Current Health Care System Research Articles

Determinants of successful opioid deprescribing: Insights from French pain physicians-A qualitative study.

Long-term use of opioids does not result in significant clinical improvement and has shown more adverse than beneficial effects in chronic pain conditions. When opioids cause more adverse effects than benefits for the patient, it may be necessary to initiate a process of deprescribing. To explore the perceptions of French pain physicians regarding the process of opioid deprescribing in patients experiencing chronic non-cancer and to generate an understanding of the barriers and levers to the deprescribing process. We conducted a multicentric observational study with qualitative approach. Individual semi-structured interviews exploring pain physicians' perceptions, beliefs, and representations to assess the determinants of opioid deprescribing with an interview guide were used. After checking the transcripts, an inductive and independent thematic analysis of the interviews was to extract meaningful themes from the dataset. Twelve pain physicians were interviewed. The main obstacles to deprescribing revolved around patient-specific attributes, characteristics of the opioids themselves, and limitations within the current healthcare system, that hinder optimal patient management. Conversely, patient motivation and education, recourse to hospitalization in a Pain Department with multidisciplinary care, follow-up by the general practitioner, and training and information dissemination among patients and clinicians emerged as facilitative elements for opioid deprescribing. This study underscores the needs to improve the training of healthcare professionals, the effective communication of pertinent information to patients, and the establishment of a therapeutic partnership with the patient. It is therefore essential to carry out the deprescribing process in a collaborative and interprofessional manner, encompassing both pharmaceutical and non-pharmaceutical strategies.

Understanding Myeloma-Related Information Needs and Communication Preferences Within Black American Communities: An Exploratory Study.

Myeloma is the third most common blood cancer and one of the most complex and expensive cancers to treat. Black Americans face health disparities related to myeloma incidence, age at diagnosis, access to novel treatments, and mortality. To help reduce health disparities among Black Americans through education and outreach, the Leukemia & Lymphoma Society has implemented its Myeloma Link initiative. In 2022, a formative, qualitative evaluation was conducted across the 15 U.S. cities that implemented Myeloma Link to better understand the information and communication needs and preferences of three groups: patients, community members, and primary care providers (PCPs). Data collection included interviews with eight patients, two focus groups with a total of ten community members, and interviews with six PCPs. Patients expressed wanting information about treatment experiences, including clinical trials, and emotional and peer support services, particularly from other Black American patients. Community members were largely unfamiliar with myeloma and desired outreach via trusted community organizations about disease signs and symptoms. Both groups discussed the importance of self-advocacy within the current healthcare system and wanted actionable messaging, rather than messaging leading with disparities statistics. PCPs described systemic capacity and time challenges in the context of needing to address more frequently encountered health conditions; nonetheless, PCPs welcomed information and brief trainings about myeloma diagnosis and treatment options, referrals to specialists, and how to improve care, prognosis, and caregiver support. Findings underscore the importance of outreach initiatives such as Myeloma Link to help meet these needs and reduce health disparities.

Impact of war on stroke incidence in Ivano-Frankivsk, Ukraine

Stroke is an extensive health problem in Ukraine, the prominence and effects of which are aggravated by the burden of the ongoing Russo-Ukrainian War. In this study, we aimed to holistically examine the overall stroke epidemiology in Ivano-Frankivsk using data from a secondary healthcare center in the city. We determine an increasing trend in stroke admissions since 2020, with a notable 22.4% increase in 2023, mainly due to ischemic stroke occurrence. In the same year, a significant non-linear relationship between stroke incidence and frequency of news about attacks was observed. Ordinal regression analysis of general sociodemographic, clinical, and healthcare-related factors influencing outcomes for intravenous thrombolysis-treated patients, revealed the significance of the 24-h National Institutes of Health Stroke Scale score (0.32 ± 0.03) and interaction of age and Door-to-Needle Time (− 0.28 ± 0.08). However, the extension of the latter independently is not significantly correlated with patient outcomes. In conclusion, war-induced stress, intranational migrations, and lack of adequate chronic cardiovascular disease management are primarily responsible for these results. Modulations and improvements to the current healthcare system, including managing chronic diseases and early stroke symptom recognition, are necessary to optimize patient outcomes.

Assessment of selected elements of healthcare in the opinion of healthcare workers

The healthcare system is an important part of the functioning of any country. A special role in this system is played by the personnel — especially medical, but also non-medical personnel, who perform their tasks based on the available resources. The article considers the opinions of healthcare workers about selected elements of this system proposed by Zgliczyński. The opinions of employees regarding the current healthcare system compared to the one in 2019 are also included, highlighting the nature of these changes. Bearing in mind the relatively limited literature in the field of the considerations undertaken in this article, they can be regarded as important, up-to-date, and filling the research gap in this respect. The aim of the study was achieved using a critical analysis of the literature on the subject and a diagnostic survey. Empirical data were obtained from fieldwork conducted among staff of public and/or private sector healthcare facilities.

“They made me feel like I mattered”: a qualitative study of how mobile crisis teams can support people experiencing homelessness

BackgroundMobile crisis teams (MCTs) can be important alternatives to emergency medical services or law enforcement for low-acuity 911 calls. MCTs address crises by de-escalating non-violent situations related to mental health or substance use disorders and concurrent social needs, which are common among people experiencing homelessness (PEH). We sought to explore how an MCT in one city served the needs and supported the long- and short-term goals of PEH who had recently received MCT services.MethodsWe conducted 20 semi-structured interviews with service recipients of the Street Crisis Response Team, a new 911-dispatched MCT implemented in San Francisco in November 2020. In the weeks after their encounter, we interviewed respondents about their overall MCT experience and comparisons to similar services, including perceived facilitators and barriers to the respondent’s self-defined life goals. We analyzed interview transcripts with thematic analysis to capture salient themes emerging from the text and organized within a social-ecological model.ResultsNearly all respondents preferred the MCT model over traditional first responders, highlighting the team’s person-centered approach. Respondents described the MCT model as effectively addressing their most immediate needs (e.g., food), short-term relief from the demands of homelessness, acute mental health or substance use symptoms, and immediate emotional support. However, systemwide resource constraints limited the ability of the team to effectively address longer-term factors that drive crises, such as solutions to inadequate quality and capacity of current housing and healthcare systems and social services navigation.ConclusionsIn this study, respondents perceived this MCT model as a desirable alternative to law enforcement and other first responders while satisfying immediate survival needs. To improve MCT’s effectiveness for PEH, these teams could collaborate with follow-up providers capable of linking clients to resources and services that can meet their long-term needs. However, these teams may not be able to meaningfully impact the longstanding and complex issues that precipitate crises among PEH in the absence of structural changes to upstream drivers of homelessness and fragmentation of care systems.

Predictive Modeling of Medical and Orthopaedic-Related 90-Day-Readmissions Following Primary Total Knee Arthroplasty

BackgroundAs the demand for total knee arthroplasty (TKA) escalates, 90-day readmissions have emerged as a pressing clinical and economic concern for the current value-based health care system. Consequently, health care providers have focused on estimating the risk levels of readmitted patients; however, it is unknown if specific factors are associated with different types of complications (ie, medical or orthopaedic-related) that lead to readmissions. Therefore, this study aimed to (1) determine the overall, medical-related, and orthopaedic-related 90-day readmission rate and (2) develop a predictive model for risk factors affecting overall, medical-related, and orthopaedic-related 90-day readmissions following TKA. MethodsA prospective cohort of primary unilateral TKAs performed at a large tertiary academic center in the United States from 2016 to 2020 was included (n = 10,521 patients). Unplanned readmissions were reviewed individually to determine their primary cause, either medical or orthopaedic-related. Orthopaedic-related readmissions were specific complications affecting the joint, prosthesis, or surgical wound. Medical readmissions were due to any other cause requiring medical management. Multivariable logistic regression models were used to investigate associations between prespecified risk factors and 90-day readmissions, as well as medical and orthopaedic-related readmissions independently. ResultsOverall, the rate of 90-day readmissions was 6.7% (n = 704). Over 82% of these readmissions were due to medical-related causes (n = 580), with the remaining 18% being orthopaedic-related (n = 124) readmissions. The area under the curve for the 90-day readmission model was 0.68 (95% confidence interval: 0.67 to 0.70). Sex, smoking, length of stay, and discharge disposition were associated with orthopaedic readmission, while age, sex, race, the Charlson Comorbidity Index, insurance, surgery day, opioid overdose risk score, length of stay, and discharge disposition were associated with medical-related 90-day readmissions. ConclusionsMedical-related readmissions after TKA are more prevalent than orthopaedic-related readmissions. Through successfully constructing and validating multiple 90-day readmission predictive models, we highlight the distinct risk profiles for medical and orthopaedic-related readmissions. This emphasizes the necessity for nuanced, patient-specific risk stratification and preventive measures.

The transition of patient care: Exploring the outcomes of prehospital to hospital patient handover practices and healthcare provider education

IntroductionInadequate patient handover is linked to numerous medical errors and lapses in communication between hospital healthcare providers and prehospital healthcare providers. Undergraduate healthcare curricula may limit programme-specific education on patient handover and shift learning to informal learning opportunities. This study aimed to investigate the outcomes of qualified healthcare provider (HCPs) educational programmes to determine the adequacy of handover practices, the source of their training, and their interprofessional acceptance of these practices. MethodsA multi-method study design was used – a document analysis of HCP programme outcomes and a two-section questionnaire. The questionnaire was sent to HCPs to determine the impact of patient handover practices on current healthcare systems and their opinion on whether the training on handovers is sufficient. ResultsHCPs indicated little educational interaction regarding patient handover. Most participants felt handover education relied predominantly on informal training. With their existing knowledge, many HCPs revealed that they were comfortable in handing over a patient. Little interprofessional confidence regarding patient handover information indicates minimal interprofessional collaboration toward standardised approaches for patient handover. ConclusionThis study indicates a lack of standardised handover procedures, which leads to HCP self-interpretations. There is low trust between HCPs regarding information received. The study highlights the need for standardised handover training in healthcare curricula to improve patient safety and interprofessional collaboration.

Countering the Identified Barriers to Delivered Oral Care for Children With Special Healthcare Needs: A Narrative Review.

Children with Special Health Care Needs (SHCNs) have poor oral health as a result of structural and systemic barriers. These children frequently have limited access to dental treatment, a higher prevalence and incidence of dental problems, and worse oral hygiene than the rest of the population.This review aims to offer an understanding of the existing oral care barriers of children with SHCNs. We reviewed the literature on children with SHCNs and their caregivers to identify the implications of the barriers faced by these individuals. Some of the perceived barriers to appropriate oral healthcare faced by these children include obstacles to adequate oral care and hygiene in the home, challenging behaviours, and limited preventive care and accessibility. We focussed on interventions and different management approaches to support the stakeholders responsible for these children. There is a need for strong communication as well as care coordination between caregivers, dentists, and other providers to achieve positive outcomes. The current dental healthcare system appears to desert the needed demands of this demographic.

Never Say “NO” (Strategies for Nurses to Communicate Politely)

Effective communication is the cornerstone of quality patient care and nurses are essential in fostering understanding, compassion, and respect in their interactions with patients, families, and other healthcare professionals. In the current healthcare system, one of the frequent complaints that patients express on post-discharge satisfaction surveys is rude behavior of the staff. By directly saying “NO”, nurses make patients to feel unwanted and neglected. Many times, this neglect has landed in the loss of patient attachment and lead to an increased risk of liability and dissatisfaction. In this article the impact of saying no to the patient and alternative strategiesof saying no has been discussed

Enhancing transparency and security in blood donation management through blockchain technology

In the context of the increasing importance of digitalization and cybersecurity, exploring the application of blockchain and smart contract technologies in blood donation management aims to enhance data transparency and privacy protection, addressing challenges in current healthcare systems. This paper explores the transformative potential of blockchain and smart contract technologies in digitalizing the blood donation process. By leveraging the Ethereum platform and employing a Browser/Server (B/S) architecture integrated with Solidity programming and web development practices, this paper proposes a novel framework designed to enhance the transparency, digitalization, and shared accessibility of blood donation data. The implementation of this system within a healthcare context promises to streamline the donation process, ensuring the integrity and confidentiality of donor data, thereby fostering trust among all stakeholders involved. The findings indicate that the application of blockchain technology not only facilitates a more efficient and secure management of blood donation records but also sets a precedent for future healthcare innovations.

Healthcare professionals' perceptions of digital care in clinical practice for patients with non-cardiac chest pain

Abstract Background Healthcare professionals’ attitudes and perceptions of digital care are crucial for successful introduction of a new digital form of treatment in the workplace. Purpose This study aimed to describe healthcare professionals’ perceptions of digital care in clinical practice for patients with non-cardiac chest pain. Methods A qualitative descriptive study design with individual semi-structured interviews, analyzed using inductive thematic analysis based on Braun and Clarke (2006). Study data were collected by individual digital (15) and face-to-face (2) interviews with licensed healthcare professionals (doctors and nurses) working in emergency care or cardiology. Results The results illustrate healthcare professionals’ perceptions of digital care within clinical settings in emergency and cardiology care for patients with non-cardiac chest pain. Four themes and eleven subthemes were identified. The first theme "New ground to walk on" describes healthcare professionals' experiences of digital care. The second theme: "A challenge to current healthcare system" depicts how digital care was seen as a challenge for the current healthcare system. The third theme: "Digital care has its potential" shows that a majority believed healthcare can gain valuable insights from embracing digital care. The last theme: "Prerequisites for use in clinical practice" describes factors that can facilitate the adoption of digital care in clinical practice. Conclusions The findings delineate the diverse knowledge and experiences of healthcare professionals in digital care. The perception of digital care ranged from skepticism to trust, illustrating challenges in implementing digital solutions in clinical care. Healthcare professionals expressed concerns about potential errors, the reliability of digital solutions, and concerns regarding resistance to change among colleagues. Nevertheless, they also recognized benefits and identified several factors that can facilitate the implementation of digital care into clinical practice and expressed cautious trust in digital care.

Use of Machine Perfusion to Increase the Number of Expanded Criteria Deceased Donor Kidney Transplants: A Pharmacoeconomic Analysis.

The discard of expanded criteria donor (ECD) kidneys is unacceptably high, considering the growing demand for transplantation. Using machine perfusion may reduce the discard rate, increase the number of transplants, and reduce mortality on the waiting list. We developed a 5-y Markov model to simulate incorporating the pulsatile perfusion machine into the current government-funded healthcare system. The model compared the universal use of static cold storage for all kidneys with the selective use of machine perfusion for ECD kidneys. Real-life data were used to compose the cohort characteristics in this model. This pharmacoeconomic analysis aimed to determine the cost-effectiveness and budgetary impact of using machine perfusion to preserve ECD kidneys. Compared with the universal use of static cold storage, the use of machine perfusion for ECD kidneys was associated with an increase in the number of kidney transplants (n = 1123), a decrease in the number of patients on the waiting list (n = 815), and decrease in mortality (n = 120), with a cost difference of US dollar 4 486 009 in the period. The budget impact analysis revealed an additional cost of US dollar 4 453 749 >5 y. The budget impact analysis demonstrated a progressive reduction in costs, becoming cost-saving during the last year of the analysis. This stochastic model showed that incorporating machine perfusion for ECD kidneys is most often a dominant or cost-effective technology associated with an increase in the number of transplants and a reduction in the number of patients on the waiting list, reducing mortality on the waiting list.

End of life and palliative care decisions in advanced head neck cancer

The complexity of care for patients with advanced head and neck cancer is a significant issue, and current healthcare systems must focus on appropriate referral criteria, increased integration and coordination of care, and robust evaluation of specific care components. Linkage between research and service design delivery across teams, disciplines, and care settings is also important. Palliative care needs of patients with advanced head and neck cancer pose unique complexities due to the impact the illness has on eating, speaking, appearance, and breathing. Specialty palliative care consultation by trained experts helps primary teams facilitate goals of care discussions, symptom management, and medical resource navigation for the terminally ill patient. Early initiation of palliative care results in less invasive and more cost-effective patient-centered care. There is little literature on care practices in this population, and hospital-based care may increase towards the end of life to address potentially reversible conditions or uncertain prognosis. Early advanced care planning and end-of-life care options should be supported alongside continuation of therapy lines.

Admission prioritization of heart failure patients with multiple comorbidities.

The primary objective of this study was to enhance the operational efficiency of the current healthcare system by proposing a quicker and more effective approach for healthcare providers to deliver services to individuals facing acute heart failure (HF) and concurrent medical conditions. The aim was to support healthcare staff in providing urgent services more efficiently by developing an automated decision-support Patient Prioritization (PP) Tool that utilizes a tailored machine learning (ML) model to prioritize HF patients with chronic heart conditions and concurrent comorbidities during Urgent Care Unit admission. The study applies key ML models to the PhysioNet dataset, encompassing hospital admissions and mortality records of heart failure patients at Zigong Fourth People's Hospital in Sichuan, China, between 2016 and 2019. In addition, the model outcomes for the PhysioNet dataset are compared with the Healthcare Cost and Utilization Project (HCUP) Maryland (MD) State Inpatient Data (SID) for 2014, a secondary dataset containing heart failure patients, to assess the generalizability of results across diverse healthcare settings and patient demographics. The ML models in this project demonstrate efficiencies surpassing 97.8% and specificities exceeding 95% in identifying HF patients at a higher risk and ranking them based on their mortality risk level. Utilizing this machine learning for the PP approach underscores risk assessment, supporting healthcare professionals in managing HF patients more effectively and allocating resources to those in immediate need, whether in hospital or telehealth settings.

Revisiting the Policy Implications of Medical Tourism in the Post-COVID-19 Pandemic From a Malaysian Perspective: A Qualitative Study.

Background Malaysia has been one of the most prominent destination countries for medical tourism. The industry received significant government support to create a conducive environment for its growth, such as the provision of an investment tax allowance for the facilities participating in medical tourism and the establishment of the Malaysia Healthcare Travel Council (MHTC) to coordinate collaboration between various industry stakeholders to promote medical tourism activities at the international level and facilitate inbound medical tourists. The establishment of the MHTC facilitates collaboration between various industry stakeholders. In addition to facilitating medical tourism activities, MHTC is also involved in analysing relevant data, including but not limited to the socio-demography of medical tourists, the trend of their healthcare service utilisation, revenue generated, and market intelligence to promote the industry's growth. The council serves as a medium to facilitate the collaboration of stakeholders such as the hospitals participating in medical tourism, the Association of Private Hospitals Malaysia, the Malaysian Society for Quality in Health, and various government agencies, including the Ministry of Health and the Department of Immigration, Malaysia. We explore the policy-related implications of medical tourism and its relationship with the Malaysian national healthcare system. Methodology We revisited Pocock and Phua's conceptual framework of policy implications for medical tourism to explore its relevance after more than a decade of intensive government support and the aftermath of the COVID-19 pandemic. We employed a qualitative case study design using semi-structured, in-depth interviews with stakeholders from the Ministry of Health Malaysia, the private health sector, professional bodies, academics, and health-related civil society organisations. Results Our study found that many issues identified in the original framework remain relevant after over a decade. However, we also identified additional implications, such as the role of insurance portability in encouraging the growth of international hospital accreditation and the issue of equitable access to healthcare within the context of the current Malaysian healthcare system in the aftermath of COVID-19. Conclusion Due to its vulnerability, there is a need to develop a strategic collaboration that includes incorporating medical tourism activities into a broader framework, such as promoting aged care within the retirement destinations package for expatriates, which could ensure its sustainability instead of relying solely on medical tourism activities. In the meantime, policy implications arising from the industry remain relevant and should be addressed through a comprehensive structural reform of the national healthcare system involving stakeholders from the public and private health sectors.

Understanding the patients' concept of the alliance-One step back to take two steps forward.

Current health care systems emphasize consensual collaboration between clinicians and patients to reduce symptoms and improve well-being (e.g., World Health Organization, 2023). The alliance is the internationally best-studied collaborative process characteristic in psychotherapy research. Recent empirical studies on the alliance have tripled in comparison to the entire 20th century. This increase in empirical data illustrates the cumulative outstanding scientific activities in this field (e.g., Wampold & Flückiger, 2023). The reasons for the international popularity of the pantheoretical alliance concept may lie in the practical experience of many practitioners that a balanced collaborative quality is a central ethical and conceptual premise for treatment progress (Horvath, 2018). The aim of a "Viewpoint" article is to provide thought-provoking notes on the current state of research, innovations, weaknesses in the field, and current debates. This article is limited to three aspects. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Future of Digital Healthcare in Cardiac Prevention Programme in Indonesia: From Bedside to Boardroom

Digital technology has become integral to the practice of medicine, especially in response to the COVID-19 pandemic and its associated lockdowns and social distancing measures. It has allowed patients, including those undergoing cardiac rehabilitation, to access healthcare services regardless of their geographical location. However, the widespread integration of digital healthcare on a national scale presents numerous challenges. These obstacles encompass various aspects, including patient–physician relationships, legal policies, health information system quality, data privacy, cost–benefit analysis and the potential loss of essential human interaction. To address these hurdles, Indonesia has developed a framework and strategy for implementing digital healthcare. This review examines the experiences of digital healthcare leaders in different countries, considering their unique healthcare systems, cultural contexts and approaches to tackling these issues. Additionally, an analysis of Indonesia’s current healthcare system implementation is provided. By showcasing successful examples and considering critical factors, we hope to facilitate a successful implementation of digital healthcare in cardiac prevention while gathering valuable insights from these endeavours.

Healthcare Through the Lens of Music

In this episode of SoundPractice, host Mike Sacopulos interviews Stephen Klasko and Ken Terry about the future of healthcare. They talk about their book, Feelin’ Alright: How the Message in Music Can Make Healthcare Healthier, which explores the power of music to bring people together and send messages about healthcare. They discuss the negative effects of the current healthcare system, including fragmentation and inequity, and propose solutions such as moving healthcare to outpatient sites and using technology such as large language models and wearables to improve patient care. They also discuss the importance of addressing social determinants of health and reducing healthcare inequalities. Klasko and Terry offer a novel proposal for reforming healthcare financing and delivery without adopting Medicare for all, and they emphasize the importance of doctors having a stake in the healthcare system and address the mistrust that currently exists.

A New Horizon for Healthcare Delivery: A System of Systems Perspective and Governing Proposition

AbstractThe healthcare system is grappling with inherent challenges, functioning akin to a fragmented cottage‐like industry, leading to significant cost implications and compromised care quality. This paper employs a systematic approach to scrutinize the Healthcare Delivery System (HDS) comprehensively, categorizing it as a Collaborative System of Systems (SoS), where multiple independent systems operate collectively, maintaining individual autonomy. Through a detailed examination, we identify the Collaborative SoS nature of the current healthcare system as the primary cause of its fragmentation. We address a gap in the current literature on the characteristics of SoS, focusing on the often‐overlooked aspect of dependence and exploring why constituent systems collaborate to achieve common objectives. Then, we propose a hybrid SoS model where an external governing entity at the national level assumes the authority to determine objectives and drivers for the healthcare SoS. We contend that effective SoS governance is indispensable for addressing systemic issues, providing necessary coordination, allocating resources, establishing policies, fostering sustainable change, and ensuring a well‐organized and efficient healthcare system.

An analysis of the impact on total cost of care within a pharmacist‐led comprehensive medication management program

AbstractIntroductionThe rise in health care expenditures continues to pose a significant concern regarding the longevity of the current health care system design. The literature has demonstrated a positive return on investment (ROI) when pharmacists perform medication management services. Building upon positive ROI literature, a clinically integrated network (CIN) in Michigan developed an approach to patient targeting for comprehensive medication management (CMM) services in existing alternative payment model (APM) Medicare Advantage, Medicaid, and Commercial contracts.ObjectivesThe primary objective of this study was to examine the real‐world impact of an advanced ambulatory care pharmacy model, inclusive of embedded clinic‐based ambulatory pharmacists, centralized ambulatory pharmacists, centralized population health pharmacists, and specially trained pharmacy technicians, on the total cost of care (TCOC) within a large integrated health system.MethodsFor CMM dates of service occurring in calendar year 2022, pharmacy and medical claims were evaluated during the 6‐month period prior to and following the initial CMM patient encounter. Upon completion of the study period, data were evaluated to assess TCOC and utilization trends for the study population.ResultsStatistically significant differences in median TCOC ($1427.84, p < 0.001), prescription drug costs ($222.82, p < 0.001), and medical costs ($462.26, p < 0.001) were observed between the pre‐CMM and post‐CMM timeframes for the study population. A 16% reduction in hospital admissions was observed between the pre‐CMM and post‐CMM timeframes.DiscussionThis study further supports that pharmacist intervention as part of a CMM program can favorably affect health care costs. Criteria such as a population's benchmark costs and utilization, insurance product types, and core conditions present can help determine whether expanding or initiating CMM services could be beneficial in improving care and health care costs.