Geographical Difference in Patient Satisfaction With Healthcare Services for Older Adults in Vietnam

Health Care Transitions: A Peek Into the Future

This study examined the prevalence of cognitive impairment among older adults in central Vietnam and the roles of communication (with or without communication devices) in the association between cognitive impairment and hearing loss. This cross-sectional study was performed on 725 randomly selected community-dwelling older adults aged ≥60 years from Thua Thien Hue province, Vietnam. Participants attended a face-to-face survey. Sociodemographic characteristics, social interaction with or without communication devices, health status and cognitive function using the Mini-Mental State Examination were reported. Ordinal logistic regression analysis was performed to quantify the association between hearing loss and cognitive function by frequency of communication with and without devices. Mild and severe cognitive impairment had prevalence rates of 23.6% and 19.3%, respectively. Cognitive impairment was more prevalent among older adults with hearing-loss, vision loss and difficulties with instrumental activities of daily living (IADL). The association between hearing loss and cognitive impairment was not significant when older adults had frequent communication with others using devices. This study presented the relatively high prevalence of cognitive impairment in community-dwelling older adults in Vietnam. Frequent communication using devices attenuated the association between hearing loss and cognitive impairment.

The Chinese government values the older adults' sense of gain from healthcare service. The aim of this study was to construct a Sense of Gain Scale for traditional Chinese medicine (TCM) healthcare services for older adults in the community, and evaluate its reliability and validity. Based on literature review and expert consultation, this study developed a Sense of Gain Scale for TCM healthcare services for older adults in the community. A total of 460 participants were recruited to perform reliability analysis, exploratory factor analysis, and Spearman correlation analysis, while another 673 participants were used for confirmatory factor analysis to evaluate the validity of the scale. The Sense of Gain Scale was composed of 14 items that could be classified into the following five dimensions: satisfaction, effectiveness, accessibility, fairness, and responsiveness. The overall Cronbach's α coefficient of the scale was 0.961, with each dimension ranging from 0.861 to 0.928. The split-half reliability of the total scale was 0.971, indicating good reliability. Five common factors were extracted to explain 85.49% of the total variation. exploratory factor analysis showed that the scale had good construct validity. Satisfaction with Life Scale (SWLS) was used to evaluate criterion validity, and the correlation coefficient between test score and criterion was > 0.6. The Sense of Gain Scale has good reliability and validity, and can be used as a measurement tool to evaluate the level of sense of gain for TCM healthcare services for older adults in the community.

Previous research has highlighted a lack of continuity of care when young people with a neurodevelopmental condition make the transition from children's to adult specialist healthcare services. A lack of planning, consistency, and availability of adult services has been found to lead to; increased anxiety, poor health outcomes, reduced support and some young people not receiving healthcare. The majority of transition research has focused on what health professionals consider important in the transition process, rather than focusing on the experiences of the young people and those closest to them. Our objective was to gather evidence from young people (and their families) who had experienced transition from children's to adult specialist healthcare services through semi-structured interviews. Volunteers were recruited from two London boroughs. All young people were aged between 18 and 25years with a neurodevelopmental condition (Attention Deficit Hyperactivity Disorder, Autism Spectrum Disorder and/or an Intellectual Disability). Overall, we interviewed six young people with support from a family member. Five further family members were interviewed on behalf of the young person. In total, ten semi-structured interviews were transcribed verbatim and analysed using Interpretative Phenomenological Analysis. Four themes emerged from the analysis: (a) Parents as advocates, (b) Availability of adult's specialist health and social care services, (c) Lack of information sharing and (d) Transition as a binary, abrupt change. Our findings suggest the transition experience could be improved by changing service specifications to incorporate assessment and handover across the age range of 16-20years. Additionally, statutory services should understand and provide the coordination role now offered by parents in transition. We suggest future research could evaluate the feasibility of a patient-owned online information sharing tool with information about relevant services for young people and their families.

Introduction/Aim: Determination and planning of a sufficient number of primary physicians is a prerequisite for high-quality primary health care. The aim of this paper was to determine the supply of primary physicians in the primary health care institutions and by districs in the Republic of Serbia in 2017, to analyze their workload and to compare the obtained values with the prescribed supply and workload. Methods: A secondary analysis of the supply and the workload of primary physicians in the health care services for adults, small and pre-school children, school children and women for 2017 was carried out in the public primary health care institutions (health centers and institutions) in the Republic of Serbia. The assessment of the supply and the workload of the primary physicians was made in relation to the values prescribed by the legislation. Results: In 2017, the supply of primary physicians in Serbia in the health care service for adults was higher than the prescribed one by 2% (1564 inhabitants per a physician), and higher by 13% (735 children per a physician) in the health care service for small and preschool children. There was a shortage of physicians, i.e. the supply of physicians in the health care service for women was lower than the prescribed one by 3% (6706 women per a physician) and by 9% (1630 school children per a physician) for the health care of school children. The supply that was more unfavorable than the prescribed one existed in 13 districts in the health care services for adults and women, in 7 districts in the health care service for small and pre-school children, and in 17 districts in the health care service for school children. The average daily workload of physicians was higher than the prescribed execution measures in the health care services for adults (36,5) and for children (30,6), and it was lower in the health care service for women (26,2), but it was at the prescribed level in the health care service for school children (30,0). The workload of physicians (expressed as the average number of visits per a physician) was higher than the prescribed one in 17 districts in the health service for adults, in 10 districts in the health care service for small and pre-school children, in 13 districts in the health care service for school children, in 6 districts in the health care service for women. Conclusion: There are great differences in the supply and workload of primary physicians by districts. It is necessary to ensure adequate human resource planning that takes into account both of these parameters and which will contribute to the advancement of personnel policies to reduce district disparities.

BackgroundTransition from paediatric to adult heath care services is a challenging time for many adolescents with chronic illnesses and may include deterioration in illness control as a consequence of inadequate self-management skills, poor understanding of their chronic illness and failure to engage with adult services. Successful transfer of health care requires the development of self-management skills and increased autonomy. Mobile technology has been proposed as a modality to assist this process. Evidence is limited and generally restricted to illness specific applications. The TransitionMate app (TMApp) is a generic (non-illness specific) mobile application designed to support young people with chronic illness in their transition from paediatric to adult health care services. The overall aim of the study is to assess the effectiveness of TMApp in improving engagement and retention of adolescents with chronic illness within adult healthcare services, as well as preventing the deterioration in illness control and unplanned hospitalisations.MethodsThe TransitionMate trial is a dual centre, pragmatic, single arm, mixed methods cohort study conducted within two university teaching tertiary paediatric hospitals in Australia. Data collection points are planned at 0, 6, 12 and 18 months. Outcome indicators include: usage of TransitionMate, engagement with adult services, quantitative markers of illness control, and unplanned hospital admissions. Data are collected through telephone interviews with the participants, their primary healthcare providers, electronic medical records and de-identified mobile application analytics. The development of the application involved co-design with recently transitioned young people with a number of chronic illnesses as well as online user experience in younger adolescents.DiscussionThe TransitionMate study is the first identified trial of a generic mobile application designed to support adolescents with chronic illnesses during the transition process. Results are expected to provide novel insights into the value of technological tools in the transition space, especially their effectiveness in improving both the transition process and clinical outcomes of adolescents with chronic illnesses. Furthermore, the approach of a pragmatic study design may help identify research methods better designed to overcome inherent challenges in research involving adolescents, transition of care and use of mobile application technology.Trial registrationRegistered retrospectively as of 30/1/2020 with Australian New Zealand Clinical Trials Registry: ACTRN12620000074998.

BackgroundLimited studies focused on the situation and related factors of access to healthcare services for older adults with limited activities of daily living (ADL) in China. This study explores factors associated with access to healthcare services of them based on Andersen's healthcare utilization model (namely, need, predisposing, and enabling dimensions).MethodsA total of 3,980 participants aged 65 years and older adults with limited ADL from the latest wave (2018) of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were included. Binary logistic regression was used to explore the influencing factors.ResultsFactors in enabling dimension were associated with access to healthcare services for older adults with limited ADL. Those who lived with better economic status (fair vs poor, OR = 2.98, P < 0.01; rich vs poor, OR = 7.23, P = 0.01), could afford daily life (yes vs no, OR = 2.33, P = 0.03), and lived in the eastern or central region of China (eastern vs western, OR = 2.91, P < 0.01; central vs western, OR = 2.40, P = 0.02) could access to healthcare services more easily. However, factors in predisposing dimension and need dimension showed no statistical significance. Meanwhile, inconvenience in the movement was the major barrier reported by some participants for not going to the hospital when they got sick.ConclusionAccess to healthcare services for older adults with ADL limitation was mainly related to the factors of economic status, affordability for daily life, and living regions in enabling dimension. Strategies focused on health insurance, healthcare system, barrier-free facilities, and social support were proposed to increase the access to healthcare services for participants, which could benefit their health.

This paper is a report of a study to identify family caregivers' needs and satisfaction levels in adult day healthcare services for older adults with stroke. With a growing number of older people suffering from chronic illnesses, the demand for adult day care is growing worldwide. However, in Asia, caregivers face unique challenges in selecting and using culturally acceptable models of care for older people with stroke, and there are still unmet needs in adult day healthcare services. A cross-sectional descriptive survey was carried out in 2006 with a convenience sample of 119 family caregivers from nine centres in Korea. The questionnaire included the Modified Caregiver Satisfaction Scale. Korean family caregivers of older people with stroke were moderately satisfied with the adult day healthcare services. In particular, health management was an area with a high level of needs but with a low level of satisfaction. Respondents also had unmet needs such as speech therapy, patient-tailored exercise and physical therapy. There was a statistically significant difference in degree of satisfaction according to whether or not Registered Nurses delivered care at the centres. It is important to reflect family caregivers' needs by providing quality care, which is culture-specific adult day healthcare services and focuses on health management and skilled nursing care.

Adolescents with diabetes have unique health needs, which impact upon their transition from children's health care services into adult health care services. These health needs result from the precarious period in their lives, when they have to cope with the stresses of being a maturing person. This coincides with their move from the children's into the adult health care service. Whilst coping with these pressures they must also keep their diabetes under control. The impact of emotional and physical demands upon the adolescent means that they are more susceptible to non-adherence, which may result in reduced diabetic control. This literature review identifies some of the many barriers erected to the transition into the adult health care system; these barriers may be constructed by any one of the parties involved: the children's health care team, adult health care team, the adolescent or their family. Principles of a successful transition are explored, along with the prerequisite qualities required of health care providers and the health care service.

The effectiveness of structured interdisciplinary collaboration for adult home hospice patients on patient satisfaction and hospital admissions and re-admission: a systematic review protocol

BackgroundThis study aimed to analyze the needs and utilization of the home and community integrated healthcare and daily care services (“home and community care services” for short) among older adults in China and to investigate the inequity in services utilization.MethodsCross-sectional data were obtained from the 2018 China Health and Retirement Longitudinal Study. Needs and utilization rates of the home and community care services in older adults of 60 years old and above were analyzed. Binary logistic regression analysis was performed to explore the factors associated with services utilization among older adults with limited mobility. Concentration index, horizontal inequity index, and Theil index were used to analyze inequity in services utilization. Decomposition analyses of inequity indices were conducted to explain the contribution of different factors to the observed inequity.ResultsAbout 32.6% of older adults aged 60 years old and above had limited mobility in China in 2018, but only 18.5% of them used the home and community care services. Among the single service utilization, the highest using rate (15.5%) was from regular physical examination. Limited mobility, age group, income level, region, self-assessed health, and depression were statistically significant factors associated with utilization of any one type of the services. Concentration indices of any one type service utilization and regular physical examination utilization were both above 0.1, and the contribution of income to inequity were both over 60%. Intraregional factor contributed to about 90% inequity of utilizing any one type service, regular physical examination and onsite visit.ConclusionsThis current study showed that older adults with needs of home and community care services underused the services. Pro-rich inequities in services utilization were identified and income was the largest source of inequity. The difference of the home and community care service utilization was great among provinces but minor across regions. Policies to optimize resources allocation related to the home and community care services are needed to better satisfy the needs of older adults with limited mobility, especially in the low-income group and the central region.

Young children with disabilities and their carers or parents tend to form a long-term dependent relationship with a paediatrician throughout childhood. At some stage when the young person with a disability reaches early adulthood, the relationship is severed. This paper draws upon recent research undertaken by the authors that describes the difficulties experienced by young people with disabilities as they go through the transition from paediatric care to adult mainstream health care services. The purpose of this article is to present the argument that the dependent, paternalistic relationship that tends to exist between young people with disabilities (and/or their carers) and paediatricians throughout childhood does not facilitate the successful negotiation of adult mainstream health care services, nor optimally promote the well-being of these young people with disabilities. It is proposed that the promotion of autonomy (or self-determination) via a well planned transition program will increase the likelihood that young adults with disabilities and/or their carers will be empowered to successfully negotiate the current mainstream health care system in Australia, and will enhance the well-being of young adults with disabilities.

The transition to a super-aged society and regional disparities in demographic structure significantly affect older adults’ access to healthcare services. Empirical analysis of these factors is essential for developing region-specific healthcare policies. This study considers the worsening disparity in access to healthcare services for older adults due to population decline and regional extinction. By predicting future regional trends of the older adult population and utilizing Geographic Information System (GIS) and spatial analysis techniques, the study examines the current status of healthcare services and the spatial accessibility of older adults to these services at the administrative district level. The aim is to explore areas vulnerable to healthcare service access. Through this, the study aims to diagnose the problem of unequal access to healthcare services for older adults and propose strategies for more equitable healthcare policies and efficient medical service placement in the future.

The transition process from paediatric to adult healthcare is recognised in the UK and internationally as a period of significance in a young a young person’s life. The objectives of this study were to identify the young person’s experiences of physiotherapy within: i. paediatric services, ii. adult services, and iii. the transition between the two services. Semi-structured interviews with 7 young adults (19-23 years, diagnosed with complex and cognitive disabilities), who had access to on-site physiotherapy, occupational therapy and speech and language therapy, were completed at a third level college setting. Their verbatim transcripts were thematically analysed. The experiences were mixed with both positive findings and some areas for improvements, leading to identification of four main themes. i. perceptions of physiotherapy service delivery ii. experiences of the transition period. iii. interdependence iv. recommendations for transition development Recommendations included improved communication channels between paediatric and adult services and the involvement of young adults in research to assist in service developments. Action is needed between paediatric and adult orientated healthcare services. Improved channels of communication, personalised transition interventions and availability of physiotherapy services are necessary to assist in positive transition outcomes. Creating connections and bonds between paediatric and adult services can have a significant impact on improved and smooth transition experiences for service users.

The prevalence of oral diseases in the older adult population remains high worldwide and is expected to surge in the coming decade. The World Health Organization (WHO) has listed the oral health of older adults as one of its pivotal concerns. Oral health affects general health, and oral diseases increase mortality and morbidity in older adults. Integrating oral health into the general health service with a patient-centred approach can be an effective way to improve oral and systemic health for older adults simultaneously. This integration tackles the shared risk factors of both oral and noncommunicable diseases, aids in the early detection of systemic disease, strengthens health surveillance, enhances efficient data sharing, and allows for the better allocation of resources and the workforce in the healthcare system. However, the oral healthcare sector operates as an isolated field, with an emphasis on intervention rather than prevention, which presents a key challenge to the success of integration. Therefore, refocusing oral healthcare service on prevention is paramount. In addition, approaches taken in clinical practice implementation, interprofessional education and training, technology and innovation, research and evaluation, advocacy by national professional oral healthcare organizations, and policy making will ensure the efficient, effective, and long-term integration of oral and general health services. Integrating these services would foster the accessibility and affordability of oral healthcare services for older adults to improve their oral health and overall well-being in the coming decade. This review aims to discuss the merits and outline the challenges of integrating oral health into general health services for older adults and to propose the approaches that could be taken.