Changes In Health Care System Research Articles

Health Care Science—Why another journal and why we will be different?

<i>Health Care Science</i>—Why another journal and why we will be different?

Therapeutic Dilemma in Personalized Medicine.

The practice of medicine depends, over a long time, on identifying therapies that target an entire population. The increase in scientific knowledge over the years has led to the gradual change towards individualization and personalization of drug therapy. The hope of this change is to achieve a better clinical response to given medications and reduction of their adverse effects. Tailoring of medicine on the road of personalized medicine considers molecular and genetic mapping of the individual. However, many factors still impede the smooth application of personalized medicine and represent challenges or limitations in its achievement. In this article, we put some clinical examples that show dilemmas in the application of personalized medicine such as opioids in pain control, fluoropyrimidines in malignancy, clopidogrel as antiplatelet therapy and oral hypoglycemic drugs in Type2 diabetes in adults. Shaping the future of medicine through the application of personalized medicine for a particular patient needs to put into consideration many factors such as patient's genetic makeup and life style, pathology of the disease and dynamic changes in its course as well as interactions between administered drugs and their effects on metabolizing enzymes. We hope in the coming years, the personalized medicine will foster changes in health care system in the way not only to treat patients but also to prevent diseases.

A Blueprint for Change: Guiding Principles for a System of Services for Children and Youth With Special Health Care Needs and Their Families.

Children and youth with special health care needs (CYSHCN) and their families continue to face challenges in accessing health care and other services in an integrated, family-centered, evidence-informed, culturally responsive system. More than 12 million, or almost 86%, of CYSHCN ages 1-17 years do not have access to a well-functioning system of services. Further, the inequities experienced by CYSHCN and their families, particularly those in under-resourced communities, highlight the critical need to address social determinants of health and our nation's approach to delivering health care. To advance the system and prioritize well-being and optimal health for CYSHCN, the Health Resources and Services Administration's Maternal and Child Health Bureau, with input from diverse stakeholders, developed a set of core principles and actionable strategies for the field. This article presents principles and strategies in the Blueprint for Change: Guiding Principles for a System of Services for CYSHCN and Their Families (Blueprint for Change), which acknowledges the comprehensive needs of CYSHCN, a changing health care system, and the disparities experienced by many CYSHCN. Four critical areas drive the Blueprint for Change: health equity, family and child well-being and quality of life, access to services, and financing of services. Although discussed separately, these critical areas are inherently interconnected and intend to move the field forward at the community, state, and federal levels. Addressing these critical areas requires a concerted, holistic, and integrated approach that will help us achieve the goal that CYSHCN enjoy a full life from childhood through adulthood and thrive in a system that supports their families and their social, health, and emotional needs, ensuring their dignity, autonomy, independence, and active participation in their communities.

Covid-19 Face Mask Detection and People Count

Abstract: During this pandemic the problems faced was shortage of testing services, vaccines and poor medical care all these lead to lockdown for a long run which affected our daily lives. During this pandemic the problems faced were shortage of testing services, vaccine and poor medical care all these lead to lockdown for the long run which affected our daily lives. The prevention for this problem was to wear masks in public areas. Facemask detection had seen remarkable growth in the image processing and deep learning domain. Facemask detection is already an existing concept in which they had used different algorithms and techniques to show better results. The proposed system in this project is developed to avoid mask-less people from entering the desired places by detecting face-mask, and sending a signal to an Arduino device that connects to the sensors and counts the people while entering and exiting. This helps to maintain the social distancing inside those places and limit the Total number of persons. If the total number of people count increases, the Arduino microcontroller will give the buzzer alarm to notify the person. In This project, we use live detection and identify either the person wears a mask or not. Therefore, this proposed approach will make a significant change in the public healthcare system. Keywords: Deep Learning, Sensors, Computer Vision, Convolutional Neural Networks (CNNs), public Safety, face mask detection, OpenCV, COVID-19.

Structural changes in the Russian health care system: do they match European trends?

ВackgroundIn the last two decades, health care systems (HCS) in the European countries have faced global challenges and have undergone structural changes with the focus on early disease prevention, strengthening primary care, changing the role of hospitals, etc. Russia has inherited the Semashko model from the USSR with dominance of inpatient care, and has been looking for the ways to improve the structure of service delivery. This paper compares the complex of structural changes in the Russian and the European HCS.MethodsWe address major developments in four main areas of medical care delivery: preventive activities, primary care, inpatient care, long-term care. Our focus is on the changes in the organizational structure and activities of health care providers, and in their interaction to improve service delivery. To describe the ongoing changes, we use both qualitative characteristics and quantitative indicators. We extracted the relevant data from the national and international databases and reports and calculated secondary estimates. We also used data from our survey of physicians and interviews with top managers in medical care system.ResultsThe main trends of structural changes in Russia HCS are similar to the changes in most EU countries. The prevention and the early detection of diseases have developed intensively. The reduction in hospital bed capacity and inpatient care utilization has been accompanied by a decrease in the average length of hospital stay. Russia has followed the European trend of service delivery concentration in hospital-physician complexes, while the increase in the average size of hospitals is even more substantial. However, distinctions in health care delivery organization in Russia are still significant. Changes in primary care are much less pronounced, the system remains hospital centered. Russia lags behind the European leaders in terms of horizontal ties between providers. The reasons for inadequate structural changes are rooted in the governance of service delivery.ConclusionThe structural transformations must be intensified with the focus on strengthening primary care, further integration of care, and development of new organizational structures that mitigate the dependence on inpatient care.

Employing Family Caregivers: An Innovative Health Care Model.

Employing Family Caregivers: An Innovative Health Care Model.

Compassion fatigue, compassion satisfaction, and burnout: A study of nurses in a large Texas health-care system.

The purpose of this study is to examine compassion satisfaction, compassion fatigue, and burnout in nurses at a large nonprofit, Catholic-based health-care system in southern Texas. This is a cross-sectional, exploratory study using a self-report survey. The survey included a demographic questionnaire and the Professional Quality of Life Scale version 5 (ProQOL 5). It was emailed to 1000 nurses at a large health-care system in Texas, USA. Three hundred and eighteen nurses completed the survey for a response rate of 31.8%. The results find low mean levels of compassion fatigue (CF) and burnout and high mean levels of compassion satisfaction (CS) among the nurses. Hours worked and nursing specialty emerged as factors in whether the nurses experienced CF or CS. The nurses with less than 10 years of experience have lower levels of CS and higher levels of burnout than those with over 10 years of experience. Finally, nurses who hold professional certification have statistically significant higher CF scores than those who do not. Health-care settings may need to take into consideration the number of hours worked and nursing specialty as significant factors in whether nurses experience CF or CS. Three key elements in CF prevention are education, awareness, and self-care. Often the climate in health-care settings discourages medical professionals from practicing effective self-care. The strategies for combating burnout are linked to changing health-care systems so that nurses are supported. Hospitals may explore alternative work schedules and lower patient loads to prevent CF and burnout.

Inclusive Governance and National Rural Health Mission: A Case study of Pulwama (J&amp;K)

Background: Inclusive governance signifies both processes and outcomes in developmental strategies across the world. More inclusive states are more prosperous, influential, and vibrant. Process-based inclusion refers to the decision and policy-making processes and how, why, and whose voices are considered. Outcome-based inclusion refers to the disbursement of developmental outcomes. One of the government’s programs that it has launched is the National Rural Health Mission (NRHM). This programme is functional all over the Union Territory of Jammu and Kashmir. District Pulwama is part of this region. Objectives: whether this programme meets the area-specific needs and whether there is a need for any modification in the healthcare administration to make the programme more inclusive and efficient. Methods: Sampling, literature review, interviews, questionaries, and focused group discussions are employed. The sample size of participants is one hundred, including doctors, patients, common citizens, paramedical staff and administrators. Results: Results were drawn which showed that the strategic convergence of healthcare and other related programs from village level upwards, context-specific alterations, and workable resources allocation elevate this program’s dynamicity. 80% of respondents favoured area-specific modifications needed to reach all society sections. Conclusion: To meet Sustainable Development Goals within the prescribed time limits, the program can result in a remarkable change in the overall healthcare system. It needs to be in sync with the current healthcare scenario, like the outbreak of pandemics like COVID-19. Suggestions are provided to make it more effective, result-oriented, and in sync with the existing ground realities. Int. J. Soc. Sc. Manage. Vol. 9, Issue-2: 88-93.

The Relationship between Self-Efficacy, Self-Care Behavior, and Generalized Anxiety Disorder in COVID-19: A Path Analysis Model

Background: The outbreak of the COVID-19 pandemic has a strong impact on individuals and becomes a very stressful period. Long-term exposure to stress due to lockdown scenario may also increase psychological distress by reducing support resources, and in these circumstances, personal resources such as self-efficacy and its relationships appear important. It is important to explore people’s beliefs about their capabilities to produce designated levels of behavior in the face of COVID-19, which is not known in the target population, and also to show its effect on anxiety.Purpose: This study aimed to investigate the relationship between self-efficacy, self-care behavior, and generalized anxiety disorder in COVID-19.Methods: A cross-sectional online survey was performed after COVID-19 was confirmed in Iran. The population of the study was 500 residents in a province in Iran that were randomly selected. Demographic data, general self-efficacy, self-care behavior, and the Generalized Anxiety Disorder (GAD-7) questionnaires were used for data collection. The data were analyzed using bivariate correlation and hierarchical linear regression models by using the SPSS statistical version (V.20).Results: The mean(SD) of age participants was 31.9(11.9). Their GAD-7 scores had severe anxiety (score ≥17). There was a negative and significant relationship between generalized anxiety disorder and self-efficacy (r=-0.238, p≤0.01). Also, there was a positive and significant relationship between self-efficacy and self-care behavior. No significant relationship between generalized anxiety disorder and self-care behavior was found. The path analysis model estimated anxiety and self-efficacy as about 4% of the variance self-care behavior in COVID-19.Conclusion: This study revealed that enhancing self-efficacy levels might reduce anxiety. Self-efficacy-enhancing programs should be used as part of the routine readiness effort drives and health care system change.

Definition and conceptualization of the patient-centered care pathway, a proposed integrative framework for consensus: a Concept analysis and systematic review

BackgroundConfusion exists over the definition of the care pathway concept and existing conceptual frameworks contain various inadequacies which have led to implementation difficulties. In the current global context of rapidly changing health care systems, there is great need for a standardized definition and integrative framework that can guide implementation. This study aims to propose an accurate and up-to-date definition of care pathway and an integrative conceptual framework.MethodsAn innovative hybrid method combining systematic review, concept analysis and bibliometric analysis was undertaken to summarize qualitative, quantitative, and mixed-method studies. Databases searched were PubMed, Embase and ABI/Inform. Methodological quality of included studies was then assessed.ResultsForty-four studies met the inclusion criteria. Using concept analysis, we developed a fine-grained understanding, an integrative conceptual framework, and an up-to-date definition of patient-centered care pathway by proposing 28 subcategories grouped into seven attributes. This conceptual framework considers both operational and social realities and supports the improvement and sustainable transformation of clinical, administrative, and organizational practices for the benefit of patients and caregivers, while considering professional experience, organizational constraints, and social dynamics. The proposed attributes of a fluid and effective pathway are (i) the centricity of patients and caregivers, (ii) the positioning of professional actors involved in the care pathway, (iii) the operation management through the care delivery process, (iv) the particularities of coordination structures, (v) the structural context of the system and organizations, (vi) the role of the information system and data management and (vii) the advent of the learning system. Antecedents are presented as key success factors of pathway implementation. By using the consequences and empirical referents, such as outcomes and evidence of care pathway interventions, we went beyond the single theoretical aim, proposing the application of the conceptual framework to healthcare management.ConclusionsThis study has developed an up-to-date definition of patient-centered care pathway and an integrative conceptual framework. Our framework encompasses 28 subcategories grouped into seven attributes that should be considered in complex care pathway intervention. The formulation of these attributes, antecedents as success factors and consequences as potential outcomes, allows the operationalization of this model for any pathway in any context.

A patient-led, peer-to-peer qualitative study on the psychosocial relationship between young adults with inflammatory bowel disease and food.

BackgroundInflammatory bowel diseases (IBDs) are chronic gastrointestinal diseases that negatively affect the enjoyment of food and engagement in social and cultural gatherings. Such experiences may promote psychosocial challenges, an aspect of IBD often overlooked and under‐supported in clinical settings and research.ObjectivesThis study explored the psychosocial experiences that young adults with IBD have with food via a qualitative patient‐led research process.MethodsTrained patient researchers conducted this study by engaging peers via semi‐structured interviews and focus groups in a three‐step co‐design process. Participants (n = 9) identified the research topic (SET), explored the topic and identified emerging themes (COLLECT), refined themes and made recommendations for healthcare system change (REFLECT).ResultsThemes that emerged included: ‘Experimenting with Food’, ‘Evolution Over Time’, ‘Diet Changes are Emotional’ and ‘Role of Stigma’. Participants identified the significance and frustrations of repeated testing and experimenting with food compatibility, and noted nuances in food relationships as they gain knowledge and experience over time. They emphasized the importance of maintaining a sense of hope throughout and wished to impart this to newly diagnosed patients.ConclusionParticipants experience numerous psychosocial challenges as they strive to manage their diet, noting gaps in support available from IBD practitioners. Participants made practical recommendations for healthcare system change to improve patient outcomes, highlighting the importance of sharing stories and collaboratively including patients in the development of new services and protocols. Authors recommend further research in this area to build a body of knowledge and support that helps IBD patients maintain hope while navigating challenges with food.Patient or Public ContributionThe first four authors on this paper were the lead researchers in this study's design and analysis and identify as patients; they conducted the research with this identity at the forefront following a peer‐to‐peer research model. These authors were mentored by patient researchers who also contributed to the manuscript, and the research process itself was co‐lead and directed by other patient participants and consultants. Results and recommendations coming from this paper came directly from patient participants.

Preference for shared decision-making among Arabic-speaking people with chronic diseases: a cross-sectional study

ObjectivesTo assess Arabic-speaking patients’ preference for involvement in decision-making in the United Arab Emirates (UAE) and characterise people who preferred involvement in decision-making.DesignCross-sectional quantitative study. The conduct and reporting of...

Revascularization prevents amputation among patients with diabetic foot during the COVID-19 era.

The COVID-19 pandemic has led to significant changes in healthcare systems that impact the management of chronic diseases such as diabetic foot (DF). We hypothesized that lack of access to healthcare would increase the severity of disease and lead to worse outcomes. The medical records of patients with DF were reviewed to determine demographic data and outcomes including wound healing, major amputation (MA), and death. Groups were divided into the pre-COVID-19 era (15 March 2019-15 March 2020) and the COVID-19 era (16 March 2020-16 March 2021); multivariable logistic analysis was performed to identify risk factors for MA. 261 patients with DF were included, 163 in the pre-COVID-19 era and 98 during the COVID-19 era. Patients in the COVID-19 presented with increased cardiovascular disease (19 vs 7%, p = 0.01), increased mean HbA1C (9.1 ± 2.1 vs 8.2 ± 2.1, p = 0.008) and higher WIFI-IV stage (78 vs 53%, p ≤ 0.0001). Patients with DF in the COVID-19 era were more likely to require MA (41 vs 21%, p ≤ 0.0001). Revascularization (OR = 0.12; 95% CI, 0.038-0.38) was a protective factor to reduce MA. MA among DF patients increased two-fold during the COVID-19 era. Revascularization avoids MA in diabetic patients even during the COVID-19 pandemic, suggesting that revascularization should be performed when possible.

Sustainable low-field cardiovascular magnetic resonance in changing healthcare systems.

Cardiovascular disease continues to be a major burden facing healthcare systems worldwide. In the developed world, cardiovascular magnetic resonance (CMR) is a well-established non-invasive imaging modality in the diagnosis of cardiovascular disease. However, there is significant global inequality in availability and access to CMR due to its high cost, technical demands as well as existing disparities in healthcare and technical infrastructures across high-income and low-income countries. Recent renewed interest in low-field CMR has been spurred by the clinical need to provide sustainable imaging technology capable of yielding diagnosticquality images whilst also being tailored to the local populations and healthcare ecosystems. This review aims to evaluate the technical, practical and cost considerations of low field CMR whilst also exploring the key barriers to implementing sustainable MRI in both the developing and developed world.

Evaluation of two European risk models for predicting medication harm in an Australian patient cohort.

To externally evaluate the performance of two European risk prediction models, for identifying patients at high-risk of medication harm, in an Australian hospital setting. This was a secondary analysis of a pre-existing cohort study described in a recently published study by Falconer et al. (Br J Clin Pharmacol 87(3):1512-1524, 2021) describing the development of a predictive risk model for inpatient medication harm. We retrospectively extracted relevant variables using the electronic health records of general medical and geriatric patients admitted to a quaternary hospital, in Brisbane, over 6months from July to December 2017. This dataset was used to externally evaluate the two European models, The Brighton Adverse Drug Reaction Risk (BADRI) model by Tangiisuran et al. and a risk model developed by Trivalle et al. The variables were entered into both models and the patients' risk of medication harm was calculated, and compared with actual patient outcomes. Predictive performance was evaluated by measuring area under the receiver operative characteristic (AuROC) curves. The Australian patient cohort included 1982 patients (median age 74years), of which 136 (7%) patients experienced ≥ 1 medication harm event(s). External evaluation of the two European models identified that both the BADRI and the Trivalle models had reduced predictive performance in an Australian patient cohort, compared with their original studies (AuROC of 0.63 [95% CI: 0.58-0.68] and 0.60 [95% CI: 0.55-0.65], respectively). Neither model demonstrated sufficient discrimination to warrant further evaluation in our local setting. This is likely a result of variations between the development and the validation cohorts, and the change in healthcare systems over time, and highlights the need for an up-to-date and context-specific risk prediction model.

Toward a better understanding of transition from paediatric to adult care in type 1 diabetes: A qualitative study of adolescents.

Type 1 diabetes is associated with significant morbidity, with an increasing risk of acute diabetes-related complications in adolescence and emerging adulthood. Purposeful transition from paediatric to adult-oriented care could mitigate this risk but is often lacking. Detailed understanding of the perspectives of adolescents in their final year of paediatric care is essential to inform delivery of transition care programs. We conducted semi-structured interviews with adolescents (aged 17years) with type 1 diabetes at an academic institution from April 2017 to May 2018. Participants were recruited through convenience sampling. Sixty-one interviews were transcribed for analysis. Coding followed the principles of thematic analysis. Thirty-six percent of participants were male, and participants were from diverse socioeconomic backgrounds. We found three overarching themes in our analysis: first, difficulties navigating changing relationships with parents and healthcare teams; second, the need to increase type 1 diabetes self-management and differing comfort levels based on age of diagnosis; and third, perceived responsibilities for transition care preparation (for both the paediatric team and adolescents themselves) focused not only on type 1 diabetes-specific skills but also on healthcare system structures. Our findings suggest that novel transition programs addressing changing inter-personal relationships, disease-specific self-management (adapted for age of diagnosis), and healthcare system navigation, supported by parents and peers, may be needed to improve transition care for adolescents with type 1 diabetes.

POSA205 Adoption of Tumour-Agnostic Therapies (TATS): Are Healthcare Systems Getting Ready?

The introduction of TATs is challenging for stakeholders involved in cancer care; their approval in several markets and initiatives to support their uptake are changing healthcare systems’ readiness for precision oncology. We aimed to measure healthcare systems’ readiness for TATs over time and in different countries.

Opportunities and constraints in the job search by public health graduates in their opinion

Strengthening of the professionalism of public health (PH) specialists may be the response to changes in health care systems. The aim of the study was to explore the potential and restrictions associated with job search by PH graduates, as well as to examine their opinions on their position on the labor market. The survey was conducted using questionnaire (CAWI) on 107 respondents from two medical universities in 2019. The average age of the respondents was 24.5. 5.61% and 17.76% of graduates from both universities respectively declared that the university prepared students well. Most respondents indicate internships, apprenticeships organized by employers (78%) and accepting graduates without professional experience (64%) as employers’ activities which facilitate entering the labor market. Graduates considered the most important obstacles in finding work to be: low interest in PH graduates work, insufficient contacts and relationships and insufficient professional experience. Their competencies do not coincide with the expectations of employers. Employers and universities do not establish sufficient cooperation. Although the dependency between the place of study and the graduates’ perception of the role of university and employers facilitating entry into the labor market and re-selection of the study is not strong, it should not be ignored in shaping education programs.

The Impact of the SARS-CoV-2 Pandemic on Healthcare Provision in Italy to non-COVID Patients: a Systematic Review.

BackgroundItaly has been one of the countries most affected by the SARS-CoV-2 pandemic, and the regional healthcare system has had to quickly adapt its organization to meet the needs of infected patients. This has led to a drastic change in the routine management of non-communicable diseases with a potential long-term impact on patient health care. Therefore, we investigated the management of non-COVID-19 patients across all medical specialities in Italy.MethodsA PRISMA guideline-based systematic review of the literature was performed using PubMed, Embase, and Scopus, restricting the search to the main outbreak period in Italy (from February 20 to June 25 2020). We selected articles in English or Italian that detailed changes in the Italian hospital care for non-COVID-19 patients due to the pandemic. Our keywords included all medical specialities combined with our geographical focus (Italy) and COVID-19.ResultsOf the 4643 potentially eligible studies identified by the search, 247 were included. A decrease in the management of emergencies in non-COVID patients was found together with an increase in mortality. Similarly, non-deferrable conditions met a tendency toward decreased diagnosis. All specialities have been affected by the re-organization of healthcare provision in the hub-and-spoke system and have benefited from telemedicine.ConclusionsOur work highlights the changes in the Italian public healthcare system to tackle the developing health crisis due to the COVID-19 pandemic. The findings of our review may be useful to analyse future directions for the healthcare system in the case of new pandemic scenarios.

Healthcare Providers’ Perceptions of Changes in Reproductive Healthcare Systems, Treatment, and Hospital Visits for Elderly Infertility Patients During COVID-19

Healthcare Providers’ Perceptions of Changes in Reproductive Healthcare Systems, Treatment, and Hospital Visits for Elderly Infertility Patients During COVID-19