Health Care Delivery In Areas Research Articles

Psychological and educational effects of the COVID-19 pandemic on online students and faculty of a ghanaian university

This is a qualitative study that employed exploratory design to inquire from 15 participants of Central University (Ghana) about their experience with the COVID-19 pandemic in Ghana. An in-depth interview was conducted, and data were analyzed using thematic analysis. The findings indicate that participants experienced fear expressed in four key domains reported under four key themes thus: Experiencing psychological distress; Burden of economic hardships; Fear of inefficient health system; and Educational disruptions and worries involved in online teaching and learning. The study concludes that the upsurge of COVID-19 has triggered psychological, economic, and educational conundrums that have to be addressed. This paper contributes to the growing body of studies on COVID-19 and effects on lecturers and students. The burgeoning evidence of the mental health distress following COVID-19 should be a wake-up call for universities and Ghana as a whole to invest both in infrastructure and manpower in this area of health care delivery. Vaccine hesitancy research must be conducted to improve upon health educational campaigns. The significant disruption from the pandemic is a fair warning to all stakeholders to make educational e-learning infrastructure resilient against similar future shocks. The implications of the findings for health and educational policies in Ghana are addressed.

The Impact of District Assembly Common Fund on Socio-Economic Activities in the New Juaben Municipality

This paper's value is in determining how the district assembly common money affects socioeconomic activity in NJM. The study, which focused on five thematic areas—instruction, health, poverty eradication, social facilities, and infrastructural development—obtained quantitative and qualitative data using questionnaires, interview guides, and observation. The sample size was thirty-two (32) and included every member of the NJM Assembly. According to the report, society has benefited from a number of advancements in the areas of health care delivery, poverty reduction, social amenities, and infrastructure development. Researchers suggest, based on their findings, that a program be funded by DACF with the goal of cooperating with the Ministry of Food and Agriculture to create a rural environment that is conducive to agricultural development. Last but not least, the management of the fund should be governed by tight rules. The impoverished should be the objective, not the wealthy.
 
 Received: 11 December 2022 / Accepted: 21 February 2023 / Published: 6 March 2023

IMPLEMENTING SYSTEM DYNAMICS AND PARTICIPATORY ACTION RESEARCH AT THE NEXUS OF PATIENT CARE FACTORS

Ponte Academic JournalFeb 2023, Volume 79, Issue 2 IMPLEMENTING SYSTEM DYNAMICS AND PARTICIPATORY ACTION RESEARCH AT THE NEXUS OF PATIENT CARE FACTORSAuthor(s): Maseeha Mahomed Farouk Ansermeah ,Cecile Gerwel ProchesJ. Ponte - Feb 2023 - Volume 79 - Issue 2 doi: 10.21506/j.ponte.2023.2.7 Abstract:Purpose: Factors influencing patient care were analyzed in a public health setting in a bid to enhance patient experience and identify areas of health care delivery which could be improved upon. Methods: Patients and members of health care staff were interviewed by means of purposeful sampling. Causal loop diagrams and stock flow diagrams were merged with the use of Systems archetypes under the broad purview of System Dynamics and Participatory Action Research. Results and Conclusion: System Dynamics heuristics unmasked flaws in the system which were then acted upon utilizing Participatory Action Research interventions. Overall there has been a homogenous improvement in understanding the factors which contribute to patient care. Download full text:Check if you have access through your login credentials or your institution Username Password

Artificial Intelligence: Applications in Nursing

As in many areas of health-care delivery, nursing practice is being transformed by technological advances such as artificial intelligence (AI). Nurses play an integral role in health-care delivery system and it is essential for nurses to integrate these new technologies into practice. Nursing students, practicing nurses, nursing faculty, and nurse leaders need be aware of AI and its implications in nursing. This paper presents the significance of AI technologies application in health care specially nursing.

Implementing shared decision-making in Australia

Person-centred care (PCC) and shared decision-making (SDM) are part of national clinical standards for an increasing number of areas of health care delivery. In addition to existing standards for accrediting hospitals, day surgery facilities, public dental services and medical education in Australia, new standards governing primary health care and digital mental health services have been added. Implementation and measurement of PCC and SDM to comply with standards, and training of health professionals, remain challenges for the Australian health sector. Consumer involvement in health research, policy and clinical service governance continues to increase and the National Health and Medical Research Council has begun to encourage consumer and community involvement in health and medical research. This increased consumer engagement and moves towards more PCC provision is reflected in a focus on encouraging patients to ask questions during their clinical care and supports improvements in consumer health literacy. SDM support tools are now being culturally adapted whilst a need for more systemic approaches to their development and implementation persists. With increasing resources and tools for all aspects of PCC and SDM challenges to find sustainable solutions to ensure tools are kept up to date with the best available evidence remain.

Cardiovascular Health Care Implications of the COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has challenged the capacity of health care systems around the world, including substantial disruptions to cardiovascular care across key areas of health care delivery. In this narrative review, we examine the implications of the COVID-19 pandemic for cardiovascular health care, including excess cardiovascular mortality, acute and elective cardiovascular care, and disease prevention. Additionally, we consider the long-term public health consequences of disruptions to cardiovascular care across both primary and secondary care settings. Finally, we review health care inequalities and their driving factors, as highlighted by the pandemic, and consider their importance in the context of cardiovascular health care.

DISRUPTIVE INNOVATION IN HEALTHCARE: A REVIEW AND FUTURE RESEARCH AGENDAS

Disruptive innovation (DI) refers to a mode of low cost high ancillary performance innovation that starts at the lower end of the market and gradually moves up to eventually displace its incumbent counterparts. The concept of DI has become more and more popular in the healthcare sector. The paper studies how healthcare research has embraced the concept of DI in various areas within the healthcare sector. Areas of healthcare, where DI has been adopted as a management strategy, were identified in the last two decades, through initially shortlisting 157 papers and the final reviewed set of 117 papers. Through a multi-method approach comprising of co-word analysis, identification of themes, mapping of research work across these themes and geography, the study found that, although from a management perspective there are 13 major themes, the majority of the focus is on four major themes–healthcare delivery and services, healthcare administration, technology and equipment, and nursing and palliative care. Furthermore, the majority of the geography-specific research was conducted in developed countries, especially the USA. It was also observed that organisational strategies for successfully implementing DI in the healthcare sector are still in the nascent stage and the focus is mostly in the area of healthcare delivery and administration from the management perspective. Future research studies could aim at looking at the role that DI plays in the healthcare sector of the developing countries, as well as using DI in other areas of healthcare, rather than a few concentrated areas.

Health system resilience and health workforce capacities: health system responses during COVID-19

Abstract Background The present crisis offers a unique opportunity to better understanding the specific contribution of the health workforce to health system resilience, and more specifically to the adaptive, absorptive and transformative capacities that influence how health systems respond to the COVID-19 pandemic. Methods The study examined different capacities in the context of the health system as the central prerequisite of health system resilience. We compared health policies and services responses in Austria, Denmark, Germany, Italy, the Netherlands and the UK. The selection is based on differences in types of health care systems and pandemic burdens in the first wave. Country experts complied descriptive case studies using written secondary and primary sources. Results During the first wave of the pandemic, the contribution of the health workforce rested on a broad range of capacities. The absorptive capacity concerned the freeing up capacities for newly established Covid-19 wards in hospitals. The adaptive capacity focused on increasing health workers. The transformative capacity concerned new service offerings. The influence of health systems was most visible in relation to the substantive areas of health care delivery at play, and less so in relation to the specific range of capacities of the health workforce. The lack of distinct patterns was striking, considering the inclusion of health systems, which differ on many counts. Conclusions The study calls for a reconceptualization of the institutional perquisites of health system resilience to grasp more fully the manifold and unique health workforce contribution. Governance is the key to effective health system responses to the COVID-19 crisis, and health professions are part and parcel of governance as frontline workers and collective actors. This requires improving health workforce capacities and strengthening the integration of health professions in health governance.

Perceptions of the Health Care Workers about the Guideline Implemented for Safe Surgical Practice during COVID-19 Pandemic in a University Teaching Hospital.

One area of health care delivery that has been affected badly in most of the institutions is the running of the surgical services. This is due to various factors such as the presence of asymptomatic carrier stage, increased morbidity and mortality in surgical procedures in a COVID-19 patient, and possible transmission of disease to the health care workers (HCWs). A guideline was formulated in our institution, which is a tertiary care university teaching hospital to resume the surgical activities in full. Following its implementation, a questionnaire-based study was conducted to understand the perception of the HCWs about the guidelines. The questionnaire had four domains with questions related to the impact of the epidemic on the practices, composition of the guidelines, its implementation, and effects. There were 217 responders which included doctors and the supportive staff. Majority of the responders welcomed the introduction of the guidelines, and felt that it ensured patient's safety and helped streamline the services. Quarantine and preoperative reverse transcription polymerase chain reaction testing were found to be appropriate measures by the respondents. In some areas, there was a difference in the responses from the doctors to that from the supportive group which assumed statistical significance. These included the reason for drop in patient numbers was the reduced patient accessibility which was felt mainly by the doctors. The doctors perceived a delay in carrying out the work, increased workload, and mental agony due to the presence of the guidelines.

Lean approach to improving performance and efficiency in a nuclear medicine department

Healthcare organizations using Lean Management have the potential to decrease the number of errors, reduce wait time and increase productivity. The aim of this review is to assess the literature with regard to the use and efficacy of Lean thinking and Lean methodologies within a Department of Nuclear Medicine. Several health departments have adopted lean thinking as a consistent approach to quality improvement. We considered studies that demonstrated improvements across a variety of outcomes: the common factor was the aim to improve services to the patient. Lean methodology was selected because it is widely used in the healthcare environment and many Lean tools (VSM, one-piece flow, 5S, spaghetti diagram, A3, cell design, SMED) were analyzed for different processes. Many Lean studies have resulted in shortened queuing time, in cost-saving, in reducing defects, in increasing patient volume and in increasing staff and patient safety and satisfaction. Lean tools have the potential to reduce error and costs and improve quality. Because Radiology and Nuclear Medicine departments are similar concerning patient processes, they have plenty of potentials to benefit from systematic Lean adoption. We believe these principles can be applied to other health care delivery areas.

Impact of COVID-19 on health services utilization in Province-2 of Nepal: a qualitative study among community members and stakeholders

BackgroundThe COVID-19 pandemic has posed unprecedented challenges and threats to the health care system, particularly affecting the effective delivery of essential health services in resource-poor countries such as Nepal. This study aimed to explore community perceptions of COVID-19 and their experiences towards health services utilization during the pandemic in Province-2 of Nepal.MethodsThe semi-structured qualitative interviews were conducted among purposively selected participants (n = 41) from a mix of rural and urban settings in all districts (n = 8) of the Province 2 of Nepal. Virtual interviews were conducted between July and August 2020 in local languages. The data were analyzed using thematic network analysis in NVivo 12 Pro.ResultsThe findings of this research are categorized into four global themes: i) Community and stakeholders’ perceptions towards COVID-19; ii) Impact of COVID-19 and lockdown on health services delivery; iii) Community perceptions and experiences of health services during COVID-19; and iv) COVID-19: testing, isolation, and quarantine services. Most participants shared their experience of being worried and anxious about COVID-19 and reported a lack of awareness, misinformation, and stigma as major factors contributing to the spread of COVID-19. Maternity services, immunization, and supply of essential medicine were found to be the most affected areas of health care delivery during the lockdown. Participants reported that the interruptions in health services were mostly due to the closure of health services at local health care facilities, limited affordability, and involvement of private health sectors during the pandemic, fears of COVID-19 transmission among health care workers and within health centers, and disruption of transportation services. In addition, the participants expressed frustrations on poor testing, isolation, and quarantine services related to COVID-19, and poor accountability from the government at all levels towards health services continuation/management during the COVID-19 pandemic.ConclusionsThis study found that essential health services were severely affected during the COVID-19 pandemic in all districts of Province-2. It is critical to expand and continue the service coverage, and its quality (even more during pandemics), as well as increase public-private sector engagement to ensure the essential health services are available for the population.

Implications of continuity of care on infant caloric intake in the neonatal intensive care unit.

To estimate the association of continuity of neonatologist care with caloric intake and growth velocity (GV) in very low birth weight (VLBW) infants. We created a daily continuity index (DCI) defined as the number of days the neonatologist worked in the previous week. We estimated the independent associations between this index and infants' daily caloric intake (kcal/kg/day) and GV (g/kg/day) through the first 6 weeks of life using regression analyses. Twenty-eight neonatologists cared for 115 infants over 4643 patient-days. The DCI was independently associated with increased caloric intake (β = 1.27 kcal/kg/day per each day of continuity, p < 10-4); this effect was magnified (β = 3.33, p < 10-4) in the first 2 weeks. No association was observed between the index and GV. Neonatologist continuity may contribute to caloric intake in VLBW infants. Quality metrics focused on this area of health care delivery warrant further discovery.

Virtual patients versus small-group teaching in the training of oral and maxillofacial surgery: a randomized controlled trial

BackgroundComputerized virtual patients (VP) have spread into many areas of healthcare delivery and medical education. They provide various advantages like flexibility in pace and space of learning, a high degree of teaching reproducibility and a cost effectiveness. However, the educational benefit of VP as an additive or also as an alternative to traditional teaching formats remains unclear. Moreover, there are no randomized-controlled studies that investigated the use of VP in a dental curriculum. Therefore, this study investigates VP as an alternative to lecturer-led small-group teaching in a curricular, randomized and controlled setting.MethodsRandomized and controlled cohort study. Four VP cases were created according to previously published design principles and compared with lecturer-led small group teaching (SGT) within the Oral and Maxillofacial Surgery clerkship for dental students at the Department for Cranio-, Oral and Maxillofacial Plastic Surgery, Goethe University, Frankfurt, Germany. Clinical competence was measured prior (T0), directly (T1) and 6 weeks (T2) after the intervention using theoretical tests and a self-assessment questionnaire. Furthermore, VP design was evaluated using a validated toolkit.ResultsFifty-seven students (VP = 32; SGT = 25) agreed to participate in the study. No competence differences were found at T0 (p = 0.56). The VP group outperformed (p < .0001) the SGT group at T1. At T2 there was no difference between both groups (p = 0.55). Both interventions led to a significant growth in self-assessed competence. The VP group felt better prepared to diagnose and treat real patients and regarded VP cases as a rewarding learning experience.ConclusionsVP cases are an effective alternative to lecture-led SGT in terms of learning efficacy in the short and long-term as well as self-assessed competence growth and student satisfaction. Furthermore, integrating VP cases within a curricular Oral and Maxillofacial Surgery Clerkship is feasible and leads to substantial growth of clinical competence in undergraduate dental students.

The hidden sharks of clinical practice.

The hidden sharks of clinical practice.

A facility-based study of women\u2019 satisfaction and perceived quality of reproductive and maternal health services in the Kenya output-based approach voucher program

BackgroundThis is a facility-based study designed to assess perceived quality of care and satisfaction of reproductive health services under the output-based approach (OBA) services in Kenya from clients’ perspective.MethodAn exit interview was conducted on 254 clients in public health facilities, non-governmental organizations, faith-based organizations and private facilities in Kitui, Kilifi, Kiambu, and Kisumu counties as well as in the Korogocho and Viwandani slums in Nairobi, Kenya using a 23-item scale questionnaire on quality of reproductive health services. Descriptive analysis, exploratory factor analysis, reliability test, and subgroup analysis using linear regression were performed.ResultsClients generally had a positive view on staff conduct and healthcare delivery but were neutral on hospital physical facilities, resources, and access to healthcare services. There was a high overall level of satisfaction among the clients with quick service, good handling of complications, and clean hospital stated as some of the reasons that enhanced satisfaction. The County of residence was shown to impact the perception of quality greatly with other social demographic characteristics showing low impact.ConclusionMajority of the women perceived the quality of OBA services to be high and were happy with the way healthcare providers were handling birth related complications. The conduct and practice of healthcare workers is an important determinant of client’s perception of quality of reproductive and maternal health services. Findings can be used by health care managers as a guide to evaluate different areas of healthcare delivery and to improve resources and physical facilities that are crucial in elevating clients’ level of satisfaction.

The Effects Of Medicaid Expansion Under The ACA: A Systematic Review.

Expanding eligibility for Medicaid was a central goal of the Affordable Care Act (ACA), which continues to be debated and discussed at the state and federal levels as further reforms are considered. In an effort to provide a synthesis of the available research, we systematically reviewed the peer-reviewed scientific literature on the effects of Medicaid expansion on the original goals of the ACA. After analyzing seventy-seven published studies, we found that expansion was associated with increases in coverage, service use, quality of care, and Medicaid spending. Furthermore, very few studies reported that Medicaid expansion was associated with negative consequences, such as increased wait times for appointments-and those studies tended to use study designs not suited for determining cause and effect. Thus, there is evidence to document improvements in several areas of health care delivery following the ACA Medicaid expansion. We outline areas for future research that can further reduce current knowledge gaps.

Impact of Technological Innovation Management on Health Care Service Delivery: A Systematic Review

This work was funded by the National Nature Science Foundation of China (71774069). Abstract The objective of this study is to provide a comprehensive, systematic review on the progress of research on technological innovation management literature in healthcare delivery and its impact, whereby we seek to highlight the knowledge gaps, and provide researchers and scholars’ approaches for future research. We statistically reviewed and analyzed 289 articles relevant to our research objectives using publications in journals, articles, conferences and those available in press from 1990 to 2018. Based on which we critically synthesized 36 articles for content analysis (conceptual, and empirical studies) and created a framework for technological innovation management research. Content analysis showed some appreciable contributions of conceptual, empirical, evidential and review articles in the field. We observed that though there has been some research into the area of innovation, open innovation and the application of technological innovation in the area of health care delivery, little study has been done in assessing the impact management of such technological innovation on the delivery of public health care services to citizens; thus the use of our proposed framework will provide guidance for researchers and scholars seeking to advance discussions and studies in this area. Keywords: Technological innovation management, technological innovation, process innovation, open innovation, public health, research and development (R & D).

A modified Delphi study to determine the level of consensus across the European Union on the structures, processes and desired outcomes of the management of polypharmacy in older people.

BackgroundInappropriate use of multiple medicines (inappropriate polypharmacy) is a major challenge in older people with consequences of increased prevalence and severity of adverse drug reactions and interactions, and reduced medicines adherence. The aim of this study was to determine the levels of consensus amongst key stakeholders in the European Union (EU) in relation to aspects of the management of polypharmacy in older people.MethodsForty-six statements were developed on aspects of healthcare structures, processes and desired outcomes, with consensus defined at ≥ 80% agreement. Panel members were strategists (e.g. directors, leading clinicians and commissioners) from each of the 28 EU member states, with a target recruitment of five per member state. Three Delphi rounds were conducted via email, with panel members being provided with summative results and collated, anonymised comments at the commencement of Rounds 2 and 3.ResultsNinety panel members were recruited (64.3% of target), with high participation levels throughout the three Delphi rounds (91.1%, 83.3%, 72.2%). During Round 1, consensus was obtained for 27/46 statements (58.7%), with an additional two statements in Round 2 and none in Round 3. Consensus was obtained for statements relating to: potential gain arising from polypharmacy management (3/4 statements); strategic development (7/7); change management (5/7) indicator measures (4/6); legislation (0/3); awareness raising (5/5); polypharmacy reviews (5/7); and EU vision (0/7). Analysis of free text comments indicated that the vision statements were too ambitious and not achievable by the specified timeframe of 2025.ConclusionConsensus was obtained amongst key EU strategists around many aspects of polypharmacy management in older people. Notably, no consensus was achieved in relation to statements relating to the need to alter legislation in areas of healthcare delivery, remuneration and practitioner scope of practice. While the vision for the EU by 2025 was considered rather ambitious, there is great potential and clear opportunity to advance polypharmacy management throughout the EU and beyond.

Creating an integrated behavioral/developmental care partnership: financing and measuring effective change

A new template for improved behavioral healthcare delivery for children in areas with limited resources will be presented. The Center for Advancement of Youth (CAY) was created at the University of Mississippi Medical Center in partnership with the Division of Medicaid (a jointly funded state-federal health insurance program for the needy) in response to the overwhelming need for services for children with developmental and behavioral disorders in our region. Mississippi has more than 30,000 children with developmental and behavioral disorders and has traditionally been a desert for behavioral healthcare, with limited services and qualified providers. Increasing numbers of children have been placed on medication for developmental/behavioral difficulties without adequate monitoring or behavioral intervention services. As developmental and behavioral disorders are on the rise, the resources for parents and children in many areas remain insufficient. The lack of resources ultimately puts pressure on the primary care provider to manage and treat intricate disorders with pharmaceutical interventions. In our state, rate of diagnosis for conditions such as ADHD is very high (http://www.cdc.gov/ncbddd/adhd/prevalence.html), as well as the rate of medication use (http://www.pharmacytimes.com/news/State-ADHD-Medication-Rates-Vary-Widely). Medicaid provided funding to help remake behavioral care for children in our state in order achieve better, more efficient care while improving patient and caregiver satisfaction. The CAY model provides integrative child and adolescent behavioral health services across the state of Mississippi, a geographically large and predominately rural state, through a centralized location. Children referred by their medical home enter into an intensive triage and screening protocol with case management designed for efficiency. Telehealth and onsite visits are used. The majority of children receive services near their home town. Results have shown a diminished wait time, robust behavioral improvement and fewer medications dispensed. The goal of the CAY Center is to give children in our region access to appropriate services quickly, while avoiding redundant or unnecessary services through coordinated care and continuing to encourage the medical home concept. In this session, we will discuss the problem of providing ease of access into the behavioral care system for children and their families. We will also discuss the building process that is required, by describing the partnerships that lead to better results. Finally, we will discuss the positive outcomes that can be achieved by examining and restructuring healthcare delivery to these children. The learner will be provided a template for improved behavioral healthcare delivery in areas with limited resources.

Delivering Prolonged Intensive Care to a Non-human Primate: A High Fidelity Animal Model of Critical Illness

Critical care needs have been rising in recent decades as populations age and comorbidities increase. Sepsis-related admissions to critical care contribute up to 50% of volume and septic shock carries a 35–54% fatality rate. Improvements in sepsis-related care and mortality would have a significant impact of a resource-intensive area of health care delivery. Unfortunately, research has been hampered by the lack of an animal model that replicates the complex care provided to humans in an intensive care unit (ICU). We developed a protocol to provide full ICU type supportive care to Rhesus macaques. This included mechanical ventilation, continuous sedation, fluid and electrolyte management and vasopressor support in response to Ebolavirus-induced septic shock. The animals accurately recapitulated human responses to a full range of ICU interventions (e.g. fluid resuscitation). This model can overcome current animal model limitations by accurately emulating the complexity of ICU care and thereby provide a platform for testing new interventions in critical care and sepsis without placing patients at risk.