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Giebel GD, Abels C, Plescher F, Speckemeier C, Schrader NF, Börchers K, Wasem J, Neusser S, Blase N. Problems and Barriers Related to the Use of mHealth Apps From the Perspective of Patients: Focus Group and Interview Study. J Med Internet Res 2024; 26:e49982. [PMID: 38652508 DOI: 10.2196/49982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/24/2023] [Accepted: 01/31/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Since fall 2020, mobile health (mHealth) apps have become an integral part of the German health care system. The belief that mHealth apps have the potential to make the health care system more efficient, close gaps in care, and improve the economic outcomes related to health is unwavering and already partially confirmed. Nevertheless, problems and barriers in the context of mHealth apps usually remain unconsidered. OBJECTIVE The focus groups and interviews conducted in this study aim to shed light on problems and barriers in the context of mHealth apps from the perspective of patients. METHODS Guided focus groups and individual interviews were conducted with patients with a disease for which an approved mHealth app was available at the time of the interviews. Participants were recruited via self-help groups. The interviews were recorded, transcribed, and subjected to a qualitative content analysis. The content analysis was based on 10 problem categories ("validity," "usability," "technology," "use and adherence," "data privacy and security," "patient-physician relationship," "knowledge and skills," "individuality," "implementation," and "costs") identified in a previously conducted scoping review. Participants were asked to fill out an additional questionnaire about their sociodemographic data and about their use of technology. RESULTS A total of 38 patients were interviewed in 5 focus groups (3 onsite and 2 web-based) and 5 individual web-based interviews. The additional questionnaire was completed by 32 of the participants. Patients presented with a variety of different diseases, such as arthrosis, tinnitus, depression, or lung cancer. Overall, 16% (5/32) of the participants had already been prescribed an app. During the interviews, all 10 problem categories were discussed and considered important by patients. A myriad of problem manifestations could be identified for each category. This study shows that there are relevant problems and barriers in the context of mHealth apps from the perspective of patients, which warrant further attention. CONCLUSIONS There are essentially 3 different areas of problems in the context of mHealth apps that could be addressed to improve care: quality of the respective mHealth app, its integration into health care, and the expandable digital literacy of patients.
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Affiliation(s)
- Godwin Denk Giebel
- Institute for Health Care Management and Research, Universität Duisburg-Essen, Essen, Germany
| | - Carina Abels
- Institute for Health Care Management and Research, Universität Duisburg-Essen, Essen, Germany
| | - Felix Plescher
- Institute for Health Care Management and Research, Universität Duisburg-Essen, Essen, Germany
| | - Christian Speckemeier
- Institute for Health Care Management and Research, Universität Duisburg-Essen, Essen, Germany
| | - Nils Frederik Schrader
- Institute for Health Care Management and Research, Universität Duisburg-Essen, Essen, Germany
| | | | - Jürgen Wasem
- Institute for Health Care Management and Research, Universität Duisburg-Essen, Essen, Germany
| | - Silke Neusser
- Institute for Health Care Management and Research, Universität Duisburg-Essen, Essen, Germany
| | - Nikola Blase
- Institute for Health Care Management and Research, Universität Duisburg-Essen, Essen, Germany
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Segur-Ferrer J, Moltó-Puigmartí C, Pastells-Peiró R, Vivanco-Hidalgo RM. Methodological Frameworks and Dimensions to Be Considered in Digital Health Technology Assessment: Scoping Review and Thematic Analysis. J Med Internet Res 2024; 26:e48694. [PMID: 38598288 DOI: 10.2196/48694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 12/01/2023] [Accepted: 02/20/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Digital health technologies (dHTs) offer a unique opportunity to address some of the major challenges facing health care systems worldwide. However, the implementation of dHTs raises some concerns, such as the limited understanding of their real impact on health systems and people's well-being or the potential risks derived from their use. In this context, health technology assessment (HTA) is 1 of the main tools that health systems can use to appraise evidence and determine the value of a given dHT. Nevertheless, due to the nature of dHTs, experts highlight the need to reconsider the frameworks used in traditional HTA. OBJECTIVE This scoping review (ScR) aimed to identify the methodological frameworks used worldwide for digital health technology assessment (dHTA); determine what domains are being considered; and generate, through a thematic analysis, a proposal for a methodological framework based on the most frequently described domains in the literature. METHODS The ScR was performed in accordance with the guidelines established in the PRISMA-ScR guidelines. We searched 7 databases for peer reviews and gray literature published between January 2011 and December 2021. The retrieved studies were screened using Rayyan in a single-blind manner by 2 independent authors, and data were extracted using ATLAS.ti software. The same software was used for thematic analysis. RESULTS The systematic search retrieved 3061 studies (n=2238, 73.1%, unique), of which 26 (0.8%) studies were included. From these, we identified 102 methodological frameworks designed for dHTA. These frameworks revealed great heterogeneity between them due to their different structures, approaches, and items to be considered in dHTA. In addition, we identified different wording used to refer to similar concepts. Through thematic analysis, we reduced this heterogeneity. In the first phase of the analysis, 176 provisional codes related to different assessment items emerged. In the second phase, these codes were clustered into 86 descriptive themes, which, in turn, were grouped in the third phase into 61 analytical themes and organized through a vertical hierarchy of 3 levels: level 1 formed by 13 domains, level 2 formed by 38 dimensions, and level 3 formed by 11 subdimensions. From these 61 analytical themes, we developed a proposal for a methodological framework for dHTA. CONCLUSIONS There is a need to adapt the existing frameworks used for dHTA or create new ones to more comprehensively assess different kinds of dHTs. Through this ScR, we identified 26 studies including 102 methodological frameworks and tools for dHTA. The thematic analysis of those 26 studies led to the definition of 12 domains, 38 dimensions, and 11 subdimensions that should be considered in dHTA.
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Affiliation(s)
- Joan Segur-Ferrer
- Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
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Dietrich D, Bornet Dit Vorgeat H, Perrin Franck C, Ligier Q. A Mobile App (Concerto) to Empower Hospitalized Patients in a Swiss University Hospital: Development, Design, and Implementation Report. JMIR Med Inform 2024; 12:e47914. [PMID: 38546728 PMCID: PMC11009845 DOI: 10.2196/47914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/31/2023] [Accepted: 09/06/2023] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Patient empowerment can be associated with better health outcomes, especially in the management of chronic diseases. Digital health has the potential to promote patient empowerment. OBJECTIVE Concerto is a mobile app designed to promote patient empowerment in an in-patient setting. This implementation report focuses on the lessons learned during its implementation. METHODS The app was conceptualized and prototyped during a hackathon. Concerto uses hospital information system (HIS) data to offer the following key functionalities: a care schedule, targeted medical information, practical information, information about the on-duty care team, and a medical round preparation module. Funding was obtained following a feasibility study, and the app was developed and implemented in four pilot divisions of a Swiss University Hospital using institution-owned tablets. IMPLEMENTATION (RESULTS) The project lasted for 2 years with effective implementation in the four pilot divisions and was maintained within budget. The induced workload on caregivers impaired project sustainability and warranted a change in our implementation strategy. The presence of a killer function would have facilitated the deployment. Furthermore, our experience is in line with the well-accepted need for both high-quality user training and a suitable selection of superusers. Finally, by presenting HIS data directly to the patient, Concerto highlighted the data that are not fit for purpose and triggered data curation and standardization initiatives. CONCLUSIONS This implementation report presents a real-world example of designing, developing, and implementing a patient-empowering mobile app in a university hospital in-patient setting with a particular focus on the lessons learned. One limitation of the study is the lack of definition of a "key success" indicator.
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Affiliation(s)
- Damien Dietrich
- Geneva Hub for Global Digital Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Kheops Technologies SA, Plan-Les-Ouates, Switzerland
| | | | - Caroline Perrin Franck
- Geneva Hub for Global Digital Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Djiofack Kentsop HB, Zarowsky C, Von Oettingen JE. Type 1 diabetes care delivery in Yaoundé, Cameroon: Social and political representations. Afr J Prim Health Care Fam Med 2024; 16:e1-e16. [PMID: 38572859 PMCID: PMC11019050 DOI: 10.4102/phcfm.v16i1.4229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 02/04/2024] [Accepted: 02/04/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Increasing chronic diseases challenges the health systems of low- and middle-income countries, including Cameroon. Type 1 diabetes (T1D), among the most common chronic diseases in children, poses particular care delivery challenges. AIM We examined social representations of patients' roles and implementation of T1D care among political decision-makers, healthcare providers and patients within families. SETTING The study was conducted in Yaoundé, Cameroon. METHODS Eighty-two individuals were included in the study. The authors conducted semi-structured interviews with policy makers (n = 5), healthcare professionals (n = 7) and patients 'parents (n = 20). Questionnaires were administered to paediatric patients with T1D (n = 50). The authors also observed care delivery at a referral hospital and at a T1D-focused non-governmental organisation over 15 days. Data were analysed using thematic content analysis and descriptive statistics. RESULTS Cameroonian health policy portrays patients with T1D as passive recipients of care. While many practitioners recognised the complex social and economic determinants of adherence to T1D care, in practice interactions focused on specific biomedical issues and offered brief guidance. Cultural barriers and policy implementation challenges prevent patients and their families from being fully active participants in care. Parents and children prefer an ongoing relationship with a single clinician and interactions with other patients and families. CONCLUSION Patients and families mobilise experience and lay knowledge to complement biomedical knowledge, but top-down policy and clinical practice limit their active engagement in T1D care.Contribution: Children with T1D and their families, policy makers, healthcare professionals, and civil society have new opportunities to contribute to person-centred care, as advocated by the Sustainable Development Goals.
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Affiliation(s)
- Hervé B Djiofack Kentsop
- Department of Social and Preventive Medicine, Faculty of Public Health, University of Montreal, Montreal, Canada; Public Health Research Center, Faculty of Public Health, University of Montreal, Montreal, Canada; and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal.
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Mohamed AI, Bashir MS, Taha SM, Hassan YM, Al Zhranei RM, Obaid AA, Albarakati AM. A Cross-Sectional Study of Anesthesia Safety in Wad Medani, Sudan: A Pre-war Status Indicating a Post-war Crisis. Cureus 2024; 16:e56725. [PMID: 38646214 PMCID: PMC11032737 DOI: 10.7759/cureus.56725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND As the surgical burden grows, increasing patient safety during anesthesia and surgery becomes a major global public health priority. Anesthesia can be safely administered in higher-income countries, yet it is more challenging in third-world countries. This study focuses on Sudan, a third-world country, and its unmet anesthetic needs before the current war and how these needs might compromise the post-war status. AIM The aim of this study is to compare Sudan's outstanding anesthesia requirements to the World Health Organization's safe anesthesia practice standards in terms of workforce, medications, equipment, and anesthesia conduct. METHODS This study was carried out in four hospitals (Wad Medani Teaching Hospital, Wad Medani Maternity Hospital, Gezira Centre for Renal and Urological Surgeries, and the National Centre for Pediatric Surgeries) in Wad Medani, two of which were referral and two were state-run. Each hospital from every category was identified using a convenience sampling technique. The World Health Organization-World Federation of Societies of Anesthesiologists International Standard and earlier regional African publications were used to determine the minimum predicted safe anesthesia needs. RESULTS The results of our study demonstrate that overall, the hospitals surveyed fulfilled the minimum standards set by the World Health Organization and the World Federation of Societies of Anesthesiologists (WHO-WFSA) for safe anesthesia practice by 73% with no significant difference in the safety of anesthesia practice between state and referral hospitals. CONCLUSIONS The state of safe anesthesia care in Wad Medani hospitals surveyed fell well short of the expected minimal criteria due to important requirements such as patient monitoring indicators, the inaccessibility of life-saving facilities such as defibrillators, and difficult intubation instruments. More importantly, the conduct of anesthesia was far below the standard.
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Affiliation(s)
- Alaa I Mohamed
- Department of Anesthesia Technology, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Mohammed S Bashir
- Department of Anesthesia Technology, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Sami M Taha
- Department of Urology, University of Gezira, Wad Medani, SDN
- Department of Urology, Gezira Hospital for Renal and Urological Surgeries, Wad Medani, SDN
| | - Yassir M Hassan
- Department of Obstetrics and Gynaecology, University of Gezira, Wad Medani, SDN
- Obstetrics and Gynecology, Wad Medani Maternity Hospital, Wad Medani, SDN
| | - Raid M Al Zhranei
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Ahmad A Obaid
- Department of Anesthesia Technology, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Abdulrahman M Albarakati
- Department of Anesthesia Technology, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
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AbdulHussein A, Butt ZA, Dimitrov S, Cozzarin B. Factors Associated With Worsened Mental Health of Health Care Workers in Canada During the COVID-19 Pandemic: Cross-Sectional Survey Study. Interact J Med Res 2024; 13:e50064. [PMID: 38358785 PMCID: PMC10905361 DOI: 10.2196/50064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 11/26/2023] [Accepted: 01/12/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Health care workers (HCWs) in Canada have endured difficult conditions during the COVID-19 pandemic. Many worked long hours while attending to patients in a contagious environment. This introduced an additional burden that may have contributed to worsened mental health conditions. OBJECTIVE In this study, we examine the factors associated with worsened mental health conditions of HCWs as compared to before the start of the pandemic. METHODS We use data from a survey of HCWs by Statistics Canada. A regression model is used to estimate the odds ratios (ORs) of worsened mental health after the start of the pandemic. The estimated odds ratio (OR) is associated with different independent variables that include demographics (age, sex, immigration status, and geographic area), occupational factors (work status, occupational group, and exposure category), and different access levels to personal protective equipment (PPE). RESULTS Of 18,139 eligible participants surveyed, 13,990 (77.1%) provided valid responses. We found that HCWs younger than 35 years old were more likely (OR 1.14, 95% CI 1.03-1.27; P=.01) to exhibit worsened mental health as compared to the reference group (35-44 years old). As for sex, male HCWs were less likely (OR 0.76, 95% CI 0.67-0.86; P<.001) to exhibit worsened mental health as compared to female HCWs. Immigrant HCWs were also less likely (OR 0.57, 95% CI 0.51-0.64; P<.001) to exhibit worsened mental health as compared to nonimmigrant HCWs. Further, HCWs working in Alberta had the highest likelihood of exhibiting worsened mental health as compared to HCWs working elsewhere (Atlantic provinces, Quebec, Manitoba, Saskatchewan, Ontario, British Columbia, and Northern Territories). Frontline workers were more likely (OR 1.26, 95% CI 1.16-1.38; P<.001) to exhibit worsened mental health than nonfrontline HCWs. Part-time HCWs were less likely (OR 0.85, 95% CI 0.76-0.93; P<.001) to exhibit worsened mental health than full-time HCWs. HCWs who reported encountering COVID-19 cases were more likely (OR 1.55, 95% CI 1.41-1.70; P<.001) to exhibit worsened mental health as compared to HCWs who reported no contact with the disease. As for PPE, HCWs who never had access to respirators, eye protection, and face shields are more likely to exhibit worsened mental health by 1.31 (95% CI 1.07-1.62; P<.001), 1.51 (95% CI 1.17-1.96; P<.001), and 1.41 (95% CI 1.05-1.92; P=.02) than those who always had access to the same PPE, respectively. CONCLUSIONS Different HCW groups experienced the pandemic differently based on their demographic and occupational backgrounds as well as access to PPE. Such findings are important to stakeholders involved in the planning of personalized support programs and aid mental health mitigation in future crises. Certain groups require more attention.
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Affiliation(s)
- Ali AbdulHussein
- Department of Management Science, Faculty of Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Zahid Ahmad Butt
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | - Stanko Dimitrov
- Department of Management Science, Faculty of Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Brian Cozzarin
- Department of Management Science, Faculty of Engineering, University of Waterloo, Waterloo, ON, Canada
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Benda N, Dougherty K, Gebremariam Gobezayehu A, Cranmer JN, Zawtha S, Andreadis K, Biza H, Masterson Creber R. Designing Electronic Data Capture Systems for Sustainability in Low-Resource Settings: Viewpoint With Lessons Learned From Ethiopia and Myanmar. JMIR Public Health Surveill 2024; 10:e47703. [PMID: 38345833 PMCID: PMC10897790 DOI: 10.2196/47703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/19/2023] [Accepted: 12/12/2023] [Indexed: 02/15/2024] Open
Abstract
Electronic data capture (EDC) is a crucial component in the design, evaluation, and sustainment of population health interventions. Low-resource settings, however, present unique challenges for developing a robust EDC system due to limited financial capital, differences in technological infrastructure, and insufficient involvement of those who understand the local context. Current literature focuses on the evaluation of health interventions using EDC but does not provide an in-depth description of the systems used or how they are developed. In this viewpoint, we present case descriptions from 2 low- and middle-income countries: Ethiopia and Myanmar. We address a gap in evidence by describing each EDC system in detail and discussing the pros and cons of different approaches. We then present common lessons learned from the 2 case descriptions as recommendations for considerations in developing and implementing EDC in low-resource settings, using a sociotechnical framework for studying health information technology in complex adaptive health care systems. Our recommendations highlight the importance of selecting hardware compatible with local infrastructure, using flexible software systems that facilitate communication across different languages and levels of literacy, and conducting iterative, participatory design with individuals with deep knowledge of local clinical and cultural norms.
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Affiliation(s)
- Natalie Benda
- School of Nursing, Columbia University, New York, NY, United States
| | - Kylie Dougherty
- School of Nursing, Columbia University, New York, NY, United States
| | | | - John N Cranmer
- Emory-Ethiopia Partnership, Bahir Dar, Ethiopia
- Bahir Dar University, Bahir Dar, Ethiopia
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | | | - Katerina Andreadis
- New York University Grossman School of Medicine, New York, NY, United States
| | - Heran Biza
- Emory-Ethiopia Partnership, Bahir Dar, Ethiopia
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Tabatabaei-Jafari H, Furst MA, Bagheri N, D’Cunha NM, Bail K, Sachdev PS, Salvador-Carulla L. The Integrated Atlas of Dementia Care in the Australian Capital Territory: A Collective Case Study of Local Service Provision. Health Serv Insights 2024; 17:11786329241232254. [PMID: 38348356 PMCID: PMC10860480 DOI: 10.1177/11786329241232254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/25/2024] [Indexed: 02/15/2024] Open
Abstract
Background This study evaluates the dementia care system in a local area and aimed to include all specialised services designed to provide health and social services to people with dementia or age-related cognitive impairment, as well as general services with a high or very high proportion of clients with dementia. Methods The study used an internationally standardised service classification instrument called Description and Evaluation of Services and DirectoriEs for Long Term Care (DESDE-LTC) to identify and describe all services providing care to people with dementia in the Australian Capital Territory (ACT). Results A total of 47 service providers were eligible for inclusion. Basic information about the services was collected from their websites, and further information was obtained through interviews with the service providers. Of the 107 services offered by the 47 eligible providers, 27% (n = 29) were specialised services and 73% (n = 78) were general services. Most of the services were residential or outpatient, with a target population mostly of people aged 65 or older, and 50 years or older in the case of Aboriginal and Torres Strait Islander Australians. There were government supports available for most types of care through various programmes. Conclusions Dementia care in the ACT relies heavily on general services. More widespread use of standardised methods of service classification in dementia will facilitate comparison with other local areas, allow for monitoring of changes over time, permit comparison with services provided for other health conditions and support evidence-informed local planning.
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Affiliation(s)
- Hossein Tabatabaei-Jafari
- Mental Health Policy Unit, Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Mary Anne Furst
- Mental Health Policy Unit, Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Nasser Bagheri
- Mental Health Policy Unit, Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Nathan M. D’Cunha
- School of Rehabilitation and Exercise Science, Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Kasia Bail
- School of Nursing, Midwifery and Public Health, Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
| | - Luis Salvador-Carulla
- Mental Health Policy Unit, Health Research Institute, University of Canberra, Canberra, ACT, Australia
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Sharma Y, Saha A, Goldsack JC. Defining the Dimensions of Diversity to Promote Inclusion in the Digital Era of Health Care: A Lexicon. JMIR Public Health Surveill 2024; 10:e51980. [PMID: 38335013 PMCID: PMC10891484 DOI: 10.2196/51980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/08/2023] [Accepted: 01/07/2024] [Indexed: 02/10/2024] Open
Abstract
The pandemic provided a stark reminder of the inequities faced by populations historically marginalized by the health care system and accelerated the adoption of digital health technologies to drive innovation. Digital health technologies' purported promises to reduce inefficiencies and costs, improve access and health outcomes, and empower patients add a new level of urgency to health equity. As conventional medicine shifts toward digital medicine, we have the opportunity to intentionally develop and deploy digital health technologies with an inclusion focus. The first step is ensuring that the multiple dimensions of diversity are captured. We propose a lexicon that encompasses elements critical for implementing an inclusive approach to advancing health care quality and health services research in the digital era.
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Affiliation(s)
| | - Anindita Saha
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, United States
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Jeong CH, Oh H, Palinkas LA, Lusenhop W. Perceptions of Health Insurance Among Self-employed Korean Immigrants From South Korea in the United States. Health Educ Behav 2024; 51:167-175. [PMID: 36495118 DOI: 10.1177/10901981221139169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Korean Americans in the United States are more likely than other Asian ethnic groups to lack health insurance despite their high education and economic prosperity. According to the model of health service selection, immigrants' perceptions of the health care system and health care behaviors in their host country are affected by sociocultural referents including premigration health care experience in the country of origin. This study explored Korean immigrants' perceptions of health insurance and their intentions to purchase and maintain health insurance in the United States. We conducted in-depth interviews with 24 self-employed Korean immigrants who migrated from South Korea and were living in the Greater Los Angeles area in 2015. Participants generally had negative perceptions of U.S. health insurance in terms of cost, benefits, simplicity, and accessibility. Coupled with their positive experiences with the single-payer, universal health insurance in South Korea, respondents evaluated U.S. health insurance as not worth purchasing, and indicated they would not maintain health insurance once the individual mandate of the Affordable Care Act was abolished. On the contrary, respondents who immigrated prior to the establishment of the Korean universal health insurance in South Korea were relatively satisfied with U.S. health insurance and had maintained health insurance for substantial periods of time. Korean immigrants' premigration health care experiences appeared to influence their decisions to purchase health insurance in the United States and their intention to maintain health insurance. The study findings highlight the necessity of tailored health education that takes into account sociocultural determinants of health coverage among immigrants.
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Johnson DN, Patel S, Howard ED, Bowley MR. Critical Changes in the Maternal Health Landscape: Community Care, Doulas, and Coverage. Nurs Womens Health 2024; 28:23-29. [PMID: 38206238 DOI: 10.1016/j.nwh.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/21/2023] [Accepted: 11/05/2023] [Indexed: 01/12/2024]
Abstract
In this commentary, we present an overview of the accelerating trend toward community-based models for pregnancy care. Doula services, as part of community care programs, are the major target for new coverage changes. Obstetric professionals who include community care providers in their treatment plans can benefit from these local resources in the prenatal, birthing, and postpartum stages of patient management. Including community care programs may help achieve goals of improving health outcomes and health equity.
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Calear AL, Batterham PJ, McCallum SM, Banfield M, Moore E, Johnson N, Morse AR. Designing a Web-Based Navigation Tool to Support Access to Youth Mental Health Services: Qualitative Study. JMIR Form Res 2024; 8:e48945. [PMID: 38236625 PMCID: PMC10835581 DOI: 10.2196/48945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/23/2023] [Accepted: 11/22/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Many young people with mental health problems do not readily seek help or receive treatment and support. One way to address low help-seeking behavior is to improve access to information on mental health services and how to navigate the mental health system via a web-based tool. Seeking input from the end users (young people and parents or caregivers) on key features of the tool is imperative to ensure that it is relevant, engaging, and likely to meet their needs and expectations. OBJECTIVE This study aims to investigate young person and parent or caregiver views on the design, content, functioning, and user experience of a web-based mental health navigation tool to support connection to mental health services for children and young people aged up to 25 years. METHODS A total of 4 online focus groups were conducted: 2 with young people aged 16 years and older (total n=15) and 2 with parents or caregivers (total n=13). Focus groups were structured around a series of guiding questions to explore participants' views on content, features, user experience, and design of a mental health navigation website. Focus groups were audio recorded with detailed notes taken. In addition, 53 young people aged 16-25 years and 97 parents or caregivers completed an online survey, comprising closed- and open-ended questions; open-ended responses were included with the focus group data in the qualitative analysis. All qualitative data were analyzed using thematic analysis. RESULTS A total of 2 topic areas and 7 themes were developed. The first topic area covered the types of information needs of young people and parents. Identified themes concerned the scope of the navigation website, as well as the provision of up-to-date and practical information on how to navigate the whole help-seeking process. The second topic area covered website features that would be beneficial and included the consideration of the website design; search engines; supported navigation; and forums, reviews, and user accounts. CONCLUSIONS This study provides important insights into the navigation needs of young people and parents or caregivers in seeking mental health services. Key findings identified through this research have directly informed the development of MindMap, a web-based youth navigation tool providing a searchable database of local services, including a clear description, their location, and potential wait times. The website can be navigated independently or with support.
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Affiliation(s)
- Alison L Calear
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Sonia M McCallum
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Michelle Banfield
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
- ALIVE National Centre for Mental Health Research Translation, Melbourne, Australia
| | - Elizabeth Moore
- Office for Mental Health and Wellbeing, ACT Health, Canberra, Australia
| | - Natalie Johnson
- Office for Mental Health and Wellbeing, ACT Health, Canberra, Australia
| | - Alyssa R Morse
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
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13
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Manschel J, Porthun J, Winkler U, Beuckels JMAT, Martin D. Characteristics, Opportunities, and Challenges of Osteopathy Based on the Perceptions of Osteopaths in Austria: Qualitative Interview Study. JMIR Hum Factors 2024; 11:e45302. [PMID: 38231542 PMCID: PMC10831693 DOI: 10.2196/45302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 11/27/2023] [Accepted: 11/27/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND There are no uniform regulations for the osteopathic profession in Europe. It is subject to country-specific regulations defining who shall be allowed to practice osteopathy and which qualification shall be required. In recent years, legal regulations have been established in several European countries for the profession of osteopathy; however, these are also still pending for Austria. Currently, physiotherapists and physicians with osteopathic training are practicing osteopathy in Austria. OBJECTIVE This study aims to examine the characteristics, challenges, and opportunities of osteopaths in Austria. METHODS Guideline-based interviews with osteopaths (N=10) were conducted. The different research questions were examined using a qualitative content analysis. RESULTS The study provided a differentiated insight into the professional situation of osteopaths in Austria. The most important result was that all interviewees unanimously supported a legal regulation of their profession. However, owing to their different professional self-image-on the one hand, individuals working on a structural basis, and, on the other hand, individuals working on a cranial or biodynamic basis-they were able to imagine a uniform professional regulation only to a limited extent. Additional topics for the interviewed osteopaths in Austria were the quality assurance of training and the urgent need for scientific research. Furthermore, the study also dealt with the influence of the COVID-19 pandemic on daily practice and on education and training in osteopathy. CONCLUSIONS This study is a pioneering study with regard to systematic basic research on osteopathy in Austria. The obtained results and the newly acquired research questions not only have the potential to serve as a basis for further studies but also provide insight into the working and professional situation of osteopaths in Austria for universities, schools, professional associations, politics, and-last but not least-all interested parties. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/15399.
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Affiliation(s)
- Jonas Manschel
- Institute of Integrative Medicine, Department of Medicine, Health Faculty, University Witten/Herdecke, Herdecke, Germany
| | - Jan Porthun
- Norwegian University of Science and Technology, Campus Gjøvik, Gjøvik, Norway
| | | | - Jean Marie A T Beuckels
- Institute of Integrative Medicine, Department of Medicine, Health Faculty, University Witten/Herdecke, Herdecke, Germany
- Department of Osteopathy, Faculty of Health and Social Sciences, Hochschule Fresenius, Munich, Germany
| | - David Martin
- Institute of Integrative Medicine, Department of Medicine, Health Faculty, University Witten/Herdecke, Herdecke, Germany
- Tübingen University Children's Hospital, Tübingen, Germany
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14
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Khabriev RU, Kolomiychenko ME. [The comparative analysis of health care systems]. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med 2024; 32:4-10. [PMID: 38349679 DOI: 10.32687/0869-866x-2024-32-1-4-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/02/2023] [Indexed: 02/15/2024]
Abstract
Within the framework of the national development goal of the Russian Federation "preservation of population, health and well-being of people" the target indicator "the increase of life expectancy up to 78 years" is to be achieved by 2030. The achievement of this value is also directly affected by functioning of of health care system. In 2015, the United Nations, within the framework of the Sustainable Development Goals for the period up to 2030, formulated the task that implies ensuring of universal health services coverage "including financial risk security, access to qualitative essential medical and sanitary services and access to safe, effective, qualitative and inexpensive essential medications and vaccines for all". In the course of the study, methodology was developed that permitted to calculate values of performance indicators of main health care systems (financial support and infrastructure development) and to conduct comprehensive comparative analysis with values of particular public health indicators. The study results confirmed possibility of such comparisons. The stable direct relationship between such indicators as "current health expenditure (CHE) per capita", "current health expenditure (CHE) as percentage of gross domestic product (GDP)", "UHC Service Coverage Index", "life expectancy" was revealed. The inverse dependency between such indicators as "out-of-pocket expenditure as percentage of current health expenditure (CHE)" and "UHC Service Coverage Index" as well as between "UHC Service Coverage Index" and "total NCD mortality rate" and "probability of premature dying from non-infectious diseases" was determined.
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Affiliation(s)
- R U Khabriev
- N. A. Semashko National Research Institute of Public Health, 105064, Moscow, Russia
| | - M E Kolomiychenko
- N. A. Semashko National Research Institute of Public Health, 105064, Moscow, Russia,
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15
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Santana GO, Couto RDM, Loureiro RM, Furriel BCRS, Rother ET, de Paiva JPQ, Correia LR. Economic Evaluations and Equity in the Use of Artificial Intelligence in Imaging Exams for Medical Diagnosis in People With Skin, Neurological, and Pulmonary Diseases: Protocol for a Systematic Review. JMIR Res Protoc 2023; 12:e48544. [PMID: 38153775 PMCID: PMC10784972 DOI: 10.2196/48544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/23/2023] [Accepted: 10/24/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Traditional health care systems face long-standing challenges, including patient diversity, geographical disparities, and financial constraints. The emergence of artificial intelligence (AI) in health care offers solutions to these challenges. AI, a multidisciplinary field, enhances clinical decision-making. However, imbalanced AI models may enhance health disparities. OBJECTIVE This systematic review aims to investigate the economic performance and equity impact of AI in diagnostic imaging for skin, neurological, and pulmonary diseases. The research question is "To what extent does the use of AI in imaging exams for diagnosing skin, neurological, and pulmonary diseases result in improved economic outcomes, and does it promote equity in health care systems?" METHODS The study is a systematic review of economic and equity evaluations following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and CHEERS (Consolidated Health Economic Evaluation Reporting Standards) guidelines. Eligibility criteria include articles reporting on economic evaluations or equity considerations related to AI-based diagnostic imaging for specified diseases. Data will be collected from PubMed, Embase, Scopus, Web of Science, and reference lists. Data quality and transferability will be assessed according to CHEC (Consensus on Health Economic Criteria), EPHPP (Effective Public Health Practice Project), and Welte checklists. RESULTS This systematic review began in March 2023. The literature search identified 9,526 publications and, after full-text screening, 9 publications were included in the study. We plan to submit a manuscript to a peer-reviewed journal once it is finalized, with an expected completion date in January 2024. CONCLUSIONS AI in diagnostic imaging offers potential benefits but also raises concerns about equity and economic impact. Bias in algorithms and disparities in access may hinder equitable outcomes. Evaluating the economic viability of AI applications is essential for resource allocation and affordability. Policy makers and health care stakeholders can benefit from this review's insights to make informed decisions. Limitations, including study variability and publication bias, will be considered in the analysis. This systematic review will provide valuable insights into the economic and equity implications of AI in diagnostic imaging. It aims to inform evidence-based decision-making and contribute to more efficient and equitable health care systems. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48544.
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Affiliation(s)
| | - Rodrigo de Macedo Couto
- Imaging Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Department of Preventive Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Brunna Carolinne Rocha Silva Furriel
- Imaging Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Computer Engineering School, Universidade Federal de Goiás, Goiânia, Brazil
- Studies and Research in Science and Technology Group (GCITE), Instituto Federal de Goiás, Goiânia, Brazil
| | - Edna Terezinha Rother
- Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Lucas Reis Correia
- PROADI-SUS, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Department of Preventive Medicine, Universidade de São Paulo, São Paulo, Brazil
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16
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Melnick G. Editorial: Health systems performance: market structure, consolidation, and health care prices. Front Public Health 2023; 11:1344939. [PMID: 38169706 PMCID: PMC10758441 DOI: 10.3389/fpubh.2023.1344939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Affiliation(s)
- Glenn Melnick
- University of Southern California, Los Angeles, CA, United States
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17
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John A, M J, Rubeshkumar P, Ganeshkumar P, Masanam Sriramulu H, Narnaware M, Singh Bedi G, Kaur P. Implementation of a Triage Protocol Outside the Hospital Setting for Timely Referral During the COVID-19 Second Wave in Chennai, India. JMIR Form Res 2023; 7:e42798. [PMID: 37235721 PMCID: PMC10758940 DOI: 10.2196/42798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 03/31/2023] [Accepted: 04/06/2023] [Indexed: 05/28/2023] Open
Abstract
India experienced a surge in COVID-19 cases during the second wave in the period of April-June 2021. A rapid rise in cases posed challenges to triaging patients in hospital settings. Chennai, the fourth largest metropolitan city in India with an 8 million population, reported 7564 COVID-19 cases on May 12, 2021, nearly 3 times higher than the number of cases in the peak of COVID-19 in 2020. A sudden surge of cases overwhelmed the health system. We had established standalone triage centers outside the hospitals in the first wave, which catered to up to 2500 patients per day. In addition, we implemented a home-based triage protocol from May 26, 2021, to evaluate patients with COVID-19 who were aged ≤45 years without comorbidities. Among the 27,816 reported cases between May 26 and June 24, 2021, a total of 16,022 (57.6%) were aged ≤45 years without comorbidities. The field teams triaged 15,334 (55.1%), and 10,917 (39.2%) patients were evaluated at triage centers. Among 27,816 cases, 19,219 (69.1%) were advised to self-isolate at home, 3290 (11.8%) were admitted to COVID-19 care centers, and 1714 (6.2%) were admitted to hospitals. Only 3513 (12.7%) patients opted for the facility of their choice. We implemented a scalable triage strategy covering nearly 90% of the patients in a large metropolitan city during the COVID-19 surge. The process enabled early referral of high-risk patients and ensured evidence-informed treatment. We believe that the out-of-hospital triage strategy can be rapidly implemented in low-resource settings.
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Affiliation(s)
- Alby John
- Greater Chennai Corporation, Government of Tamil Nadu, Chennai, India
| | - Jagadeesan M
- Greater Chennai Corporation, Government of Tamil Nadu, Chennai, India
| | - Polani Rubeshkumar
- Indian Council of Medical Research-National Institute of Epidemiology, Chennai, India
| | | | | | - Manish Narnaware
- Greater Chennai Corporation, Government of Tamil Nadu, Chennai, India
| | | | - Prabhdeep Kaur
- Indian Council of Medical Research-National Institute of Epidemiology, Chennai, India
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18
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Yimer TM, Chan GCK, Belete H, Hides L, Leung J. Treatment-seeking behavior and barriers to mental health service utilization for depressive symptoms and hazardous drinking: The role of religious and traditional healers in mental healthcare of Northwest Ethiopia. Glob Ment Health (Camb) 2023; 10:e92. [PMID: 38179466 PMCID: PMC10765018 DOI: 10.1017/gmh.2023.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/24/2023] [Accepted: 12/13/2023] [Indexed: 01/06/2024] Open
Abstract
Understanding mental healthcare seeking and associated factors is essential for planning mental health services. This study aimed to assess treatment seeking and barriers to care for depressive symptoms and hazardous drinking in a community sample of Northwest Ethiopia. A cross-sectional study was conducted to screen 1,728 participants for depressive symptoms (n = 414) and hazardous drinking (n = 155). Participants were asked whether they had sought mental healthcare. We also assessed the barriers to seeking mental healthcare. Logistic regression was used to identify associated factors. Among people with depressive symptoms, 14.3%, 15.5%, and 19.6% sought treatment from healthcare settings, non-healthcare settings, or any sources, respectively. Religious places (39.5%) were the most helpful treatment sources. People with low levels of internalized stigma (adj OR = 3.00 [1.41, 6.42]) and positive attitudes towards mental illness (adj OR = 2.84 [1.33, 6.07]) were nearly threefold more likely to seek depression treatment. No participants with hazardous drinking sought treatment from healthcare settings, and only 1.3% had sought help from families/friends. Over 97% of participants with depressive symptoms and hazardous drinking reported at least one barrier to treatment-seeking from a healthcare setting. Religious and traditional healers were as important as healthcare settings for treatment-seeking.
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Affiliation(s)
- Tesfa Mekonen Yimer
- School of Psychology, The University of Queensland, Brisbane, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- Psychiatry Department, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gary CK Chan
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Habte Belete
- School of Psychology, The University of Queensland, Brisbane, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- Psychiatry Department, Bahir Dar University, Bahir Dar, Ethiopia
| | - Leanne Hides
- School of Psychology, The University of Queensland, Brisbane, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Janni Leung
- School of Psychology, The University of Queensland, Brisbane, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
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Lavoie JG, Clark W, McDonnell L, Nickel N, Dutton R, Kanayok J, Fowler-Woods M, Anawak J, Brown N, Voisey Clark G, Evaluardjuk-Palmer T, Wong ST, Sanguins J, Mudryj A, Mullins N, Ford M, Clark J. Mitigating the impact of the COVID-19 pandemic on Inuit living in Manitoba: community responses. Int J Circumpolar Health 2023; 82:2259135. [PMID: 37752773 PMCID: PMC10538448 DOI: 10.1080/22423982.2023.2259135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023] Open
Abstract
We document community responses to the COVID-19 pandemic among Inuit living in the province of Manitoba, Canada. This study was conducted by the Manitoba Inuit Association and a Council of Inuit Elders, in partnership with researchers from the University of Manitoba. We present findings from 12 health services providers and decision-makers, collected in 2021.Although Public Health orders led to the closure of the Manitoba Inuit Association's doors to community events and drop-in activities, it also created opportunities for the creation of programming and events delivered virtually and through outreach. The pandemic exacerbated pre-existing health and social system's shortcomings (limited access to safe housing, food insecurity) and trauma-related tensions within the community. The Manitoba Inuit Association achieved unprecedented visibility with the provincial government, receiving bi-weekly reports of COVID-19 testing, results and vaccination rates for Inuit. We conclude that after over a decade of advocacy received with at best tepid enthusiasm by federal and provincial governments, the Manitoba Inuit Association was able effectively advocate for Inuit-centric programming, and respond to Inuit community's needs, bringing visibility to a community that had until then been largely invisible. Still, many programs have been fueled with COVID-19 funding, raising the issue of sustainability.
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Affiliation(s)
- Josée G. Lavoie
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Ongomiizwin Indigenous Institute for Health and Healing, University of Manitoba, Winnipeg, Manitoba, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Wayne Clark
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leah McDonnell
- Ongomiizwin Indigenous Institute for Health and Healing, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nathan Nickel
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rachel Dutton
- Manitoba Inuit Association, Winnipeg, Manitoba, Canada
| | - Janet Kanayok
- Manitoba Inuit Association, Winnipeg, Manitoba, Canada
| | - Melinda Fowler-Woods
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jack Anawak
- Isumataq Sivuliuqti, Qanuinngitsiarutiksait Study, Canada
| | - Nuqaalaq Brown
- Isumataq Sivuliuqti, Qanuinngitsiarutiksait Study, Canada
| | | | | | - sabrina T. Wong
- National Institute of Nursing Research, Division of Intramural Research, Bethesda, Manitoba, Canada
| | | | - Adriana Mudryj
- Ongomiizwin Indigenous Institute for Health and Healing, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Marti Ford
- Manitoba Inuit Association, Winnipeg, Manitoba, Canada
| | - Judy Clark
- Manitoba Inuit Association, Winnipeg, Manitoba, Canada
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20
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Jalali M, Dehghan H, Habibi E, Khakzad N. Application of "Human Factor Analysis and Classification System" (HFACS) Model to the Prevention of Medical Errors and Adverse Events: A Systematic Review. Int J Prev Med 2023; 14:127. [PMID: 38264566 PMCID: PMC10803676 DOI: 10.4103/ijpvm.ijpvm_123_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 10/27/2022] [Indexed: 01/25/2024] Open
Abstract
Hospitals, as one of most important subsectors in human societies, are responsible for providing safe and effective medical services to clients. But sometimes these hospitals are the source of injury and death in patients by creating medical errors. In this systematic review study, the application of human factor analysis and classification system (HFACS) method in the classification of medical errors was investigated. Major electronic databases including Scopus, Web of Science, and MEDLINE were searched. All studies that investigated the application of HFACS method for coding, causation, and classification of medical errors and adverse events conducted from 2001 until February 2021 were included. A total of 108 articles were found. Due to duplication, 18 studies were removed from the review list. After reading the titles and abstracts, 50 of these publications were excluded because they had objectives different from this review. The remaining 40 publications were retrieved for further assessment. Of these, 28 publications were excluded because it did not meet the inclusion criteria. Finally, 12 articles remained for the final systematic review. We found that in 65% of the selected studies, preconditions for unsafe acts have been the major causal level of medical errors and adverse events. In the majority of the studies, communication and coordination, adverse mental states, physical environment, crew resource management, and technological environment have also been recognized as the most important causal categories in this study. As a result, to prevent medical errors and adverse events, the main focus should be on controlling the preconditions for unsafe acts including personnel factors, operator conditions, and environmental factors.
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Affiliation(s)
- Mahdi Jalali
- Department of Occupational Health Engineering, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Habibollah Dehghan
- Department of Occupational Health Engineering, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ehsanollah Habibi
- Department of Occupational Health Engineering, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nima Khakzad
- School of Occupational and Public Health, Ryerson University, Toronto, Canada
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21
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Pastor-Idoate S, Mateos-Olivares M, Sobas EM, Marcos M, Toribio A, Pastor JC, Usategui Martín R. Short-Wavelength Light-Blocking Filters and Oral Melatonin Administration in Patients With Retinitis Pigmentosa: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e49196. [PMID: 37971796 PMCID: PMC10690531 DOI: 10.2196/49196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 09/27/2023] [Accepted: 10/10/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The medical community is beginning to recognize that retinitis pigmentosa (RP), due to its disabling progression, eventually leads to a reduction in the patient´s quality of life, a direct economic impact, and an increase in the burden on the health care system. There is no curative treatment for the origin of the disease, and most of the current interventions fail in reducing the associated negative psychological states, such as anxiety and depression, which lead to increased variability of vision and pose a continuous threat to the patient's independence. OBJECTIVE The aim of this study is to assess the effect of oral melatonin (OM) administration alone and combined with short-wavelength light (SWL)-blocking filters on patients with RP and test their effectiveness in improving the level of stress and sleep problems in many of these patients. METHODS We have developed a low-cost therapy protocol for patients with RP with sleep disorders and negative psychological stress. Patients will be randomized to receive a combined intervention with SWL-blocking filters and OM, SWL-blocking filters alone, or OM alone. There will also be a nonintervention arm as a control group. This study will be conducted across 2 retinal units in patients with RP with sleep disorders and high perceived stress and anxiety score reports. Patients will be assessed in the preintervention period, weekly during the 4 weeks of intervention, and then at 6 months postintervention. The primary outcomes are the differences in changes from baseline to postintervention in hormone release (α-amylase, cortisol, and melatonin) and sleep quality, as measured with the visual analog scale. Secondary outcome measures include clinical macular changes, as measured with optical coherence tomography and optical coherence tomography angiography; retinal function, as measured using the visual field and best-corrected visual acuity; sleep data collected from personal wearables; and several patient-reported variables, such as self-recorded sleep diaries, quality of life, perceived stress, and functional status. RESULTS This project is still a study protocol and has not yet started. Bibliographic research for information for its justification began in 2020, and this working group is currently seeking start-up funding. As soon as we have the necessary means, we will proceed with the registration and organization prior to the preliminary phase. CONCLUSIONS In this feasibility randomized clinical controlled trial, we will compare the effects of SWL blocking alone, administration of OM alone, and a combined intervention with both in patients with RP. We present this study so that it may be replicated and incorporated into future studies at other institutions, as well as applied to additional inherited retinal dystrophies. The goal of presenting this protocol is to aid recent efforts in reducing the impact of sleeping disorders and other psychological disorders on the quality of life in patients with RP and recovering their self-autonomy. In addition, the results of this study will represent a significant step toward developing a novel low-cost therapy for patients with RP and validating a novel therapeutic target. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/49196.
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Affiliation(s)
- Salvador Pastor-Idoate
- Institute of Applied Ophthalmobiology, University of Valladolid, Valladolid, Spain
- Department of Ophthalmology, Clinical University Hospital of Valladolid, Valladolid, Spain
- Networks of Cooperative Research oriented to Health Results, National Institute of Health Carlos III, Madrid, Spain
- European Reference Network dedicated to Rare Eye Diseases, Valladolid, Spain
| | - Milagros Mateos-Olivares
- Department of Ophthalmology, Clinical University Hospital of Valladolid, Valladolid, Spain
- Department of Ophthalmology, Clinical University Hospital of Caceres, Caceres, Spain
| | - Eva María Sobas
- Institute of Applied Ophthalmobiology, University of Valladolid, Valladolid, Spain
- Nursing School, University of Valladolid, Valladolid, Spain
| | - Miguel Marcos
- Department of Internal Medicine, University Hospital of Salamanca, Salamanca, Spain
- Institute of Biomedical Research of Salamanca, University of Salamanca, Salamanca, Spain
| | - Alfredo Toribio
- Federation of Associations of Hereditary Retinal Dystrophies in Spain, Valladolid, Spain
| | - José Carlos Pastor
- Institute of Applied Ophthalmobiology, University of Valladolid, Valladolid, Spain
- Networks of Cooperative Research oriented to Health Results, National Institute of Health Carlos III, Madrid, Spain
- European Reference Network dedicated to Rare Eye Diseases, Valladolid, Spain
| | - Ricardo Usategui Martín
- Institute of Applied Ophthalmobiology, University of Valladolid, Valladolid, Spain
- Department of Cellular Biology, Faculty of Medicine, University of Valladolid, Valladolid, Spain
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Amador-Fernández N, Matthey-de-l’Endroit J, Berger J. Factors Influencing the Implementation of a New Pharmacist Prescribing Service in Community Pharmacies. Pharmacy (Basel) 2023; 11:173. [PMID: 37987383 PMCID: PMC10661259 DOI: 10.3390/pharmacy11060173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/09/2023] [Accepted: 11/01/2023] [Indexed: 11/22/2023] Open
Abstract
The pharmacist prescribing service was legally permitted in 2019 in Switzerland to face challenges in the health system; however, there has been a lack of implementation. The aims of this study were to identify implementation factors and to evaluate pharmacy association interventions that aim to support implementation. A qualitative study with two methods was carried out: (1) twelve semi-structured interviews with community pharmacists were recorded, transcribed, and a thematic analysis was carried out using the Consolidated Framework of Implementation Research (CFIR); (2) questionnaires were submitted to the six pharmacy associations of French-speaking Switzerland. The main barriers found were non-reimbursement by health insurance companies, medications' lack of clinical relevance, a negative perception of GPs, and a lack of time. The main facilitators were the availability of service information, pharmacies belonging to chains/groups, a reduction in the medical consultation burden, and the accessibility of pharmacies. Five associations answered, revealing different initiatives supporting implementation, but none of them had strategies at the political level nor communication strategies aimed at patients or GPs. Based on the CFIR, the most frequent implementation factors were highlighted, and this classification facilitates the transposition of the results to other contexts. The results will allow the development of targeted strategies and add the role of the pharmacy associations, which should be considered in future studies.
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Affiliation(s)
- Noelia Amador-Fernández
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 1011 Lausanne, Switzerland
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney (UTS), 2007 Sydney, Australia
| | - Julie Matthey-de-l’Endroit
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 1011 Lausanne, Switzerland
| | - Jérôme Berger
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 1011 Lausanne, Switzerland
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23
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Snegireva YY, Ananchenkova PI, Seyfieva EN, Kovaleva IP, Strizhak MS. [The modern mechanisms of integration of medical organizations in health care system]. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med 2023; 31:1402-1407. [PMID: 38142342 DOI: 10.32687/0869-866x-2023-31-6-1402-1407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/30/2023] [Indexed: 12/25/2023]
Abstract
The article considers mechanisms of cooperation of medical organizations of various forms of property, intersectoral interaction with purpose to unify resources of organizations to resolve established tasks, to form large medical clusters and to organize interaction of medical organizations with recreation structures. The actuality of issue is conditioned by the fact that population health is the most important value of society. This value is ultimate condition of prosperity and well-being of any state and depends on quality of medical care and efficiency of functioning of medical care system. In many countries occurs search for new mechanisms permitting to increase quality of medical care and its accessibility. The issues of interaction private sector with state system of financing of health care and state medical organizations, including development of integration mechanisms in health care system with private medicine potentials to update health care system is agenda priority. The purpose of the study is to consider modern mechanisms of integration of organizations in health care system and practical involvement into action.
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Affiliation(s)
- Yu Yu Snegireva
- N. A. Semashko National Research Institute of Public Health, 105064, Moscow, Russia,
| | - P I Ananchenkova
- N. A. Semashko National Research Institute of Public Health, 105064, Moscow, Russia
| | - E N Seyfieva
- The Novorossiysk Branch of The Federal State Educational Budget Institution "The Financial University under the Government of the Russian Federation", 353907, Novorossiysk, Russia
| | - I P Kovaleva
- The Novorossiysk Branch of The Federal State Educational Budget Institution "The Financial University under the Government of the Russian Federation", 353907, Novorossiysk, Russia
| | - M S Strizhak
- The Novorossiysk Branch of The Federal State Educational Budget Institution "The Financial University under the Government of the Russian Federation", 353907, Novorossiysk, Russia
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24
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Götz K. Explaining the health system in a practical way - the use of a simulation game in medical sociology teaching. GMS J Med Educ 2023; 40:Doc57. [PMID: 37881520 PMCID: PMC10594036 DOI: 10.3205/zma001639] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/09/2023] [Accepted: 07/18/2023] [Indexed: 10/27/2023]
Abstract
Objective A simulation game is a valuable method for conveying teaching content in a practical way. The aim was to design a teaching module for medical sociology on the subject of "The German health care system" which would convey the contents and connections to the students in a practical way using a simulation game. Project description In addition to the development of scenarios for the simulation game, role cards for various institutions of the health care system were also produced as a result. The students were given the opportunity beforehand to work on theoretical content regarding the German health care system online (the "flipped classroom method"). In the 90-minute face-to-face event the simulation game was played, followed by a feedback session. The initial impressions of the students were collected. Results In the 2022 summer semester, a total of 185 students from the 4th pre-clinical semester took part in the seminar. The students were divided into twelve seminars. One scenario was worked on per seminar. The simulation game contributed to a better understanding of the health care system. The students were generally very satisfied with this type of knowledge transfer and thought that this method might well be integrated into teaching in the future. Conclusion Communicating the health care system through a simulation game is evidently suitable for explaining clearly complex issues and presenting the various interests of the individual institutions. In addition, a simulation game stimulates critical debate and can contribute to imparting theoretical content in teaching medical sociology in a practical way.
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Affiliation(s)
- Katja Götz
- University Hospital Schleswig-Holstein, Campus Lübeck, Institute of Family Medicine, Lübeck, Germany
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25
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Bie Bogh S, Fryd Birkeland S, Maj-Britt Hansen S, Alexandrovna Tchijevitch O, Hallas J, Morsø L. Harnessing patient complaints to systematically monitoring healthcare concerns through disproportionality analysis. Int J Qual Health Care 2023; 35:mzad062. [PMID: 37556110 DOI: 10.1093/intqhc/mzad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/12/2023] [Accepted: 08/07/2023] [Indexed: 08/10/2023] Open
Abstract
Staff observations are the most common source of data for driving improvements in care. However, the patient perspective should also be considered, and healthcare complaints offer concrete details that health organizations might otherwise overlook and that can highlight areas for learning and improvement in the healthcare system. However, because of the diverse nature of patient complaints, systematic analyses can be challenging. This study aimed to identify and prioritize areas for improvement using a data-driven approach to analysing patient complaints. The Danish version of the Healthcare Complaints Analysis Tool was used to categorize the content of complaint letters. All complaints managed by the national complaints authority, compensation claims to the Patient Compensation Association, and locally managed complaints that were filed directly at Odense University Hospital from 2017 to 2021 were included. Proportional reporting ratios (PRRs) were used to measure and display the top five signals of disproportionality and rank them by excess complaints at the hospital level and when divided into department types. The study included 6366 complaints containing 13 156 problems (on average, 2.1 problems mentioned per complaint letter). Surgical departments had the highest number of complaints (3818), followed by medical (1059), service (439), and emergency departments (239). Signal 1 of disproportionality, relating to quality problems during ward procedures, had the highest excess reporting of 1043 complaints at the hospital level and a PRR of 1.61 and was present in all department types. Signal 2, relating to safety problems during the examination and diagnosis stage, had an excess reporting of 699 problems and a PRR of 1.86 and was also present in all department types. Signal 3, relating to institutional problems during admission, had the highest PRR of 3.54 and was found in most department types. Signals 4 and 5, relating to environmental problems during ward procedures and care on the ward, respectively, had PRRs of 1.5 and 1.84 and were present in most department types. The study found that analysing patient complaints can identify potential areas for hospital improvement. The study identified recurring issues in multiple departments, including quality problems during ward procedures, safety problems during the examination, institutional problems during admission, and environmental problems on the ward. The study highlights disproportionality analysis of complaints as a valuable tool to monitor patient concerns systematically.
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Affiliation(s)
- Søren Bie Bogh
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19,3, Odense, Syddanmark 5000, Denmark
- Odense University Hospital, Region of Southern Denmark, J.B. Winsløws Vej 19,3, 5000, Denmark
| | - Søren Fryd Birkeland
- Odense University Hospital, Region of Southern Denmark, J.B. Winsløws Vej 19,3, 5000, Denmark
- Department of Regional Health Research, Faculty of Health Science, Forensic Mental Health Research Unit Middelfart (RFM), University of Southern Denmark, J.B. Winsløws Vej 19,3, Odense 5000, Denmark
- Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Østre Hougvej 70, Middelfart 5500, Denmark
| | - Sebrina Maj-Britt Hansen
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19,3, Odense, Syddanmark 5000, Denmark
| | - Olga Alexandrovna Tchijevitch
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19,3, Odense, Syddanmark 5000, Denmark
| | - Jesper Hallas
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, J.B. Winsløws Vej 19,3, Odense, Denmark
| | - Lars Morsø
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19,3, Odense, Syddanmark 5000, Denmark
- Odense University Hospital, Region of Southern Denmark, J.B. Winsløws Vej 19,3, 5000, Denmark
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Nasim R, Tisha JF, Dewan SMR. Only COVID-19 and not all infectious diseases are of concern: A timely observation. Health Sci Rep 2023; 6:e1589. [PMID: 37752978 PMCID: PMC10519133 DOI: 10.1002/hsr2.1589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Affiliation(s)
- Rehnuma Nasim
- Department of Pharmacy, School of MedicineUniversity of Asia PacificDhakaBangladesh
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Ayling OGS, Ailon T, Craig M, Dea N, McIntosh G, Abraham E, Jacobs WB, Johnson MG, Paquet J, Yee A, Hall H, Bailey C, Manson N, Rampersaud YR, Thomas K, Fisher CG. Patient-Reported Outcomes Following Surgery for Lumbar Disc Herniation: Comparison of a Universal and Multitier Health Care System. Global Spine J 2023; 13:1695-1702. [PMID: 34569331 PMCID: PMC10556920 DOI: 10.1177/21925682211046961] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Ambispective cohort study. OBJECTIVE Canada has a government-funded universal health care system. The United States utilizes a multitier public and private system. The objective is to investigate differences in clinical outcomes between those surgically treated for lumbar disc herniation in a universal health care and multitier health system. METHODS Surgical lumbar disc herniation patients enrolled in the Canadian Spine Outcome Research Network (CSORN) were compared with the surgical cohort enrolled in the Spine Patients Outcome Research Trial (SPORT) study. Baseline demographics and spine-related patient-reported outcomes (PROs) were compared at 3 months and 1 year post-operatively. RESULTS The CSORN cohort consisted of 443 patients; the SPORT cohort had 763 patients. Patients in the CSORN cohort were older (46.4 ± 13.5 vs 41.0 ± 10.8, P < .001) and were more likely to be employed (69.5% vs 60.3%, P = .003). The CSORN cohort demonstrated significantly greater rates of satisfaction after surgery at 3 months (87.2% vs 64.8%, P < .0001) and 1 year (85.6% vs 69.6%, P < .0001). Improvements in back and leg pain followed similar trajectories in the two cohorts, but there was less improvement on ODI in the CSORN cohort (P < .01). On multivariable logistic regression, the CSORN cohort was a significant independent predictor of patient satisfaction at 1-year follow-up (P < .001). CONCLUSIONS Despite less improvement on ODI, patients enrolled in CSORN, as part of a universal health care system, reported higher rates of satisfaction at 3 months and 1 year post-operatively compared to patients enrolled within a multitier health system.
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Affiliation(s)
- Oliver GS Ayling
- Vancouver General Hospital/University of British Columbia, Vancouver, BC, Canada
| | - Tamir Ailon
- Vancouver General Hospital/University of British Columbia, Vancouver, BC, Canada
| | - Michael Craig
- Vancouver General Hospital/University of British Columbia, Vancouver, BC, Canada
| | - Nicolas Dea
- Vancouver General Hospital/University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | | | - Albert Yee
- University of Toronto, Toronto, ON, Canada
| | | | | | - Neil Manson
- Canada East Spine Centre, Saint John, NB, Canada
| | | | | | - Charles G Fisher
- Vancouver General Hospital/University of British Columbia, Vancouver, BC, Canada
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28
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Aspö M, Visser LNC, Kivipelto M, Boström AM, Seiger Cronfalk B. Family Members' Experiences of Young-Onset Dementia: Becoming Responsible Yet Feeling Powerless. J Multidiscip Healthc 2023; 16:2379-2390. [PMID: 37609051 PMCID: PMC10441645 DOI: 10.2147/jmdh.s418285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/05/2023] [Indexed: 08/24/2023] Open
Abstract
Purpose Dementia is often associated with old age but can also occur in midlife. The latter is commonly referred to as young-onset dementia (YOD). The diagnosis not only has an impact on the persons with YOD but also on their family members. For family members, the diagnosis changes their lives, as responsibilities and roles alter when the care and wellbeing of the relative increasingly come into focus. The aim of this study was to explore family members' experiences of sharing lives with a relative diagnosed with YOD - from onset of symptoms until the person relocated to a nursing home. Patients and Methods The study has a qualitative approach with in-depth interviews. In total, the study included 15 family members aged ≥18 years participated, all with a relative diagnosed with dementia before the age of 65. At the time of the interview, all had a relative living in a nursing home. The interviews were analyzed using thematic analysis. Results Two key themes were identified: Becoming responsible and Dealing with the situation. Family members found themselves increasingly responsible for many parts of their relatives' lives and forced to make decisions on their behalf. This was experienced as being lonely, as family members wished to share their responsibility. Despite of their efforts to control and deal with their situation, family members reported a lack of power to influence certain factors, such as access to appropriate healthcare services, causing feelings of distress. Conclusion These findings emphasize the need of improved and tailored support and guidance for family members of persons with YOD. Further, the findings highlight the importance of increased knowledge and awareness among social workers and other healthcare professionals regarding support to family members of persons with YOD.
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Affiliation(s)
- Malin Aspö
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Leonie N C Visser
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Psychology, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
- Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, UK
- Stockholms Sjukhem, Research & Development Unit, Stockholm, Sweden
| | - Anne-Marie Boström
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
- Stockholms Sjukhem, Research & Development Unit, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Berit Seiger Cronfalk
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
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29
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Mueller C, Herrmann P, Cichos S, Remes B, Junker E, Hastenteufel T, Mundhenke M. Automated Electronic Health Record to Electronic Data Capture Transfer in Clinical Studies in the German Health Care System: Feasibility Study and Gap Analysis. J Med Internet Res 2023; 25:e47958. [PMID: 37540555 PMCID: PMC10439471 DOI: 10.2196/47958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Data transfer between electronic health records (EHRs) at the point of care and electronic data capture (EDC) systems for clinical research is still mainly carried out manually, which is error-prone as well as cost- and time-intensive. Automated digital transfer from EHRs to EDC systems (EHR2EDC) would enable more accurate and efficient data capture but has so far encountered technological barriers primarily related to data format and the technological environment: in Germany, health care data are collected at the point of care in a variety of often individualized practice management systems (PMSs), most of them not interoperable. Data quality for research purposes within EDC systems must meet the requirements of regulatory authorities for standardized submission of clinical trial data and safety reports. OBJECTIVE We aimed to develop a model for automated data transfer as part of an observational study that allows data of sufficient quality to be captured at the point of care, extracted from various PMSs, and automatically transferred to electronic case report forms in EDC systems. This required addressing aspects of data security, as well as the lack of compatibility between EHR health care data and the data quality required in EDC systems for clinical research. METHODS The SaniQ software platform (Qurasoft GmbH) is already used to extract and harmonize predefined variables from electronic medical records of different Compu Group Medical-hosted PMSs. From there, data are automatically transferred to the validated AlcedisTRIAL EDC system (Alcedis GmbH) for data collection and management. EHR2EDC synchronization occurs automatically overnight, and real-time updates can be initiated manually following each data entry in the EHR. The electronic case report form (eCRF) contains 13 forms with 274 variables. Of these, 5 forms with 185 variables contain 67 automatically transferable variables (67/274, 24% of all variables and 67/185, 36% of eligible variables). RESULTS This model for automated data transfer bridges the current gap between clinical practice data capture at the point of care and the data sets required by regulatory agencies; it also enables automated EHR2EDC data transfer in compliance with the General Data Protection Regulation (GDPR). It addresses feasibility, connectivity, and system compatibility of currently used PMSs in health care and clinical research and is therefore directly applicable. CONCLUSIONS This use case demonstrates that secure, consistent, and automated end-to-end data transmission from the treating physician to the regulatory authority is feasible. Automated data transmission can be expected to reduce effort and save resources and costs while ensuring high data quality. This may facilitate the conduct of studies for both study sites and sponsors, thereby accelerating the development of new drugs. Nevertheless, the industry-wide implementation of EHR2EDC requires policy decisions that set the framework for the use of research data based on routine PMS data.
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Pham Q, Wong D, Pfisterer KJ, Aleman D, Bansback N, Cafazzo JA, Casson AJ, Chan B, Dixon W, Kakaroumpas G, Lindner C, Peek N, Potts HW, Ribeiro B, Seto E, Stockton-Powdrell C, Thompson A, van der Veer S. The Complexity of Transferring Remote Monitoring and Virtual Care Technology Between Countries: Lessons From an International Workshop. J Med Internet Res 2023; 25:e46873. [PMID: 37526964 PMCID: PMC10427929 DOI: 10.2196/46873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/25/2023] [Accepted: 05/31/2023] [Indexed: 08/02/2023] Open
Abstract
International deployment of remote monitoring and virtual care (RMVC) technologies would efficiently harness their positive impact on outcomes. Since Canada and the United Kingdom have similar populations, health care systems, and digital health landscapes, transferring digital health innovations between them should be relatively straightforward. Yet examples of successful attempts are scarce. In a workshop, we identified 6 differences that may complicate RMVC transfer between Canada and the United Kingdom and provided recommendations for addressing them. These key differences include (1) minority groups, (2) physical geography, (3) clinical pathways, (4) value propositions, (5) governmental priorities and support for digital innovation, and (6) regulatory pathways. We detail 4 broad recommendations to plan for sustainability, including the need to formally consider how highlighted country-specific recommendations may impact RMVC and contingency planning to overcome challenges; the need to map which pathways are available as an innovator to support cross-country transfer; the need to report on and apply learnings from regulatory barriers and facilitators so that everyone may benefit; and the need to explore existing guidance to successfully transfer digital health solutions while developing further guidance (eg, extending the nonadoption, abandonment, scale-up, spread, sustainability framework for cross-country transfer). Finally, we present an ecosystem readiness checklist. Considering these recommendations will contribute to successful international deployment and an increased positive impact of RMVC technologies. Future directions should consider characterizing additional complexities associated with global transfer.
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Affiliation(s)
- Quynh Pham
- Centre for Digital Therapeutics, University Health Network, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Tefler School of Management, University of Ottawa, Ottawa, ON, Canada
| | - David Wong
- Department of Computer Science, The University of Manchester, Manchester, United Kingdom
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Kaylen J Pfisterer
- Centre for Digital Therapeutics, University Health Network, Toronto, ON, Canada
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Dionne Aleman
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Nick Bansback
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Joseph A Cafazzo
- Centre for Digital Therapeutics, University Health Network, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Alexander J Casson
- Department of Electrical and Electronic Engineering, The University of Manchester, Manchester, United Kingdom
- EPSRC Henry Royce Institute, Manchester, United Kingdom
| | - Brian Chan
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - William Dixon
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
| | - Gerasimos Kakaroumpas
- Alliance Manchester Business School, The University of Manchester, Manchester, United Kingdom
| | - Claudia Lindner
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Niels Peek
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Henry Ww Potts
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Barbara Ribeiro
- Manchester Institute of Innovation Research, Alliance Manchester Business School, The University of Manchester, Manchester, United Kingdom
| | - Emily Seto
- Centre for Digital Therapeutics, University Health Network, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Charlotte Stockton-Powdrell
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Alexander Thompson
- Manchester Centre for Health Economics, Division of Population Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Sabine van der Veer
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
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Bernardi FA, Mello de Oliveira B, Bettiol Yamada D, Artifon M, Schmidt AM, Machado Scheibe V, Alves D, Félix TM. The Minimum Data Set for Rare Diseases: Systematic Review. J Med Internet Res 2023; 25:e44641. [PMID: 37498666 PMCID: PMC10415943 DOI: 10.2196/44641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/24/2023] [Accepted: 06/27/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND The minimum data set (MDS) is a collection of data elements to be grouped using a standard approach to allow the use of data for clinical and research purposes. Health data are typically voluminous, complex, and sometimes too ambiguous to generate indicators that can provide knowledge and information on health. This complexity extends further to the rare disease (RD) domain. MDSs are essential for health surveillance as they help provide services and generate recommended population indicators. There is a bottleneck in international literature that reveals a global problem with data collection, recording, and structuring in RD. OBJECTIVE This study aimed to identify and analyze the MDSs used for RD in health care networks worldwide and compare them with World Health Organization (WHO) guidelines. METHODS The population, concept, and context methodology proposed by the Joanna Briggs Institute was used to define the research question of this systematic review. A total of 4 databases were reviewed, and all the processes were reported using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. The data elements were analyzed, extracted, and organized into 10 categories according to WHO digital health guidelines. The quality assessment used the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist. RESULTS We included 20 studies in our review, 70% (n=14) of which focused on a specific health domain and 30% (n=6) of which referred to RD in general. WHO recommends that health systems and networks use standard terminology to exchange data, information, knowledge, and intelligence in health. However, there was a lack of terminological standardization of the concepts in MDSs. Moreover, the selected studies did not follow the same standard structure for classifying the data from their MDSs. All studies presented MDSs with limitations or restrictions because they covered only a specific RD, or their scope of application was restricted to a specific context or geographic region. Data science methods and clinical experience were used to design, structure, and recommend a fundamental global MDS for RD patient records in health care networks. CONCLUSIONS Our study highlights the difficulties in standardizing and categorizing findings from MDSs for RD because of the varying structures used in different studies. The fundamental RD MDS designed in this study comprehensively covers the data needs in the clinical and management sectors. These results can help public policy makers support other aspects of their policies. We highlight the potential of our results to help strategic decisions related to RD. TRIAL REGISTRATION PROSPERO CRD42021221593; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=221593. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1016/j.procs.2021.12.034.
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Affiliation(s)
- Filipe Andrade Bernardi
- Health Intelligence Laboratory, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
- Brazilian Rare Disease Network, Porto Alegre, Brazil
| | - Bibiana Mello de Oliveira
- Brazilian Rare Disease Network, Porto Alegre, Brazil
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Diego Bettiol Yamada
- Health Intelligence Laboratory, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
- Brazilian Rare Disease Network, Porto Alegre, Brazil
| | - Milena Artifon
- Brazilian Rare Disease Network, Porto Alegre, Brazil
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Amanda Maria Schmidt
- Brazilian Rare Disease Network, Porto Alegre, Brazil
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Victória Machado Scheibe
- Brazilian Rare Disease Network, Porto Alegre, Brazil
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
- Faculty of Medicine, Lutheran University of Brazil, Canoas, Brazil
| | - Domingos Alves
- Health Intelligence Laboratory, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
- Brazilian Rare Disease Network, Porto Alegre, Brazil
| | - Têmis Maria Félix
- Brazilian Rare Disease Network, Porto Alegre, Brazil
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
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Amlaev KR, Mazharov VN, Zafirova VB. [The brief characteristic of certain aspects of functioning of health care systems of Iran and the United Arab Emirates (a review)]. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med 2023; 31:645-650. [PMID: 37642110 DOI: 10.32687/0869-866x-2023-31-4-645-650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/13/2023] [Indexed: 08/31/2023]
Abstract
The article presents review of publications and national reports concerning various aspects of functioning of health care systems of Iran and the UAE. It is noted that the state in these countries plays different role in supporting population with medical care. It is larger and more significant in Iran than in the UAE. At that, private medical organizations dominate in health care of both countries in area of out-patient care (in the UAE it expressed more intensively). The analysis of medical insurance demonstrated that in the UAE insurance systems and accessibility of medical care for citizens and expatriates differ significantly. It is emphasized that quality and accessibility of medical care in Iran was impacted by international sanctions that in the first place affected provision of patients with imported medicines. The characteristics of these health care systems include the transfer of functions of provision of medical and educational services to medical universities in Iran and implementation of mandatory private health insurance in the UAE.
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Affiliation(s)
- K R Amlaev
- The Federal State Budget Educational Institution of Higher Education "The Stavropol State Medical University" of Minzdrav of Russia, 355017, Stavropol, Russia,
| | - V N Mazharov
- The Federal State Budget Educational Institution of Higher Education "The Stavropol State Medical University" of Minzdrav of Russia, 355017, Stavropol, Russia
| | - V B Zafirova
- The Federal State Budget Educational Institution of Higher Education "The Stavropol State Medical University" of Minzdrav of Russia, 355017, Stavropol, Russia
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Nelson W, Khanna N, Ibrahim M, Fyfe J, Geiger M, Edwards K, Petch J. Optimizing Patient Record Linkage in a Master Patient Index Using Machine Learning: Algorithm Development and Validation. JMIR Form Res 2023; 7:e44331. [PMID: 37384382 PMCID: PMC10365597 DOI: 10.2196/44331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/03/2023] [Accepted: 05/30/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND To provide quality care, modern health care systems must match and link data about the same patient from multiple sources, a function often served by master patient index (MPI) software. Record linkage in the MPI is typically performed manually by health care providers, guided by automated matching algorithms. These matching algorithms must be configured in advance, such as by setting the weights of patient attributes, usually by someone with knowledge of both the matching algorithm and the patient population being served. OBJECTIVE We aimed to develop and evaluate a machine learning-based software tool, which automatically configures a patient matching algorithm by learning from pairs of patient records previously linked by humans already present in the database. METHODS We built a free and open-source software tool to optimize record linkage algorithm parameters based on historical record linkages. The tool uses Bayesian optimization to identify the set of configuration parameters that lead to optimal matching performance in a given patient population, by learning from prior record linkages by humans. The tool is written assuming only the existence of a minimal HTTP application programming interface (API), and so is agnostic to the choice of MPI software, record linkage algorithm, and patient population. As a proof of concept, we integrated our tool with SantéMPI, an open-source MPI. We validated the tool using several synthetic patient populations in SantéMPI by comparing the performance of the optimized configuration in held-out data to SantéMPI's default matching configuration using sensitivity and specificity. RESULTS The machine learning-optimized configurations correctly detect over 90% of true record linkages as definite matches in all data sets, with 100% specificity and positive predictive value in all data sets, whereas the baseline detects none. In the largest data set examined, the baseline matching configuration detects possible record linkages with a sensitivity of 90.2% (95% CI 88.4%-92.0%) and specificity of 100%. By comparison, the machine learning-optimized matching configuration attains a sensitivity of 100%, with a decreased specificity of 95.9% (95% CI 95.9%-96.0%). We report significant gains in sensitivity in all data sets examined, at the cost of only marginally decreased specificity. The configuration optimization tool, data, and data set generator have been made freely available. CONCLUSIONS Our machine learning software tool can be used to significantly improve the performance of existing record linkage algorithms, without knowledge of the algorithm being used or specific details of the patient population being served.
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Affiliation(s)
- Walter Nelson
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, ON, Canada
- Department of Statistical Sciences, University of Toronto, Toronto, ON, Canada
| | - Nityan Khanna
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Mohamed Ibrahim
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, ON, Canada
| | | | - Maxwell Geiger
- Department of Biology, University of Hawaii, Hilo, HI, United States
| | - Keith Edwards
- Department of Computer Science, University of Hawaii, Hilo, HI, United States
| | - Jeremy Petch
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
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Hoover J, Bolton P, Clonchmore A, Sussman L, Frymus D. Responding to the impact of COVID-19 on the mental health and well-being of health workers in LMICs. Glob Ment Health (Camb) 2023; 10:e41. [PMID: 37854419 PMCID: PMC10579644 DOI: 10.1017/gmh.2023.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/02/2023] [Accepted: 06/14/2023] [Indexed: 10/20/2023] Open
Abstract
The COVID-19 pandemic has worsened mental health among health workers around the world. With a projected global shortage of 10.2 million health workers by 2030, further exacerbated by COVID-19, taking action to support health worker mental health needs to be an integral component of investments to overcome this gap and build resiliency of systems for the future. Health workers are functioning in highly stressful environments at great personal risk to provide services that improve quality of life and save lives. To reduce burnout and early exits from the workforce, health workers must be protected and equipped to work in supportive environments, manage stress, and access mental health services when needed. This article explores the impact of COVID-19 on health worker mental health and proposes actions for health systems and workplaces to support health workers which draw on available evidence and examples of USAID-supported partner activities.
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Affiliation(s)
- Jerilyn Hoover
- Office of HIV/AIDS, U.S. Agency for International Development, Washington, DC, USA
| | - Paul Bolton
- Inclusive Development Hub, Bureau for Development, Democracy, and Innovation, U.S. Agency for International Development, Washington, DC, USA
| | - Ashley Clonchmore
- Office of HIV/AIDS, Credence Management Solutions, LLC, Global Health Training, Advisory, and Support Contract at the U.S. Agency for International Development, Vienna, VA, USA
| | - Linda Sussman
- (Formerly) Office of Population and Reproductive Health (PRH), Bureau of Global Health, U.S. Agency for International Development, Washington, DCUSA
| | - Diana Frymus
- Office of HIV/AIDS, U.S. Agency for International Development, Washington, DC, USA
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Babiker S, Ogunmwonyi I, Georgi MW, Tan L, Haque S, Mullins W, Singh P, Ang N, Fu H, Patel K, Khera J, Fricker M, Fleming S, Giwa-Brown L, A Brennan P, Irune E, Vig S, Nathan A. Variation in Experiences and Attainment in Surgery Between Ethnicities of UK Medical Students and Doctors (ATTAIN): Protocol for a Cross-Sectional Study. JMIR Res Protoc 2023; 12:e40545. [PMID: 37327055 DOI: 10.2196/40545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 04/18/2023] [Accepted: 05/03/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND The unequal distribution of academic and professional outcomes between different minority groups is a pervasive issue in many fields, including surgery. The implications of differential attainment remain significant, not only for the individuals affected but also for the wider health care system. An inclusive health care system is crucial in meeting the needs of an increasingly diverse patient population, thereby leading to better outcomes. One barrier to diversifying the workforce is the differential attainment in educational outcomes between Black and Minority Ethnic (BME) and White medical students and doctors in the United Kingdom. BME trainees are known to have lower performance rates in medical examinations, including undergraduate and postgraduate exams, Annual Review of Competence Progression, as well as training and consultant job applications. Studies have shown that BME candidates have a higher likelihood of failing both parts of the Membership of the Royal Colleges of Surgeons exams and are 10% less likely to be considered suitable for core surgical training. Several contributing factors have been identified; however, there has been limited evidence investigating surgical training experiences and their relationship to differential attainment. To understand the nature of differential attainment in surgery and to develop effective strategies to address it, it is essential to examine the underlying causes and contributing factors. The Variation in Experiences and Attainment in Surgery Between Ethnicities of UK Medical Students and Doctors (ATTAIN) study aims to describe and compare the factors and outcomes of attainment between different ethnicities of doctors and medical students. OBJECTIVE The primary aim will be to compare the effect of experiences and perceptions of surgical education of students and doctors of different ethnicities. METHODS This protocol describes a nationwide cross-sectional study of medical students and nonconsultant grade doctors in the United Kingdom. Participants will complete a web-based questionnaire collecting data on experiences and perceptions of surgical placements as well as self-reported academic attainment data. A comprehensive data collection strategy will be used to collect a representative sample of the population. A set of surrogate markers relevant to surgical training will be used to establish a primary outcome to determine variations in attainment. Regression analyses will be used to identify potential causes for the variation in attainment. RESULTS Data collected between February 2022 and September 2022 yielded 1603 respondents. Data analysis is yet to be competed. The protocol was approved by the University College London Research Ethics Committee on September 16, 2021 (ethics approval reference 19071/004). The findings will be disseminated through peer-reviewed publications and conference presentations. CONCLUSIONS Drawing upon the conclusions of this study, we aim to make recommendations on educational policy reforms. Additionally, the creation of a large, comprehensive data set can be used for further research. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/40545.
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Affiliation(s)
| | | | - Maria W Georgi
- University College London Medical School, London, United Kingdom
| | | | - Sharmi Haque
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - William Mullins
- St Georges University Hospital National Health Service Trust, London, United Kingdom
| | - Prisca Singh
- University of Birmingham Medical School, Birmingham, United Kingdom
| | - Nadya Ang
- Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Howell Fu
- South West London Elective Orthopaedic Centre, London, United Kingdom
| | - Krunal Patel
- University College London Medical School, London, United Kingdom
| | - Jevan Khera
- University Hospital Coventry & Warwickshire, Coventry, United Kingdom
| | | | - Simon Fleming
- Institute of Health Sciences Education, Queen Mary University of London, London, United Kingdom
| | - Lolade Giwa-Brown
- Barts Health National Health Service Trust, Royal London Hospital, London, United Kingdom
| | - Peter A Brennan
- Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Ekpemi Irune
- Department of Otolaryngology, Head and Neck Surgery, Cambridge University Hospitals National Health Service Foundation, Cambridge, United Kingdom
| | - Stella Vig
- Department of Vascular and General Surgery, Croydon University Hospital, London, United Kingdom
| | - Arjun Nathan
- Division of Surgery and Interventional Sciences, University College London, London, United Kingdom
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Berg KA, DeRenzo M, Carpiano RM, Lowenstein I, Perzynski AT. Go-along interview assessment of community health priorities for neighborhood renewal. Am J Community Psychol 2023; 71:437-452. [PMID: 36947385 DOI: 10.1002/ajcp.12661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 01/05/2023] [Accepted: 02/02/2023] [Indexed: 06/06/2023]
Abstract
Healthcare systems are increasingly investing in approaches to address social determinants of health and health disparities. Such initiatives dovetail with certain approaches to neighborhood development, such as the EcoDistrict standard for community development, that prioritize both ecologically and socially sustainable neighborhoods. However, healthcare system and community development initiatives can be untethered from the preferences and lived realities of residents in the very neighborhoods upon which they focus. Utilizing the go-along approach to collecting qualitative data in situ, we interviewed 19 adults to delineate residents' community health perspectives and priorities. Findings reveal health priorities distinct from clinical outcomes, with residents emphasizing social connectedness, competing intra- and interneighborhood perceptions that potentially thwart social connectedness, and a neighborhood emplacement of agency, dignity, and self-worth. Priorities of healthcare systems and community members alike must be accounted for to optimize efforts that promote health and social well-being by being valid and meaningful to the community of focus.
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Affiliation(s)
- Kristen A Berg
- Center for Health Care Research and Policy, The MetroHealth System, Cleveland, Ohio, USA
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Maria DeRenzo
- Center for Health Care Research and Policy, The MetroHealth System, Cleveland, Ohio, USA
| | - Richard M Carpiano
- School of Public Policy, University of California, Riverside, California, USA
- Department of Sociology, University of California, Riverside, California, USA
- Center for Healthy Communities, University of California, Riverside, California, USA
| | | | - Adam T Perzynski
- Center for Health Care Research and Policy, The MetroHealth System, Cleveland, Ohio, USA
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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Tabatabaei-Jafari H, Bagheri N, Lueck C, Furst MA, Salinas-Perez JA, Salvador-Carulla L. Standardized Systematic Description of Provision of Care for Multiple Sclerosis at a Local Level: A Demonstration Study. Int J MS Care 2023; 25:124-130. [PMID: 37250197 PMCID: PMC10211356 DOI: 10.7224/1537-2073.2022-014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND This study evaluates and describes the pattern of services provided for people living with multiple sclerosis (MS) in a local area as a starting point for a more global assessment. METHODS A health care ecosystem approach has been followed using an internationally standardized service classification instrument-the Description and Evaluation of Services and DirectoriEs for Long Term Care (DESDE-LTC)-to identify and describe all services providing care to people with MS in the Australian Capital Territory, Australia. Available services were classified according to the target population into those specifically dedicated to people living with MS and those providing general neurologic services, both public and private, and across both social and health sectors. RESULTS A limited range of services was available. There were no local facilities providing or coordinating multidisciplinary integrated care specific to people with MS. Subspecialty services specific to MS were limited in number (6 of the 28 services), and use of specialist services provided in neighboring states was frequently reported. Overall, very few services were provided outside the core health sector (4%). CONCLUSIONS The provision of care to people living with MS in the Australian Capital Territory is fragmented and relies heavily on generic neurology services in the public and private sectors. More widespread use of the DESDE-LTC as a standardized method of service classification in MS will facilitate comparison with other local areas, allow monitoring of changes over time, and permit comparison with services provided for other health conditions (eg, dementia, mental disorders).
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Affiliation(s)
- Hossein Tabatabaei-Jafari
- From the Mental Health Policy Unit, Health Research Institute, Faculty of Health, University of Canberra, Canberra, ACT, Australia (HT-J, NB, MAF, JAS, LS-C)
| | - Nasser Bagheri
- From the Mental Health Policy Unit, Health Research Institute, Faculty of Health, University of Canberra, Canberra, ACT, Australia (HT-J, NB, MAF, JAS, LS-C)
| | - Christian Lueck
- From the Mental Health Policy Unit, Health Research Institute, Faculty of Health, University of Canberra, Canberra, ACT, Australia (HT-J, NB, MAF, JAS, LS-C)
- Department of Neurology, Canberra Hospital, Canberra, ACT, Australia (CL)
- Australian National University Medical School, Canberra, ACT, Australia (CL)
| | - Mary Anne Furst
- From the Mental Health Policy Unit, Health Research Institute, Faculty of Health, University of Canberra, Canberra, ACT, Australia (HT-J, NB, MAF, JAS, LS-C)
| | - Jose A. Salinas-Perez
- From the Mental Health Policy Unit, Health Research Institute, Faculty of Health, University of Canberra, Canberra, ACT, Australia (HT-J, NB, MAF, JAS, LS-C)
- Department of Quantitative Methods, Loyola University Andalucia, Seville, Spain (JAS-P)
| | - Luis Salvador-Carulla
- From the Mental Health Policy Unit, Health Research Institute, Faculty of Health, University of Canberra, Canberra, ACT, Australia (HT-J, NB, MAF, JAS, LS-C)
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia (LS-C)
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A Shilmenova, E Otar, O Arinova, K Sokolovskiy. Credibility of Kazakhstan’s health care system and medical advice in the context of Covid-19 and vaccination: Covariation of belief and science credibility. Ethics Med Public Health 2023:100900. [ DOI: 10.1016/j.jemep.2023.100900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Background: The paper investigates the covariation of belief and science credibility in Kazakhstan in the context of Covid-19 and vaccination. Methodology: The research methodology is based on a multi-country analysis of Covid-19 indicators from a global database of Covid-19 vaccinations and the covariance of belief and science credibility was estimated in the case of Kazakhstan. Results: According to the survey, 33.5% of respondents changed their opinions in favor of vaccination, and 29.6% of those surveyed affirmed their commitment to vaccination. Furthermore, 58.8% of respondents believe that this is the only and effective way to protect themselves from Covid-19. Conclusions: Some of the main reasons for refusing to get a vaccine include contraindications (14.1%), fear of possible severe consequences (4.5%), and lack of confidence in vaccines and medicine in general (4.5%). Less than 1 percent of all respondents cited religious beliefs as the main reason for unwillingness to get vaccinated.
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Abdullahi IY, Raab R, Küderle A, Eskofier B. Aligning Federated Learning with Existing Trust Structures in Health Care Systems. Int J Environ Res Public Health 2023; 20:5378. [PMID: 37047992 PMCID: PMC10094512 DOI: 10.3390/ijerph20075378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/17/2023] [Accepted: 03/29/2023] [Indexed: 06/19/2023]
Abstract
Patient-centered health care information systems (PHSs) on peer-to-peer (P2P) networks (e.g., decentralized personal health records) enable storing data locally at the edge to enhance data sovereignty and resilience to single points of failure. Nonetheless, these systems raise concerns on trust and adoption in medical workflow due to non-alignment to current health care processes and stakeholders' needs. The distributed nature of the data makes it more challenging to train and deploy machine learning models (using traditional methods) at the edge, for instance, for disease prediction. Federated learning (FL) has been proposed as a possible solution to these limitations. However, the P2P PHS architecture challenges current FL solutions because they use centralized engines (or random entities that could pose privacy concerns) for model update aggregation. Consequently, we propose a novel conceptual FL framework, CareNetFL, that is suitable for P2P PHS multi-tier and hybrid architecture and leverages existing trust structures in health care systems to ensure scalability, trust, and security. Entrusted parties (practitioners' nodes) are used in CareNetFL to aggregate local model updates in the network hierarchy for their patients instead of random entities that could actively become malicious. Involving practitioners in their patients' FL model training increases trust and eases access to medical data. The proposed concepts mitigate communication latency and improve FL performance through patient-practitioner clustering, reducing skewed and imbalanced data distributions and system heterogeneity challenges of FL at the edge. The framework also ensures end-to-end security and accountability through leveraging identity-based systems and privacy-preserving techniques that only guarantee security during training.
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Keirns C. History of Health Policy: Explaining Complexity through Time. J Hist Med Allied Sci 2023; 78:34-45. [PMID: 36772959 DOI: 10.1093/jhmas/jrac048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
History can be a powerful tool for teaching health policy. Particularly in the United States, with its complex system of public and private payers and providers of health services, understanding the historical origins of policies, programs, and institutions makes the system's contours legible. Historical analysis may also help health care providers to navigate this system and to advocate for changes within it. The US Medical Licensing Examination (USMLE) and the Accreditation Council on Graduate Medical Education (ACGME) have curricular standards for students to understand specific aspects of health policy and "systems-based practice," and historians working within the curricular structures of US medical education may find reference to these standards useful in explaining and justifying their role in preparing medical students and resident physicians for practice. This paper explores some examples of how to use history to teach health professions students about the historical development of the US health care system, the constraints that defined how it came to be, and possibilities for reform.
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Kaitz J, DeLaughter K, Deeney C, Cutrona SL, Hogan TP, Gifford AL, Jackson GL, White B, King H, Reardon C, Nevedal A, Henderson B, Fix GM. Leveraging Organizational Conditions for Innovation: A Typology of Facility Engagement in the Veterans Health Administration Shark Tank-Style Competition. Perm J 2023:1-8. [PMID: 36946078 DOI: 10.7812/tpp/22.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Introduction The development and spread of innovation are known challenges in health care. The US Veterans Health Administration (VHA) created a "Shark Tank"-style competition directed at frontline employees. In this annual, systemwide competition, employees submit innovations to the competition, and winning innovations receive support for implementation in other facilities. Method A multiple case study design was used to understand facility engagement in the competition, and the relationship between engagement and organizational conditions. The authors created a typology to describe the relationship between facility engagement in the competition and organizational conditions for innovation. Results Overall, there was high participation in the VHA's competition across all 130 facilities. The authors identified 7 mutually exclusive types of facility engagement. Discussion As expected, facilities with the most established conditions for innovation were the most engaged in the competition. Additionally, other facilities had various ways to be involved. Consequently, there may be benefit to the VHA tailoring how they work with facilities, based on organizational conditions. Larger facilities with ongoing research and more resources may be more suited to develop innovations, whereas smaller facilities could benefit from a focus on adoption. Conclusion These insights are valuable to the VHA and can be used by other health care systems to tailor innovation programs and allocate resources based on diverse needs across a vast health care system.
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Affiliation(s)
- Jenesse Kaitz
- Center for Healthcare Organization and Implementation Research, VA Bedford and Boston Healthcare Systems, Bedford and Boston, MA, USA
| | - Kathryn DeLaughter
- Center for Healthcare Organization and Implementation Research, VA Bedford and Boston Healthcare Systems, Bedford and Boston, MA, USA
| | - Christine Deeney
- Center for Healthcare Organization and Implementation Research, VA Bedford and Boston Healthcare Systems, Bedford and Boston, MA, USA
| | - Sarah L Cutrona
- Center for Healthcare Organization and Implementation Research, VA Bedford and Boston Healthcare Systems, Bedford and Boston, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, VA Bedford and Boston Healthcare Systems, Bedford and Boston, MA, USA
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Allen L Gifford
- Center for Healthcare Organization and Implementation Research, VA Bedford and Boston Healthcare Systems, Bedford and Boston, MA, USA
- Boston University Chobanian & Avedisian School of Medicine, Section of General Internal Medicine, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
| | - George L Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
- Department of Population Health Sciences and Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Brandolyn White
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
| | - Heather King
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
- Department of Population Health Sciences and Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Caitlin Reardon
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Andrea Nevedal
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Blake Henderson
- Department of Veterans Affairs, VHA Innovation Ecosystem/Diffusion of Excellence, Washington, DC, USA
| | - Gemmae M Fix
- Center for Healthcare Organization and Implementation Research, VA Bedford and Boston Healthcare Systems, Bedford and Boston, MA, USA
- Boston University Chobanian & Avedisian School of Medicine, Section of General Internal Medicine, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
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Mishra N, Grant R, Patel MT, Guntupalli S, Hamilton A, Carr J, McKnight E, Wise W, deRoode D, Jellison J, Collins NV, Pérez A, Karki S. Automating Case Reporting of Chlamydia and Gonorrhea to Public Health Authorities in Illinois Clinics: Implementation and Evaluation of Findings. JMIR Public Health Surveill 2023; 9:e38868. [PMID: 36917153 PMCID: PMC10131639 DOI: 10.2196/38868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/16/2022] [Accepted: 10/31/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Chlamydia and gonorrhea cases continue to rise in Illinois, increasing by 16.4% and 70.9% in 2019, respectively, compared with 2015. Providers are required to report both chlamydia and gonorrhea, as mandated by public health laws. Manual reporting remains a huge burden; 90%-93% of cases were reported to Illinois Department of Public Health (IDPH) via electronic laboratory reporting (ELR), and the remaining were reported through web-based data entry platforms, faxes, and phone calls. However, cases reported via ELRs only contain information available to a laboratory facility and do not contain additional data needed for public health. Such data are typically found in an electronic health record (EHR). Electronic case reports (eCRs) were developed and automated the generation of case reports from EHRs to be reported to public health agencies. OBJECTIVE Prior studies consolidated trigger criteria for eCRs, and compared with manual reporting, found it to be more complete. The goal of this project is to pilot standards-based eCR for chlamydia and gonorrhea. We evaluated the throughput, completeness, and timeliness of eCR compared to ELR, as well as the implementation experience at a large health center-controlled network in Illinois. METHODS For this study, we selected 8 clinics located on the north, west, and south sides of Chicago to implement the eCRs; these cases were reported to IDPH. The study period was 52 days. The centralized EHR used by these clinics leveraged 2 of the 3 case detection scenarios, which were previously defined as the trigger, to generate an eCR. These messages were successfully transmitted via Health Level 7 electronic initial case report standard. Upon receipt by IDPH, these eCRs were parsed and housed in a staging database. RESULTS During the study period, 183 eCRs representing 135 unique patients were received by IDPH. eCR reported 95% (n=113 cases) of all the chlamydia cases and 97% (n=70 cases) of all the gonorrhea cases reported from the participating clinical sites. eCR found an additional 14 (19%) cases of gonorrhea that were not reported via ELR. However, ELR reported an additional 6 cases of chlamydia and 2 cases of gonorrhea, which were not reported via eCR. ELR reported 100% of chlamydia cases but only 81% of gonorrhea cases. While key elements such as patient and provider names were complete in both eCR and ELR, eCR was found to report additional clinical data, including history of present illness, reason for visit, symptoms, diagnosis, and medications. CONCLUSIONS eCR successfully identified and created automated reports for chlamydia and gonorrhea cases in the implementing clinics in Illinois. eCR demonstrated a more complete case report and represents a promising future of reducing provider burden for reporting cases while achieving greater semantic interoperability between health care systems and public health.
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Affiliation(s)
- Ninad Mishra
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Reynaldo Grant
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States.,Division of Infectious Diseases, Office of Health Protection, Illinois Department of Public Health, Springfield, IL, United States
| | - Megan Toth Patel
- Division of Infectious Diseases, Office of Health Protection, Illinois Department of Public Health, Springfield, IL, United States
| | - Siva Guntupalli
- Division of Infectious Diseases, Office of Health Protection, Illinois Department of Public Health, Springfield, IL, United States
| | | | | | | | - Wendy Wise
- Lantana Consulting Group, East Thetford, VT, United States
| | - David deRoode
- Lantana Consulting Group, East Thetford, VT, United States
| | - Jim Jellison
- Public Health Informatics Institute, Atlanta, GA, United States
| | | | - Alejandro Pérez
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Saugat Karki
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Lubuzo B, Hlongwana K, Ginindza T. Model for Achieving a Coordinated Access to Lung Cancer Care in Selected Public Health Facilities in KwaZulu-Natal, South Africa: Protocol for a Qualitative Study. JMIR Res Protoc 2023; 12:e34341. [PMID: 36867453 PMCID: PMC10024215 DOI: 10.2196/34341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Timely delivery of high-quality cancer care to all patients is barely achieved in South Africa and many other low- and middle-income countries, mainly due to poor care coordination and access to care services. After health care visits, many patients leave facilities confused about their diagnosis, prognosis, options for treatment, and the next steps in their care continuum. They often find the health care system disempowering and inaccessible, thereby making access to health care services inequitable, with the resultant outcome of increased cancer mortality rates. OBJECTIVE The aim of this study is to propose a model for cancer care coordination interventions that can be used to guide and achieve coordinated access to lung cancer care in the selected public health care facilities in KwaZulu-Natal. METHODS This study will be conducted through a grounded theory design and an activity-based costing approach that will include health care providers, patients, and their caregivers. The study participants will be purposively selected, and a nonprobability sample will be selected based on characteristics, experiences of the health care providers, and the objectives of the study. With the study's objectives in mind, communities in Durban and Pietermaritzburg were selected as study sites, for the study along with the 3 public health facilities that provide cancer diagnosis, treatment, and care in the province. The study involves a range of data collection techniques, namely, in-depth interviews, evidence synthesis reviews, and focus group discussions. A thematic and cost-benefit analysis will be used. RESULTS This study receives support from the Multinational Lung Cancer Control Program. The study obtained ethics approval and gatekeeper permission from the University's Ethics Committee and the KwaZulu-Natal Provincial Department of Health, as it is being conducted in health facilities in KwaZulu-Natal province. As of January 2023, we had enrolled 50 participants, both health care providers and patients. Dissemination activities will involve community and stakeholder dissemination meetings, publications in peer-reviewed journals, and presentations at regional and international conferences. CONCLUSIONS This study will provide comprehensive data to inform and empower patients, professionals, policy architects, and related decision makers to manage and improve cancer care coordination. This unique intervention or model will address the multifactorial problem of cancer health disparities. If successful, this study will affect the design and implementation of coordination programs to promote optimal cancer care for underserved patients. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/34341.
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Affiliation(s)
- Buhle Lubuzo
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Khumbulani Hlongwana
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Themba Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Simms L, Ottman KE, Griffith JL, Knight MG, Norris L, Karakcheyeva V, Kohrt BA. Psychosocial Peer Support to Address Mental Health and Burnout of Health Care Workers Affected by COVID-19: A Qualitative Evaluation. Int J Environ Res Public Health 2023; 20:4536. [PMID: 36901545 PMCID: PMC10002014 DOI: 10.3390/ijerph20054536] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/17/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
Health care workers in the U.S. are experiencing alarming rates of burnout. Furthermore, the COVID-19 pandemic has worsened this issue. Psychosocial peer-support programs that address general distress and are tailored to health care systems are needed. A Care for Caregivers (CFC) Program was developed at an American metropolitan university hospital and outpatient health care system. The CFC program trains "Peer Caregivers" and managers and has four components: the identification of colleagues in need of support; psychological first aid; linkage to resources; and the promotion of hope among colleagues experiencing demoralization. Qualitative interviews (n = 18) were conducted with Peer Caregivers and Managers participating in the initial piloting of the program. Results suggest that the CFC program shifts the organizational culture, teaches staff skills for recognizing and supporting others in distress, and supports those staff who are already providing these services informally. Findings suggest that staff distress resulted primarily from external factors and secondarily from internal organizational stressors. External stressors were exacerbated by the COVID-19 pandemic. Although the program has promise for addressing staff burnout, other organizational efforts are needed to simultaneously promote staff wellness. Ultimately, psychosocial peer support programs for health care workers are feasible and potentially impactful, but also require other systemic changes within a health care system to improve and sustain staff well-being.
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Affiliation(s)
- Lea Simms
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC 20037, USA
| | - Katherine E. Ottman
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC 20037, USA
| | - James L. Griffith
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC 20037, USA
| | - Michael G. Knight
- Medical Faculty Associates, George Washington University, Washington, DC 20037, USA
| | - Lorenzo Norris
- GW Resiliency & Well-Being Center, School of Medicine and Health Sciences, George Washington University, Washington, DC 20037, USA
| | - Viktoriya Karakcheyeva
- GW Resiliency & Well-Being Center, School of Medicine and Health Sciences, George Washington University, Washington, DC 20037, USA
| | - Brandon A. Kohrt
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC 20037, USA
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Slezak J, Sacks D, Chiu V, Avila C, Khadka N, Chen JC, Wu J, Getahun D. Identification of Postpartum Depression in Electronic Health Records: Validation in a Large Integrated Health Care System. JMIR Med Inform 2023; 11:e43005. [PMID: 36857123 PMCID: PMC10018380 DOI: 10.2196/43005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/03/2023] [Accepted: 01/15/2023] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The accuracy of electronic health records (EHRs) for identifying postpartum depression (PPD) is not well studied. OBJECTIVE This study aims to evaluate the accuracy of PPD reporting in EHRs and compare the quality of PPD data collected before and after the implementation of the International Classification of Diseases, Tenth Revision (ICD-10) coding in the health care system. METHODS Information on PPD was extracted from a random sample of 400 eligible Kaiser Permanente Southern California patients' EHRs. Clinical diagnosis codes and pharmacy records were abstracted for two time periods: January 1, 2012, through December 31, 2014 (International Classification of Diseases, Ninth Revision [ICD-9] period), and January 1, 2017, through December 31, 2019 (ICD-10 period). Manual chart reviews of clinical records for PPD were considered the gold standard and were compared with corresponding electronically coded diagnosis and pharmacy records using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Kappa statistic was calculated to measure agreement. RESULTS Overall agreement between the identification of depression using combined diagnosis codes and pharmacy records with that of medical record review was strong (κ=0.85, sensitivity 98.3%, specificity 83.3%, PPV 93.7%, NPV 95.0%). Using only diagnosis codes resulted in much lower sensitivity (65.4%) and NPV (50.5%) but good specificity (88.6%) and PPV (93.5%). Separately, examining agreement between chart review and electronic coding among diagnosis codes and pharmacy records showed sensitivity, specificity, and NPV higher with prescription use records than with clinical diagnosis coding for PPD, 96.5% versus 72.0%, 96.5% versus 65.0%, and 96.5% versus 65.0%, respectively. There was no notable difference in agreement between ICD-9 (overall κ=0.86) and ICD-10 (overall κ=0.83) coding periods. CONCLUSIONS PPD is not reliably captured in the clinical diagnosis coding of EHRs. The accuracy of PPD identification can be improved by supplementing clinical diagnosis with pharmacy use records. The completeness of PPD data remained unchanged after the implementation of the ICD-10 diagnosis coding.
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Affiliation(s)
- Jeff Slezak
- Kaiser Permanente Southern California, Pasadena, CA, United States
| | - David Sacks
- Kaiser Permanente Southern California, Pasadena, CA, United States.,Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Vicki Chiu
- Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Chantal Avila
- Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Nehaa Khadka
- Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Jiu-Chiuan Chen
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Jun Wu
- Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA, United States
| | - Darios Getahun
- Kaiser Permanente Southern California, Pasadena, CA, United States.,Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States
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Mavragani A, Batterham PJ, Gulliver A, Morse A, Calear AL, McCallum S, Banfield M, Shou Y, Newman E, Dawel A. The Factors Associated With Telehealth Use and Avoidance During the COVID-19 Pandemic: Longitudinal Survey. J Med Internet Res 2023; 25:e43798. [PMID: 36649254 PMCID: PMC9947771 DOI: 10.2196/43798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/16/2022] [Accepted: 01/06/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Social distancing requirements due to the COVID-19 pandemic saw a rapid increase in the delivery of telehealth consultations as an alternative to face-to-face health care services. OBJECTIVE The aims of this study were to assess the use and acceptability of telehealth during the early stages of the pandemic and identify factors associated with telehealth avoidance during this period. METHODS Data were obtained from waves 4 and 7 of a longitudinal survey designed to assess the impact of the COVID-19 pandemic on the health and behavior of a representative sample of Australian adults. Participants reported on their use or avoidance of telehealth during the assessment period, as well as the mode of telehealth used and acceptability. RESULTS Approximately 30% of participants reported using telehealth during the assessment periods, with the most common telehealth modality being the telephone. Acceptance of telehealth was generally high and was higher among those who used telehealth compared with those who did not. Approximately 18% of participants reported avoiding health care due to telehealth. Across assessment waves, avoidance was associated with younger age, speaking a language other than or in addition to English, having a current medical diagnosis, and lower levels of telehealth acceptability. CONCLUSIONS While most participants in this study were accepting of telehealth services, there remain barriers to use, especially among those from particular sociodemographic groups. At a population level, avoidance of health services in nearly one in five adults may have considerable long-term impacts on morbidity and potentially mortality. Targeted efforts to promote engagement with telehealth services are critical if these adverse outcomes are to be avoided, particularly during periods when access to face-to-face services may be limited.
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Affiliation(s)
| | - Philip J Batterham
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Amelia Gulliver
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Alyssa Morse
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Alison L Calear
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Sonia McCallum
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Michelle Banfield
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Yiyun Shou
- Research School of Psychology, The Australian National University, Canberra, Australia.,Saw See Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Lloyd's Register Foundation Institute for the Public Understanding of Risk, National University of Singapore, Singapore, Singapore
| | - Eryn Newman
- Research School of Psychology, The Australian National University, Canberra, Australia
| | - Amy Dawel
- Research School of Psychology, The Australian National University, Canberra, Australia
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Zindler A, Wunderlich H, Nitschke-Janssen M. [Refugee Minors from Ukraine and their Families - First Experiences from an Intercultural Practice for Child and Adolescents Psychiatry and an Outpatient Clinic for Refugees/Hamburg]. Prax Kinderpsychol Kinderpsychiatr 2023; 72:129-47. [PMID: 36744497 DOI: 10.13109/prkk.2023.72.2.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Due to the Russian invasion in Ukraine, many families were forced to flee to Germany, often having to leave relatives behind.The outpatient clinic for refugees at Universitätsklinikum Eppendorf coordinates the psychosocial and psychotherapeutic care for refugee minors from Ukraine in Hamburg. The intercultural practice for child and adolescents psychiatry offers on-site consultations for children and adolescents in camps in order to provide a low-threshold access to counseling and diagnostics. Diagnostic and therapeutic experiences to this point indicate the contribution of multifactorial stress to the development of symptoms in Ukrainian minors.The threat of war and displacement seems to be only one of many factors. Although there are some remarkable resilience factors for Ukrainian refugee children and adolescents in comparison to refugees from other countries of origin, the forced adaptation to living and studying conditions in Hamburg bears challenges for many. Additionally due to war experiences psychotherapeutic and psychiatric care is frequently needed. On Germany's side, there is a need for action to ameliorate the accessibility to the health care system for refugees and migrants. Support of therapists in this complex working field is thereby as important as advocacy for the needs of minor refugees in German society.
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Eysenbach G, Cavalini H, Shetty S, Delanerolle G. Digital Maturity Consulting and Strategizing to Optimize Services: Overview. J Med Internet Res 2023; 25:e37545. [PMID: 36649060 PMCID: PMC9890346 DOI: 10.2196/37545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 10/19/2022] [Accepted: 11/16/2022] [Indexed: 11/18/2022] Open
Abstract
The National Health Service (NHS), the health care system of the United Kingdom, is one of the largest health care entities in the world and has been successfully serving the UK population for decades. The NHS is also the fourth-largest employer globally. True to its reputation, some of the most modern and technically advanced medical services are available in the United Kingdom. However, between the acute, primary, secondary, and tertiary care providers of the NHS, there needs to be seamless integration and interoperability to provide timely holistic care to patients at a national level. Various efforts have been taken and programs launched since 2002 to achieve digital transformation in the NHS but with partial success rates. As it is important to understand a problem before trying to solve it, in this paper, we focus on tools used to assess the digital maturity of NHS trusts and organizations. Additionally, we aim to present the impact of ongoing transformation attempts on secondary services, particularly mental health. This paper considered the literature on digital maturity and performed a rapid review of currently available tools to measure digital maturity. We have performed a multivocal literature review that included white papers and web-based documents in addition to peer-reviewed literature. Further, the paper also provides a perspective of the ground reality from a mental health service provider's point of view. Assessment tools adopted from the global market, later modified and tailor-made to suit local preferences, are currently being used. However, there is a need for a robust framework that assesses status, allows target setting, and tracks progress across diverse providers.
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Affiliation(s)
| | - Heitor Cavalini
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Suchith Shetty
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Gayathri Delanerolle
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, United Kingdom.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Rydlewska-Liszkowska I. [Directions of organizational and economic changes in occupational health services as a response to the COVID-19 pandemic - challenges to the health crises]. Med Pr 2022; 73:471-483. [PMID: 36576399 DOI: 10.13075/mp.5893.01310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The COVID-19 pandemic caused not only short-term organizational and economic changes in the functioning of occupational health services, but also enforced to include them in the formulation of a strategic systemic approach to this link of the health care system. The aim of the article is to identify and describe the organizational and economic changes in occupational health services during the pandemic. On this basis, the directions of further research on the improvement of the activities of health care entities of working people in response to future health crises have been formulated. The review covered legal acts relating to organizational and economic changes, Polish and foreign expert publications, full-text Polish and English-language scientific articles included in the PubMed database, publications beyond the specified period, consistent and useful in explaining the concepts of organization, management and economics. The changes in occupational health services presented in the literature during the pandemic consisted of: introducing additional organizational forms of providing health care to employees including occupational medicine leaders, strengthening supervision over working conditions, interdisciplinary cooperation for managing the health of working people, participation in pro-vaccination campaigns, activities in the field of rehabilitation after COVID-19 and new-quality cooperation with public and private health stakeholders. As the result of the review, problems were formulated for future research, which included ensuring the security of occupational medicine entities in terms of resource availability, adjusting the allocation of resources to new financial needs during and after a pandemic, evaluation of organizational and economic changes introduced during the pandemic and the legitimacy of their maintenance in subsequent periods, the development of economic and organizational instruments for the time of crisis, the scope and principles of cooperation with health care stakeholders and the introduction of medical technologies based on a medical and economic assessment according to Health Technology Assessment. Med Pr. 2022;73(6):471-83.
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Affiliation(s)
- Izabela Rydlewska-Liszkowska
- Uniwersytet Medyczny w Łodzi / Medical University of Lodz, Łódź, Polska (Wydział Nauk o Zdrowiu, Zakład Ubezpieczeń Medycznych i Finansowania Ochrony Zdrowia / Faculty of Health Sciences, Department of Medical Insurance and Health Care Financing)
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50
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Abou-Arraj NE, Maddah D, Buhamdan V, Abbas R, Jawad NK, Karaki F, Alami NH, Geldsetzer P. Perceptions of, and Obstacles to, SARS-CoV-2 Vaccination Among Adults in Lebanon: Cross-sectional Online Survey. JMIR Form Res 2022; 6:e36827. [PMID: 36383635 DOI: 10.2196/36827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/06/2022] [Accepted: 09/14/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic is an additional burden on Lebanon's fragmented health care system and adds to its ongoing political, economic, and refugee crises. Vaccination is an important means of reducing the impact of the pandemic. OBJECTIVE Our study's aims were to (1) assess the prevalences of intention to vaccinate and vaccine hesitancy in Lebanon; (2) determine how vaccine hesitancy in Lebanon varies by sociodemographic, economic, and geographic characteristics; and (3) understand individuals' motivations for vaccinating as well as concerns and obstacles to vaccination. METHODS We performed a cross-sectional study from January 29, 2021, to March 11, 2021, using an online questionnaire of open- and closed-ended questions in Arabic via convenience "snowball" sampling to assess the perceptions of adults residing in Lebanon. RESULTS Of the 1185 adults who participated in the survey, 46.1% (95% CI: 43.2%-49.0%) intended to receive the SARS-CoV-2 vaccine when available to them, 19.0% (95% CI 16.8%-21.4%) indicated they would not, and 34.0% (95% CI 31.3%-36.8%) were unsure (with an additional 0.9% skipping this question). The most common reasons for hesitancy were concerns about safety, limited testing, side effects, and efficacy. Top motivations for vaccinating were to protect oneself, protect one's family and the public, and end the pandemic. Despite financial hardships in Lebanon, barriers to vaccine access were not frequently described as concerns. Established health care facilities, rather than new temporary vaccination centers, were most frequently selected as preferred vaccination sites. CONCLUSIONS Vaccine hesitancy appears to be high in Lebanon. Disseminating clear, consistent, evidence-based safety and efficacy information on vaccines may help reduce vaccine hesitancy, especially among the large proportion of adults who appear to be unsure about (rather than opposed to) vaccination.
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Affiliation(s)
- Nadeem Elias Abou-Arraj
- School of Public Health, University of California, Berkeley, Berkeley, CA, United States.,Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States.,Division of General Medicine, Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Diana Maddah
- School of Health Sciences, Modern University for Business and Science, Beirut, Lebanon
| | - Vanessa Buhamdan
- School of Health Sciences, Modern University for Business and Science, Beirut, Lebanon
| | - Roua Abbas
- School of Health Sciences, Modern University for Business and Science, Beirut, Lebanon
| | - Nadine Kamel Jawad
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Fatima Karaki
- Refugee and Asylum Seeker Health Initiative (RAHI), Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Nael H Alami
- School of Health Sciences, Modern University for Business and Science, Beirut, Lebanon
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States.,Chan Zuckerberg Biohub, San Francisco, CA, United States
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