Community Health Care Services Research Articles

Opting out of cardiac rehabilitation in local community healthcare services: Patients'perspectives and reflections.

Despite cardiac rehabilitation and medical treatment being integrated parts of the pathway of patients with cardiovascular disease, as well as the well-establish positive effect, cardiac rehabilitation remains underutilised. In recent years, cardiac rehabilitation has increasingly been moved from the hospitals to the community healthcare services. This transition may be challenging for patients with cardiovascular disease. To investigate reflections and perspectives of patients opting out of cardiac rehabilitation in community healthcare services to improve participation and adherence to cardiac rehabilitation in the future. A total of eight patients opting out of cardiac rehabilitation participated in individual interviews. Opting out of cardiac rehabilitation is defined as never enroled or did not complete cardiac rehabilitation. The Interpretive Description methodology was used in the analysis where two themes and six subthemes were identified: (1) 'Structural and organisational factors' with three subthemes; Being a patient in the healthcare system, Enroling into CR when it is meaningful, and Getting back to work is vital, and (2) 'Patients'internal factors' with three subthemes; Feeling a desire to regain control, Seeing yourself as recovered, and Being aware of own needs. The analysis indicates that patients'decision to opt out of CR was multidimensional and based on a combination of factors. Ensuring that the healthcare professionals in the community have sufficient information regarding the patient and a clear communication plan between the healthcare professionals and the patient may reduce the transition causing confusion and frustrations for patients. Incorporating a vocational element in CR and ensuring that employers understand the importance of CR may hamper returning to work as a challenge to CR. Ensuring timely CR referral and enrolment and a transition coordinator may reduce the challenge of patients not viewing CR as meaningful. However, further studies are needed to fully understand how CR could become meaningful for patients opting out of CR.

Readiness of malaria elimination in community and health facility of Mannaung Township, Rakhine State, Myanmar in 2022: a mixed-methods study

Background: Myanmar aims to eliminate Plasmodium falciparum malaria by 2025 and all human strains by 2030. In 2018, three townships including Mannaung township in Rakhine State were chosen for elimination pilot projects. The readiness assessment of community health-seeking behaviour and healthcare services of a malaria surveillance system for malaria elimination was conducted in Mannaung township. Methods: In December 2022, a mixed-methods survey interviewed 400 villagers regarding health-seeking behaviour and in-depth interviews (IDI) with Healthcare Providers (HCPs) from eight Health Centers and three hospitals for healthcare services of surveillance systems for malaria elimination. Results: Of 400 households, 154 (38.5%) had at least one family member contracting fever in the last 3 months. Among the 686 members contacted, 220 (32.1%) had a fever within the 3 months. Of these reported fever, 70 respondents (31.8%) were tested with RDT of which 51 (72.9%) were tested within 24 hours. Three main themes emerged from qualitative data analysis: experience of malaria prevention and control activities, malaria case-based response activities and suggestions to improve malaria surveillance. Although most of the HCPs expressed their understanding of testing criteria for malaria elimination, some had a knowledge gap in malaria elimination response activities. The HCPs received malaria elimination training in 2019, but they suggested providing malaria elimination-related training annually. Conclusions: The readiness assessment revealed delayed health-seeking behaviour in malaria thus awareness raising within the community should be provided. The HCPs need to enhance their ability to conduct surveillance activities for malaria elimination.

Factors affecting Implementation of Primary Health Care Services among Nurses in Level 3 Health Facilities in Kiambu County, Kenya

Primary health care is instrumental to delivery of quality basic health care services in communities. Its significance lies in ensuring that appropriate basic healthcare services are offered to all who need them competently, fairly and efficiently based on a people-centered approach. The study therefore sought to assess the factors affecting implementation of primary health care services among nurses in level 3 health facilities in Kiambu County, Kenya. This was an analytical cross-sectional study conducted among 141 nurses who worked in level 3 health facilities in Kiambu County and recruited using simple random sampling technique. They responded to a self-administered questionnaire. Data was probed descriptively with measures including proportions along with counts utilizing SPSS version 25.0. Relationships in study attributes were probed with chi-square test at 95% CI with outcomes shown in tables and figures. From the findings, majority (91.5%, n = 129) of the nurses rated the level of implementation of primary health care services in their work stations as sub-optimal. The factors found to strongly correlate with the poor implementation of the primary health care services were inadequate number of available healthcare personnel (p = 0.002); poor or low remuneration of health care providers (p = < 0.000); poor supply of essential medicine/drugs (p = 0.011); unavailability of essential medical equipment (p = 0.000); poor planning of the PHC programs (p = 0.024); lack of or inadequate support to HCPs from the hospital management (p = 0.013) and significant underfunding of the primary health care services (p = 0.001). Efforts are therefore required on the part of relevant stakeholders in Kiambu County to address the various factors that impede effective delivery of primary health care services

How to Meet Elders’ Needs: A Strategy for Community Healthcare Service

The elderly care services model based on community involvement is a significant approach to address challenges posed by aging populations. Nevertheless, there is a noticeable gap in effectively gauging the actual needs and preferences of the elderly regarding these services, which is particularly prevalent in developing regions like China. Therefore, we conducted a comprehensive analysis through literature reviews; data surveys; and interviews with 16 elderly individuals, their family members, and caregivers in a community in Shenyang City. Additionally, a Delphi test was conducted to identify the specific needs related to elderly care services. Next, the Kano model explored the genuine needs of the elderly for community-based care services. This model helped us understand how various factors of demand influence satisfaction levels of the elderly, and we designed a service blueprint based on these findings. The study involved 102 participants. Our findings revealed that the extent to which different service needs are met varyingly impact elderly users’ satisfaction. Catering to these needs in a targeted manner enhances the adaptability of services and boosts the subjective satisfaction of the elderly. Consequently, future research should focus on developing suitable community elderly care service plans that are more aligned with their needs.

Challenges and coping strategies for providing maternal health care services among health care professionals in rural health facilities in Wolaita Zone, Southern Ethiopia: a qualitative study

BackgroundMany factors can decrease job productivity and cause physical and psychological complications for health care professionals providing maternal care. Information on challenges and coping strategies among healthcare professionals providing maternal healthcare services in rural communities is crucial. However, there needs to be more studies, especially qualitative research, to explore challenges and coping strategies for providing maternal health care services in Ethiopia among health care professionals, particularly in the Wolaita zone.ObjectiveTo explore the challenges and coping strategies of professionals providing maternal health care in rural health facilities in Wolaita Zone, Southern Ethiopia, in 2023.MethodA phenomenological qualitative study design was applied from May 20 to June 20, 2023. The study was conducted in rural areas of the Wolaita Zone, southern Ethiopia. Healthcare professionals from rural areas were selected using purposive sampling, and in-depth interviews were conducted. A qualitative thematic analysis was employed to analyze the data. Field notes were read, recordings were listened to, and each participant’s interview was written word for word and analyzed using ATLAS.ti 7 software.ResultFive main themes emerged from the data analysis. These themes included inadequate funding from the government, societal barriers to health and access to health care, professionals’ personal life struggles, infrastructure related challenges and health system responsiveness, and coping strategies. Reporting to responsible bodies, teaching mothers about maternal health care services, and helping poor mothers from their pockets were listed among their coping strategies.ConclusionHealthcare professionals have a crucial role in supporting women in delivering babies safely. This study revealed that they are working under challenging conditions. So, if women’s lives matter, then this situation requires a call to action.

Effect of community-based public health service on health-related quality of life among middle-aged and older adults with chronic diseases in China

BackgroundThe growing prevalence of non-communicable chronic diseases poses a significant public health challenge globally, particularly impacting the well-being of aging populations. This study aims to assess the impact of community-based public health service (PHS) on the health-related quality of life (HRQoL) among middle-aged and older adults with chronic diseases in China.MethodsUtilizing data from the China Health and Retirement Longitudinal Study, we constructed a novel scale based on the 36-Item Short Form Health Survey (SF-36) to measure the HRQoL of middle-aged and older patients with hypertension and/or type-2 diabetes. Multivariate linear regression models with Instrument Variables and Propensity Score Matching techniques were applied to examine the effect of PHS on the HRQoL of identified chronic disease patients.ResultsAmong 8,403 hypertensive and/or diabetic patients, only 10.98% had received PHS. After adjusting for covariates, PHS exhibited a significant association with an elevated overall SF-36 score (β = 3.539, p < 0.001). Similar effects were observed in the physical and mental component summary scores, with increases of 1.982 (p < 0.001) and 5.095 (p < 0.001), respectively. Sensitive analysis affirmed the robustness of these findings. Heterogeneity analysis revealed significant HRQoL improvements among males, females, those aged 70 and older, patients with comorbidities, and urban residents, while the effect was less pronounced in the middle-aged, those without comorbidities, or rural dwellers.ConclusionCommunity-based PHS has exerted a positive impact on both the physiological and psychological aspects of HRQoL among middle-aged and older chronic disease patients, with effects varying among individuals with different characteristics. Our findings advocate for enhancing the delivery and utilization of government-funded PHS, increasing health literacy, and promoting early prevention strategies for chronic diseases. Furthermore, targeted health management initiatives for patients with comorbidities and enhancements in the quality of community healthcare services, particularly in rural areas, are deemed necessary.

Community health services in European literature: A systematic review of their features, outcomes, and nursing contribution to care.

To meet the population's needs, community care should be customized and continuous, adequately equipped, and monitored. Considering their fragmented and heterogeneous nature, a summary of community healthcare services described in European literature is needed. The aim of this study was to summarize their organizational models, outcomes, nursing contribution to care, and nursing-related determinants of outcomes. A systematic review was performed by searching PubMed, CINAHL, Scopus, and Embase in October 2022 and October 2023 (for updated results). Quantitative studies investigating the effects of community care, including nursing contribution, on patient outcomes were included and summarized. Reporting followed the PRISMA checklist. The review protocol was registered on PROSPERO (CRD42022383856). Twenty-three studies describing six types of community care services were included, which are heterogeneous in terms of target population, country, interventions, organizational characteristics, and investigated outcomes. Heterogeneous services' effects were observed for access to emergency services, satisfaction, and compliance with treatment. Services revealed a potential to reduce rehospitalizations of people with long-term conditions, frail or older persons, children, and heart failure patients. Models are mainly multidisciplinary and, although staffing and workload may also have an impact on provided care, this was not enough investigated. Community health services described in European literature in the last decade are in line with population needs and suggest different suitable models and settings according to different care needs. Community care should be strengthened in health systems, although the influence of staffing, workload, and work environment on nursing care should be investigated by developing new management models. Community care models are heterogeneous across Europe, and the optimum organizational structure is not clear yet. Future policies should consider the impact of community care on both health and economic outcomes and enhance nursing contributions to care.

On the pathway to health equity: Creating a harm reduction strategy for a large academic acute care hospital.

An urban centre in southwestern Ontario continues to be faced with the extensive impacts of high rates of substance use. To more effectively meet the quintuple aim, in a way that authentically considers patients who use substances, the need for a cohesive, comprehensive organizational harm reduction strategy at the large academic acute care hospital providing community and regional healthcare services was clear. Community-based harm reduction expertise was leveraged to support the development work. Information gathered through literature review and interviews with patients, internal staff and leaders, partner healthcare agencies, and Canadian hospitals leading in harm reduction work provided key insights and supported the formulation of emerging recommendations that will be used to shape the acute care hospital's formal organizational harm reduction strategy.

Unraveling patient satisfaction, associated factors, and dissatisfaction reasons in the provision of health care services for rural communities in Bangladesh: A cross-sectional investigation

BackgroundAccess to high-quality healthcare is a fundamental right, but rural communities in Bangladesh face challenges in accessing such services. Patient satisfaction plays a crucial role in healthcare outcomes. Identifying factors influencing satisfaction is vital for targeted interventions. MethodsA cross-sectional investigation was conducted in rural areas of Sirajganj, Rajshahi, Bangladesh, from April to June 2023. Convenient sampling was employed, and face-to-face interviews were conducted using a semi-structured questionnaire. A total of 411 participants were included in the final analysis. Descriptive statistics, as well as bivariate and multivariable logistic regression analyses, were carried out using SPSS software. ResultsMost unmarried participants (mean age: 41.93 ± 14.54 years; age range: 18–88 years) had primary education and a family income below 15,000 BDT. Among them, 80.3 % reported dissatisfaction with treatment. Significant factors linked to dissatisfaction included low education, being a businessman, living in nuclear families, daily physical exercise, difficulty accessing healthcare, average doctor-patient communication, high treatment costs, long waiting times, government hospital services, proximity to healthcare centers, lack of follow-up services, and absence of Telemedicine or M-health services. ConclusionThis study identifies key factors affecting patient satisfaction in rural Bangladesh. Interventions should focus on improving doctor-patient communication, reducing treatment costs and waiting times, enhancing access to healthcare and follow-up services, and incorporating Telemedicine or M-health services. Special attention is needed for businessmen, nuclear family residents, those who exercise daily, and patients using government hospitals or living near healthcare centers, as these groups report higher dissatisfaction.

Spatial accessibility and equity of community healthcare: unraveling the impact of varying time and transport mode.

Achieving a higher level of accessibility and equity to community healthcare services has become a major concern for health service delivery from the perspectives of health planners and policy makers in China. In this study, we introduced a comprehensive door-to-door (D2D) model, integrating it with the open OD API results for precise computation of accessibility to community hospitals over different transport modes. For the D2D public transit mode, we computed the temporal variation and standard deviation of accessibility at different times of the day. Additionally, accessibility values for D2D riding mode, D2D driving mode, and simple driving mode were also computed for comparison. Moreover, we introduced Lorenz curve and Gini index to assess the differences in equity of community healthcare across different times and transport modes. The D2D public transit mode exhibits noticeable fluctuations in accessibility and equity based on the time of day. Accessibility and equity were notably influenced by traffic flow between 8 AM and 11 AM, while during the period from 12 PM to 10 PM, the open hours of community hospitals became a more significant determinant in Nanjing. The moments with the most equitable and inequitable overall spatial layouts were 10 AM and 10 PM, respectively. Among the four transport modes, the traditional simple driving mode exhibited the smallest equity index, with a Gini value of only 0.243. In contrast, the D2D riding mode, while widely preferred for accessing community healthcare services, had the highest Gini value, reaching 0.472. The proposed method combined the D2D model with the open OD API results is effective for accessibility computation of real transport modes. Spatial accessibility and equity of community healthcare experience significant fluctuations influenced by time variations. The transportation mode is also a significant factor affecting accessibility and equity level. These results are helpful to both planners and scholars that aim to build comprehensive spatial accessibility and equity models and optimize the location of public service facilities from the perspective of different temporal scales and a multi-mode transport system.

Integrating Dayak Ngaju culture: cross-paradigm practices in community healthcare services.

Integrating Dayak Ngaju culture: cross-paradigm practices in community healthcare services.

Effect of Early Intervention Programs on Developmental Delays in Infants and Toddlers in Malawi

Purpose: The aim of the study was to analyze the effect of early intervention programs on developmental delays in infants and toddlers in Malawi. Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: Early intervention programs in Malawi for developmental delays in infants and toddlers have shown significant positive outcomes. These programs, integrated into community healthcare services, focus on early identification, assessment, and tailored interventions. They improve motor skills, language development, cognitive abilities, and social-emotional skills. Parental involvement is crucial, with caregivers educated to support developmental progress at home. Unique Contribution to Theory, Practice and Policy: Ecological systems theory, social learning theory &amp; bioecological model of development may be used to anchor future studies on effect of early intervention programs on developmental delays in infants and toddlers in Malawi. Enhance the involvement of parents and caregivers in EIPs through structured training and support. Advocate for increased funding and resource allocation to support the expansion and sustainability of EIPs. Policy recommendations should focus on securing public and private investments in early childhood development, prioritizing programs that demonstrate evidence-based effectiveness.

Pharmaceutical Care in Primary Healthcare-A Study of Nurses', Pharmacists', and Physicians' Experiences of Interprofessional Collaboration.

Implementation of pharmaceutical care for the benefit of patients and health services has been highlighted worldwide. Interprofessional collaboration between nurses, pharmacists, and physicians may contribute to raising awareness of pharmacological challenges, increasing quality, and minimising errors in pharmaceutical care. This study aimed to investigate how nurses, pharmacists, and physicians experience interprofessional collaboration in pharmaceutical care within community healthcare in Norway. The study had an explorative and descriptive design with a qualitative approach. Individual interviews were conducted with 12 healthcare personnel with key roles in pharmaceutical care within community healthcare services. The data were analysed using systematic text condensation. The results revealed three categories and four subcategories: The category "Professional challenges" contained the subcategories "Blurred responsibilities" and "The importance of trust and continuity". The category "Organisational barriers" contained the subcategories "Lack of information exchange and suitable communications channels" and "Lack of time and meeting places". The third category was "Nurses-the important link". This study reveals challenges to and factors of success in increasing high-quality and safe pharmaceutical care, knowledge that can be used in quality work in the community health services and as input in curriculum development for the three professions.

Social Factors Associated with Insecurity in Nigerian Society

The study examines the societal issues that contribute to the level of insecurity in Nigerian society using the Autoregressive Distributed Lag (ARDL) co-integration technique with data from 1991 to 2022. The variables used as independent and societal factors generating insecurity include the unemployment rate; the high cost of living in society; insufficient funds for education, community social services, healthcare services, and infrastructure; and agricultural development. Among the criteria evaluated, inadequate school financing and the unemployment rate appear to be the most significant sources of insecurity in society as a result of young people’s involvement in abduction, violence, and other societal issues. The study recognizes that government measures aimed at reorienting society towards a peaceful environment for habitation are critical. It is of the utmost importance to provide employment for young people and adequately support schools in order to lower the number of youngsters who are not in school. These out-of-school children are readily persuaded to join groups that make society untenable. Thus, free education is strongly suggested to engage and develop their thoughts in a constructive manner so that they can be valuable to society.

Menstruating while homeless: navigating access to products, spaces, and services

BackgroundPeople experiencing homelessness (PEH) in the United States face substantial challenges related to menstruation, exacerbated by the COVID-19 pandemic. Limited access to period products, heightened stigma, and gynecological challenges contribute to increased hardships for PEH, highlighting the need for improved services and policies to address period equity and overall well-being for this vulnerable population.MethodsWe conducted semi-structured qualitative interviews with PEH (n = 12) and community healthcare and social service providers (e.g., case managers, shelter directors, community health workers, and nurses, n = 12) in Lafayette, Indiana, a city located between Indianapolis and Chicago in the United States. We used thematic analysis techniques for data analysis.ResultsPEH’s limited access to products, services, and safe spaces hindered effective menstruation management within restrictive community contexts. Although community healthcare and service providers offered some support, complex interactions with the healthcare system, stigma, and limited access to spaces exacerbated barriers. The COVID-19 pandemic further intensified these difficulties by closing public spaces, worsening economic conditions, and straining service provider resources.ConclusionsResults highlight critical organizational and policy gaps in the United States for menstruation management resources and services, emphasizing the need for better integration into health and well-being programs for PEH. These insights will advance reproductive and public health research, shedding light on the disparities faced by PEH in managing menstruation in Indiana and contributing to the national discourse on addressing these barriers. Amid the complex landscape of public health, particularly during and after the pandemic, prioritizing menstrual health remains essential for all individuals’ overall well-being, including those experiencing homelessness.

Perceptions of Delay in Seeking Medical Help among People with Diabetic Foot Ulcers in Rural Southwest China

Diabetic foot infection is one of the most severe complications of diabetes mellitus. Immediately seeking medical attention is vital after foot ulcers occur; however there are often delays in seeking treatment. This study used a qualitative descriptive approach to explore the perceptions of delay in people seeking medical help for foot ulcers in three villages in Baise, rural areas of southwest China. Fifteen patients were recruited in this study. In-depth interviews were performed to collect data from August to October 2022, and thematic analysis was used to analyze the data. This study identified four main themes: personal estimation; supernatural and traditional power; health service expertise, cost and access to hospital care; and psychological and complementary care. Inadequate awareness of potential ulcers and a preference for alternative methods significantly contributed to delays in medical foot care. Additionally, a shortage in community healthcare services impeded the timely initiation of proper foot care actions. It was worth noting that the preference for Traditional Chinese Therapy was relevant to the delay in seeking medical attention on foot, yet it was not perceived before. These findings serve as crucial evidence for developing interventions and future policy adjustments. Further consideration of the multifaceted impacts is necessary to incentivize prompt treatment decisions for diabetic foot ulcers. Nurse specialists should be concerned regarding psychological care, and dual-way support between nurses and families is vital for prompt medical care-seeking. Nursing education should emphasize knowledge of pathophysiology integrating prayer merits and Chinese therapies for patient empowerment.

Concept of Micro Healthcare Entrepreneurship (MHE) to Facilitate Universal Health Coverage (UHC): Prospects and Challenges

In the pursuit of Universal Health Coverage (UHC), developing countries with limited resources face significant hurdles. Traditional top-down approaches, spearheaded by governments, often entail lengthy planning periods and substantial costs to reach underserved communities. This paper proposes a bottom-up, cost-effective, and preventive approach aimed at empowering local human resources and using advanced technology. We call it the Micro Healthcare Entrepreneurship (MHE) model. The MHE model comprises four primary components: (1) utilization of local human resources, (2) disruptive healthcare technology, (3) continuous training, and (4) available funds. Extensive testing of the digital health and social business elements across diverse contexts underscores their efficacy. Furthermore, the viability of social business funds has been established. To solicit feedback and refine the MHE concept, three workshops, conducted in phases, engaged 60 community healthcare service providers. This paper elucidates both the potential advantages and the challenges inherent in implementing the MHE model. By shifting the paradigm toward grassroots empowerment and leveraging existing community assets, this approach offers promise in advancing healthcare accessibility and sustainability in resource-constrained settings to achieve UHC.

Extended use of point-of-care technology versus usual care for in-home assessment by acute community nurses in older adults with signs of potential acute respiratory disease: an open-label randomised controlled trial protocol

BackgroundDue to ageing-related physiological changes, diagnosing older adults is challenging. Delayed disease recognition may lead to adverse health outcomes and increased hospitalisation, necessitating the development of new initiatives for timely diagnosis and treatment of older adults. Point-of-care technology, such as focused lung ultrasound scan and bedside analysis of blood samples (leucocytes with differential count, electrolytes, and creatinine) conducted in the patients’ home, may support clinical decision-making, and potentially reduce acute hospital admissions.We present the protocol for a randomized controlled trial, which aims at assessing the effect of focused lung ultrasound scan and bedside blood analysis during in-home assessments among older adults with signs of potential acute respiratory disease on hospital admissions.MethodWe will use a parallel open-label, individually randomised controlled trial design in an acute community healthcare setting. The trial will initiate on October 2022 and is expected to end one year later. The study population will include older adults (65 + year), with at least one of the following inclusion criteria: Cough, dyspnoea, fever, fall, or rapid functional decline. Expected study sample will comprise 632 participants. Participants in the control group will receive usual care, while the intervention group will undergo extended point-of-care technology (focused lung ultrasound scan and bedside venous blood analysis), in addition to usual care.The primary outcome is acute hospital admission within 30 days follow-up. Secondary outcomes include readmissions, mortality, length of hospital stay, hospital-free days, complications during hospital admission, treatment initiations or changes, functional level, re-referrals to the acute community healthcare service, and contacts to the primary care physician. A tertiary outcome is the diagnostic accuracy of Acute Community Nurses for conducting focused lung ultrasound compared with a specialist. Outcomes will be analysed as intention-to-treat.DiscussionTo our knowledge, this is the first randomised controlled trial examining the effect of extended use of point-of-care technology conducted in an in-home setting. We expect that the results may contribute to the development of new interventions aiming to improve timely diagnostics, treatment decisions, and reduce acute hospital admissions.Trial Registration www.clinicaltrials.org NCT05546073 (Date of registration: September 19th, 2022).

Implementation of community health care services to counter the SARS-CoV2 pandemic

BackgroundThe COVID-19 pandemic has ravaged many countries worldwide since December 2019. The high infection rates, and the need for health care assistance for individuals with comorbidities, strained the national health care systems around the world. Outbreak peaks increased the burden on hospitals that where perceived as high-risk places by people, who often decided to cancel or defer hospital visits. Thus, Italian Local Health Authorities had to develop new organizational models to meet the increased health care needs of the population. The aim of this study is to assess the impact of strengthened community health services on the hospital burden.MethodsWe analysed the number of Emergency Department access at the Hospital De Lellis covered by the Local Health Authority in Rieti, from March 2020 to November 2021. We then assessed the effects of community health services: the Special District Continuing Care Units (SDCUs) and the the COVID hub, on the COVID-19-related ED access, admission and mortality rates. A Chi-squared test for trend and three multivariable logistic regression models were used to investigate the trends and the possible predictors of COVID ED access, COVID hospital admissions, and deaths.ResultsBeing male (OR = 1.41, CI95% 1.05–1.90; p = 0.022) and older age (OR = 1.03, CI95% 1.02–1.04; p < 0.0001) increase the likelihood of hospitalisation for Sars-CoV-2. The implementation of the nursing and medical SDCUs contributed to reducing COVID-19-related deaths (OR = 0.09, CI95% 0.03–0.29; p < 0.0001). The simultaneous implementation of the COVID hub and of the nursing SDCUs had a synergistic effect in reducing the likelihood of hospitalisation (OR = 0.24, CI95% 0.09–0.65; p = 0.005). The subsequent implementation of the medical SDCUS has further contributed to lowering the admission rates. These protective effects persisted also after potential cofounders, such as age, sex, clinical condition on admission, and the immunisation status, were adjusted.ConclusionsThese measures have helped in the management of patients in a complex context such as that of a pandemic by reducing the hospital load and playing an important role in the management of the pandemic. Further studies could assess the transferability of this model in a non-pandemic context.

What preconception health services would the public find when searching the internet in Australia?: results from a simulated internet-search study

BackgroundAustralian preventive health strategy outlines the importance of preconception health in improving health in the community, across multiple generations and places primary and community healthcare services as a central pillar to effective preconception care. However, there is no national implementation plan to see preconception care proactively offered in healthcare settings in Australia. Instead, there is evidence that most women search the internet for information about pregnancy planning and preparation. In response, this study explores the availability and characteristics of health services found by searching for preconception care online in Australia.MethodSimulated Google searches were conducted using search terms ‘preconception’ and the name of a city/town with a population > 50,000. Related terms, ‘fertility’ and ‘pregnancy’ were also searched. Characteristics of the health services and the information available on relevant websites were extracted and reported descriptively.ResultsThe searches identified 831 website links, including 430 websites for health services. The health services were most often located in cities/towns with populations equal to or less than 200 000 (54.2%), and housing multiple health professionals (69.8%) including a specialist doctor (66.5%), nurse (20.9%), psychologist/counsellor (2.0%) and/or naturopath (13.0%). All the health services identified online explicitly mentioned women among their target populations, while 69.1% (n = 297) also referred to providing services for men or partners. More than one third of websites included blogs (36.9%) while external links were included in 10.8% of the online sites.ConclusionsThis study provides a preliminary examination of health services that may be found through internet-based searching by Australian consumers seeking health advice or support prior to becoming pregnant. Our descriptive results suggest couples may find a variety of health professionals when seeking health services for preconception care. Future research involving co-design of search terms with consumers, ongoing monitoring of health services and ensuring access to meaningful, and accurate information found through internet-searching are all necessary to ensure people of reproductive age are able to access the preconception health information and care they need.