Comprehensive Health Care System Research Articles

New technology and working methods to improve healthcare for suspected malignant skin lesions: Implementation of teledermatoscopy in comprehensive healthcare

AbstractBackgroundSuspected malignant skin lesions are common and challenging in terms of diagnostic accuracy and lead time. Efficient use of teledermatoscopy has the potential to improve these factors.ObjectivesThis report aims to explore the implementation of teledermatoscopy for quality improvement in a comprehensive healthcare system.MethodsA stepwise implementation started in 2012 in the Stockholm Region, Sweden, serving 2.4 million inhabitants across approximately 240 primary healthcare centres. The full‐scale implementation occurred from May 2021 to February 2023, utilising a double‐reading teledermatoscopy system. The RE‐AIM framework (reach, effectiveness, adoption, implementation, maintenance) guided the evaluation, including measures such as participant engagement, referrals, diagnoses, staff participation, and centres going on post‐implementation. Descriptive statistics were used.ResultsIn the full‐scale implementation period, 10,862 referrals were transmitted, with 17% recommended for biopsy or excision. Among these, 282 (15%) were confirmed melanomas and 516 (28%) non‐melanoma skin cancers. Challenges were observed during the stepwise phase, particularly in engaging primary healthcare and establishing dermatologic consultation capacity. However, all centres and 1263 primary care physicians participated in the fully scaled implementation. Challenges included contractual compliance, adopting a collective system perspective, effective management transition of referrals, cost allocation, and communication improvements. Six months post‐study, most centres used the system, with around 1500 monthly referrals.ConclusionsThe evaluation revealed the overall satisfactory performance of the teledermatoscopy system in terms of reach, effectiveness, adoption, implementation, and maintenance during the fully scaled phase. Results underscore the effectiveness of a stepwise implementation to successfully address contextual challenges. The findings emphasise the system's potential for a broader patient outreach. In conclusion, implementation of teledermatoscopy for quality improvement in a comprehensive healthcare system is an organisational challenge but has the potential to improve healthcare quality for suspected malignant skin lesions.

Reducing disparities in the treatment of hyperparathyroidism

BackgroundHyperparathyroidism is common with African American patients historically experiencing disparate outcomes. With a comprehensive outreach program and systematic treatment plans, we sought to evaluate our institution's ability to reduce disparities in hyperparathyroidism. MethodsWe performed a retrospective review of prospectively collected data at a single medical center for all patients undergoing parathyroidectomy by endocrine surgeons from 2015 to 2021 for primary (PHPT) and tertiary (THPT) hyperparathyroidism. Patient demographics, pre-and post-operative clinical and biochemical data were collected and analyzed by race. ResultsOf the 757 patients included, 675 patients had PHPT with 135 (20 %) African-American (AA) and 528(78 %) female. Of 82 patients with THPT, 44 (53 %) were AA and 34 (32 %) were female. AA patients were younger than Caucasian (CA) patients with a mean age (±SD) of 56 ± 15 vs 60 ± 14 years in PHPT (p < 0.01) and 50 ± 10 vs 55 ± 10 years in THPT (p = 0.02).Median (IQR) preoperative PTH was higher in AA with PHPT 134 (97–190) vs 102 (75–144) pg/mL (p < 0.01) and in AA with THPT 285 (189–544) vs 218 (145–293) (p = 0.01) pg/mL. AA PHPT patients had significantly higher preoperative mean (±SD) calcium levels 10.9 ± 0.8 vs 10.6 ± 0.8 mg/dL(p < 0.001). Biochemical cure rates at 6 months and complication rates were not different between races. ConclusionsAA patients with PHPT and THPT disease experienced similar cure rates to their CA counterparts despite having a more severe biochemical disease. Health care disparities may be ameliorated with treatment by high volume surgeons embedded in a comprehensive health care system.

The Future of Health Insurance in India: A Case of Ayushman Bharat

Introduction: In 2017, the National Health Policy recommended the introduction of Ayushman Bharat to promote Universal Health Coverage (UHC), with the aim of providing comprehensive, need-based, and equitable healthcare services to the Indian population. The scheme comprises two primary components: the creation of 1,50,000 Health and Wellness Centres (HWCs) and the implementation of the Pradhan Mantri Jan Arogya Yojana (PM-JAY). These initiatives aim to enhance infrastructure related to comprehensive primary healthcare, maternal and child healthcare, non-communicable diseases, and improved drug delivery and diagnostic services. Out of 28 states and 8 Union territories in India, Delhi, Odisha, and West Bengal have not implemented the AB-PMJAY scheme. Telangana joined the scheme in May 2021, and each state has adopted different models to accommodate their healthcare requirements. Objective: The study elicits the various aspects of Ayushman Bharat, the scheme’s evolution throughout different timelines and its future prospects. Conclusion: The Ayushman Bharat scheme has played an enormous role in achieving comprehensive healthcare system by leveraging various technologies and digital health methods. During the pandemic, the rates of utilization have changed, and Ayushman Bharat is anticipated to contribute significantly to achieve UHC in the future.

Advance care planning in the treatment of implantable left ventricular assist device: a republication of the review published in Japanese Journal of Artificial Organs.

Advance care planning (ACP) is essential in managing serious and chronic illnesses to ensure that patients receive care aligned with their personal values, goals, and preferences. This review focuses on integrating ACP in the treatment of patients receiving implantable left ventricular assist devices (VADs). The heart failure palliative care team developed a unique advance directive form and pamphlet to facilitate ACP discussions, emphasizing not only medical treatment preferences but also patients' values and life goals.The study highlights the distinction between bridge to transplantation (BTT) and destination therapy (DT) in VAD patients, with different goals and considerations for ACP. The use of decision aids developed especially for DT candidates as a communication tool helps in sharing patients' wishes and facilitates shared decision-making, particularly in the complex decisions surrounding DT therapy.Challenges in implementing ACP, such as time constraints due to urgent medical conditions, difficulties in patient communication, and the recent COVID-19 pandemic, are addressed. The need for a comprehensive healthcare system capable of supporting patients' ACP wishes, especially in the community setting, is also pointed out.Future directions include not only developing materials to ease ACP discussions and ensuring that ACP content is shared among healthcare providers to foster collaborative and detailed planning, but also a call for widespread adoption of ACP in Japan.This is a translation of a paper written in Japanese Journal of Artificial Organs (Vol. 52, No. 1, pp. 89-92) with additions and corrections.

Low access and inadequate treatment in mental health care for asylum seekers and refugees in Germany-A prospective follow-up study over 12 months and a nationwide cross-sectional study.

Refugees experience elevated rates of mental health problems, but little is known about mental health service utilization and quality among asylum seekers and refugees in Europe. In a 12-month follow-up study of newly arrived refugees (N= 166, Mage = 32.38 years, 30.7% female) and a nationwide cross-sectional study (N= 579, Mage = 33.89 years, 36.2% female) of refugees who had been living in Germany for an average of 6 years, we examined objective need for mental health treatment, perceived need, access to treatment services, and adequacy of treatment. We defined minimally adequate mental health treatment according to the WHO World Mental Health Survey as ≥8 sessions of psychotherapy (minimally adequate psychotherapy) or pharmacotherapy plus ≥4 medical visits (minimally adequate pharmacotherapy). In both studies, two in three individuals screened for mental health symptoms and additionally perceived a need for professional treatment. Of those, less than half had contact to any service provider, with only 1 in 14 receiving minimally adequate psychotherapy. Overall, no more than one in seven of refugees in need received minimally adequate treatment. Despite a comprehensive mental health-care system, refugees' access to mental health care and the treatment provided are inadequate. Health policies are urgently needed to provide equitable mental health care for all.

Enhancing System Safety and Reliability through Integrated FMEA and Game Theory: A Multi-Factor Approach

This study aims to address the limitations of traditional Failure Mode and Effect Analysis (FMEA) in managing safety and reliability within complex systems characterized by interdependent critical factors. We propose an integrated framework that combines FMEA with the strategic decision-making principles of Game Theory, thereby enhancing the assessment and mitigation of risks in intricate environments. The novel inclusion of the Best Worst Method (BWM) and Pythagorean fuzzy uncertain linguistic variables refines the accuracy of risk evaluation by overcoming the inherent deficiencies of conventional FMEA approaches. Through sensitivity analysis, the framework’s efficacy in identifying and prioritizing failure modes is empirically validated, guiding the development of targeted interventions. The practical application of our methodology is demonstrated in a comprehensive healthcare system analysis, showcasing its versatility and significant potential to improve operational safety and reliability across various sectors. This research is particularly beneficial for systems engineers, risk managers, and decision-makers seeking to fortify complex systems against failures and their effects.

Challenges and strategies for conducting research in primary health care practice: an integrative review

BackgroundProviding accessible and high-quality patient-centered healthcare remains a challenge in many countries, despite global efforts to strengthen primary health care (PHC). Research and knowledge management are integral to enhancing PHC, facilitating the implementation of successful strategies, and promoting the use of evidence-based practices. Practice-based research in primary care (PC-PBR) has emerged as a valuable approach, with its external validity to diverse PHC settings, making it an effective means of translating research findings into professional practice.ObjectiveTo identify challenges and strategies for conducting practice-based research in primary health care services.MethodAn integrative literature review was conducted by searching the PubMed, Embase, Scopus, Web of Science, and Lilacs databases. The research question, guided by the PICo framework, directed the execution of study selection and data extraction. Data analysis followed the RAdAR method's three phases: pre-analysis, data analysis, and interpretation of results.ResultsOut of 440 initially identified articles, 26 met the inclusion criteria. Most studies were conducted in high-income countries, primarily the United States. The challenges and strategies for PC-PBR were categorized into six themes: research planning, infrastructure, engagement of healthcare professionals, knowledge translation, the relationship between universities and health services, and international collaboration. Notable challenges included research planning complexities, lack of infrastructure, difficulties in engaging healthcare professionals, and barriers to knowledge translation. Strategies underscore the importance of adapting research agendas to local contexts, providing research training, fostering stakeholder engagement, and establishing practice-based research networks.ConclusionThe challenges encountered in PC-PBR are consistent across various contexts, highlighting the need for systematic, long-term actions involving health managers, decision-makers, academics, diverse healthcare professionals, and patients. This approach is essential to transform primary care, especially in low- and middle-income countries, into an innovative, comprehensive, patient-centered, and accessible healthcare system. By addressing these challenges and implementing the strategies, PC-PBR can play a pivotal role in bridging the gap between research and practice, ultimately improving patient care and population health.

ANALYSIS OF ELECTROHYSTEROGRAM SIGNALS AND PREDICTION OF PRETERM BIRTHS USING MACHINE LEARNING

The World Health Organization (WHO) estimates that over 15 million infants are born before the entire period of pregnancy. Over a million neonatal deaths occurred in 2015 as a result of preterm delivery, which is the prime cause for most deaths among children under the age of five. Although preterm birth has no hereditary link, only 10% of preterm deliveries in high-income settings result in deaths, compared to a mortality rate of up to 90% in low-income nations. When preterm cases are discovered, in addition to enhanced care provided at home for the expecting mother, the growing foetus may also benefit from medication, hospitalization for the duration of the pregnancy, or both. Low-income countries also struggle with a lack of access to a comprehensive healthcare system, which makes it difficult to proactively detect premature births. Machine learning techniques have a great potential to improve this situation by providing an intelligent framework for the detection of critical situations and consequently alerting the individual in cases of anomalies. This will require further follow-up with medical specialists. In this work, we investigate the application of deep learning and machine learning techniques for the analysis of electrohysterogram (EHG) data, which are uterine electrical impulses used to detect preterm deliveries. The TPEHG dataset is used to train a variety of machine learning classifiers, such as Support Vector Machines, Logistic Regression, and Decision Trees, as well as Deep Neural Networks like Convolutional Neural Networks and LSTMs. Additionally, we use plurality voting to build an ensemble of various neural networks and binary classifiers that are trained to classify EHG signals. The ensemble machine learning classifier with five base classifiers produced the best results overall, with an accuracy of 98.99%, sensitivity of 98.3%, and specificity of 97.9% outperforming several state-of-the-art algorithms for preterm birth detection.

Interprofessional collaboration to support patient-centered care: literature review

Patient-centered care is the hope of every patient who needs health care to handle their problems immediately, physically, psychologically, socially and culturally. Interprofessional collaboration of active health workers will create comprehensive services to manage and make the right decisions in patient care. This literature review aimed to explore how interprofessional collaboration can create a comprehensive professional service system to support patient-focused care. Nine articles were included in this literature review. Interprofessional collaboration begins by communicating and coordinating with members of the health care provider team, which has been proven to reduce errors and increase satisfaction in providing health services, providing a sense of comfort in interacting. Implementing interprofessional collaboration in a health care system allows all aspects of health care providers to provide complete services to realize a comprehensive and comprehensive health care system for patients. Coordination in services that prioritizes interprofessional collaboration is the creation of synergies in services, clinical decision-making of care and accuracy in handling all patient problems so that services that focus on patient needs are the main goals achieved. Interprofessional collaboration is proven to make patients feel satisfied with the perceived service system, namely holistic and comprehensive services focusing on patients and families

Landscape Analysis of Traditional Tribal Healers and Their Healing Practices in the Tribal-dominated States of India

Tribal communities have a rich history as some of the earliest inhabitants of the Indian subcontinent, living in harmony with nature for thousands of years. These indigenous or ethnic groups are spread throughout India, with significant concentrations in states like Chhattisgarh (30.5%), Jharkhand (26.0%), Odisha (22.8%), Madhya Pradesh (21.0%), Gujarat (14.7%), Rajasthan (13.4%), and Maharashtra (9.3%). In the peninsular region, notable tribal groups include Bhils, Santhals, Gonds, Ho, Kondh, Kols, Mundas, and Kharia, while in the northeast region, the prominent ones are Nagas, Mizos, Mikris, and Kukis. However, their access to healthcare is hindered by limited infrastructure, illiteracy, poverty, unemployment, socio-economic challenges, and marginalization. As a result, tribal communities often turn to traditional healers and indigenous medicinal practices, giving preference to traditional healing over modern healthcare options. Tribal traditional healers lack formal medical degrees, but their deep connection with indigenous communities makes them a preferred choice for healthcare. They are easily accessible to tribal populations and offer cost-effective services. These healers rely on their extensive traditional knowledge and skills, utilizing locally available medicinal plants, animal, and mineral substances, and incorporating specific ritual practices in their treatment methods for patients. Tribal healers are integral components of the available local healthcare system and play a critical role in delivering primary care services. The primary objective of this landscape analysis was to conduct a comprehensive examination of the socio-economic status, healing practices, and knowledge transfer methods of tribal healers and folk practitioners. Additionally, it aimed to create an evidence-based roadmap for their integration into the mainstream through upskilling, certificating, and federating the tribal healers. The study was ethnographic descriptive cross-sectional research conducted between May 15th and September 30th, 2023. The study comprised 1649 participants, encompassing Herbalists, Spiritual Healers, Diviners, Bone Setters, and Traditional Birth Attendants hailing from 43 districts in 7 tribal dominated states predominantly inhabited by tribal communities, namely Chhattisgarh, Jharkhand, Odisha, Madhya Pradesh, Maharashtra, Assam, and Arunachal Pradesh. Data collection occurred across 43 districts situated within the aforementioned states. The selection of tribal healers was done using an Exponential non-discriminative snowball non-probability sampling approach. The research methodology encompassed ethnographic research, interviews with healers, and documentary analysis. The analysis showcased the diversity of traditional healers, representing about 240 tribes, and emphasized the rich cultural and regional variations in their healing practices. The study involved tribal healers with an average age of 52.6 years, of which 82.4% were above 40 years old. These healers had varied roles and expertise, such as general herbalists, bone setters, Ojhas, or Dondai, each employing distinct diagnostic methods and treatments for the indigenous population. About 53.9% of folk healers were skilled in indigenous medicine, using natural substances for healthcare. Additionally, 42.5% of religious practitioners integrated social, cultural, and religious beliefs into their treatments, including rituals and sacrifices. Knowledge transmission followed the traditional guru-shishya tradition, where tribal healers learned from experienced healers orally, without written texts. Certification was valued as a way to gain public trust, and NGOs and federations played pivotal roles in advocating for traditional healing practices. Successful integration into mainstream healthcare required collaboration, coordination, and mutual respect between traditional and modern healthcare providers. Despite deep-rooted connections with their own communities, traditional healers face several common challenges in their practice such as Stigmatization and lack of recognition, Limited resources and infrastructure, Lack of formal training and certification, Legal and regulatory challenges, Ethical and legal dilemmas, and economic challenges. In conclusion, the landscape analysis shed light on the diverse healing traditions within tribal communities, emphasizing the importance of preserving and respecting these practices to safeguard cultural heritage and wisdom. Integrating traditional healing into comprehensive healthcare systems can enhance inclusivity and provide holistic care for tribal populations.

Application of natural language processing to assess the performance status documentation quality metric in patients with non–small-cell lung cancer.

e13582 Background: Performance status (PS) assessment is important for cancer prognosis and treatment decision-making. PS documentation for stage IV non-small cell lung cancer (NSCLC) is a quality measure for ASCO Quality Oncology Practice Initiative (QOPI) Certification Program. We used natural language processing (NLP) to extract PS from unstructured electronic medical records (EMR) clinical notes in patients with metastatic NSCLC to verify PS documentation compliance and disparities in PS documentation. Methods: We identified oncology progress notes of stage IV NSCLC patients from Harris Health System, which is an integrated comprehensive healthcare system for underserved patients in Houston, TX. All progress notes within 60 days of first oncology clinic visit date were filtered based on visit type and author type. A rule-based regular expression NLP algorithm was used to extract the PS, namely Eastern Standard Cooperative Group (ECOG) or Karnofsky Performance Status (KPS). A total of 400 oncology notes were randomly selected from 400 distinct patients and annotated by two clinician reviewers, and discrepancies were resolved by a senior clinician judge. The annotated notes were split randomly into 200 training notes and 200 validation notes, and the performance of the NLP algorithm was evaluated. We used logistic regression to analyze potential disparity in PS documentation. Results: We identified 15,239 progress notes from 757 stage IV NSCLC patients. The NLP algorithm accuracy validated on the test data was 99% with corresponding positive predictive values (PPVs) for ECOG PS 0, 1, 2, 3, 4 of 100%, 100%, 95%, 94%, 94%, respectively. The NLP algorithm identified 85% of patients with appropriate PS documentation (sensitivity 100%, specificity 91%, positive predictive value 98%, negative predictive value 100%). Logistic regression analyses showed no significant differences in association between PS documentation and race/ethnicity, language, or sex. Conclusions: We developed an internally validated NLP algorithm to extract PS from EMR clinical notes. Despite potential language barriers, the QOPI metric of &gt;75% PS documentation was met in our hospital system without significant disparities in clinical care. [Table: see text]

Resilience of front-line facilities during COVID-19: evidence from cross-sectional rapid surveys in eight low- and middle-income countries.

Responsive primary health-care facilities are the foundation of resilient health systems, yet little is known about facility-level processes that contribute to the continuity of essential services during a crisis. This paper describes the aspects of primary health-care facility resilience to coronavirus disease 2019 (COVID-19) in eight countries. Rapid-cycle phone surveys were conducted with health facility managers in Bangladesh, Burkina Faso, Chad, Guatemala, Guinea, Liberia, Malawi and Nigeria between August 2020 and December 2021. Responses were mapped to a validated health facility resilience framework and coded as binary variables for whether a facility demonstrated capacity in eight areas: removing barriers to accessing services, infection control, workforce, surge capacity, financing, critical infrastructure, risk communications, and medical supplies and equipment. These self-reported capacities were summarized nationally and validated with the ministries of health. The analysis of service volume data determined the outcome: maintenance of essential health services. Of primary health-care facilities, 1,453 were surveyed. Facilities maintained between 84% and 97% of the expected outpatient services, except for Bangladesh, where 69% of the expected outpatient consultations were conducted between March 2020 and December 2021. For Burkina Faso, Chad, Guatemala, Guinea and Nigeria, critical infrastructure was the largest constraint in resilience capabilities (47%, 14%, 51%, 9% and 29% of facilities demonstrated capacity,respectively). Medical supplies and equipment were the largest constraints for Liberia and Malawi (15% and 48% of facilities demonstrating capacity, respectively). In Bangladesh, the largest constraint was workforce and staffing, where 44% of facilities experienced moderate to severe challenges with human resources during the pandemic. The largest constraints in facility resilience during COVID-19 were related to health systems building blocks. These challenges likely existed before the pandemic, suggesting the need for strategic investments and reforms in core capacities of comprehensive primary health-care systems to improve resilience to future shocks.

Interventions to Reduce Repeat Presentations to Hospital Emergency Departments for Mental Health Concerns: A Scoping Review of the Literature.

The number of readmissions to the emergency department (ED) for mental health services each year is significant, which increases healthcare costs and negatively affects the morale and quality of life of patients and their families. This scoping review aimed to establish a better understanding of interventions that have been implemented to reduce psychiatric patient readmission and ED use within the ED, to identify areas for improvement, and therefore to assist in the development of more effective actions in the future. The scoping review was conducted on several bibliographic databases to identify relevant studies. Two researchers independently screened and reviewed titles, abstracts, and full-text articles that met the inclusion criteria. Using Covidence software, 26 out of 6951 studies were eligible for inclusion in this scoping review based on the PRISMA checklist. Data were extracted, collated, summarized, presented, and discussed. This review identified 26 studies which examined interventions aimed to reduce ED visits, such as the High Alert Program (HAP), the Patient-Centered Medical Home (PCMH), the Primary Behavioral Health Care Integration (PBHCI), and the Collaborative Care (CC) Program, etc. Twenty-three of the studies were conducted in North America, while the rest were conducted in Europe and Australia. A total of 16 studies examined interventions directed to any mental health conditions, while the rest addressed specific health conditions, such as substance use disorders, schizophrenia, anxiety, depression. Interventions involved comprehensive and multidisciplinary services, incorporation of evidence-based behavioral and pharmacological strategies, and emphasized the case management that was found to be effective. Additionally, there was a marked consideration for diverse mental health groups, such as those with substance use disorder and of young age. Most interventions showed a positive effect on reducing psychiatric ED visits. Various initiatives have been implemented worldwide to reduce the number of emergency department visits and the associated burden on healthcare systems. This review highlights the greater need for developing more accessible interventions, as well as setting up a comprehensive community health care system aiming to reduce frequent ED presentations.

Overview of Traditional Birth Attendance in Nigeria

Traditional Birth Attendance (TBA) has played a significant role in maternal healthcare in Nigeria for centuries. This paper provides an overview of Traditional Birth Attendance practices in Nigeria, exploring the conceptual analysis, determinants of traditional birth attendance usage, mothers’ reasons for Choosing TBAs for delivery services, and integration into the Health Care System. The paper highlights the essential role of TBAs in preserving cultural heritage, community support, and local knowledge related to childbirth. However, it also identifies numerous challenges associated with TBA practices, including inadequate training, limited medical knowledge, unhygienic birthing conditions, and the potential risks of complications during childbirth. In conclusion, this overview sheds light on the complex landscape of Traditional Birth Attendance in Nigeria. The coexistence of traditional practices and modern healthcare systems presents unique challenges and opportunities. A balanced approach that respects cultural traditions, while prioritizing safe and skilled birth attendance, holds the potential to enhance maternal and child health outcomes in Nigeria. Further research and collaborative efforts are needed to create an integrated and comprehensive healthcare system that caters to the diverse needs of the Nigerian population.

Abortion Is Healthcare: Lessons From a Public Hospital

Abortion Is Healthcare:Lessons From a Public Hospital Amy Zanoni (bio) Since the Supreme Court's Dobbs v. Jackson Women's Health Organization decision, many have invoked the coat hanger and the public hospital septic abortion ward as portents of life after the fall of Roe. Illinois Governor J. B. Pritzker was one of many pro-choice advocates who made direct reference to Ward 41 at Chicago's public hospital, Cook County Hospital. But by only paying attention to the horror stories of botched abortions in the pre-Roe era, we miss the other lessons that public hospitals like Cook County can teach us: even during Roe, access to abortion was limited, hard-fought, and dependent on local conditions. Public hospitals are key to understanding the brutal consequences of policies that limit people's access to healthcare, as well as the role that local governments often play in a country with no national healthcare system. In providing care to everyone who came through its doors, the public hospital approximated the right to healthcare. When county, state, and federal lawmakers undermined the right to reproductive care, Chicagoans demanded its reinstatement at Cook County Hospital. These struggles and the hospital's history shed light on the importance of tethering demands for reproductive rights to a more expansive welfare state and healthcare system. They also help us understand the crucial importance of federal action. Cook County Hospital Before Roe The State of Illinois passed its first anti-abortion law in 1827. But making abortion illegal never prevented women from having abortions. In the twentieth century, even before Roe, "abortion was not extraordinary, but ordinary," according to historian Leslie Reagan. Women with means were often able to access safe abortions in doctors' or midwives' offices. Low-income women were more likely to self-induce abortion and, as a result, more likely to suffer complications and end up in the hospital. [End Page 33] In Chicago, more often than not, that hospital was Cook County. Opened in 1866 to fulfill the county's legal obligation to finance medical care for the indigent, County (as it was called by many Chicagoans) provided a full spectrum of healthcare to the city's marginalized people. Communities of color, especially Black Chicagoans, relied disproportionately on County, the city's only public hospital until the 1990s. Historically barred from the industrial jobs most likely to provide insurance, Black Chicagoans were uninsured at higher rates. Private hospitals also routinely discriminated against Black Chicagoans. Medicaid, created in 1965, left out many people because the program was means-tested and because many private providers did not care for publicly insured patients. Before and after Roe, County provided care, reproductive and otherwise, to Chicagoans who needed it. Public hospitals all over the country played similar roles. In 1934, County admitted 1,159 patients suffering complications related to abortion; in 1949, the number reached 1,683 patients—about thirty-two per week in a city of approximately 3.6 million. By the early 1960s, hospital personnel cared for around 5,000 patients suffering complications from abortions annually. In 1965, one abortion patient was admitted to County for every 4.1 deliveries, compared to 1 in 10.8 at other Chicago hospitals. A twenty-one-year-old woman who underwent an illegal abortion in September 1970 was one such patient. An ambulance first brought her to a private hospital less than two miles from her South Side home. But hospital personnel sent her to County, about five miles to the northwest, claiming they had no obstetric beds available and that she had not previously seen a doctor on staff. (Private hospitals routinely sent uninsured or otherwise "undesirable" patients to County, a practice advocates decried as "patient dumping.") When she arrived at County, she was hemorrhaging and, according to the Chicago Daily Defender, "reacting adversely to poisoning from the dead fetus" left in her uterus. She died soon after. Cook County Hospital After Roe Roe v. Wade made abortion legal in 1973. But it did not guarantee the right to abortion: the absence of a comprehensive healthcare system put the onus on pregnant people to find providers and pay for abortions, as scholars including Dorothy Roberts and...

Rural residents' willingness to participate in basic medical insurance and influential factors: A survey of three provinces in China.

Rural residents' participation in medical insurance has a significant relationship to the affordability of their medical care. This study aims to investigate the willingness of rural residents to participate in basic medical insurance for urban and rural residents and its determinants so as to enhance their willingness to participate in medical insurance. Data were obtained from 1,077 validated questionnaires from rural residents. Chi-square test and multiple logistic regression analysis were adopted to analyze determinants of rural residents' willingness to participate in basic medical insurance for urban and rural residents. 94.3% of respondents were willing to participate in basic medical insurance for urban and rural residents and this was associated with the familiarity with the medical insurance policies [OR = 2.136, 95% CI (1.143, 3.989)], the reasonability of medical insurance premiums [OR = 2.326, 95% CI (0.998, 5.418)], the normality of doctors' treatment behavior [OR = 3.245, 95% CI (1.339, 7.867)] and the medical insurance's effectiveness in reducing the economic burden of disease [OR = 5.630, 95% CI (2.861, 11.079)]. Even though most respondents were willing to participate in basic medical insurance for urban and rural residents, some aspects need to be improved. The focus should be on promoting and regulating the behavior of medical staff. Financing policies and reimbursement of treatment costs need to be more scientifically developed. A comprehensive basic healthcare system needs to be optimized around the core function of "hedging financial risks".

Primary health care reforms in Estonia: using financial incentives to encourage multidisciplinary care

Abstract Estonia has a historical legacy of large hospital networks and municipality-owned specialist clinics, with a low emphasis on primary health care (PHC). Since the 1990s, a transition towards PHC has occurred, delivering PHC in family physician practices rather than in specialist clinics. The transition has been underpinned by a series of comprehensive healthcare system reforms starting in the late 1990s. The most recent reforms, although lacking a legal basis, have been accompanied by financial incentives including EU structural funds to encourage change. These financial incentives were designed to improve quality of care, encourage working in remote areas, and more. A key focus of PHC reforms has been an emphasis on multidisciplinary care, and the reforms have aimed at increasing the involvement of home nurses, midwives, and physiotherapists in PHC. The reforms have also prioritized PHC centres, with multiple practicing physicians, over single physician practices. Although EU structural funds have supported building the infrastructure for expanded scope of services at PHC level, the uncertainty of long-term funding of expanded services remained a key challenge limiting the success of the reform. Further, the supply of family physicians will be problematic in the future, as the number of permanently vacant positions has quadrupled in the last five years and almost half are 60 years of age or older. As the PHC reform process in Estonia continues until today, it can serve as a case study for other countries interested in strengthening their PHC systems.

1321MO Relevance index by cancer type: Trends and regional variation analysis, 2016-2020, Republic of Korea

In order to prepare a comprehensive healthcare system for cancer patients in the region, it is necessary to first prepare data on how cancer patients in the region use medical institutions. The data on cancer patients’ use of regional medical institutions will be useful in establishing plans to strengthen facilities and manpower for cancer patient care at medical institutions in the region. In this study, relevance index, which is a type of analysis indicator for medical service area, was analyzed for cancer diseases. Claim data from the Korean National Health Insurance Service were used for the analysis. Specifically, from 2016 to 2020, the inpatient and outpatient medical service use data of clinics, medical institutions, and public health institutions for medical or dental field were analyzed. The relevance index, which is the value obtained by dividing the amount of services used by medical institutions located in a specific area by the total medical services used by people living in a specific area, was measured by medical service type (outpatient and inpatient) and indicator type (number of patients and co-payments). Korea’s relevance index for cancer in inpatient treatment has hardly improved. In particular, the relevance index for cancer was highly variable by region. Seoul had the highest relevance index for cancer (5-year average 89.98%), while Gyeongsangbuk-do (5-year average 30.76%) had the lowest relevance index for cancer. “Bone and connective tissue cancer” (5-year average of 40.2%) had the lowest relevance index, while “Other neoplasms and unspecified cancers” (5-year average of 70.3%) had the highest relevance index. The relevance index for cancer in outpatient treatment tended to be higher than that in inpatient treatment. Furthermore, the relevance index for cancer based on co-payment tended to be lower than that based on the number of patients. In order to provide timely, effective, and patient-centered cancer treatment, it is necessary to have a comprehensive cancer treatment system in the region. The relevance index for each cancer type and year in Korea calculated in this study will be an important indicator to monitor in order to establish a comprehensive cancer treatment system in the region.

The Main Challenges Facing Social Policy Makers in Less Developed Countries: A Case Study of Healthcare in China

Population ageing brings additional challenges to many countries around the world. As China became the first country in the world to have more than 1 billion people aged 60 and above in 2010, this has put forward higher requirements for the amount of medical resources, quality of medical services, reliability and fairness in China. Providing a comprehensive health care system is a major challenge for policymakers. The purpose of this article is to discuss the challenges facing policymakers in less developed countries. This paper selects the Chinese healthcare system as a case study for analysis. To explore the effectiveness of the Chinese government's measures to formulate relevant basic medical security policies, reform the medical insurance system and subsidy levels, and comprehensively cover medical insurance. The study found that while health insurance levels have grown significantly, there are still challenges in coordinating programs, and many management and financing issues have arisen in the sustainable development of hospital services. Finally, it will describe how policymakers can use the current health insurance system to address these challenges. This article will discuss in detail two specific challenges facing the health care reform process, one is the discussion on the coverage and segmentation of medical insurance, and the other is the analysis on the future reform of public hospitals.

Human Rights Activist Grégoire Ahongbonon Delivers Chester Pierce Award Lecture

Back to table of contents Previous article Next article Annual MeetingFull AccessHuman Rights Activist Grégoire Ahongbonon Delivers Chester Pierce Award LectureMark MoranMark MoranSearch for more papers by this authorPublished Online:28 Jun 2022https://doi.org/10.1176/appi.pn.2022.07.7.47AbstractTen 200-bed inpatient centers have been established across three countries, headed by registered nurses and staffed mostly by remitted patients who receive training from visiting and local psychiatrists. Nearly 50 Saint-Camille outpatient clinics provide follow-up care and medication and treat new patients from the surrounding villages.“We have to change the way we look at people who are fragile—because this is about humanity,” said Grégoire Ahongbonon, the founder of the Association Saint-Camille-de-Lellis (ASC), a comprehensive mental health care system in West Africa approved by the World Health Organization (WHO). Ahongbonon delivered the inaugural Chester M. Pierce Human Rights Award Lecture at APA’s Annual Meeting in New Orleans, titled “Person-Oriented Psychiatry: Changing the Way People With Mental Illness Are Viewed and Treated in West Africa and Around the World.”Ahongbonon, who was born in Benin, developed depression in his 20s after experiencing a bankruptcy. He recovered and decided to dedicate his life to those in distress. In 1983, he founded ASC, where he worked with poor patients with leprosy or AIDS, prisoners, and homeless children. In 1990, upon discovering the plight of African psychiatric patients, whose human rights were blatantly violated, ASC began to house them and treat them with dignity.Grégoire Ahongbonon holds up chains that were used to restrain a man rescued by the Association Saint-Camille-de-Lellis.Mark MoranAhongbonon enlisted the help of a psychiatrist in Bouake, Ivory Coast, where he had lived since 1971, and ASC began establishing its own mental health care facilities. Since then, Ahongbonon and ASC have created a comprehensive mental health system that offers affordable and adapted neuropsychiatric inpatient, outpatient, and rehabilitation care to individuals in Ivory Coast, Benin, and Togo. Nearly 130,000 patients have now benefited from ASC’s services.Speaking through an interpreter—Benoit Des Roches, M.D., an APA member in Montreal—Ahongbonon described in searing terms the suffering of individuals with mental illness. “In Africa, the mentally ill are considered possessed by the devil,” he said. “They are treated literally like trash—people throw stones at them, families are ashamed. Women in the street are raped.”His lecture also featured a haunting video showing naked men and women lying in the street; it included scenes of “prayer camps” where individuals with severe mental illness are chained to trees until a healer determines they can be freed. Ahongonon held up for the audience the chains used to restrain one man rescued by ASC.Ten 200-bed inpatient centers have been established across the three countries, headed by registered nurses and staffed mostly by remitted patients who receive training from visiting and local psychiatrists. Nearly 50 Saint-Camille outpatient clinics provide follow-up care and medication and treat new patients from the surrounding villages.Ahongbonon’s work has been recognized by numerous organizations. This year he was awarded the WHO’s Geneva Prize for Human Rights and was named an Aurora Humanitarian by the Aurora Humanitarian Initiative. In 2020 he received the Dr. Guislain Breaking the Chains of Stigma Award, a joint initiative of the Brothers of Charity and Janssen Research & Development. Inspired by her father’s work, Ahongbonon’s daughter became a psychiatrist.Des Roches said the St. Camille model of care fulfills WHO recommendations for extending care in underserved areas: It uses community workers, regardless of education level, to diagnose and treat priority patients under the supervision of skilled personnel. The skilled personnel are trained with manuals in the local language, avoiding scientific jargon. A limited number of affordable medications are used, and community workers have access to referral services for the most difficult patients.In presenting the Chester M. Pierce Human Rights Award, APA President Vivian Pender, M.D., called Ahongbonon an inspiration. “As the founder of the Association Saint-Camille-de-Lellis, Grégoire has helped transform the landscape of mental health care in West Africa. Through his dedicated leadership and guidance, over 130,000 individuals in Benin, Togo, and the Ivory Coast have benefitted from mental health services, including psychiatric care, many of whom would otherwise be turned away by society. His efforts bring dignity to a marginalized population and address the need for community mental health services worldwide.”Originally established in 1990 as the APA Human Rights Award, it was renamed in 2017 to honor Chester M. Pierce, M.D., an innovative researcher; an advocate against mental health disparities, stigma, and discrimination; and a visionary in global mental health. In 2021, funds were raised to support an award lecture by the APA Foundation’s Chester M. Pierce Human Rights Endowment Campaign. This year’s lecture was the first under the endowment. ■ResourcesInformation about the Association Sainte-Camille-de-LellisInformation about the Chester M. Pierce Human Rights Endowment Campaign ISSUES NewArchived