Benefits Of Health Services Research Articles

OP230 How Legitimate Is The Process Of Updating the Benefits Package In Israel? A 20 Year Overview

IntroductionThe National Health Insurance Law enacted in 1995 stipulates a minimum list of health services (benefits package) that the four health plans in Israel have to provide to their members. The recommendations on which new technologies or new indications for existing ones should be added every year to the benefits package, subject to a predetermined budget, are made by a public committee that evaluates and prioritizes candidate technologies according to their clinical merit, economic (mainly budget impact), social, ethical and other aspects. We assessed the legitimacy of this coverage decision process over the past 20 years.MethodsThe legitimacy of the process was assessed by adherence to the conditions outlined in the accountability for reasonableness (A4R) framework. A4R defines four conditions for legitimate and fair healthcare coverage decision processes: relevance, publicity, appeals/reversibility, and enforcement. We reviewed the changes made in the coverage decision process over the past 20 years and examined whether these changes have changed its legitimacy.ResultsOur analysis suggests that despite several changes made over the years in the process for updating the benefits package, for example, increase in transparency, introducing a structured appeal process, it only partially fulfills the four A4R conditions. In order to accomplish these goals more fully, several widely used considerations such as cost-effectiveness analysis and incorporating views from patients should be included. Additionally, this decision-making process should become even more transparent than it currently is.ConclusionsThe annual process of updating the benefits package in Israel where hundreds of technologies are “competing” with each other for coverage under a pre-defined budget is unique and not without merit. This process has been operating in the same pattern with only minor changes made since 1999. The main barriers for fulfilling all A4R conditions may relate in part to the large number of technologies assessed each year within a short time frame. Several changes in the process including the assessment of societal values, involvement of diverse stakeholders including patient advocate groups should be made to improve its legitimacy.

Research round-up

Potential benefits of digital mental health services are highlighted by Nickolai Titov and colleagues in their report of the 7-year outcomes after implementation of the Australian MindSpot Clinic. Between 2013 and 2019, of 121 652 individuals who registered for MindSpot, 96 018 (79%) completed the screening assessment. At baseline, more than two-thirds of individuals reported depression, and almost one-third had suicidal thoughts. In individuals who started an online therapist-guided treatment course (n=21 745), there were improvements in scores from baseline to post-treatment on the Patient Health Questionnaire 9 (52·2% change [95% CI 51·6–52·8]; Cohen's d effect size 1·40 [1·37–1·43]), Generalized Anxiety Disorder 7-Item Scale (52·5% [52·1–52·9]; 1·45 [1·42–1·47]), and Kessler Psychological Distress 10-Item Plus Scale (46·3% [45·9–46·7]; 1·42 [1·40–1·44]), with benefits still apparent at 3 months follow-up.

Peripheral intravenous catheter non-infectious complications in adults: A systematic review and meta-analysis.

The aim of this systematic review and meta-analysis was to summarize and quantify peripheral intravenous catheter-related complications. This systematic review is reported by means of the Cochrane process for randomized controlled trials and the Meta-analysis of Observation Studies in Epidemiology for cohort studies. The Cochrane Central Register of Controlled Trials, PubMed, CINAHL and EMBASE databases, clinical trial registries such as ClinicalTrials.gov and the reference list of included studies were searched from 2000 -April 2019. Using a purpose designed data extraction tool, two authors independently identified studies for full review, data extraction and quality assessment. Dichotomous outcomes were pooled after Freeman-Tukey double arcsine transformation using random-effects meta-analysis; estimates of heterogeneity were taken from inverse-variance fixed-effect models. Seventy observational studies and 33 randomized controlled trials were included (76,977 catheters). Peripheral intravenous catheter-related complications were as follows: phlebitis (with definition) 19.3%, phlebitis (without definition) 4.5%, infiltration/extravasation 13.7%, occlusion 8%, leakage 7.3%, pain 6.4% and dislodgement 6.0%. Subgroup analysis found infiltration/extravasation for emergency department-inserted catheters was significantly higher (25.2%; p=.022) than for those inserted in other departments and pain was significantly higher (p<.001) in countries with developing economies compared with developed economies. Peripheral intravenous catheter complications are unacceptably common worldwide. This review suggests substantial and multi-specialty efforts are needed to address the sequalae associated with complications. The potential benefits for patients and health services are considerable if complications are reduced. Peripheral intravenous complications interrupt important treatment which can be distressing for patients and result in longer hospital stays with increased healthcare costs. This review found phlebitis and infiltration are the most prevalent reason for catheter failure. These results provide nurses with a strong evidence base for the development of effective interventions for practice which are vital for preventing poor outcomes for patients with peripheral intravenous catheters.

Telemedicina e uberização da saúde: médicos operários ou consumidores?

Objetivo: o artigo visa analisar as mudanças na categorização legal dos médicos devido a possíveis mudanças na profissão médica provocadas pela telemedicina, vislumbrando-se uma possível precarização das relações de trabalho médicas e a uberização da medicina. Metodologia: a abordagem metodológica parte dos conceitos de custos de transação e de informação desenvolvidos pela economia neoinstitucional e da análise sociológica jurídica, feitas para definir um cenário possível da profissão médica e de sua estrutura legal. O tipo ideal de telemedicina mediada por uma plataforma digital dominante é o ponto de partida para a análise legal de possíveis categorizações de médicos e serviços de saúde. Com base nesse modelo ideal, são traçadas diversas considerações sobre as suas possíveis consequências para o exercício da profissão médica. Resultados: a principal contribuição é a discussão legal da rivalidade entre a categorização como trabalhador ou consumidor, bem como uma possível dupla incidência de regimes legais. Conclusão: os papéis futuros dos médicos como profissionais, trabalhadores ou consumidores dependerão não apenas da dinâmica do mercado, mas centralmente do quadro jurídico. O controle da qualidade e dos benefícios sociais dos serviços de saúde depende do arcabouço legal, na medida em que estão vinculados aos papéis dos profissionais.

Moving beyond solutionism: Re-imagining placements through an activity systems lens.

Clinical placements are central to the process of preparing future health professionals for practice. Health care environments are increasingly complex and demanding with clinical placements often being perceived as a burden on busy health professionals giving rise to a service-education tension. This tension creates a situation ripe for simplistic solutionist approaches. For example, characterising the problem of clinical placements as students negatively impacting on service productivity results in a reductionist solution such as universities compensating health services for student education. Challenges faced by placement seekers and placement providers are multifaceted and complex requiring a more sophisticated understanding and response to the challenges of involving students in the workplace to prepare them for the future workforce. We argue that the health and education systems have become de-coupled. Learning and working are seen as distinct activities that are at odds with one another. Re-imagining the purposes and practices of clinical placements for the mutual benefit of patients, health services and students may fruitfully address this disconnect. We present a worked example using the conceptual and analytical tools of cultural-historical activity theory to articulate what we have learnt about this health-education disconnect. Our worked example draws on research involving a series of clinical education case studies within acute care contexts. Through the lens of cultural-historical activity theory, we highlight that solutionist approaches are entrenched in a de-coupling of health from education where the shared object of preparing the future workforce is fragmented. Successful re-coupling requires a partnership that is founded on a shared commitment to preparing the future workforce; recognises that learning and practice are inseparable; and understands that both activity systems are fluid and that collaboration to stay focused on the shared object of preparing the future workforce is complex, challenging and ongoing work.

A structural equation model of factors associated with HIV risk behaviors and mental health among men who have sex with men in Malawi

BackgroundMen who have sex with men (MSM) bear a disproportionate burden of HIV in Malawi. Early prevention efforts in Malawi have been largely focused on preventing heterosexual and vertical transmission of HIV, and MSM have rarely been the specific benefactors of these efforts, despite facing both higher prevalence of HIV coupled with multiple barriers to prevention and care. To better facilitate the design of culturally relevant HIV prevention programs and prioritize resources among MSM in resource limited settings, the objective of this analysis was to estimate the relationship between social factors and HIV related risk behaviors and mental health.Methods338 MSM were recruited using respondent-driven sampling in Blantyre, Malawi from April 2011 to March 2012. Structural equation models were built to test the association between six latent factors: participation in social activities, social support, stigma and human rights violations, depression symptomatology, condom use, and sexual risk behaviors, including concurrent sexual partnerships and total number of partners.ResultsThe mean age of participants was 25 years old. Almost 50% (158/338) of the participants were unemployed and 11% (37/338) were married or cohabiting with women. More than 30% (120/338) of the participants reported sexual behavior stigma and 30% (102/338) reported depression symptomatology. Almost 50% (153/338) of the participants reported any kind of HIV-related risk behaviors and 30% (110/338) participated in one of the recorded social activities. Significant associations were identified between stigma and risk behaviors (β = 0.14, p = 0.03); stigma and depression symptomatology (β = 0.62, p = 0.01); participation in social activities and depression symptomatology (β = 0.17, p = 0.01).ConclusionResults suggest MSM reporting stigma are more likely to report sexual risk practices associated with HIV/STI transmission and depressive symptoms, while those reporting participation in social activities related to HIV education are less likely to be depressed. Furthermore, interventions at the community level to support group empowerment and engagement may further reduce risks of HIV transmission and improve mental health outcomes. Taken together, these results suggest the potential additive benefits of mental health services integrated within comprehensive HIV prevention packages to optimize both HIV-related outcomes and general quality of life among MSM in Malawi.

Prevalence and Factors Associated with Health Services Utilization of Sindhupalchowk District, Nepal

&#x0D; &#x0D; &#x0D; &#x0D; Introduction: In Nepal, preference of health service for treatment is different for different people, which is affected by their level of knowledge , socio-demographic factors and so on. The objective of this study was to find the first preference of health services of the people for the treatment of their illness andfactors affecting their preference.&#x0D; Methods: A descriptive cross-sectional study was conducted among 260 respondents of Maneswora Ward, Sindhupalchowk district which was selected through systematic random sampling. Data collection was done after taking ethical approval. Face-to-face interview was done to collect the data through semi- structured questionnaire. Data was entered and analyzed in SPSS v16.&#x0D; Results: One-third (36.9%) of the respondents were found to be visiting the traditional health services and more than half (63.1%) of the respondents visited modern health services. Education (0.016), duration of stay (0.014), type of disease (&lt;0.001), distance to the health services (&lt;0.001), modes of transportation (&lt;0.001), affordability (0.013), waiting time (&lt;0.001) and availability of health care provider (&lt;0.001) demonstrated association with utilization of health services at 95% level of confidence (p&lt;0.05).&#x0D; Conclusions: Despite of modern health facilities available within walking distance, still people prefer to go to the traditional healers for almost all the health problems at first hand with firm belief that they cure it. Hence, government still lacks effective programs to attract people towards modern health services to some extent. Hence, the awareness campaign regarding the benefits of modern health services should be initiated.&#x0D; &#x0D; &#x0D; &#x0D;

Widespread Introduction of a High-Sensitivity Troponin Assay: Assessing the Impact on Patients and Health Services.

Adoption of High-sensitivity troponin (hs-cTn) assays by hospitals worldwide is increasing. We sought to determine the effects of a simultaneous state-wide hs-cTn assay introduction on the implementing health service. A quasi-experimental pre–post design was used. Participants included all adult patients presenting to 21 Australian hospitals who had troponin testing commenced within the Emergency Department (ED). Data were collected for 124,357 episodes of care between 30 April 2018 and 23 April 2019; six months pre- and six months post-implementation of the assay. The primary outcome was hospital length of stay (LOS). Secondary outcomes included ED LOS, 90-day cardiovascular mortality, elevated troponin, diagnosis of acute myocardial infarction (AMI), admission to a cardiology ward, invasive cardiac procedures, and total hospital costs. Following hs-cTn implementation, there was a 1.9-h (95% CI: −2.9 to −1.0 h) reduction in overall LOS. This equated to a cost saving of over 9 million Australian dollars per year. There was no increase in diagnosis of AMI, invasive cardiac procedures or ward admissions. The use of hs-cTn assays facilitates important benefits for health services by enabling more rapid evaluation protocols within the ED. This benefit may be considerable given the large cohort of emergency patients with possible ACS.

Well-being of Older People (WOOP): Quantitative validation of a new outcome measure for use in economic evaluations.

There is a need for comprehensive measures to evaluate the benefits of health and social care services for older people. The newly developed Well-being of Older People measure (WOOP) aims to capture all aspects that older people find important to their well-being. This study explores the validity and test-retest reliability of the WOOP. Between December 2017 and January 2018, an online survey was used to retrieve data from 1113 people aged 65 years and older in the Netherlands. Regression analyses on Cantril's Ladder scores were conducted to explore the relative importance of the items of the WOOP. Dimensionality was checked using exploratory factor analysis. Convergent and discriminant validity were investigated by relating the WOOP to several measures of health and well-being. Test-retest reliability was examined using data from 269 respondents that participated in a second online survey, distributed one week after the first. The items of the WOOP were significantly associated with Cantril's Ladder scores. When regressed simultaneously this was still true for all but the 'social contacts' item and one level of the 'acceptance and resilience' item. The dimensionality analysis revealed three factors, of which two included items of the WOOP and the EQ-5D-5L and the third only items of the WOOP. The WOOP correlated moderately to highly with physical health, and (very) highly with (mental) health and well-being measures. The test-retest reliability in terms of ICC was high, whereas the kappa for the items was fair to good, except for two items. Overall, the WOOP seems to capture aspects relevant to the well-being of older people adequately, and the results of first validity and reliability tests were satisfactory. Before the WOOP can be used in economic evaluations, further validation in a variety of health and social care settings is recommended, and utility weights need to be determined.

Do Adolescents See any Benefit in Accessing Mental Health Services? Results from an Australian Cross-Sectional Study

Identify the perceived benefit of mental health service use for two adolescent populations: (i) those who had considered getting help from a mental health service but had not yet done so, and (ii) those who had previously contacted or accessed a mental health service but not continued with care. Cross-sectional online survey of adolescents aged 14–18 years currently residing in Perth, Western Australia. Those who had previously accessed a mental health service but not continued with care often had less favourable perceptions of service benefit. Participants in both populations considered that mental health service use was least likely to be beneficial for conduct-related behaviours. Participants in both population groups from single-carer households or identifying as LGBTIQ reported a higher perceived benefit of mental health services. Our study highlights potential gaps in adolescent knowledge regarding mental health help-seeking. Perceptions of service benefit were often no different or less favourable amongst those who had previously accessed a mental health service but not continued with care. The range of sociodemographic factors significantly associated with perceived benefit across both populations in the sample indicates subpopulations of young people may require extra support within the system.

World Health Organization urges stronger focus on nutrition within health services

A stronger focus on nutrition could have myriad benefits for health services, reducing rates of preventable illness, obesity and mortality. Gemma Harris discusses reports from the World Health Organization, which set out what this stronger focus might entail for healthcare providers and the positive changes that could be achieved.

Are older and seriously ill inpatients planning ahead for future medical care?

BackgroundDespite the perceived ethical, personal and health service benefits of advance care planning (ACP), the extent to which older and seriously ill Australian inpatients have considered future health decisions remains uncertain. This study aimed to determine in a sample of older and seriously ill inpatients, the proportion who had: 1) engaged in four advance care planning (ACP) activities; 2) not engaged in ACP activities but wanted to; and 3) reasons why they had not engaged.MethodsCross-sectional face-to-face standardised interview survey with inpatients in a tertiary referral centre who were either: aged 80+ years; aged 55+ years with progressive chronic disease(s); or judged by treating clinicians as having a life expectancy of less than 12 months. Patients indicated whether they had engaged in four ACP activities: (1) appointed medical substitute-decision-maker(s), (2) recorded end-of-life wishes in an advance directive or care plan; and talked about their end-of-life wishes with their: (3) support persons and/or (4) doctors. Patients who had not engaged in activities were asked whether they wished this to occur and reasons why.ResultsOne hundred eighty-six inpatients consented to the study (80% of approached). Of these, 9% (n = 16) had engaged in four ACP activities; 27% (n = 50) had not engaged in any. Half (n = 94, 52%) had appointed a medical substitute-decision-maker, 27% (n = 50) had recorded wishes in an advance directive or care plan, 51% (n = 90) had talked about their end-of-life wishes with support persons and 27% (n = 48) had talked with their doctor. Patients who wanted to, but had not, engaged in the four ACP activities were unaware they could record wishes or appoint decision-makers, or indicated providers had not initiated conversations.ConclusionRelatively few inpatients had engaged in all four ACP activities. More inpatients had discussed end of life issues with family and appointed substitute decision makers, than completed written documents or talked with doctors. Community education and a more active role for community and hospital-based providers in supporting patients and families to collaboratively resolve end-of-life decisions may increase the probability wishes are known and followed.

Impact of antibiotic treatment duration on outcomes in older men with suspected urinary tract infection: Retrospective cohort study

Clinical guidelines recommend at least 7days of antibiotic treatment for older men with urinary tract infection (UTI). There may be potential benefits for patients, health services, and antimicrobial stewardship if shorter antibiotic treatment resulted in similar outcomes. We aimed to determine if treatment duration could be reduced by estimating risk of adverse outcomes according to different prescription durations. This retrospective cohort study included men aged greater than or equal to 65years old with a suspected UTI. We compared outcomes in men prescribed 3, 5, 7, and 8 to 14days of antibiotic treatment in a multivariable logistic regression analysis and 3 versus 7days in a propensity-score matched analysis. Our outcomes were reconsultation and represcription (proxy for treatment failure), hospitalisation for UTI, sepsis, or acute kidney injury (AKI), and death. Of 360640 men aged greater than or equal to 65years, 33745 (9.4%) had a UTI. Compared with 7days, men prescribed 3-day treatment had greater odds of reconsultation and represcription (adjusted OR 1.48; 95% CI, 1.25-1.74) but lower odds of AKI hospitalisation (adjusted OR 0.66; 95% CI, 0.45-0.97). We estimated that treating 150 older men with 3days instead of 7days of antibiotics could result in four extra reconsultation and represcriptions and one less AKI hospitalisation. We estimated annual prescription cost savings at around £2.2 million. Antibiotic treatment for older men with suspected UTI could be reduced to 3days, albeit with a small increase in risk of treatment failure. A definitive randomised trial is urgently needed.

Medicaid coverage in substance use disorder treatment after the affordable care act

The Affordable Care Act (ACA) prompted sweeping changes to Medicaid, including expanding insurance coverage to an estimated 12 million previously uninsured Americans, and imposing new parity requirements on benefits for behavioral health services, including substance use disorder treatment. Yet, limited evidence suggests that these changes have reduced the number of uninsured in substance use disorder treatment, or increased access to substance use disorder treatment overall. This study links data from a nationally-representative study of outpatient substance use disorder treatment programs and a unique national survey of state Medicaid programs to capture changes in insurance coverage among substance use disorder treatment patients after ACA implementation. Medicaid expansion was associated with a 15.7-point increase in the percentage of patients insured by Medicaid in substance use disorder treatment programs and a 13.7-point decrease in the percentage uninsured. Restrictions in state Medicaid benefits and utilization policies were associated with a decreased percentage of Medicaid patients in treatment. Moreover, Medicaid expansion was not associated with a change in the total number of clients served over the study period. Our findings highlight the important role Medicaid has played in increasing insurance coverage for substance use disorder treatment.

Sharing information safely and securely: the foundation of a modern health care system.

Sharing information safely and securely: the foundation of a modern health care system.

Why Is It So Hard to Get Help? Barriers to Help-Seeking in Postsecondary Students Struggling with Mental Health Issues: a Scoping Review

Mental illness and other subclinical mental health issues are a significant and growing problem for postsecondary students. Despite the availability and benefits of mental health services on university and college campuses across North America, many students still do not seek help. This scoping review explores the barriers to mental health help-seeking facing postsecondary students in Canada and the USA. A total of 24 journal articles were identified after searching two multidisciplinary databases. This review comprehensively summarizes the barriers to help-seeking behaviors for post-secondary students. Barriers to help-seeking experienced by students existed on the institutional, sociocultural, and personal levels. Institutional factors included access to university/college mental health services, insurance coverage, and usability of services. Further research is required to develop an understanding of all the barriers and their relation to one another.

Health care experiences of mothers of children with bronchiectasis in Counties Manukau, Auckland, New Zealand

BackgroundBronchiectasis is a worsening public health problem in New Zealand. This study aimed to explore the health care experiences of mothers of children with bronchiectasis in the Counties Manukau District Health Board area of Auckland, New Zealand.MethodsSemi-structured interviews were undertaken with ten mothers of children with bronchiectasis. Data were analysed using thematic analysis.ResultsFive themes emerged: 1) Searching for answers, describing mothers’ search for a diagnosis; 2) (Dis)empowerment, describing mothers’ acquisition of knowledge, leading to empowerment; 3) Health care and relationships, describing the impact of relationships on the mother’s health care experiences; 4) A juggling act, describing the challenges of juggling health care with school, work and family; 5) Making it work, describing how mothers overcome barriers to access health care for their child.ConclusionsThe health provider-parent relationship was crucial for fostering positive health care experiences. Mothers’ acquisition of knowledge facilitated empowerment within those relationships. Additionally, mothers’ perceptions of the quality and benefit of health services motivated them to overcome barriers to accessing care. Study findings may help to improve health care experiences for parents of children with bronchiectasis if identified issues are addressed.

Implementing healthy food policies in health services: A qualitative study.

In 2012, a large Australian metropolitan health service introduced a healthy food policy, where there was a requirement for food and drinks for sale within retail stores to conform to standards based on macronutrients and energy content. The aim of the present study was to evaluate the experience of those implementing a healthy food retail policy in order to inform the translation of such policies into other organisations. A qualitative approach was used, with semistructured interviews exploring informants' involvement in, experiences of, factors affecting and perceived outcomes of policy implementation. Interviews were conducted with seven individuals participating in the introduction of the healthy food retail policy. Results were analysed using a thematic analysis approach. Four themes and 21 sub-themes were identified, with analysis interpreted using the socio-ecological model. Participants identified that successful policy implementation hinged on the provision of resources and support by the health service to the retail staff. Trusting relationships between retail and health service staff were built through effective and frequent communication. The fear of tensions between the policy and business income had significantly lessened after implementation. A key factor contributing to this change was the use of low-risk trials to remove less healthy products or introduce new healthier foods. Implementing a healthy food retail policy within a health service benefits from dedicated resourcing, investment in relationship building with key stakeholders and introducing changes gradually with a long-term approach.

Access to Urban Green Space in Cities of the Global South: A Systematic Literature Review

This review examines disparities in access to urban green space (UGS) based on socioeconomic status (SES) and race-ethnicity in Global South cities. It was motivated by documented human health and ecosystem services benefits of UGS in Global South countries and UGS planning barriers in rapidly urbanizing cities. Additionally, another review of Global North UGS studies uncovered that high-SES and White people have access to a higher quantity of higher quality UGSs than low-SES and racial-ethnic minority people but that no clear differences exist regarding who lives closer to UGS. Thus, we conducted a systematic review to uncover (1) whether UGS inequities in Global North cities are evident in Global South cities and (2) whether inequities in the Global South vary between continents. Through the PRISMA approach and five inclusion criteria, we identified 46 peer-reviewed articles that measured SES or racial-ethnic disparities in access to UGS in Global South cities. We found inequities for UGS quantity (high-SES people are advantaged in 85% of cases) and UGS proximity (74% of cases). Inequities were less consistent for UGS quality (65% of cases). We also found that UGS inequities were consistent across African, Asian, and Latin American cities. These findings suggest that Global South cities experience similar inequities in UGS quantity and quality as Global North cities, but that the former also face inequities in UGS proximity.

UTILIZATION OF TECHNOLOGY IN THE HEALTH OF COMMUNITY HEALTH

The era of globalization is now progressing very rapidly. One of the advances in information technology penetrated the health field. Use and utilization of this technology is one of the right solutions for problem solving public services. At least utilization of it will address the geographical, time and socioeconomic issues. Some research mentioned that the utilization of technology in the field of health can improve health service and can change health behavior. Information is a very important thing, because all things related to public health is information that is well managed and safe, so it takes a safe and smooth system for all information obtained can be used for the benefit of health services more optimal and can benefit the entire community