Care Health Services Research Articles

Design of a Booking Management System, with Responsive Design Web Appointments, to Reduce Time and Improve the Quality of Health Care Services

Technology is playing an important role, especially in the current need for technological solutions focused on the health sector. There is currently much room for improvement, for example: reducing the long waiting time for patients to book an appointment according to availability in the specialty and doctor. However, there are still health centers that lack technological solutions focused on this, because most of the population does not yet have the knowledge of technology. Given this, and taking into account the needs of users with low knowledge of ICT and contribute to the health sector, will be launched the design and development of a specialized responsive website for the management of medical appointments that will solve in part the order and time of attention of each appointment requested, whose purpose is to improve the quality of care of public health services

Factors associated with depression among Type-2 Diabetic Patients in Nepal

Background: The worldwide health scenario is undergoing a shift from infectious diseases to non-communicable ones, and diabetes is now the seventh major contributor to global mortality. Depression, anticipated to be the second-highest contributor to Disability Adjusted Life Years by 2020, presents a notable public health challenge. The probability of experiencing depression is elevated two to three times in individuals with diabetes, particularly those diagnosed with Type 2 diabetes. Objectives: To assess the prevalence of depression and associated factors in Type 2 diabetic patients in Tribhuvan University Teaching Hospital. Methods: An analytical cross-sectional study was conducted among 151 Type 2 diabetic patients visiting Tribhuvan University Teaching Hospital, Nepal. Patients were selected by systematic random sampling at an interval of every third diabetic patient attending the Out-Patient Department. Depression was assessed using the Beck Depression Inventory. Data was analyzed using STATA-14 where logistic regression was performed to ascertain associations (P value <0.05) of sociodemographic, behavioral and clinical characteristics with depression. Results: The prevalence of depression among Type 2 diabetic patients was 28.5%. Among them, 15.2% had mild depression, 11.9% had moderate depression and 1.4% had severe depression. The odds of having depression was 1.24 times higher with 1 unit increase in HbA1C level (AOR=1.24, 95%CI:1.09-1.42, P-value=0.001), 4.62 times higher in patients having retinopathy as comorbidity (AOR=4.62, 95%CI:1.63-13.11, P-value=0.04) and 6.36 times higher in patients taking insulin for treatment (AOR=6.36, 95%CI:1.79-22.53, P-value=0.004) after adjusting for age, sex, occupation, marital status, ethnicity income and education. Conclusion: The study revealed that more than a quarter of Type 2 diabetic patients in this sample experienced depression. Factors such as HbA1C, treatment by insulin and retinopathy as comorbidity were identified as significant contributors. These findings highlight the emerging problem of depression among diabetic patients, emphasizing the need for integrated mental health services in diabetes care.

Quality of care in mental health services: does patient engagement play a role?

PurposeThe mental healthcare is experiencing an ever-growing surge in understanding the consumer (e.g., patient) engagement paradox, aiming to vouch for the quality of care. Despite this surge, scant attention has been given in academia to conceptualize and empirically investigate this particular aspect. Thus, drawing on the Stimulus-Organism-Response (S-O-R) paradigm, the study explores how patients engage with healthcare service providers and how they perceive the quality of the healthcare services.Design/methodology/approachData were collected from 279 respondents, and the derived conceptual model was tested by using Smart PLS 3.2.7 and PROCESS. To complement the findings of partial least squares (PLS)-based structural equation modeling (SEM), the present study also applied fuzzy set qualitative comparative analysis (fsQCA) to identify the necessary and sufficient conditions to explore substitute conjunctive paths that emerge.FindingsFindings show that patients’ perceived intimacy (PI), cohesion and privacy enhance the quality of mental healthcare service providers. The results also suggest that patients’ PI, cohesion and privacy have indirect effects on the perceived quality of care (PQC) by the service providers through consumer engagement. The fsQCA results derive that the relationship among conditions leading to patients’ perception of the quality of care in regard to mental healthcare service providers is complex and is best reflected as multiple and conjectural causation configurations.Research limitations/implicationsThe findings from this research contribute to the advancement of studies on patients’ experiences by empirically examining the unique dynamics of interaction between consumers (patients) and mental healthcare service providers, thereby enriching both the literature on social interactions and the understanding of the consumer–provider relationship.Practical implicationsThe results of this study provide practical implications for mental healthcare service providers on how to combine the study variables to enhance the quality of care and satisfy more patients.Originality/valueA significant research gap has ascertained the inter-relationship between PI, cohesion, privacy, engagement and PQC from the perspective of mental healthcare service providers. This research is one of the primary studies from a managerial and methodological standpoint. The study contributes by combining symmetric and asymmetric statistical tools in service marketing and healthcare research. Furthermore, the application of fsQCA helps to understand the interactions that might not be immediately obvious through traditional symmetric methods.

Mental and physical health morbidity among people in prisons: an umbrella review

People who experience incarceration are characterised by poor health profiles. Clarification of the disease burden in the prison population can inform service and policy development. We aimed to synthesise and assess the evidence regarding the epidemiology of mental and physical health conditions among people in prisons worldwide. In this umbrella review, five bibliographic databases (Web of Science, PubMed, PsycINFO, Embase, and Global Health) were systematically searched from inception to identify meta-analyses published up to Oct 31, 2023, which examined the prevalence or incidence of mental and physical health conditions in general prison populations. We excluded meta-analyses that examined health conditions in selected or clinical prison populations. Prevalence data were extracted from published reports and study authors were contacted for additional information. Estimates were synthesised and stratified by sex, age, and country income level. The robustness of the findings was assessed in terms of heterogeneity, excess significance bias, small-study effects, and review quality. The study protocol was pre-registered with PROSPERO, CRD42023404827. Our search of the literature yielded 1909 records eligible for screening. 1736 articles were excluded and 173 full-text reports were examined for eligibility. 144 articles were then excluded due to not meeting inclusion criteria, which resulted in 29 meta-analyses eligible for inclusion. 12 of these were further excluded because they examined the same health condition. We included data from 17 meta-analyses published between 2002 and 2023. In adult men and women combined, the 6-month prevalence was 11·4% (95% CI 9·9-12·8) for major depression, 9·8% (6·8-13·2) for post-traumatic stress disorder, and 3·7% (3·2-4·1) for psychotic illness. On arrival to prison, 23·8% (95% CI 21·0-26·7) of people met diagnostic criteria for alcohol use disorder and 38·9% (31·5-46·2) for drug use disorder. Half of those with major depression or psychotic illness had a comorbid substance use disorder. Infectious diseases were also common; 17·7% (95% CI 15·0-20·7) of people were antibody-positive for hepatitis C virus, with lower estimates (ranging between 2·6% and 5·2%) found for hepatitis B virus, HIV, and tuberculosis. Meta-regression analyses indicated significant differences in prevalence by sex and country income level, albeit not consistent across health conditions. The burden of non-communicable chronic diseases was only examined in adults aged 50 years and older. Overall, the quality of the evidence was limited by high heterogeneity and small-study effects. People in prisons have a specific pattern of morbidity that represents an opportunity for public health to address. In particular, integrating prison health within the national public health system, adequately resourcing primary care and mental health services, and improving linkage with post-release health services could affect public health and safety. Population-based longitudinal studies are needed to clarify the extent to which incarceration affects health. Research Foundation-Flanders, Wellcome Trust, National Institutes of Health.

A Bibliometric Analysis of Refugee Health Publications in the Nursing Field by Visual Mapping Method

Introduction Millions of people worldwide are forced to migrate to another country and nurses are the key professional for providing necessary health care to this population. Providing nursing care to refugees or immigrants requires diverse transcultural professional competencies based on standardized guidelines.ObjectivesThis study was aimed to examine the bibliographic characteristics of quantitative studies conducted on refugees in the nursing field.MethodsThe data were obtained from articles scanned in the Web of Science Core Collection database. The 1672 articles that were published between 1980-and 2023 and met the inclusion criteria were analyzed using VOSviewer and Microsoft 365 Excel software. The PRISMA 2020 Checklist was used for reporting.ResultsMost publications were made in 2020. The United Kingdom, the United States, Canada, and Australia have the highest number of publications, citations, and international cooperation. Additionally, “mental health” is one of the most used keywords in the studies.Conclusions The findings show the importance of empowering nurses working in this field, especially in determining the needs related to mental health services for refugees. The increased migration rates and the growing need for refugee health care highlighted the importance of investment in nursing research within this field. Nurses and researchers should aim to establish partnerships and share best practices with the leading countries. Furthermore, nurses require specialized training to competently evaluate and provide nursing care and mental health services to this vulnerable population. Policymakers must prioritize international collaboration, equitable healthcare, and the integration of mental health services within healthcare systems to improve refugee health and reduce barriers between them and health services.Disclosure of InterestNone Declared

Maternal awareness, acceptability and willingness towards respiratory syncytial virus (RSV) vaccination during pregnancy in Ireland.

Respiratory syncytial virus (RSV) is the world's leading cause of viral acute lower respiratory infections (ALRI) in infants. WHO has identified maternal RSV vaccination a priority and candidate vaccines are in development; however, vaccine hesitancy remains an impediment to successful implementation of maternal immunization. This study, the largest antenatal survey conducted to-date, aimed to examine maternal RSV awareness, likely acceptance of RSV vaccination in pregnancy, and attitudes to maternal vaccination. Pregnant women of all gestations attending antenatal clinic of a university maternity hospital in Ireland were invited to participate. An information leaflet provided, consent obtained, and survey administered examining RSV awareness, willingness to avail of antenatal RSV vaccination, factors influencing acceptability and preferred sources of assistance. Research Ethics Committee (REC) approval obtained, and general data protection regulation (GDPR) guidelines followed. 528 women completed the survey. A large proportion (75.6%) had never heard of RSV, yet 48.5% would still avail of a vaccine, 45.8% were undecided and only 5.3% would not. The main factor making vaccination acceptable to women (76.4%) was that it protects their infant from illness (p < .001, CV 0.336 for association with acceptance) and general practitioner (GP) was the preferred guidance source in decision-making (57.7%). Despite low levels of maternal awareness of RSV, pregnant women in Ireland are open to availing of antenatal vaccination. Maternal immunization strategies need to focus on infant's protection from RSV-associated ALRI along with vaccine safety, and build on an interdisciplinary collaboration of maternal, neonatal, primary care and public health services.

AKT question relating to National Health Service care entitlement

AKT question relating to National Health Service care entitlement

AKT answer relating to National Health Service care entitlement

AKT answer relating to National Health Service care entitlement

Improving measurement-based care implementation in youth mental health through organizational leadership and climate: a mechanistic analysis within a randomized trial

BackgroundTheory and correlational research indicate organizational leadership and climate are important for successful implementation of evidence-based practices (EBPs) in healthcare settings; however, experimental evidence is lacking. We addressed this gap using data from the WISDOM (Working to Implement and Sustain Digital Outcome Measures) hybrid type III effectiveness-implementation trial. Primary outcomes from WISDOM indicated the Leadership and Organizational Change for Implementation (LOCI) strategy improved fidelity to measurement-based care (MBC) in youth mental health services. In this study, we tested LOCI’s hypothesized mechanisms of change, namely: (1) LOCI will improve implementation and transformational leadership, which in turn will (2) mediate LOCI’s effect on implementation climate, which in turn will (3) mediate LOCI’s effect on MBC fidelity.MethodsTwenty-one outpatient mental health clinics serving youth were randomly assigned to LOCI plus MBC training and technical assistance or MBC training and technical assistance only. Clinicians rated their leaders’ implementation leadership, transformational leadership, and clinic implementation climate for MBC at five time points (baseline, 4-, 8-, 12-, and 18-months post-baseline). MBC fidelity was assessed using electronic metadata for youth outpatients who initiated treatment in the 12 months following MBC training. Hypotheses were tested using longitudinal mixed-effects models and multilevel mediation analyses.ResultsLOCI significantly improved implementation leadership and implementation climate from baseline to follow-up at 4-, 8-, 12-, and 18-month post-baseline (all ps < .01), producing large effects (range of ds = 0.76 to 1.34). LOCI’s effects on transformational leadership were small at 4 months (d = 0.31, p = .019) and nonsignificant thereafter (ps > .05). LOCI’s improvement of clinic implementation climate from baseline to 12 months was mediated by improvement in implementation leadership from baseline to 4 months (proportion mediated [pm] = 0.82, p = .004). Transformational leadership did not mediate LOCI’s effect on implementation climate (p = 0.136). Improvement in clinic implementation climate from baseline to 12 months mediated LOCI’s effect on MBC fidelity during the same period (pm = 0.71, p = .045).ConclusionsLOCI improved MBC fidelity in youth mental health services by improving clinic implementation climate, which was itself improved by increased implementation leadership. Fidelity to EBPs in healthcare settings can be improved by developing organizational leaders and strong implementation climates.Trial registrationClinicalTrials.gov identifier: NCT04096274. Registered September 18, 2019.

‘In the shower crying…but we came back in the following day and did it all again’. Distress and resilience in care home staff during the COVID-19 pandemic– A qualitative interview study

BackgroundCare homes (long-term care facilities) were profoundly impacted early in the COVID-19 pandemic, both in terms of resident mortality and restrictions for infection control. This study investigated the impact on the emotional well-being of care home staff of challenges faced at this time, and the strategies used to manage them.MethodsSemi-structured interviews conducted October 2020-June 2021 with care home staff and health service staff working with them explored the impact of the early waves of the COVID-19 pandemic (March 2020-June 2021). Interview data were analysed using reflexive thematic analysis.ResultsInterview participants were 16 care home staff and 10 health service staff. Analysis generated four key themes: 1)Anxiety and distress, 2)Overwhelming workload, 3)Pulling through; and 4)Resilience in a time of crisis. Care home staff experienced Anxiety and distress due to uncertainty of what to expect; witnessing illness and deaths of residents; concerns regarding their own health, and sometimes feeling their work was under-recognised. They also experienced an Overwhelming workload due to infection control measures, caring for sick residents and reduction in external healthcare support. Our theme of Pulling through reflects the peer support and problem-solving strategies with which care home staff managed the impact of the pandemic, along with a sense of responsibility and meaning towards their work. An overarching theme of Resilience in a time of crisis drew on the other three themes and describes how many staff managed, maintained, and often increased their work despite the challenges of the pandemic. Participants also described increasing emotional fatigue as the pandemic continued.ConclusionsThis paper builds on literature on the emotional impact of the pandemic on care home staff, also exploring ways that staff responded to this impact. These findings can help inform planning for future crises including disease outbreaks, and raise important questions for further work to develop pandemic preparedness in care homes and beyond. They also raise wider questions about the current cultural status of care work, which may have exposed care home staff to greater risk of distress, and which contrasts with the professionalism and responsibility shown by staff in response to pandemic challenges.

Adoption of policies to improve respectful maternity care in Timor-Leste.

There are now well-established global standards for supporting improvement in women's experience of maternity services, including frameworks for the prevention of mistreatment during childbirth. To support initiatives to improve the quality of care in maternal health services in Timor-Leste, we examine the adoption of global respectful maternity care standards in the national intrapartum care policy and in three urban birth facilities in Dili. From May to July 2022, we conducted a desk review of the Timor-Leste National Intrapartum Care Standards and Clinical Protocols for Referral Facilities and Community Health Centres. This was followed by a health-facility audit of policies, guidelines and procedures in three main maternity facilities in the capital, Dili to examine the extent to which the WHO (2016) standards for women's experiences of care have been adopted. Despite the availability of global guidelines, key standards to improve women's experience of care have not been included in the National Intrapartum Care guidelines in Timor-Leste. There was no mention of avoiding mistreatment of women, needing informed consent for procedures, or strengthening women's own capability and confidence. In the policy wording, women tended to be distanced from the care 'procedures' and the protocols could be improved by taking a more woman-centred approach. The results of the health facility assessment showed extremely low use of standards that improve women's experiences of care. Health Facility 1 and 2 met two of the 21 quality measures, while Health Facility 3 met none of them. The discourse communicated through policy fundamentally affects how health care issues are framed and how policies are enacted. Given the findings of this study, combined with previously documented issues around quality of care and low satisfaction with maternal health services, there is a need for a fundamental shift in the culture of care for women. This will require an immediate focus on leadership, training and policy-frameworks to increase respectful care for women in health facilities. It will also require longer-term effort to address the power imbalances that drive mistreatment of women within and across social systems, and to support models of care that inherently foster understanding and compassion.

A Study to Evaluate the Effectiveness of Informational Booklet on Knowledge regarding Home Care Management of Arteriovenous-Fistula among the patients undergoing Hemodialysis in selected Hospitals of Dharwad District

Chronic Kidney Diseases (CKD) causes at least 2.4 million deaths per year and is now the 6th fastest leading cause of death. Over 2 million people worldwide currently receive treatment with dialysis. Hence the use of arteriovenous fistula is increasing day by day along with this the risk of complications are also increasing therefore enhancing the home care management of AV fistula is particularly important for patients undergoing hemodialysis with AV Fistula. An experimental: one group pre-test, post-test design study was conducted among 35 hemodialysis patients with arteriovenous fistula at KLES’ Suchirayu Hospital Nephro Care Health Service Centre, Hubballi. The samples were selected using non-probability; convenient Sampling Technique. Data was collected by structure knowledge questionnaire. Data analysis was done using descriptive and inferential statistics. Overall results of the study revealed that out of 35 subjects, distribution of level of knowledge regarding home care management of AV fistula in the pre-test 23(65.72%) had average knowledge, 07(20%) had poor knowledge and 05(14.28%) had good knowledge. Whereas, in post-test after administration of informational booklet 31(88.58%) had good knowledge and 04(11.42%) had average knowledge and none of them had poor knowledge regarding home care management of arteriovenous fistula. The study concluded that, informational booklet was effective in improving the knowledge regarding home care management of arteriovenous fistula among patients undergoing hemodialysis.

Engaging Fathers for Effective Child Nutrition and Development in Tanzania (EFFECTS): study protocol for a five-arm, cluster-randomized trial

BackgroundGlobally, 144 million children under 5 years are undernourished and 250 million do not meet their developmental potential. Multi-input interventions, such as bundled nutrition and parenting interventions, are designed to mitigate risks for multiple child outcomes. There is limited evidence that bundled interventions have additive benefits to nutrition, growth, or development outcomes. These outcomes share common risks; therefore, designing interventions to tackle these risks using a common theory of change may optimize effectiveness. Emerging evidence suggests explicit engagement of fathers may benefit child outcomes, but few trials have tested this or included data collected from fathers.MethodsEngaging Fathers for Effective Child Nutrition and Development in Tanzania (EFFECTS) is a community-based cluster-randomized controlled trial that will be implemented in the rural Mara Region, Tanzania. The trial aims (1) to test a bundled nutrition and parenting program delivered to mothers’ groups, with or without fathers’ groups, over 12 months on child and caregiving outcomes compared to a nutrition program alone, and (2) to test nutrition or bundled nutrition and parenting programs delivered to mothers’ and fathers’ groups over 12 months on child and caregiving outcomes compared to programs delivered to mothers alone. The trial comprises five arms: (1) mothers’ groups receiving a nutrition program, (2) mothers’ groups receiving a bundled nutrition and parenting program, (3) mothers’ and fathers’ groups receiving a nutrition program, (4) mothers’ and fathers’ groups receiving a bundled nutrition and parenting program, and (5) control receiving standard of care health services. The primary outcomes are child dietary diversity and early child development (mental and motor development). Parents with a child under 18 months will be enrolled in peer groups and receive twice monthly intervention by trained community health workers. Data will be collected from mothers, fathers, and children at baseline (pre-intervention), midline, and endline (post-intervention).DiscussionEFFECTS will generate evidence on the effects of bundled nutrition and parenting interventions on child nutrition, growth, and development outcomes; determine the benefits of engaging fathers on child, caregiving, and caregiver outcomes; and investigate common and unique pathways between treatments and child outcomes.Trial registrationClinicalTrials.gov NCT03759821. Registered on November 30, 2018

'Something that helped the whole picture': Experiences of parents offered rapid prenatal exome sequencing in routine clinical care in the English National Health Service.

In October 2020, rapid prenatal exome sequencing (pES) was introduced into routine National Health Service (NHS) care in England. This study aimed to explore parent experiences and their information and support needs from the perspective of parents offered pES and of health professionals involved in its delivery. In this qualitative study, semi-structured interviews were conducted with 42 women and 6 male partners and 63 fetal medicine and genetic health professionals. Interviews were transcribed verbatim and analysed using thematic analysis. Overall views about pES were positive and parents were grateful to be offered the test. Highlighted benefits of pES included the value of the additional information for pregnancy management and planning for future pregnancies. An anxious wait for results was common, often associated with the need to make decisions near to 24weeks in pregnancy when there are legal restrictions for late termination. Descriptions of dealing with uncertainty were also common, even when results had been returned. Many parents described pES results as informing decision-making around whether or not to terminate pregnancy. Some professionals were concerned that a non-informative result could be overly reassuring and highlighted that careful counselling was needed to ensure parents have a good understanding of what the result means for their pregnancy. Emotional support from professionals was valued; however, some parents felt that post-test support was lacking. Parents and professionals welcomed the introduction of pES. Results inform parents' decision-making around the termination of pregnancy. When there are no diagnostic findings or uncertain findings from pES, personalised counselling that considers scans and other tests are crucial. Directing parents to reliable online sources of information and providing emotional support throughout could improve their experiences of care.

Multidisciplinary providers’ perceptions of care delivery for sleep disorders: A qualitative case study

ObjectivesSleep disorders are wide-ranging in their causes and impacts on other physical and mental health conditions. Thus, sleep disorders could benefit from a multidisciplinary approach to assessment and treatment. An integrated care model is often recommended but is costly to implement. We sought to understand how, in the absence of an established organizational structure for integrated sleep care, providers from different clinics work together to provide care for sleep disorders. MethodsA qualitative case study at one U.S. Department of Veterans Affairs (VA) medical center. We used a purposeful nested sampling strategy, combining maximum variation sampling and snowball sampling to recruit key staff involved in sleep care. ResultsWe interviewed providers (N = 10) from sleep medicine, primary care, and mental health services. Providers identified the ubiquity of sleep disorders and a concomitant need for multidisciplinary care. However, they described limited opportunities for multidisciplinary interactions and consequently a negative impact on clinical care. Providers described fragmentation in two areas: among sleep specialists and between sleep specialists and other referring and managing providers. ConclusionsA range of interventions, based on setting and resources, could improve care coordination both among sleep specialists and between sleep and nonsleep providers. While integrated sleep specialist clinics could reduce care fragmentation, they may not directly impact coordination with referring providers, like primary care and general mental health, who are essential in managing chronic conditions. Future work should continue to explore improving care coordination for sleep problems to ensure patients receive high-quality, timely, patient-centered care.

Use of Health Care Services and Its Associated Factors Among People With Type 2 Diabetes in Nepal.

This study aimed to assess the utilization of health care services and its associated factors among people with type 2 diabetes mellitus (T2DM) in Nepal. Data on the utilization of health care services were assessed in 481 adults aged 30 to 70 years with T2DM in Nepal. Multiple logistic regression analysis was performed to determine the factors associated with the utilization of health care services. Over 6 months, 66.1% of participants visited health care facilities or health service providers, followed by specialist visits (3.5%), hospitalization (2.1%), and emergency department visits (1.9%). Visit to health care facilities was significantly higher among those aged 50 to 59 years old (ORA: 1.64), practicing Hinduism (ORA: 2.4), and earning NRs ≥30 000 (≥USD 226.10) (ORA: 1.82) as compared to those aged ≥60 years old, practicing other religions, and with monthly family income NRs ≤10 000 (≤USD 75.37), respectively. The utilization of health care services among people with T2DM in Nepal was reasonably low. Identifying the underlying causes of low use of health care services is of great importance to bridge the gap in using health care services for management of diabetes.

The Impact of COVID-19 on Care Leavers

The survey of the COVID-19 outbreak focused on studying the impact and long-term consequences on care leavers, especially residential care leavers who are living independently. Employment, education, physical health, hygienic practices, psychosocial and emotional health, and coping strategies adopted by care leavers were studied. Bronfenbrenner’s Ecological Systems Theory (1979 ) was used to study the impact of COVID-19 on care leavers at every system level in Sri Lanka. The methodology adopted was mixed method. The data collection was mainly a quantitative survey. Focused group discussion and semi-structured interviews were used to elicit qualitative aspects of survey findings. The findings highlight that care leavers were primarily female (69%) and young adults between the ages of 16 and 28 (61%); the majority of care leavers (80%) lived with their families and only 20% lived alone. Care leavers were well adapted to precautionary measures to prevent COVID-19. This study on care leavers has shed light on various social and economic issues, including care-leaving debt, lack of access to digital learning, food insecurity and homelessness, as well as lack of access to a continuum of care and mental health services. The impact was more severe care leavers’ employment and educational opportunities, which led to long-term consequences on their life cycle. The absence of income maintenance or social protection nets could further affect care leavers’ long-term consequences. The research recommends a range of interventions to support youth leaving alternative care settings and to promote their independence and dignity.

Audit Rekam Medis dalam Upaya Peningkatan Kualitas Pengisian Rekam Medis di RSUD Sleman

A hospital is a health service institution that provides complete individual health services for inpatient, outpatient, and emergency care. Hospitals as health service providers are required to maintain medical records. The administration of medical records for each hospital refers to the Regulation of the Minister of Health of the Republic of Indonesia. A medical record audit is needed to determine the completeness of data in medical records both in quantity and quality. The purpose of this study was to determine the medical record audit at RSUD Sleman. The type of research used is analytic observational with a cross-sectional study design. This research was conducted at RSUD Sleman, Special Region of Yogyakarta. The research was done from April to October 2022, during a period of 7 months. Simple random sampling was used to collect data from 94 medical records. The audit of 94 samples of medical records resulted in the following findings: completeness, patient identity 100%, professional identity in providing care 99.01%, date and time 70.21%, initial assessment 90.42%, subjective examination 98.84%, objective examination 66.01%, management plan 91.49%, clinical pathology examination 58.51%, radiological examination 75.53%, primary diagnosis 100%, secondary diagnosis 100%, and general agreement 100%. The lowest percentage of 58.51% was obtained for incomplete data.

Perceptions of volunteers on the effectiveness of Kenya Medical Training College-run free medical camps in enhancing access to healthcare by vulnerable communities

In certain regions of Kenya, such as Nyahururu, Kabarnet, Kasikeu, and Mbooni, inadequate access to healthcare services contributes to avoidable deaths. Organizations like the Kenya Medical Training College (KMTC) address this challenge by organizing free medical camps, involving both local and international volunteer healthcare workers. This study explored the effectiveness of KMTC's free medical camps through interviews with 18 key informants, including faculty, non-faculty members, and community leaders from purposefully sampled hardship areas, namely, Nyahururu, Kabarnet, Kasikeu, and Mbooni. The study found that KMTC's free clinics offered crucial services like curative care, immunization, maternal and child health services, disease sensitization, reproductive health services, and substance abuse education. However, limitations were identified, including a shortage of medications, lack of specialized screening, follow-up care, and referral services. Resources available included community health volunteers, KMTC and hospital staff, socio-structural support, and physical infrastructure. Challenges faced by volunteers included motivation issues, inadequate facilitation, limited stakeholder involvement in planning, and perceived service comprehensiveness issues. Despite these challenges, the community acknowledged the vital role of medical camps in delivering essential services to marginalized groups. Addressing resource shortages, enhancing stakeholder engagement, improving service comprehensiveness, and boosting volunteer motivation were highlighted as crucial steps to maximize community benefits.

Challenges in the delivery of health services for people living with HIV in Dar es Salaam, Tanzania: a qualitative descriptive study among healthcare providers.

Healthcare providers play an important role in the provision of health services in care and treatment clinics (CTCs), as they help clients cope with their HIV/AIDS diseases by providing health education and counseling. Little is known about the challenges that healthcare providers face when providing such services to people living with HIV (PLWH) in low-resource settings. This study aimed to explore and understand the challenges that healthcare providers face in delivering care to PLWH in Dar es Salaam, Tanzania. We conducted a qualitative descriptive study to explore and understand the challenges that healthcare providers face when providing health services to PLWH. This study was carried out in the CTCs in the Ubungo District, Dar es Salaam, Tanzania. A total of 10 healthcare providers were recruited using a purposive sampling technique until information saturation was attained. Face-to-face interviews were conducted to obtain the data. We transcribed the interviews verbatim and analyzed them using reflexive thematic analysis to obtain the themes and subthemes. Client-related challenges included difficulty in managing antiretroviral (ARV) drug reactions of clients and their financial, follow-up, and index tracking problems; facility-related challenges included inadequate and limited space for CTC services, lack of integrated HIV services, and shortage of staff, which needed collaborative efforts to overcome; and healthcare provider-related challenges included a lack of up-to-date knowledge and limited access to health information. These challenges limit the provision of quality HIV care to the clients. This study highlights the important challenges that hinder the quality of HIV services at CTCs. The implementation of appropriate infrastructure to promote the privacy and confidentiality of clients is necessary as it alleviates the burden on the jobs of healthcare providers. The findings also suggest that healthcare providers improvise solutions to meet the needs of the clients in the study setting. Permanent resolution is required to overcome the challenges in CTCs. Further research on both providers and clients should be conducted to explore the challenges in CTCs in other similar settings.