Implementing IPSAS within a new government accounting framework as a competitive management advantage in public healthcare units

Background: The integration of mental health in primary health care, throughout its various functional units and with effective articulation between primary health care and mental health services, has been considered an essential objective of the legislative documents produced in the last three decades in Portugal, among them the National Health Plan 2011-2016.Goals: This study aimed to inquire health professionals’ perceptions about mental health care provided by public primary health care units, namely their perceptions about the mental health of their patients. It also intended to explore the difficulties perceived by the health professionals in their daily activity about the mental health problems of their patients and about the need of clinical psychologists’ activity in the public primary health care.Methods: This is an observational cross-sectional study with two non-probabilistic samples: health professionals (doctors, nurses and psychologists) and patients from two public health care units. Health professionals were interviewed (individual structured face-to-face interviews) about their perceptions of needs for improving their capacity to provide mental healthcare and about patients’ mental health conditions. Patients responded (by self-administration) to the Depression, Anxiety and Stress Scale (DASS-21), providing a characterization of patients’ stress, anxiety and symptoms of depression.Results: Health professionals in their daily practice often identify in their patients symptoms of stress, anxiety and depression (most particularly in adults),. Several issues were identified as problematic, such as: poor access of the referral system for psychiatric and clinical psychological specialized care, insufficient number of health professionals, particularly of psychologists, and lack of appropriate mental health care specialization. The results also revealed relevant levels of stress, anxiety and depression in primary health care patients (both genders), which seem to increase with age. Discussion: Difficulties identified by health professionals may relate to the centralisation of resources, resistance to change from human resources management, lack of consensus among the various decision groups linked to mental health and, at institutional level, insufficient and inadequate funding. These factors may contribute to a failure in early diagnosis of symptoms of depression, anxiety and stress. It is expected that articulation between primary health services and differentiated health services will improve, with improvement in teamwork among professionals and increase of the quality of life of users, satisfaction with work, from health professionals, and reduction of health costs.

Introduction: The ABC pathway (A: Avoid stroke; B: Better symptoms; C: Comorbidities and lifestyle management) has been proposed to ensure a holistic or integrated care approach to atrial fibrillation (AF) management. There are scarce data about compliance with this strategy in low- and middle-income countries, where the AF populational burden is likely to increase. Hypothesis: Compliance with ABC pathway (ABC-compliance) in Brazil is low and associated with certain patient characteristics. Methods: We included 700 patients (46% women, 69±15 years) with confirmed AF. Participants were recruited from private and public healthcare units in São Paulo city. We built logistic regression models to analyze if age, sex, race, HAS-BLED scores, or healthcare sector (public or private) were associated with lack of ABC-compliance (Table 1). Results: ‘A’, ‘B’, ‘C’ and ABC-compliance occurred in 42%, 82%, 50%, and 21%, respectively. In multiple models (Table 2), lack of ABC-compliance was associated with female sex and high HAS-BLED scores. Lack of ‘B’ component compliance was associated with non-White race. Treatment in public units was positively associated with a lack of ‘A’ component compliance but this was inversely associated with a lack of ‘C’ component compliance. Age and ABC-compliance were not independently associated. Conclusions: Compliance with ABC pathway in our healthcare setting was low. Female sex and high HAS-BLED scores were markers of poor compliance with this integrated approach. Patients treated in private health units may have higher access to oral anticoagulants, while better comorbidity control in public health units may reflect a less segmented system of care.

OBJECTIVE Determine the coverage rate of syphilis testing during prenatal care and the prevalence of syphilis in pregnant women in Brazil.METHODS This is a national hospital-based cohort study conducted in Brazil with 23,894 postpartum women between 2011 and 2012. Data were obtained using interviews with postpartum women, hospital records, and prenatal care cards. All postpartum women with a reactive serological test result recorded in the prenatal care card or syphilis diagnosis during hospitalization for childbirth were considered cases of syphilis in pregnancy. The Chi-square test was used for determining the disease prevalence and testing coverage rate by region of residence, self-reported skin color, maternal age, and type of prenatal and child delivery care units.RESULTS Prenatal care covered 98.7% postpartum women. Syphilis testing coverage rate was 89.1% (one test) and 41.2% (two tests), and syphilis prevalence in pregnancy was 1.02% (95%CI 0.84;1.25). A lower prenatal coverage rate was observed among women in the North region, indigenous women, those with less education, and those who received prenatal care in public health care units. A lower testing coverage rate was observed among residents in the North, Northeast, and Midwest regions, among younger and non-white skin-color women, among those with lower education, and those who received prenatal care in public health care units. An increased prevalence of syphilis was observed among women with < 8 years of education (1.74%), who self-reported as black (1.8%) or mixed (1.2%), those who did not receive prenatal care (2.5%), and those attending public (1.37%) or mixed (0.93%) health care units.CONCLUSIONS The estimated prevalence of syphilis in pregnancy was similar to that reported in the last sentinel surveillance study conducted in 2006. There was an improvement in prenatal care and testing coverage rate, and the goals suggested by the World Health Organization were achieved in two regions. Regional and social inequalities in access to health care units, coupled with other gaps in health assistance, have led to the persistence of congenital syphilis as a major public health problem in Brazil.

Managing public health care units has failed to attract the attention of decision-makers to date. This laissez-faire approach of sorts creates an environment in which these units have to face an evergrowing competition on the part of their non-public rivals. This paper starts with an analysis of the background of changes in the management of public health care units which have occurred in Poland in recent years. Next, described are the findings from a study concerning management quality conducted in 2003–2008 in public health care units in Poland. The research was based on a model developed specifically to that end involving the compliance of health care units with the regulations currently in force and good management practices. The survey consisted of a questionnaire composed of closed questions. In total, 154 units were surveyed (51 of them twice), which were divided into the following groups: surgical hospitals, non-surgical hospitals and other units. The results obtained indicate that the units were managed in very different ways. The best results were obtained by voivodship surgical hospitals, the poorest – non-surgical hospitals. Results of every repeated survey were decidedly better than those of the first one. These better results were related to the achievement of goals, which were adopted by the participants after the first survey. It is hard to overrate the part played in the management of health care units by their founding bodies, which can motivate them to achieve better results. On the other hand, lack of the commitment on the part of the owner has a demotivating impact on the way the health care units are managed.

Health information is an essential factor of public health performance depends on the effectiveness of documentation use for routine and evidence based decisions. Medical record is the chronological, organized and comprehensive documentation of services delivered by service providers to the patients or clients. On the other hand, the quality of medical records (MRs) is rarely evaluated and quality dimensions of medical record are not well assessed particularly in the study area as well as in Ethiopia. The study was assessed the quality of medical record in public health care units of Soro district, Hadiya Zone, Southern Ethiopia. Facility based cross- sectional study design supplemented with qualitative inquiry was conducted among randomly selected four public health care units (PHCU) in Soro district, Hadiya zone. Data on the quality of medical records were collected by reviewing document using checklist, while qualitative data for triangulation were obtained by interviewing key informants from the health center and to describe possible reasons for poor medical record quality. The data were entered in to Epi-data version 3.1, exported, and analyzed by SPSS version 22.0. A total of 384 medical records were reviewed from one-year medical records of four public health care units with 98% retrieval rate. Among the dimensions of MRs quality, none of health centers had enough facility for medical record quality and no auditing of medical record document as of the standard. Majority of medical records had incomplete administrative, clinical and legal components as of health centers standard of the country. The studied PHCUs are not fulfilled the national medical record management requirements to run medical record system of health centers since the Ethiopian PHCUs standard set the medical record personnel to be a health information technician and a minimum of three in numbers. Thus, medical record service providers should be trained and necessary supplies should be equipped in all health center.

Avaliou-se a prática da integralidade, a partir da saúde da criança. Estudo de caso exploratório-descritivo (natureza transversal, abordagem quantitativa) que foi desenvolvido em duas unidades de saúde: uma, cujo eixo estruturante da assistência era o Programa de Saúde da Família e outra que organizava a assistência no modelo tradicional. Os dados foram levantados por entrevista com pais/responsáveis pelas crianças (n=195) e analisados com teste qui-quadrado e t-student. Constatou-se que o acesso era difícil em ambas às unidades, com média de 2-3 idas ao serviço para marcação de consulta. Acesso a medicamento e o sistema de referência/contra-referência foi mais bem garantido na unidade de saúde da família. O princípio da integralidade não se mostrou incorporado, mesmo na unidade de saúde da família. Assim, ainda permanecem como desafios, a busca de modelos assistenciais que contemplem o acesso aos serviços de saúde e a integralidade da atenção.

Information visualization is a significant, measured and potential advantage of Electronic Health Records (EHR) for understanding patient data to physicians. Doctors take primarily interest in understanding a complete knowledge from different portions of visualization that is comprised of numbers, pictures, texts and colored icons. However, complex presentation due to non-identification of different knowledge driven factors in EHR tools results in lesser attraction for its daily use in public health care units. Understanding and analysis of these factors that affect the utilization and sole understanding of visualization in EHR by physicians is main issue. Based on previous work by different researchers in same domain, these factors are shortlisted and compared to analyze the use of such tools by doctors. A survey based questionnaire study with a group of doctors is conducted using a approach to understand the deficiency areas for EHR tools. This figure out the requirements and expectations of doctors with EHR that may also assist other stakeholders like database professionals and visualization designers to align the tools based upon physician’s requirements. Results are analyzed based on feedback of doctors from emergency and outdoor departments of hospitals as they are first to deal with patients and their data in daily routine. Facts are represented in two different categories where first is mentioning the rate of knowledge skills of physicians about visualization and second is mentioning future expectations from such tools. Results concluded that EHR tools should facilitate in more insight about multiple patients history and more skills improvement is required for doctors to use such tools. This research paper is also an integral part of our ongoing effort for developing an integrated model, CARE1.0 that has been proposed in one of the previous work.

Purpose: The aim of this article is to present an efficient evaluation methodology for the hospital resources used in a study on units of healthcare system and their analysis in the organizational and legal forms. Design/Methodology/Approach: A research group constituted 48 health care units has been used. For the empirical part, a non-parametric DEA method was used to evaluate the efficiency of functioning of hospital units (surgical and internal medicine, both public and private) for 2014-2018. All the units that were qualified to the study had a contracted hospital agreement. Findings: Past analysis on the units of a healthcare system proved that efficiency of the usage of material or personal resources was underestimated and only a financial result was vital which in the units of healthcare system cannot play a major role. The authors proved that to manage efficiency it has to be previously measured with usage of the DEA method and the outcomes can be treated as a basis for developing and publishing detailed ranking lists that allow comparison between medical units. Results did not confirm that public health care units were less efficient than private units, which is very often taken as given. Practical Implications: Presented results – together with a recommended method – apart from experimental virtue also have a huge practical value. They can be used in a process of benchmarking which is getting more important as one of modern managing conception and is easily used in a health care sector. Originality/Value: Limitation of the resources in a system of health care determines necessity to constantly control the area of input-outcome. Conducted studies and conclusions constitute a new view on efficiency of health care units. The authors believe that it is necessary to continue studies in the regional field and also on different levels of protection systems.

BackgroundNursing professionals exhibit high prevalence of stress-related health problems. Job demands and job resources are parallel drivers of health and well-being among employees. Better job resources associate with better job satisfaction, job motivation and engagement even when job demands are high. To date, there is limited research which explores the association between job demands, job resources and health outcomes among nursing professionals in the Swedish context. The aim of this study was therefore to investigate Swedish nursing professionals’ job demands and job resources in relation to health outcomes, with comparisons between the private and public healthcare sectors. The specific research questions were as follows: (1) Are there differences between private and public healthcare regarding job demands, job resources, and health outcomes? and (2) Are there prospective associations between job demands and job resources in relation to health outcomes?MethodsData were drawn from the Swedish Longitudinal Occupational Survey of Health (SLOSH) 2016 and 2018, including 520 nurses and 544 assistant nurses working in the private and public healthcare sectors from 2016 (baseline). Data were analyzed using binary logistic regression.ResultsNursing professionals reported higher threats, lower bullying, lower control, lower social support, and lower cohesion in the public healthcare units compared to the private healthcare units. The prospective analyses showed that job resources in terms of social support and rewards were associated with higher self-rated health and lower burnout. Cohesion was associated with higher self-rated health. Job demands in terms of psychological demands and job efforts were associated with lower self-rated health, higher burnout, and higher sickness absence, while emotional demands were associated with higher burnout.ConclusionsNursing professionals’ job resources are deficient in public healthcare units. Job resources are associated with positive health outcomes, whereas job demands are associated with negative health outcomes, among nursing professionals. Strengthening job resources among nursing professionals in the private and public healthcare sectors can promote and sustain their work-related health.

Study designRetrospective medical record review.ObjectiveTo determine the prevalence and describe the profile of person with SCI (PWSCI) admitted in the public healthcare sector in Gauteng, South Africa.SettingSpecialized public healthcare rehabilitation units in Gauteng, South Africa.MethodsMedical records of PWSCI admitted to public healthcare rehabilitation units between 01 January 2018 and 31 December 2019 were perused. Data were collected anonymously and then summarised using descriptive and inferential statistics. Significance was set at p < 0.05.Results386 of 998 participants (38.7%) were admitted following SCI and the mean age was 36.9 years. Most participants were male (69.9%), with females significantly more likely to sustain a NTSCI (p < 0.001), which was the least common cause of SCI (34.9%). Those sustaining a TSCI were found to be significantly younger than their NTSCI counterparts (p < 0.001). Assault was the leading cause of injury (35.2%), and a positive HIV status with the presence of comorbidities were found to be significant risk factors for developing a NTSCI (p < 0.001). Most injuries were between T7-T12 (39.9%) and were complete (56.9%). The rehabilitation length of stay 85.6 days, with a mortality rate of 6.48%.ConclusionsGauteng has among the highest global proportion of TSCI due to assault. Of interest, more females sustained a NTSCI than their male counterparts. There is a need to strengthen SCI prevention strategies, particularly targeting assault in young males and infectious causes in females and older populations. Further epidemiological and outcomes-based research is required for PWSCI.

The purpose of this study is to demonstrate practical experience of the managerial decision-making process allowing of the impact and importance of stakeholders of the health units. The empirical evidence, gathered among selected public and private health care units form the region of Silesia, presents different approach to the decision-making process according to the stakeholder’s impact and importance for the entire entity. The study concentrate mainly on public health care units, in view of the importance of its numerous stakeholder groups, as well as special connections, relations and influence they imprint on decision-making process.

Purpose: This paper aims to scrutinize the healthcare service quality in the rural population of a developing economy like India. It further aims at analyzing the service quality gap of the healthcare sector as perceived by its customers. &#x0D; Design/ Methodology/Approach: This paper used the SERVQUAL model to examine the service quality of the health care units. For this study, only public health care units from the rural areas were considered.&#x0D; Findings: The results entail that the hospitals have little or no provision of necessary infrastructural facilities inside the hospital in terms of medical equipment. The healthcare personnel do not provide personalized attention to the patients. Research&#x0D; Limitations: The study was limited to rural state-owned hospitals' status; the results and interpretations may not be completely applicable or relevant to the private sector hospitals and urban hospitals.&#x0D; Practical Implication: The study clearly states that the patients know their expectations in terms of service quality.&#x0D; Originality/ Value: Vivid research has been done to examine the quality of services provided by the healthcare units, the least of them focusing on the rural front. This study is a genuine work by the authors to understand the healthcare providers' rural population's expectations.

To describe the geographical coverage of the Mexican Healthcare System (MHS) services and to assess the utilization of its General Hospitals. A Geographic Information System (GIS) was used to include sociodemographic data by locality, the geographical location of all MHS healthcare services, and data on hospital discharge records. A maximum likelihood estimation model was developed to assess the utilization levels of 217 MHS General Hospitals. The model included data on human resources, additional infrastructure, and the population within a 25 km radius. In 1998, 10,806 localities with 72 million inhabitants had at least one public healthcare unit, and 97.2% of the population lived within 50 km of a healthcare unit; however, over 18 million people lived in rural localities without a healthcare unit. The mean annual hospital occupation rate was 48.5 +/- 28.5 per 100 bed/years, with high variability within and between states. Hospital occupation was significantly associated with the number of physicians in the unit, and in the Mexican Institute of Social Security units utilization was associated with additional health infrastructure, and with the population's poverty index. GIS analysis allows improved estimation of the coverage and utilization of MHS hospitals.

Descreve existência de atendimento para crianças, as faixas etárias atendidas, a qualificação do profissional, os tipos de procedimentos realizados para a dentição decídua e permanente e a existência de programas educativos de promoção de saúde bucal nas Unidades de Saúde do Município de São Luís com assistência odontológica, por meio de visitas e entrevistas estruturadas. Os resultados mostram que o atendimento odontológico para crianças e adolescentes é disponibilizado em 91,1% das unidades de saúde, se concentrando na faixa etária de 6 a 12 anos, tanto nas unidades que prestam assistência diária e universal (65,75%) quanto naquelas (34,15%) onde o atendimento é feito em consultório restrito, específico e/ou em dias específicos. Todas as unidades visitadas oferecem tratamento cirúrgico para a dentição permanente. O tratamento restaurador é mais disponibilizado para os dentes permanentes do que para os dentes decíduos. Vinte e cinco (55,5%) das unidades de saúde não apresentam ou não desenvolvem programas de educação em saúde bucal. Na maioria das unidades (75,5%) visitadas, o tratamento odontológico para crianças e adolescentes é restrito à atenção básica e voltado para a dentição permanente. O modelo assistencial tradicional de atendimento de livre demanda permanece.

This paper presents the situation of the medical equipment management under the Department of Health of Bahia (SESAB), since the implementation of the Directorate of Science, Technology and Innovation in Health (DITEC). The article describes a specific set of actions to enhance management of medical equipment at the SESAB's Central Level and on its health care units.