Aspects Of Health Care Provision Research Articles

The burden of Finke Desert race-related trauma: A 10-year retrospective descriptive analysis.

The Finke Desert Race is an annual motorsport race (motorbikes, cars and buggies) held in Alice Springs resulting in a significant major trauma burden. This imposes unique challenges in one of the world's most remote healthcare settings. To quantify the volume and characteristics of Finke Desert Race-related trauma presenting to the Alice Springs Hospital. A retrospective descriptive study was undertaken to review all patients presenting to the Alice Springs Hospital with Finke Desert Race-related trauma over a 10-year period. Information collected included demographic data, injury characteristics, patient disposition and required management. Over the 9 years the event was held, 325 patients were admitted to the Alice Springs Hospital. Patients were almost exclusively male (98.8%), with a mean age of 34.75 and residing outside of Alice Springs (82.2%). There were a total of 460 distinct injuries with the clavicle, spine and ribs the three most commonly injured sites. A total of 129 operations were required, of which 19 required retrieval to an interstate centre. Alice Springs is one of the most remote and geographically isolated centres on Earth. This rurality poses unique challenges when trying to coordinate medical and retrieval services, exacerbated for a concentrated, yet highly resource intensive event such as Finke. It has far reaching impacts, placing additional stresses on all aspects of healthcare provision. This review has quantified the trauma burden of the event for the first time, enabling local and interstate stakeholders' ability to plan an adequate and sustainable response while also enabling the future effectiveness evaluation of recent safety reforms.

“The trip actually opened our eyes to things that we were supposed to do and we were not doing”: developing primary health care system leadership in a low-income country with peer exchanges

BackgroundHealth care systems in low and middle-income countries are decentralizing and devolving power to the periphery. Transferring power without systematic processes to develop and nurture leaders at the district compromises the effectiveness and sustainability of the decentralized health system. To address this problem, we developed an approach to leadership learning by observation and experience that improved the organization and performance of the health care system in a district in Ghana.MethodologyUsing two rounds of a longitudinal qualitative study, the study explores the determinants of implementing the Community-Based Health Planning and Services (CHPS) initiative in a district in Ghana. Insights were gained concerning the leadership regimes of two leaders who administered health services in a common geographic area at different points in time with remarkably contrasting outcomes. Insights of health workers who participated in both periods were elicited to clarify interview contexts. Ten focus group discussions (FGDs) and five expert interviews were conducted for each round of the study. The study was informed by a systems appraisal approach that utilized a thematic analytical framework.ResultsProviding district leaders with a practical observational experience had a significant influence on health care delivery in all aspects of health care provision at the district level. Exposing participants to models of best practices facilitated the replication of processes that improved the conduct of service delivery and CHPS implementation. Upon reflection, district leaders attributed performance constraints to their lack of understanding of practical ways of responding to complex district health system development needs. Observation from community members, volunteers, and health workers who witnessed the system development period corroborated narratives that leaders had expressed.ConclusionEffective leadership is optimally developed with participatory learning that provides leaders with direct access to fully functioning systems. Learning by observation can be structured and used to quicken the spread of managerial excellence.

Optimizing Care for Adults with Congenital Heart Disease: Results of a Conjoint Analysis Based on a Nationwide Sample of Patients Included in the German National Register.

(1) Background: Congenital heart disease (CHD) requires lifelong specialized care. Failure to follow up and gaps in care are common in this group and lead to increased morbidity/mortality. We evaluated patients’ perceived needs and expectations regarding specialized care using state-of-the-art statistical and market research techniques based on a nationwide sample of CHD patients. (2) Methods: A random sample of adults with CHD registered in the German National Register for Congenital Heart Defects were invited to answer an adaptive online questionnaire based on the conjoint analysis (CA) technique. CA determines the relative importance of various aspects of health care provision and allows individuals to trade between characteristics, thus recognizing limited resources. (3) Results: 637 patients participated (mean age 33.8 ± 12.6 years; 55.6% female; disease complexity: simple defect 12.6%, moderate complexity 40.3%, complex CHD 40.2%) in the analysis. Patients assigned the highest relative importance to aspects of patient–physician communication, physician qualifications, waiting time, medical care, and medical equipment. Comfort-related aspects such as driving time or hotel aspects of care received much lower scores. We identified four well-defined clusters of patients with differing expectation patterns: (i) time sensitive patients; (ii) excellence seeking patients; (iii) continuity seekers, and (iv) support seeking patients. (4) Conclusions: Adult CHD patients rank effective patient–physician interaction and communication as the most important factors. As we identified significant heterogeneity between CHD patients, centers should cater for individual preferences and integrate individual needs into treatment plans to prevent failure to follow up and ensure patient compliance.

COVID-19 and cap: What changed in training and practice for early career child/adolescent psychiatrists?

The Covid-19 pandemic has transformed the world since the beginning of 2020 and many aspects of health care provision has changed dramatically. Despite not being regarded as a frontline field at first look, Child and Adolescent Psychiatry (CAP) has been highly impacted by the pandemic as a fundamentally biopsychosocial branch. CAP specialty training has also become a different experience due to the reprioritization of health care services along with the restricting rules of the ‘new normal’. In this symposium presentation, we will discuss the effects of the Covid-19 pandemic on the training and practice of CAP specialty trainees and early career specialists through the results of the ‘Early Career Psychiatrists in Europe during COVID-19 outbreak’ survey study, organized by the EPA and EFPT. The survey covers different areas including reorganization of training/practice during the pandemic, personal experiences with Covid-19 and adoption of Telepsychiatry practices. This pan-European study is expected to shed a light on the emerging issues for young doctors in CAP to plan necessary improvements on a European scale.DisclosureNo significant relationships.

Patient length of stay, patient readmission rates and the provision of professional interpreting services in healthcare in Australia.

Linguistic and ethnic diversity is a feature of patient profiles at almost all public healthcare facilities in urban areas in Australia. Patients with limited proficiency in the socially dominant language - in this case Limited English proficiency (LEP) patients - commonly form a significant patient group in public healthcare settings. Communication barriers that exist between patients and healthcare professionals necessitate the provision of translation and interpreting (T&I) services. This study presents longitudinal data from Melbourne, Australia, on the provision of (T&I) services together with patient length of stay (LOS) and patient readmission rates over a 10-year period at a large, public healthcare provider. Patient LOS and patient readmission rates are key metrics for effective diagnosis and treatment of patients and commonly used to measure the performance of various aspects of healthcare provision. The augmentation of T&I services within a general policy of patient-centred care is shown to accompany decreased LOS and lower readmission rates for LEP patients.

Resource allocation: exploring concepts of justice and utility

In the first of a new series of articles, Peter Ellis will examine the ethics of resource allocation. In its sister piece on page 44, he will then look at the principles relating to this aspect of health-care provision in the context of kidney care. This approach, where ethical theory is examined and then applied to a topic pertinent to renal medicine, will be repeated in subsequent papers in the series.

Enhancing patient education skills of physiotherapy students in a clinical education setting

Introduction: Effective patient education is a fundamental aspect of healthcare provision, which requires the use of effective clinical and communication skills. Simulation approaches using group discussion and feedback are effective for clinical and communication skills training in healthcare students. The purpose of this study was to investigate such an approach in improving physiotherapy students’ patient education skills and self-efficacy in a clinical education setting. Methods: A simulated learning activity consisting of a case study and structured role play with feedback and discussion was developed for use during the first week of final‑year musculoskeletal physiotherapy clinical placements. Student self-efficacy in relation to patient education was evaluated before and after, and compared using non-parametric statistical tests. Student performance of patient education was contrasted to that of previous cohorts. Student and clinical educator perception of the intervention was also evaluated with descriptive statistics and qualitative framework analysis. Results: Twenty-four students took part in the study. Student self-efficacy significantly improved following the intervention ( p < 0.01). Although performance scores were not significantly higher than those of previous cohorts, all students within the current study passed the assessment of physiotherapy practice, which contrasts to previous cohorts. The intervention was well received by students, and themes relating to importance of patient education, improved quality and increased engagement in patient education were generated from clinical educator and student qualitative data. Conclusion: Within physiotherapy clinical placement settings, a small group learning intervention using case studies, simulation, facilitated feedback and discussion provides an effective and well-received approach to patient education skills training.

Working in partnership with patients and carers.

Health policy and healthcare professional guidelines promote patient and carer involvement, which includes working in partnership with service users in all aspects of healthcare provision, research and education. This article explores the expectations for nurses to work in partnership with patients and carers, examines the definitions and theories of working in partnership and related concepts, as well as considering examples of partnership working in nursing practice.

Health status of and health-care provision to asylum seekers in Germany: protocol for a systematic review and evidence mapping of empirical studies.

BackgroundThere are more than 100,000 asylum seekers registered in Germany, who are granted limited access to health services. This study aims to provide a systematic overview of the empirical literature on the health status of and health-care provision to asylum seekers in Germany in order to consolidate knowledge, avoid scientific redundance, and identify research gaps.Methods/designA systematic review and evidence mapping of empirical literature on the health status of and health-care provision to asylum seekers in Germany will be performed. We will apply a three-tiered search strategy: 1. search in databases (PubMed/MEDLINE, Web of Science, IBSS, Sociological s, Worldwide Political Science s, CINAHL, Sowiport, Social Sciences Citation Index, ASSIA, MedPilot, DNB), dissertation and theses databases, and the internet (Google); 2. screening references of included studies; 3. contacting authors and civil society organizations for grey literature. Included will be studies which report quantitative and/or qualitative data or review articles on asylum seekers in Germany, published in German or English language. Outcome measures will include physical, mental, or social well-being, and all aspects of health-care provision (access, availability, affordability, and quality). Search results will be screened for eligibility by screening titles, abstracts and full texts. Data extraction comprises information on study characteristics, research aims, and domains of health or health-care services analyzed. The quality of studies will be appraised and documented by appropriate assessment tools. A descriptive evidence map will be drawn by categorizing all included articles by research design and the health conditions and/or domains of health-care provision analyzed. The body of evidence will be evaluated, and a narrative evidence synthesis will be performed by means of a multi-level approach, whereby quantitative and qualitative evidence are analyzed as separate streams and the product of each stream is configured in a final summary.DiscussionThis systematic review will provide an evidence map and synthesis of available research findings on the health status of and health-care provision to asylum seekers in Germany. In anticipation of identifying areas which are amenable to health-care interventions, deserve immediate action, or further exploration, this review will be of major importance for policy-makers, health-care providers, as well as researchers.Systematic review registrationPROSPERO 2014: CRD42014013043Electronic supplementary materialThe online version of this article (doi:10.1186/2046-4053-3-139) contains supplementary material, which is available to authorized users.

The Development of Healthcare Chaplaincy

Healthcare chaplaincy is going through a period of considerable challenge amidst current financial austerity within public sector provision. However, such cutbacks have sharpened the need for chaplains not only to show that their practice enhances the wellbeing of service users, their carers, staff and organisations but that their contribution is unique and value for the tax payers’ money. This article seeks to enable readers to understand more fully the different roles healthcare chaplain play as an increasingly integrated aspect of healthcare provision. It also describes the need for chaplains to be proficient in the language of healthcare culture as well as pastoral theology and why reflective practice is key to person-centred spiritual care.

Health technology assessment and its role in the future development of the Indian healthcare sector.

Public expenditure on healthcare in India is low by international comparison, and access to essential treatment pushes many uninsured citizens below the poverty line. In many countries, policymakers utilize health technology assessment (HTA) methodologies to direct investments in healthcare, to obtain the maximum benefit for the population as a whole. With rising incomes and a commitment from the Government of India to increase the proportion of gross domestic product spent on health, this is an opportune moment to consider how HTA might help to allocate healthcare spending in India, in an equitable and efficient manner. Despite the predominance of out-of-pocket payments in the Indian healthcare sector, payers of all types are increasingly demanding value for money from expenditure on healthcare. In this review we demonstrate how HTA can be used to inform several aspects of healthcare provision. Areas in which HTA could be applied in the Indian context include, drug pricing, development of clinical practice guidelines, and prioritizing interventions that represent the greatest value within a limited budget. To illustrate the potential benefits of using the HTA approach, we present an example from a mature HTA market (Canada) that demonstrates how a new treatment for patients with atrial fibrillation — although more expensive than the current standard of care — improves clinical outcomes and represents a cost-effective use of public health resources. If aligned with the prevailing cultural and ethical considerations, and with the necessary investment in expert staff and resources, HTA promises to be a valuable tool for development of the Indian healthcare sector.

Erhebung der Patientenperspektive bei chronischer Krankheit: Diskussion des Instruments „Österreichischer Patientenbericht“

The provision of adequate care for patients with chronic conditions necessitates the knowledge of their perspectives and opinions in order to plan and deliver health services appropriately. The aim of the initiative "Austrian Patients Report" is to collect information on the expectations and requirements of Austrian chronic care patients towards the Austrian health-care system and its actors. The basis of the "Austrian Patients Report" is an anonymous, structured paper and pencil questionnaire which is adapted to the specific requirements of the chronic condition with the help of patient focus groups. The questionnaire is distributed to the patients via self-help groups, doctor's offices and outpatient centres. The results clearly indicate that patients expect not only the provision of medical and medicinal care from their doctors, they also value a comprehensive consultation with their doctors, information on different treatment options and a good cooperation between specialists and primary care doctors as highly important. Another important aspect is the respect and understanding of the society concerning the problems which arise from living with a chronic condition. The "Austrian Patients Report" provides an opportunity to look at aspects of health-care provision from the patient's perspective. The standardisation of the method makes comparisons between patient groups with different chronic conditions possible. This in turn, gives insights into those areas of service provision where improvements need to be made and what is especially important from the patient's view.

A guide to setting up a simulation training unit within an ambulance trust

Education and training departments are a core element of UK ambulance services. There is an emphasis on ensuring the adequate provision of continuing professional development opportunities to staff, as well as an increased focus on patient safety across all aspects of healthcare provision. In the light of technological developments, the ways of delivering certain aspects of training or monitoring competencies and the actual physical infrastructures of educational facilities sometimes requires to be adapted. This article provides guidance on how to set up a simulation training unit within an ambulance service by either reconfiguring existing facilities or starting from a blank canvas.

Contemporaneous nursing: a conclusion to the 2008 series

This 2008 series has sought to identify, discuss and analyse two issues that confront nurses in the 21st century. First, the legal duty of care that all healthcare professionals and other workers owe has been reflected on in the context 'standards'. The question asked was that of how differently the legal principle, from the political expectation, is identified and applied in practice by nurses and other healthcare providers. The second issue was professional regulation. By considering the political expectations placed on nurses and others it has been possible to trace the ways in which the Government has sought to assert increasing direct control on nursing as an aspect of healthcare provision, and on the behaviour of nurses as providers. This article explores how while the law directly influences nursing behaviours, its influence is not always obvious or clear. The emergence of a clear political direction, set by those who are not necessarily members of the nursing profession, has consequences, consequences that this series has sought to identify and analyse. In juxtaposition to the contents of government literature, experiences of nurses as the people most likely to have been affected by the changes have been recognized. A polarization of expectation has been identified between those in positions of control over change, and those who cannot separate themselves from other elements of their lives (e.g. domestic responsibilities). This last article seeks to reassure nurses that their professionalism is not in doubt. The changes are in the clinical domain of care provision, in the ways in which practice is applied and the needs of patients measured and assured.

Reasserting the role of the state in the healthcare sector: Lessons from Asia

The paper compares healthcare reforms in China, South Korea, Singapore and Thailand with the purpose of drawing useable lessons about the appropriate role of the state in the sector. It argues that healthcare reforms in China and Korea offer many negative lessons for healthcare reformers while Singapore and Thailand offer positive lessons that may be considered for emulation elsewhere. The fundamental lesson to emerge from the successful reform experiences is that a large and active state role in various aspects of healthcare provision and financing is essential for containing expenditures and maintaining access. Public ownership of providers and prospective payments are particularly effective in controlling expenditures while direct government financing promotes equitable access. The cases also show that political economy matters: the Singapore and Thai states’ strong presence in the healthcare sector is a vital reason for their superior performance.

Satisfaction with Organizational Aspects of Health Care Provision among Lithuanian Physicians

Physician satisfaction is considered an important factor influencing quality of health care provision, patient compliance, and costs to health care systems. Dissatisfaction leads to an increase in turnover of physicians and early retirement, which has a negative impact on continuity and quality of health care. Physician dissatisfaction with certain aspects of health care provision may also help to identify potential weaknesses in satisfactory functioning of health care systems. The aim of the current research project is to study the satisfaction with different organizational aspects of health care provision in Lithuania as judged by a selection of physicians. The study was conducted in Lithuania in June 2004. Physicians in randomly selected health care centers were invited to take part in the survey, 505 primary and secondary care physicians were interviewed by external interviewers during the study period. Physicians were asked to express their satisfaction on items presented in a questionnaire. The questionnaire consisted of 22 questions, evaluating different aspects of health care services - working conditions, workload, financial remuneration, organization of health care infrastructure and availability of laboratory services. Answers were presented by the 5 point Likert type scale, ranging from "very satisfied" (5) to "very dissatisfied" (1). Physicians who were most satisfied with their working conditions were working in private primary health care practices (91.1% satisfied or very satisfied), as compared with 54% of physicians working in state-owned primary care institutions and 49.7% in hospitals. Physicians working in cities and regional centers or towns were more satisfied with organizational aspects of health care services than physicians working in rural health care centers. Satisfaction with their financial remuneration showed that 74% of respondents stated they were "dissatisfied" or "very dissatisfied". While asked about potential deficiencies in their health care institutions, the most important identified by respondents in all localities was a perceived lack of financial support for these institutions. There is a significant difference in the perception of physicians in private and state health care institutions with regard to financial remuneration as well as availability of laboratory diagnostic and treatment equipment and working conditions. Based on the study findings, possibilities to increase Primary Care financing should be considered in order to improve the quality of the delivery of health care services as well as retain physicians within the health care system. Results of this study demonstrate a need of further research to quantify what could be reasonably expected from diagnostic and investigative resources to support health care in Lithuania in current economic situation.

How do patients expect the mental health service system to act? Testing the WHO responsiveness concept for its appropriateness in mental health care

The World Health Organisation (WHO) concept of r esponsiveness has been defined as a measure of how well the health system responds to the population's legitimate expectations of non-health aspects of health care provision. It comprises eight domains: dignity, prompt attention, autonomy, choice of health care provider, clear communication, confidentiality, quality of basic amenities, and access to social support networks. The concept is of particular relevance to mental health care systems because of the specific dependency and vulnerability of their users. We tested its applicability to mental health care with five focus groups of experienced mental health care users in Hannover, Germany. The focus groups revealed 492 statements about users’ expectations in mental health care. Most concerned attention (115), dignity (108) and autonomy (86). The quotations were assigned to the eight responsiveness domains. In addition, the domain of prompt attention was extended and renamed attention, and the new domain continuity was created. The findings correspond with the literature on health care expectations of non-mental health patients, but differ slightly from the results of a WHO study on overall health care responsiveness. The need for widening the concept of continuity and extending the attention domain reflects the nature of mental health care of providing predominately long-term care. Our analysis indicates the feasibility of the responsiveness concept (if altered as proposed) as a tool for assessing the quality of mental health service from the users’ point of view. It should also be further developed to quantitatively evaluate mental health care systems and to benchmark system performance.

Perspectives on public awareness of stroke and aphasia among Turkish patients in a neurology unit

Recent studies on awareness have drawn attention to the fact that aphasia is a little known disorder to the public, in spite of all the publicity about this frequently occurring neurogenic language disorder. Being a very new concept, studies of awareness are rare in Turkey. This survey study assessed the extent of public awareness of neurological disorders, including aphasia, and information sources to answer questions about such disorders. A survey questionnaire consisting of 22 brief questions divided into three sections of awareness was administered to a convenience sample of 196 adults at a University Hospital in 2004. The results indicated that epilepsy and dementia are “the most well‐known”, and Multiple Sclerosis (MS) is “the least‐known” among the surveyed diseases/disorders. Aphasia awareness was also low. The respondents preferred doctors as the most reliable information source. Speech and language therapists were found to be one of the information sources in advocating publicity as well. Most respondents expected to receive information from the doctors; who, in Turkey, are totally occupied with the physical aspects of health care provision. Neurologists, in collaboration with speech and language therapists, should be in a position to develop educational programmes to increase public awareness.

Nursing in prisons: understanding educational needs through a case study approach

The health of people in British prisons is subject to scrutiny and comment by several agencies. These include the Home Office – who hold responsibility for services – penal reformers, prisoner representation groups, the media and providers of healthcare within prisons. Nurses make up the largest workforce within the latter group, and are employed outside the NHS. The aim of this research was to explore the educational needs of nurses working in a prison, and to map findings against a nation-wide scoping study of prison nurses’ role commissioned by the UK Central Council for Nursing, Midwifery and Health Visiting (UKCC). Very little research exists on the educational aspects of healthcare provision in prisons, although the nature of ill-health presentations is well documented. The UKCC study is unique, and enables comparison between national findings and this research, which took place in a single location. The objectives of the study were to investigate: the clinical and educational background of nurses working within prisons; the tasks and responsibilities of their role and how they were prepared for them; their perceived educational needs, including the content and structure of any proposed programme, and finally to estimate the degree of match between these findings and the UKCC national findings. Using a case study of one group of nurses working in a prison, data collection methods included a biographical timeline exercise and semi-structured interviews. Content and thematic analysis of transcripts was undertaken, followed by documentary analysis of Nursing in Secure Environments (UKCC 1999). Both sets of findings were then compared for commonalities, anomalies and gaps. Findings revealed that there is no recognized, accredited qualification for a specialist prison nursing role. Induction programmes do not exist in all institutions, and continuing professional development occurs haphazardly according to the individual nurse, with little evidence of strategic planning in order to meet the health needs of people in prison. The implications for practice are diverse, and the opportunities for improvement are enormous. The educational needs of prison nurses are inseparable from the epistemological and ontological assumptions different agencies have about the way in which a society should, or could, treat those who break its rules.

Delegation Dilemma: Accountability is Undermined by a Lack of Role Clarity

ABSTRACTA lack of clarity in role definition can pose a risk to the care of patients in the peri-operative phase. Health care teams are often made up of multi-skilled-nursing-care-providers that are not statutorily registered professionals. This may undermine who is actually responsible and accountable in practice. This delegation dilemma is due to certain market forces, like changes and reforms in health service provision, shortages of doctors and nurses, and ever rising costs. Change and development in practitioners' scope of practice has been encouraged with training to enable practitioners to take on certain specific aspects of health care provision that were traditionally part of a doctor and, or a nurse's role. These changes should be monitored and considered by risk managers or those responsible for clinical governance, as they raise important legal and professional issues. In short, there is confusion over accountability driven by issues of role expansion. The respective professional bodies, both medical and nursing and the Department of Health need to come together and find a consensus of opinion in resolving the confusion over accountability and role delineation.