un nouveau cadre est proposé ici pour le traitement basé selon les intensités variables de soins, adaptés aux besoins spécifiques des différents groupes de personnes à travers la cascade de soins. L’intensité des services est caract
Storey, Anne E.; Ziegler, Toni E.
We review recent research on the roles of hormones and social experiences on the development of paternal care in humans and non-human primates. Generally, lower concentrations of testosterone and higher concentrations of oxytocin are associated with greater paternal responsiveness. Hormonal changes prior to the birth appear to be important in preparation for fatherhood and changes after the birth are related to how much time fathers spend with offspring and whether they provide effective care. Prolactin may facilitate approach and the initiation of infant care, and in some biparental non-human primates, it affects body mass regulation. Glucocorticoids are involved in coordinating reproductive and parental behavior between mates. New research involving intranasal oxytocin and neuropeptide receptor polymorphisms may help us understand individual variation in paternal responsiveness. This area of research, integrating both biological factors and the role of early and adult experience, has the potential to suggest individually designed interventions that can strengthen relationships between fathers and their offspring. PMID:26253726
The purpose of this phenomenological study was to explore the lived experience of nurses who practice Reiki for self-care. In-person interviews were conducted with 11 nurses who met specific study criteria, using open-ended questions to examine the experience of nurses who are Reiki practitioners, to understand their perceptions of Reiki use in self-treatment, and to appreciate its meaning for them. The Colaizzi method was utilized in data analysis and independent decision trail audits were completed to promote study rigor and trustworthiness of results. Thematic categories and major and minor thematic clusters emerged around the topics of daily stress management, self-healing, spirituality, and interconnectedness of self, others, and beyond. Implications of the study findings for nursing practice and nursing education are discussed. Potential applications of study findings to Jean Watson's transpersonal caring theory located within a caring science framework are explored and recommendations for future research are offered. PMID:19411991
Kaambwa, Billingsley; Lancsar, Emily; McCaffrey, Nicola; Chen, Gang; Gill, Liz; Cameron, Ian D; Crotty, Maria; Ratcliffe, Julie
Consumer directed care (CDC) is currently being embraced internationally as a means to promote autonomy and choice for consumers (people aged 65 and over) receiving community aged care services (CACSs). CDC involves giving CACS clients (consumers and informal carers of consumers) control over how CACSs are administered. However, CDC models have largely developed in the absence of evidence on clients' views and preferences. We explored CACS clients' preferences for a variety of CDC attributes and identified factors that may influence these preferences and potentially inform improved design of future CDC models. Study participants were clients of CACSs delivered by five Australian providers. Using a discrete choice experiment (DCE) approach undertaken in a group setting between June and December 2013, we investigated the relative importance to CACS consumers and informal (family) carers of gradations relating to six salient features of CDC (choice of service provider(s), budget management, saving unused/unspent funds, choice of support/care worker(s), support-worker flexibility and level of contact with service coordinator). The DCE data were analysed using conditional, mixed and generalised logit regression models, accounting for preference and scale heterogeneity. Mean ages for 117 study participants were 80 years (87 consumers) and 74 years (30 informal carers). All participants preferred a CDC approach that allowed them to: save unused funds from a CACS package for future use; have support workers that were flexible in terms of changing activities within their CACS care plan and; choose the support workers that provide their day-to-day CACSs. The CDC attributes found to be important to both consumers and informal carers receiving CACSs will inform the design of future CDC models of service delivery. The DCE approach used in this study has the potential for wide applicability and facilitates the assessment of preferences for elements of potential future aged care
Century, Gillian; Leavey, Gerard; Payne, Helen
The provision of counselling services for refugee and asylum-seeking patients is relatively new in the UK and their complex needs may present considerable challenges within primary care, where access to specialist support resources is often limited. As far as we know, no previous research has attempted to look at the experiences of the counsellors…
Full Text Available Abstract Background Approximately 90,000 Canadians use opioids each year, many of whom experience health and social problems that affect the individual user, families, communities and the health care system. For those who wish to reduce or stop their opioid use, methadone maintenance therapy (MMT is effective and supporting evidence is well-documented. However, access and availability to MMT is often inconsistent, with greater inequity outside of urban settings. Involving community based primary-care physicians in the delivery of MMT could serve to expand capacity and accessibility of MMT programs. Little is known, however, about the extent to which MMT, particularly office-based delivery, is acceptable to physicians. The aim of this study is to survey physicians about their attitudes towards MMT, particularly office-based delivery, and the perceived barriers and facilitators to MMT delivery. Methods In May 2008, facilitated by the College of Physicians and Surgeons of Nova Scotia, a cross-sectional, e-mail survey of 950 primary-care physicians practicing in Nova Scotia, Canada was administered via the OPINIO on-line survey software, to assess the acceptability of office-based MMT. Logistic regressions, adjusted for physician sociodemographic characteristics, were used to examine the association between physicians’ willingness to participate in office-based MMT, and a series of measures capturing physician attitudes and knowledge about treatment approaches, opioid use, and methadone, as well as perceived barriers to MMT. Results Overall, 19.8% of primary-care physicians responded to the survey, with 56% who indicated that they would be willing to be involved in MMT under current or similar circumstances; however, willingness was associated with numerous attitudinal and systemic factors. The barriers to involvement in MMT that were frequently cited included a lack of training or experience in MMT, lack of support services, and potential
Full Text Available Abstract Background Patient perceptions of and satisfaction with care have become important indicators of the quality of services and the relationship of services to treatment outcomes. However, assessment of these indicators continues to be plagued by measurement problems, particularly the lack of variance in satisfaction data. In this article, we present a new approach to better capture patient perceptions of experiences in care, the Dynamics of Care (DoC assessment. It is an in-depth approach to defining and assessing patients' perspectives at different junctures in care, including their decisions about whether and where to seek care, the barriers encountered, and the treatments and services received. Methods The purpose of this article is to describe, validate, and discuss the benefits and limitations of the DoC, which was administered as part of a longitudinal study to evaluate the New York State HIV Special Needs Plan (SNP, a Medicaid managed care model for people living with HIV/AIDS. Data are from 426 study respondents across two time points. Results The results demonstrate the validity and value of the DoC. Help seeking decisions and satisfaction with care appear to be situation-specific, rather than person-specific. However, barriers to care appear to be more cross-situational for respondents, and may be associated with clients' living situations or care arrangements. Inventories in this assessment that were designed to identify potential deterrents to help seeking and difficulties encountered in care demonstrated clear principal component structures, and helped to explain satisfaction with care. The problem resolution index was found to be independent from satisfaction with care and the data were more normally distributed. DoC data were also associated with subsequent utilization and change in quality of life. Conclusion The DoC was designed to be a flexible, integrated measure to determine individuals' salient service needs, help
Alotaibi, AK; Alotaibi, SK; Alshayiqi, M; Ramalingam, S
Introduction: Ventilator-associated pneumonia is a major morbid outcome among intensive care unit (ICU) patients. Providing oral care for intubated patients is an important task by the ICU nursing staff in reducing the mortality and morbidity. The objectives of this study were to evaluate the attitudes and knowledge of ICU nurses regarding oral care delivery to critically ill patients in Saudi Arabian ICUs. The findings were further correlated to the presence of healthcare quality accreditation of the institution. Materials and Methods: The nurses’ knowledge, attitudes, and healthcare quality accreditation status of the hospital were recorded. Two hundred fifteen nurses conveniently selected from 10 random hospitals were included in this study from Riyadh city, Saudi Arabia. This is a cross-sectional study in the form of a questionnaire. Results: When comparing the knowledge of the participants to their level of education, there was no statistically significant difference between the two groups of nurses. The majority of the nurses agreed that the oral cavity is difficult to clean and that oral care delivery is a high priority for mechanically ventilated patients. Furthermore, there was no statistically significant difference in the attitudes between nurses working in accredited and nonaccredited hospitals. Conclusion: The presence of healthcare quality accreditation did not reflect any significance in attitudes or knowledge of the ICU nurses in regard to mechanically ventilated patients. Factors affecting oral care delivery should be evaluated on the personal and institutional level to achieve better understanding of them. PMID:27051375
Ross, J D C; Copas, A; Stephenson, J; Fellows, L; Gilleran, G
Information and communication technology (ICT) has the potential to improve the quality of care and efficiency in sexual health clinics, but its introduction requires input not only from health-care professionals and ICT specialists but also from service users and potential future users. In this study, views on ICT in relation to the delivery of sexual health services were assessed using a structured interview in two groups - a community sample of young people and a clinic sample of existing patients. In all, 542 community interviewees and 202 clinic patients participated. About 75% of respondents had access to the Internet and overall 60% reported that the self-collection of a sexual history on an electronic form was acceptable. Black Caribbean individuals had significantly less access to the Internet and a lower acceptance of electronic data collection. For booking an appointment, the majority of patients reported the telephone (community sample 93%, clinic sample 96%) or attending in person (community sample 77%, clinic sample 54%) to be acceptable, with a smaller proportion choosing email (community sample 10%, clinic sample 27%) or the Internet (community sample 7%, clinic sample 11%). Electronic booking was significantly less acceptable to Black Caribbean respondents. Although new technologies offer the opportunity to improve the quality of sexual health services, patient preferences and differences between groups in access to technology also need to be considered when services are reconfigured. PMID:17623499
Objective. The objective of this study was to describe the recent clinical characteristics of labor using 3 systems of Japanese midwife-led primary delivery care, as follows: (1) those intending to give birth at home managed by midwives who do not belong to our hospital, (2) those planning to give birth in our hospital managed by the same midwives, and (3) those planning to give birth managed by midwives who belong to our hospital. Methods. A retrospective cohort study was performed. Results. There were no significant differences in the obstetric or neonatal outcomes among the 3 groups. The rate of transfers during labor with the system involving midwives belonging to our hospital was higher than those with the other 2 systems. In addition, the timing of transfers in the system with the midwives belonging to our hospital was earlier than with the other 2 systems. Among the 3 groups, there were no significant differences in the rate of the main 2 indications for transfers: fetal heart rate abnormality and failure to progress. Conclusion. There were no significant differences in perinatal outcomes among the 3 systems; however, there were some differences in the status of transfers to obstetric shared care. PMID:27034827
Marshall, Deborah A.; Burgos-Liz, Lina; IJzerman, M.J.; Crown, William; Padula, William V.; Wong, Peter K.; Pasupathy, Kalyan S.; Higashi, Mitchell K.; Osgood, Nathaniel D.
In a previous report, the ISPOR Task Force on Dynamic Simulation Modeling Applications in Health Care Delivery Research Emerging Good Practices introduced the fundamentals of dynamic simulation modeling and identified the types of health care delivery problems for which dynamic simulation modeling c
Background: Systems of care is a family centered, strengths-based service delivery model for treating youth experiencing a serious emotional disturbance. Wraparound is the most common method of service delivery adopted by states and communities as a way to adhere to systems of care philosophy. Objective: The purpose of this study was to evaluate…
Cordeiro, C.; Di Girolamo, A.; Giordano, D.; Field, L.; Spiga, D.; Villazon, L.
The adoption of cloud technologies by the LHC experiments places the fabric management burden of monitoring virtualized resources upon the VO. In addition to monitoring the status of the virtual machines and triaging the results, it must be understood if the resources actually provided match with any agreements relating to the supply. Monitoring the instantiated virtual machines is therefore a fundamental activity and hence this paper describes how the Ganglia monitoring system can be used for the cloud computing resources of the LHC experiments. Expanding upon this, it is then shown how the integral of the time-series monitoring data obtained can be re-purposed to provide a consumer-side accounting record, which can then be compared with the concrete agreements that exist between the supplier of the resources and the consumer. From this alone, it is not clear though how the performance of the resources differ both within and between providers. Hence, the case is made for a benchmarking metric to normalize the data along with some results from a preliminary investigation on obtaining such a metric.
Bellato, Roseney; Araújo, Laura Filomena Santos de; Dolina, Janderléia Valéria; Musquim, Cleciene Dos Anjos; Corrêa, Geovana Hagata de Lima Souza Thaines
An essay that aims to reflect on the family experience of care in chronic situation, increasing the understanding of the family as the primary caregiver. It is based on comprehensive approach in studies conducted in three matrix searches from family care experiences. We have taken three axes to organize our reflections: a) conformation of family care in chronic situation, highlighting the multiple costs incurred to the family, which can exhaust the potential of care and establish or increase its vulnerability if it is not backed by networks support and sustenance; b) family rearrangements for the care, giving visibility to care cores in which many loved family members share the care, dynamic, plural and changeable way; c) self care modeling family care, pointing to the range of possibilities of the person taking care of diseased conditions supported by people close to them. We learn that the family takes care of itself in everyday life and in the illness experience, creating networks that can provide you support and sustenance. Thus, professionals in health practices should shape up in a longitudinal and very personal way, by reference to the family care, supporting him in what is his own. Ensaio que tem por objetivo refletir sobre a experiência familiar de cuidado na situação crônica, ampliando a compreensão da família como cuidadora primária. Embasa-se em estudos de abordagem compreensiva realizados em três pesquisas matriciais que abordaram experiências familiares de cuidado. Tomamos três eixos para organizar nossas reflexões: a) conformação do cuidado familiar na situação crônica, destacando os múltiplos custos gerados à família, que podem exaurir seus potenciais de cuidado, instaurando ou ampliando sua vulnerabilidade se não for amparada por redes de apoio e sustentação; b) rearranjos familiares para o cuidado, dando visibilidade aos núcleos de cuidado compartilhados pelos diversos entes familiares, de modo dinâmico, plural e mut
AIMS AND OBJECTIVES: The aim of this phenomenological study was to explore the emotions experienced by children\\'s nurses when caring for children with burns, in addition to ascertaining how the nurses dealt with these emotions. BACKGROUND: The nature of nursing practice is such that it inevitably generates some form of emotional response in nurses. The literature reveals that the manner nurses deal with their emotional experiences can impact on their nursing care. DESIGN: The study used Husserlian phenomenology to explore the emotional experiences of eight purposively selected children\\'s nurses who have worked on the burns unit of an Irish paediatric hospital. METHODS: Data were collected using in-depth, unstructured interviews and analysed using Colaizzi\\'s seven stage framework. RESULTS: The phenomenon of participants\\' emotional experiences is captured in four themes: (1) caring for children with burns, (2) supporting parents, (3) sustaining nurses\\' emotional well-being, and (4) learning to be a burns nurse. Nursing children with burns generated a myriad of emotions for participants. Burns dressing-changes, managing burn-related pain, supporting parents and the impact of busy workloads on the emotional care of children and their parents emerged as the most emotionally challenging aspects of participants\\' role. Participants recognised the need to manage their emotional responses and spoke of the benefits of a supportive nursing team. CONCLUSIONS: The findings offer insights into both the rewarding and challenging aspects of nursing children with burns. Nurses in this environment must be supported to recognise and manage their emotional responses to their work. RELEVANCE TO CLINICAL PRACTICE: Helping nurses to manage the emotional consequences of their work will help to sustain their emotional well-being, enhance the care received by children and also enable nurses to support parents in their role as partners in care.
Akanksha Lamba; Ramanjeet Kaur; Zulaihuma Muzafar
Background: Operative vaginal delivery using obstetric forceps is a practice that dates back several centuries. Modern obstetrics practice has witnessed an increase in the caesarean section rates. The goal of forceps delivery is to mimic spontaneous vaginal birth, thereby expediting delivery with a minimum of maternal or neonatal morbidity. The main objective of study was to evaluate the maternal and neonatal outcome of forceps assisted deliveries in a tertiary care hospital over a period of ...
Lövgren, Gunvor; Eriksson, S; Sandman, P-O
A care policy was implemented within health care in the county of Västerbotten, Sweden. A questionnaire was administered before and after the implementation of the care policy to assess its effects. Patients within hospital care and primary health care described their experiences in a base-line study (n=3950) in 1994 and a follow-up study (n=2941) in 1996. On the same occasions personnel (n=2362 and 2310, respectively) answered the same questionnaire assessing what they thought their patients experienced. No significant positive effects of the implementation were seen by the patients. Fewer patients felt that they were understood when they talked about their problems, dared to express criticism or denied they were treated nonchalantly in the follow-up study. The experiences of the personnel were in line with those of the patients concerning nonchalant treatment in the follow-up study. Furthermore, fewer staff members thought that their patients felt they had adequate help with hygiene whilst more thought that their patients felt they were responded to in a loving way. One interpretation of the negative outcome is that organizational changes, strained resources and cuts in staffing during the 90s may have reduced the possibility of integrating the care policy in spite of an ambitious and extensive intervention. PMID:11985743
Lykkesgaard, Kristina; Delmar, Charlotte
dependency by accepting negative experiences in gratitude for having recovered from critical illness. The findings might be influenced by studies being conducted in a western country setting where independence is valued. They can be used as means of reflection on nursing practice and matters such as......This study explores the perceived meaning of dependency on care as experienced by intensive care patients. Research from non-intensive settings shows that dependency is often experienced negatively, but literature on the subject experienced by patients in the ICU is sparse. The study is based on in......-depth qualitative semi-structured interviews of lived experience with three former patients admitted to an intensive care unit at a Danish university hospital. The in-depth interviews have been characterized as narratives. The main inspiration for the analysis method is Ricoeur's phenomenological hermeneutical...
Er-sheng GAO; Wei YUAN; Ning LIU
Objective To evaluate and overview the experience of quality care of family planning of China.Methods The framework of quality care of China was summarized and analyzed, that was clients, technology and management triangle program system.Results The 8 fundamental elements of quality care in China were presented:1) policy environment of QoC, 2) comprehensive services, 3) choice of method, 4) IEC to policy-makers and providers, 5) technical competence, 6) interpersonal communications, 7) institutional guideline and regulation, 8) appropriate constellation of service.Conclusion FP sectors should prepare different constellations of service to meet their individual reproductive health need for different clients and develop institutional guideline and regulation for FP service to follow up in practice. QoC should be a kind of standardized service process.
Marshall, A; Loescher, A; Marshman, Z
Background Due to the increasing prevalence of obesity within the general population it is presumed that the prevalence of overweight and obese adults accessing dental services will also increase. For this reason dentists need to be aware of implications of managing such patients.Methods A scoping review was carried out. Both Medline via OVID and Scopus databases were searched along with grey literature databases and the websites of key organizations. Inclusion and exclusion criteria were established. The data were collected on a purpose-made data collection form and analysed descriptively.Results The review identified 28 relevant published articles and two relevant items of grey literature. Following review of this literature three themes relating to adult obesity in the delivery and acceptance of dental care emerged; clinical, service delivery and patient implications. The majority of the papers focused on the clinical implications.Conclusion On the topic of adult obesity and dental care, the majority of published and grey literature focuses on the clinical implications. Further research is needed on both the patients' perspectives of being overweight or obese and the delivery and acceptance of dental care and the service delivery implications. PMID:27608579
Rannan-Eliya, Ravindra P; Anuranga, Chamara; Manual, Adilius; Sararaks, Sondi; Jailani, Anis S; Hamid, Abdul J; Razif, Izzanie M; Tan, Ee H; Darzi, Ara
Malaysia has made substantial progress in providing access to health care for its citizens and has been more successful than many other countries that are better known as models of universal health coverage. Malaysia's health care coverage and outcomes are now approaching levels achieved by member nations of the Organization for Economic Cooperation and Development. Malaysia's results are achieved through a mix of public services (funded by general revenues) and parallel private services (predominantly financed by out-of-pocket spending). We examined the distributional aspects of health financing and delivery and assessed financial protection in Malaysia's hybrid system. We found that this system has been effective for many decades in equalizing health care use and providing protection from financial risk, despite modest government spending. Our results also indicate that a high out-of-pocket share of total financing is not a consistent proxy for financial protection; greater attention is needed to the absolute level of out-of-pocket spending. Malaysia's hybrid health system presents continuing unresolved policy challenges, but the country's experience nonetheless provides lessons for other emerging economies that want to expand access to health care despite limited fiscal resources. PMID:27140990
Kirkley, Catherine; Bamford, Claire; Poole, Marie; Arksey, Hilary; Hughes, Julian; Bond, John
Ensuring the development and delivery of person-centred care in services providing respite care and short breaks for people with dementia and their carers has a number of challenges for health and social service providers. This article explores the role of organisational culture in barriers and facilitators to person-centred dementia care. As part of a mixed-methods study of respite care and short breaks for people with dementia and their carers, 49 telephone semi-structured interviews, two focus groups (N= 16) and five face-to-face in-depth interviews involving front-line staff and operational and strategic managers were completed in 2006-2007. Qualitative thematic analysis of transcripts identified five themes on aspects of organisational culture that are perceived to influence person-centred care: understandings of person-centred care, attitudes to service development, service priorities, valuing staff and solution-focused approaches. Views of person-centred care expressed by participants, although generally positive, highlight a range of understandings about person-centred care. Some organisations describe their service as being person-centred without the necessary cultural shift to make this a reality. Participants highlighted resource constraints and the knowledge, attitudes and personal qualities of staff as a barrier to implementing person-centred care. Leadership style, the way that managers' support and value staff and the management of risk were considered important influences. Person-centred dementia care is strongly advocated by professional opinion leaders and is prescribed in policy documents. This analysis suggests that person-centred dementia care is not strongly embedded in the organisational cultures of all local providers of respite-care and short-break services. Provider organisations should be encouraged further to develop a shared culture at all levels of the organisation to ensure person-centred dementia care. PMID:21545358
Storey, Anne E; Ziegler, Toni E
This article is part of a Special Issue "Parental Care".We review recent research on the roles of hormones and social experiences on the development of paternal care in humans and non-human primates. Generally, lower concentrations of testosterone and higher concentrations of oxytocin are associated with greater paternal responsiveness. Hormonal changes prior to the birth appear to be important in preparation for fatherhood and changes after the birth are related to how much time fathers spend with offspring and whether they provide effective care. Prolactin may facilitate approach and the initiation of infant care, and in some biparental non-human primates, it affects body mass regulation. Glucocorticoids may be involved in coordinating reproductive and parental behavior between mates. New research involving intranasal oxytocin and neuropeptide receptor polymorphisms may help us understand individual variation in paternal responsiveness. This area of research, integrating both biological factors and the role of early and adult experience, has the potential to suggest individually designed interventions that can strengthen relationships between fathers and their partners and offspring. PMID:26253726
Indrapal Ishwarji Meshram
Full Text Available Background: Maternal and infant mortality rates and prevalence of under nutrition are high in the State Madhya Pradesh. Regular ante-natal check-ups (ANC, delivery by trained health personnel, delivery practices and optimal infant feeding practices are important to reduce maternal and infant mortality. Objectives: The aim was to assess antenatal care, delivery and infant feeding practices of mothers of <1-year-old children in Madhya Pradesh. Materials and Methods: This was community-based cross-sectional study carried out in the rural areas of Madhya Pradesh by adopting systematic random sampling procedure. Data were collected from 5324 mothers having <1-year-old children. Information on household (HH socioeconomic and demographic particulars was collected from the mothers. Bivariate and multivariate analysis was performed to study the association between dependent and independent variables. Results and Interpretations: About 36% mothers had undergone at least three ante-natal check-ups and 73% delivered either at government or private hospitals. Only 26% mothers initiated breastfeeding within 1-h of birth and 92% fed colostrum. Step-wise regression analysis showed that ante-natal care for <3 times was significantly (P < 0.01 higher among women with high parity (≥5, illiterate women, and among lower socioeconomic group,s while home delivery was higher among women with high parity (≥5 (odds ratio [OR]: 2.3, among Scheduled Caste and Tribe women (OR: 1.5, illiteracy of head of HH (OR: 2, and among lower socioeconomic groups (OR: 1.3. Discarding colostrum was higher among illiterate women (OR: 1.6, belonging to lower socioeconomic groups (OR: 1.4 and delivery conducted by untrained person (OR: 3.9, while initiation of breastfeeding after 1-h of childbirth was higher among ≥30 years women (OR: 1.9, illiterate women (OR: 1.4, and delivery by untrained person (OR: 2.9. Conclusions: It was observed that antenatal care, delivery and infant and
Problem. Health care delivery in Germany has to face severe challenges that will lead to a closer integration of services for in- and out-patients. University hospitals play an important role due to their activities in research, education and health care delivery. They are requested to promote and evaluate new means and ways for health care delivery. Methods. The Institute of Clinical Radiology at the University Hospital of the Ludwig-Maximilians-University started teleradiological services for hospitals and general practices in January 1999 in the framework of the ''Imaging services - teleradiological center of excellence''. Legal, technical and organizational prerequisites were analyzed. Results. Networks between university hospitals and general practices are not likely to solve all future problems. They will, however, increase the availability of the knowledge of experts even in rural areas and contribute to a quality ensured health care at the patients home. Future developments may lead to international co-operations and such services may be available to patients abroad. Conclusion. Legal, technical and organizational obstacles have to be overcome to create a framework for high quality telemedical applications. University hospitals will play an important role in promoting and evaluating teleradiological services. (orig.)
Cameron, Ailsa; Abrahams, Hilary; Morgan, Karen; Williamson, Emma; Henry, Lorna
This paper reports findings from a longitudinal study of homeless women. Thirty-eight women were recruited with a retention rate of 58% over three rounds of interviews. Interviews explored specific events in women's lives, their current living arrangements and how their experiences and needs, including for social care, changed over time. Data were analysed thematically using a priori codes. Women reported a range of complex issues, consistent with experiences of deep social exclusion and received support from both statutory and voluntary agencies. Although women appreciated the support they received, many reported that services were fragmented and rarely personalised to their needs. PMID:25721440
Musyoki, David; Gichohi, Sarafina; Ritho, Johnson; Ali, Zipporah; Kinyanjui, Asaph; Muinga, Esther
Palliative care is patient and family-centred care that optimises quality of life by anticipating, preventing, and treating suffering. Open Society Foundation public health program (2011) notes that people facing life-threatening illnesses are deeply vulnerable: often in severe physical pain, worried about death, incapacitation, or the fate of their loved ones. Legal issues can increase stress for patients and families and make coping harder, impacting on the quality of care. In the absence of a clear legal provision expressly recognising palliative care in Kenya, providers may face numerous legal and ethical dilemmas that affect the availability, accessibility, and delivery of palliative care services and commodities. In order to ensure positive outcomes from patients, their families, and providers, palliative care services should be prioritised by all and includes advocating for the integration of legal support into those services. Palliative care service providers should be able to identify the various needs of patients and their families including specific issues requiring legal advice and interventions. Access to legal services remains a big challenge in Kenya, with limited availability of specialised legal services for health-related legal issues. An increased awareness of the benefits of legal services in palliative care will drive demand for easily accessible and more affordable direct legal services to address legal issues for a more holistic approach to quality palliative care. PMID:27563351
The objective of this study is to evaluate how Ghanaian women perceive the use, and their assessment of the experience, of antenatal ultrasound scanning. A cross-sectional study, using interviewer administered questionnaire, from 25th February to 16th April, 2011 was conducted at the Obstetrics Units of Korle Bu Teaching Hospital, Accra, University of Ghana Hospital, Legon and Ga South District Hospital, Weija. A total of 337 clients were randomly selected after delivery and interviewed. Issues addressed included why women went for antenatal ultrasound, their knowledge of the uses of ultrasound in pregnancy, information provided by health care providers, clients’ eagerness to know the sex of their fetuses, and their overall assessment of the ultrasound scanning experience. The results of this study showed that the mean number of scans was 2.2(1.1). Most were performed on the request of a doctor or midwife; 154(45.7%) were not told the reasons for the request and 185(54.9%) did not have the results explained to them. For 239(70.9%) women the sonographer did not explain the procedure before the examination; 89(26.4%) were allowed to ask questions and 61(18.1%) were allowed to see their fetuses on the monitor. One hundred and sixty respondents (47.5%) asked for and were told the sex of their fetuses, with accuracy at delivery of 86.5%. Most respondents perceived antenatal ultrasound as a useful tool. There is lack of information flow from health care providers to clients concerning the indications for the ultrasound, the processes involved and the results of the procedure. Improvements in these areas are needed to enhance the experience of antenatal ultrasound among Ghanaian women
Joshi, Chandni; Russell, Grant; Cheng, I-Hao; Kay, Margaret; Pottie, Kevin; Alston, Margaret; Smith, Mitchell; Chan, Bibiana; Vasi, Shiva; Lo, Winston; Wahidi, Sayed Shukrullah; Harris, Mark F
Introduction Refugees have many complex health care needs which should be addressed by the primary health care services, both on their arrival in resettlement countries and in their transition to long-term care. The aim of this narrative synthesis is to identify the components of primary health care service delivery models for such populations which have been effective in improving access, quality and coordination of care. Methods A systematic review of the literature, including published sys...
Full Text Available Introduction: In 2009, the English Department of Health appointed 16 integrated care pilots which aimed to provide better integrated care. We report the quantitative results from a multi-method evaluation of six of the demonstration projects which used risk profiling tools to identify older people at risk of emergency hospital admission, combined with intensive case management for people identified as at risk. The interventions focused mainly on delivery system redesign and improved clinical information systems, two key elements of Wagner's Chronic Care Model. Methods: Questionnaires to staff and patients. Difference-in-differences analysis of secondary care utilisation using data on 3,646 patients and 17,311 matched controls, and changes in overall secondary care utilisation. Results: Most staff thought that care for their patients had improved. More patients reported having a care plan but they found it significantly harder to see a doctor or nurse of their choice and felt less involved in decisions about their care. Case management interventions were associated with a 9% increase in emergency admissions. We found some evidence of imbalance between cases and controls which could have biased this estimate, but simulations of the possible effect of unobserved confounders showed that it was very unlikely that the sites achieved their goal of reducing emergency admissions. However, we found significant reductions of 21% and 22% in elective admissions and outpatient attendance in the six months following an intervention, and overall inpatient and outpatient costs were significantly reduced by 9% during this period. Area level analyses of whole practice populations suggested that overall outpatient attendances were significantly reduced by 5% two years after the start of the case management schemes. Conclusion: Case management may result in improvements in some aspects of care and has the potential to reduce secondary care costs. However, to improve
Full Text Available Introduction: In 2009, the English Department of Health appointed 16 integrated care pilots which aimed to provide better integrated care. We report the quantitative results from a multi-method evaluation of six of the demonstration projects which used risk profiling tools to identify older people at risk of emergency hospital admission, combined with intensive case management for people identified as at risk. The interventions focused mainly on delivery system redesign and improved clinical information systems, two key elements of Wagner's Chronic Care Model.Methods: Questionnaires to staff and patients. Difference-in-differences analysis of secondary care utilisation using data on 3,646 patients and 17,311 matched controls, and changes in overall secondary care utilisation.Results: Most staff thought that care for their patients had improved. More patients reported having a care plan but they found it significantly harder to see a doctor or nurse of their choice and felt less involved in decisions about their care. Case management interventions were associated with a 9% increase in emergency admissions. We found some evidence of imbalance between cases and controls which could have biased this estimate, but simulations of the possible effect of unobserved confounders showed that it was very unlikely that the sites achieved their goal of reducing emergency admissions. However, we found significant reductions of 21% and 22% in elective admissions and outpatient attendance in the six months following an intervention, and overall inpatient and outpatient costs were significantly reduced by 9% during this period. Area level analyses of whole practice populations suggested that overall outpatient attendances were significantly reduced by 5% two years after the start of the case management schemes.Conclusion: Case management may result in improvements in some aspects of care and has the potential to reduce secondary care costs. However, to improve
Boucher, Nathan A
Aging patients with advanced or terminal illnesses or at the end of their lives become highly vulnerable when their cultural needs-in terms of ethnic habits, religious beliefs, and language-are unmet. Cultural diversity should be taken into account during palliative care delivery (i.e., noncurative, supportive care during advanced illness or at the end of life). Providers and systems deliver disparate palliative care to diverse patients. I present 2 strategies to improve how culturally diverse populations are served during advanced illness: (1) health service provider assessment of local populations to understand service populations' cultural needs and guide services and policy; and (2) interprofessional education to improve multicultural understanding among the health care workforce. PMID:26985609
Milligan, Christine; Morbey, Hazel
In this paper, we draw on narrative correspondence from older male spousal caregivers and interviews with care providers from the voluntary and statutory sectors to explore how older male carers in the UK cope with and experience care-giving, the forms of support they draw upon, and how this impacts on their sense of self and identity as older men. We also consider how (or if) gender plays a part in shaping the forms of formal care support extended to male carers. We conclude, that how older men construct and perform care-giving, and how the wider family and community respond to older men as carers, can impact on how they perform masculinity. This in turn can contribute to a decline in their social networks and opportunities for sociability, leading to increased loneliness and social isolation. Such insights are important if we are to enrich our knowledge of the challenges they face, the coping mechanisms they employ, and the extent to which their support needs are met in their caring role. WHAT IS KNOWN ABOUT THE TOPIC. PMID:27531457
Jagdale, Swati C.; Somnath Patil; KUCHEKAR, BHANUDAS S.
The aim of the present study was to apply design of experiment (DOE) to optimize floating drug delivery of tapentadol hydrochloride. Tapentadol hydrochloride is a synthetic opioid used as a centrally acting analgesic and effective in both experimental and clinical pain. The half-life of the drug is about 4 hours and oral dose is 50 to 250 mg twice a day. For optimization 32 full factorial design was employed for formulation of tapentadol hydrochloride tablets. Sodium bicarbonate was incorpora...
Sapountzi-Krepia, Despina; Lavdaniti, Maria; Dimitriadou, Alexandra; Psychogiou, Maria; Sgantzos, Markos; He, Hong-Gu; Faros, Eythimios; Vehviläinen-Julkunen, Katri
Objectives: The study aims at exploring the feelings and the experience of fathers about their wife/partner’s delivery. Background: During the last decades birth attendance by fathers is a common phenomenon across many countries. Fathers’ birth attendance may evoke both positive and negative feelings. Methodology: The study was conducted in a city of Northern Greece. The sample consisted of 417 fathers whose wife/partner had given birth during the previous one week to one year. Data were coll...
Developing a Patient Care Co-ordination Centre in Trafford, England: lessons from the International Foundation for Integrated Care (IFIC/Advancing Quality Alliance integrated care fellowship experience
Full Text Available The NHS and Social Care in England are facing one of the biggest financial challenges for a generation. Commissioners and providers need to work on collaborative schemes to manage the increasing demand on health and social care within a period of financial constraint. Different forms of care co-ordination have been developed at different levels across the world.In the north-west of England, the Trafford health and social care economy have been working through a competitive dialogue process with industry to develop an innovative and dynamic solution to deliver seamless co-ordination for all patients and service users. The strategy is to develop a new Patient Care Co-ordination Centre, which will be responsible for the delivery of co-ordinated, quality care. The Patient Care Co-ordination Centre will work at clinical, service, functional and community levels across multiple providers covering risk stratification, preventative, elective and unscheduled care.I am the clinical lead for the Patient Care Co-ordination Centre and during my year as an Advancing Quality Alliance Integrated Care Fellow, I have had the opportunity to study examples of care coordination from UK and international sites. The learning from these visits has been assimilated into the design process of the Patient Care Co-ordination Centre.
Davis, Jennifer M; Finke, Erinn; Hickerson, Benjamin
The purpose of this study was to describe the experiences of military families with children with autism spectrum disorder (ASD) specifically as it relates to relocation. Online survey methodology was used to gather information from military spouses with children with ASD. The finalized dataset included 189 cases. Descriptive statistics and frequency analyses were used to examine participant demographics and service delivery questions. Results indicated the larger sample of military spouses largely confirmed the experiences reported qualitatively in previous studies and contributed information that was previously unknown about variables associated with the access, availability, quality, and frequency of intervention services for military families with children with ASD. PMID:26780908
Full Text Available Abstract Background Antenatal Care (ANC during pregnancy can play an important role in the uptake of evidence-based services vital to the health of women and their infants. Studies report positive effects of ANC on use of facility-based delivery and perinatal mortality. However, most existing studies are limited to cross-sectional surveys with long recall periods, and generally do not include population-based samples. Methods This study was conducted within the Health and Demographic Surveillance System (HDSS of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b in Matlab, Bangladesh. The HDSS area is divided into an icddr,b service area (SA where women and children receive care from icddr,b health facilities, and a government SA where people receive care from government facilities. In 2007, a new Maternal, Neonatal, and Child Health (MNCH program was initiated in the icddr,b SA that strengthened the ongoing maternal and child health services including ANC. We estimated the association of ANC with facility delivery and perinatal mortality using prospectively collected data from 2005 to 2009. Using a before-after study design, we also determined the role of ANC services on reduction of perinatal mortality between the periods before (2005 – 2006 and after (2008–2009 implementation of the MNCH program. Results Antenatal care visits were associated with increased facility-based delivery in the icddr,b and government SAs. In the icddr,b SA, the adjusted odds of perinatal mortality was about 2-times higher (odds ratio (OR 1.91; 95% confidence intervals (CI: 1.50, 2.42 among women who received ≤1 ANC compared to women who received ≥3 ANC visits. No such association was observed in the government SA. Controlling for ANC visits substantially reduced the observed effect of the intervention on perinatal mortality (OR 0.64; 95% CI: 0.52, 0.78 to non-significance (OR 0.81; 95% CI: 0.65, 1.01, when comparing cohorts before
Full Text Available Abstract Background Efforts to reduce neonatal mortality are essential if the Millennium Development Goal (MDG 4 is to be met. The impact of spatial dimensions of neonatal survival has not been thoroughly investigated even though access to good quality delivery care is considered to be one of the main priorities when trying to reduce neonatal mortality. This study examined the association between distance from the mother's home to the closest health facility and neonatal mortality, and investigated the influence of distance on patterns of perinatal health care utilisation. Methods A surveillance system of live births and neonatal deaths was set up in eight districts of Quang Ninh province, Vietnam, from July 2008 to December 2009. Case referent design including all neonatal deaths and randomly selected newborn referents from the same population. Interviews were performed with mothers of all subjects and GIS coordinates for mothers' homes and all health facilities in the study area were obtained. Straight-line distances were calculated using ArcGIS software. Results A total of 197 neonatal deaths and 11 708 births were registered and 686 referents selected. Health care utilisation prior to and at delivery varied with distance to the health facility. Mothers living farthest away (4th and 5th quintile, ≥1257 meters from a health facility had an increased risk of neonatal mortality (OR 1.96, 95% CI 1.40 - 2.75, adjusted for maternal age at delivery and marital status. When stratified for socio-economic factors there was an increased risk for neonatal mortality for mothers with low education and from poor households who lived farther away from a health facility. Mothers who delivered at home had more than twice as long to a health facility compared to mothers who delivered at a health care facility. There was no difference in age at death when comparing neonates born at home or health facility deliveries (p = 0.56. Conclusion Distance to the
Shidhaye, Rahul; Lund, Crick; Chisholm, Dan
This paper outlines the main elements and features of a mental health care delivery platform and its delivery channels. These include evidence-based interventions that can be delivered via this platform as well as broader health system strengthening strategies for more effective and efficient delivery of services. The focus is broadly on health systems perspective rather than strictly disorder-oriented intervention analysis. A set of evidence-based interventions within the WHO pyramid framewo...
Whiting, Stephen; Dalipanda, Tenneth; Postma, Sjoerd; de Lorenzo, Ayesha Jamshaid; Aumua, Audrey
The Solomon Islands Government is pursuing integrated care with the goal of improving the quality of health service delivery to rural populations. Under the auspices of Universal Health Coverage, integrated service delivery packages were developed which defined the clinical and public health services that should be provided at different levels of the health system. The process of developing integrated service delivery packages helped to identify key policy decisions the government needed to m...
McElwaine, Kathleen M; Freund, Megan; Campbell, Elizabeth M.; Bartlem, Kate M.; Wye, Paula M.; Wiggers, John H
Background Primary care nurses and allied health clinicians are potential providers of opportunistic preventive care. This systematic review aimed to summarise evidence for the effectiveness of practice change interventions in increasing nurse or allied health professional provision of any of five preventive care elements (ask, assess, advise, assist, and/or arrange) for any of four behavioural risks (smoking, inadequate nutrition, alcohol overconsumption, physical inactivity) within a primar...
Kaggal, Vinod C.; Elayavilli, Ravikumar Komandur; Mehrabi, Saeed; Pankratz, Joshua J.; Sohn, Sunghwan; Wang, Yanshan; Li, Dingcheng; Rastegar, Majid Mojarad; Murphy, Sean P.; Ross, Jason L.; Chaudhry, Rajeev; Buntrock, James D.; Liu, Hongfang
The concept of optimizing health care by understanding and generating knowledge from previous evidence, ie, the Learning Health-care System (LHS), has gained momentum and now has national prominence. Meanwhile, the rapid adoption of electronic health records (EHRs) enables the data collection required to form the basis for facilitating LHS. A prerequisite for using EHR data within the LHS is an infrastructure that enables access to EHR data longitudinally for health-care analytics and real time for knowledge delivery. Additionally, significant clinical information is embedded in the free text, making natural language processing (NLP) an essential component in implementing an LHS. Herein, we share our institutional implementation of a big data-empowered clinical NLP infrastructure, which not only enables health-care analytics but also has real-time NLP processing capability. The infrastructure has been utilized for multiple institutional projects including the MayoExpertAdvisor, an individualized care recommendation solution for clinical care. We compared the advantages of big data over two other environments. Big data infrastructure significantly outperformed other infrastructure in terms of computing speed, demonstrating its value in making the LHS a possibility in the near future. PMID:27385912
Rejane Marie Barbosa Davim
Full Text Available Trata da experiência vivenciada por uma enfermeira obstetra com um casal grávido de seu terceiro filho. Destaca os modelos assistenciais que valorizam a mulher e o casal no processo do nascimento e parto. Descreve a assistência prestada a um casal durante o processo da gestação e parto realizado no domicílio. Ressalta que a experiência possibilitou a participação ativa do casal e filhos no processo do nascimento e parto, propiciando, fundamentalmente, satisfação à família e ao profissional.Este estudio trata de la experiencia vivida por una enfermera obstétrica con una pareja esperando su tercero hijo. Destaca los modelos asistenciales que valorizan la mujer y la pareja en el proceso del nacimiento y parto. Describe la atención prestada a una pareja durante el proceso de la gestación y parto realizado en la casa. Resalta que la experiencia hizo posible la participación activa de la pareja y de los hijos en el proceso del nacimiento y parto, propiciando fundamentalmente, satisfacción a familia y al profesional.This study presents the experience of an obstetric nurse and of a couple who had their third child. It focuses on care standards that value women and couples in the childbirth and delivery process. It describes the care given to a couple during the pregnancy stage and during home delivery. The experience enabled the active participation of the couple and their children in the childbirth process, which essencialy provided satisfaction to the family and to the professional.
Naidoo, Kovin S; Naidoo, Kesi; Maharaj, Yashika; Ramson, Prasidh; Wallace, Diane; Dabideen, Reshma
Background In South Africa, the health service is based on a Primary Health Care (PHC) philosophy with the District Health System (DHS) as the locus of delivery. However eye care services, particularly primary eye care, refractive error and low vision, have not been prioritised accordingly. Hence the aim of the Giving Sight to KwaZulu-Natal (GSKZN) project was to integrate the delivery of eye care services into the district health system, with emphasis on addressing the need for uncorrected r...
Pinto, Meredith; Rochat, Roger; Hennink, Monique; Zertuche, Adrienne D; Spelke, Bridget
Objectives In 2011, a workforce assessment conducted by the Georgia Maternal and Infant Health Research Group found that 52 % of Primary Care Service Areas outside metropolitan Atlanta, Georgia, had an overburdened or complete lack of obstetric care services. In response to that finding, this study's aim was twofold: to describe challenges faced by providers who currently deliver or formerly delivered obstetric care in these areas, and to identify essential core components that can be integrated into alternative models of care in order to alleviate the burden placed on the remaining obstetric providers. Methods We conducted 46 qualitative in-depth interviews with obstetricians, maternal-fetal medicine specialists, certified nurse midwives, and maternal and infant health leaders in Georgia. Interviews were digitally recorded, transcribed verbatim, uploaded into MAXQDA software, and analyzed using a Grounded Theory Approach. Results Providers faced significant financial barriers in service delivery, including low Medicaid reimbursement, high proportions of self-pay patients, and high cost of medical malpractice insurance. Further challenges in provision of obstetric care in this region were related to patient's late initiation of prenatal care and lacking collaboration between obstetric providers. Essential components of effective models of care included continuity, efficient use of resources, and risk-appropriate services. Conclusion Our analysis revealed core components of improved models of care that are more cost effective and would expand coverage. These components include closer collaboration among stakeholder populations, decentralization of services with effective use of each type of clinical provider, improved continuity of care, and system-wide changes to increase Medicaid benefits. PMID:27090413