Current Health System Research Articles

A critical appraisal of professional competency frameworks: What guidance is provided for stroke rehabilitation clinicians managing 'complexity'?

Given current health system trends, clinicians increasingly care for patients with complex care needs. There is a recognized lack of evidence to support clinician decision-making in these situations, as complex or multimorbid patients have been historically excluded from the types of research that inform clinical practice guidelines. However, expert clinicians at sites of excellence (e.g., Stroke Distinction sites) provide measurably excellent care. We sought to review profession-specific competency frameworks to locate information that may be supporting the development of clinician expertise when managing the care of patients with complex care needs. We conducted a review of the professional competency frameworks for core members of the inpatient stroke rehabilitation team, to determine the degree of guidance and/or preparation for the management of patients with complex care needs. We developed and applied an assessment rubric to locate references to patient complexity, multimorbidity and complexity theory. Across the professional competency frameworks, there are some references to complexity at patient- and team-levels; there are fewer references to system-level complexity. We noted a lack of clear guidance for clinicians regarding the management of patients with complex care needs. Further research is needed to explore how clinicians develop expertise in the management of patients with complex care needs, as we noted minimal guidance in the professional competency frameworks. However, we suggest that integrating complexity-related language into professional competency frameworks could better prime novice clinicians for new learning in the workplace and ease their transition into working in a complex context.

Listening to the experts: person-centred approaches to supporting autistic people and people with an intellectual disability in the mental health system

SUMMARYDespite numerous UK government policies aimed at reducing the number of autistic people and people with an intellectual disability in mental health hospitals, little progress has been made, with many experiencing lengthy stays that offer little therapeutic benefit. Once admitted, people are at risk of restrictive interventions and significantly delayed discharge, resulting in trauma. This article draws on the cases of four people to illustrate the limitations of current mental health system approaches to the challenges experienced by autistic people and people with an intellectual disability. The importance of relational working and listening to people is explored, and we demonstrate how this can facilitate the provision of bespoke housing and care packages to enable a successful return to life in the community. Finally, we offer recommendations on the changes urgently needed to ensure that autistic people and people with an intellectual disability can live ordinary lives in their own homes, with timely and effective support from mental health services when needed, just like everyone else.

Comparing Occupational Health and Safety Systems in Kurdistan Region and Turkey: Problems, Concerns and Solutions Related to the Systems

In this study, we aim to compare the current Occupational Health and Safety(OHS) Laws and systems in Kurdistan Region and Turkey major business partners and having a huge Kurdish population and similar culture besides being close to each other. Turkey has made great improvements in the OHS in last 10 years to comply with European Union labor law. The problems and benefits of the law in the last 10 years in Turkey will be discussed and compared with Kurdistan Region. Kurdistan Region needs to develop a well-organized OHS system through considering Turkey OHS journey to improve the working life.

Delivering the precision oncology paradigm: reduced R&D costs and greater return on investment through a companion diagnostic informed precision oncology medicines approach

BackgroundPrecision oncology medicines represent a paradigm shift compared to non-precision oncology medicines in cancer therapy, in some situations delivering more clinical benefit, and potentially lowering healthcare costs. We determined whether employing a companion diagnostic (CDx) approach during oncology medicines development delivers effective therapies that are within the cost constraints of current health systems. R&D costs of developing a medicine are subject to debate, with average estimates ranging from $765 million (m) to $4.6 billion (b). Our aim was to determine whether precision oncology medicines are cheaper to bring from R&D to market; a secondary goal was to determine whether precision oncology medicines have a greater return on investment (ROI).MethodData on oncology medicines approved between 1997 and 2020 by the US Food and Drug Administration (FDA) were analysed from the Securities and Exchange Commission (SEC) filings. Data were compiled from 10-K, 10-Q, and 20-F financial performance filings on medicines’ development costs through their R&D lifetime. Clinical trial data were split into clinical trial phases 1–3 and probability of success (POS) of trials was calculated, along with preclinical costs. Cost-of-capital (CoC) approach was applied and, if appropriate, a tax rebate was subtracted from the total.ResultsData on 42 precision and 29 non-precision oncology medicines from 56 companies listed by the National Cancer Institute which had complete data available were analysed. Estimated mean cost to deliver a new oncology medicine was $4.4b (95% CI, $3.6–5.2b). Costs to bring a precision oncology medicine to market were $1.1b less ($3.5b; 95% CI, $2.7–4.5b) compared to non-precision oncology medicines ($4.6b; 95% CI, $3.5–6.1b). The key driver of costs was POS of clinical trials, accounting for a difference of $591.3 m. Additional data analysis illustrated that there was a 27% increase in return on investment (ROI) of precision oncology medicines over non-precision oncology medicines.ConclusionOur results provide an accurate estimate of the R&D spend required to bring an oncology medicine to market. Deployment of a CDx at the earliest stage substantially lowers the cost associated with oncology medicines development, potentially making them available to more patients, while staying within the cost constraints of cancer health systems.

Improving long-term care and outcomes of congenital heart disease: fulfilling the promise of a healthy life.

Advances in the prevention, diagnosis, and treatment for congenital heart disease (CHD), the most common birth defect in China, have drastically improved survival for individuals with the disease. However, China's current health system is not well prepared to manage the growing population of people with CHD and their complex medical needs, which range from early detection of the condition and intervention for physical, neurodevelopmental, and psychosocial impairment, to long-term management of major complications and chronic health problems. Health disparities caused by long-standing regional differences in access to care pose challenges when major complications such as pulmonary hypertension arise, and when individuals with complex CHD become pregnant and give birth. Currently, no data sources track neonates, children, adolescents, and adults with CHD in China and delineate their clinical characteristics and use of health resources. This scarcity of data should warrant attention from the Chinese Government and relevant specialists in the field. In the third paper of the Series on CHD in China, we summarise key literature and current data to identify knowledge gaps and call for concerted efforts by the government, hospitals, clinicians, industries, and charitable organisations to develop an actionable, lifelong framework of congenital cardiac care that is accessible and affordable for all individuals with CHD. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.

Dementia in South Africa: A Situational Analysis.

There is a need in South Africa to understand the status of available care and support to strengthen responses to dementia. This study provides a situational analysis of the current provisions of health, care and support for older persons, people living with dementia and their families in South Africa. It is a first step towards describing the landscape of needs and services available, and provides an evidence base to inform priority-setting for strengthening responses to dementia in South Africa. This situational analysis was conducted in three phases: (1) a desk review guided by a comprehensive topic guide which includes the WHO's Global Dementia Observatory indicators; (2) multi-sectoral stakeholder interviews to verify the secondary sources used in the desk review, and to identify gaps and opportunities in policy and service provisions; and (3) a SWOT-analysis examining the strengths, weaknesses, opportunities and threats in current care and support provisions in South Africa. Our findings highlight the gaps and opportunities with current service provision and show how structural factors create barriers to diagnosis, support, and care. There is an urgent need for intersectoral policy responses to support and strengthen current health, social care, and long-term support systems so that people living with dementia and their families can live and age well. This paper forms part of a larger study on strengthening responses to dementia (The STRIDE project).

Sistem Pakar Diagnosa Penyakit Pencernaan Pada Manusia Dengan Menggunakan Metode Certainty Factor Berbasis Web

ABSTRACT
 
 A study was conducted to develop a traditional system at Syhifa Medika Public Clinic to overcome the lack of information and time-consuming queues at the clinic, so that people can check their digestive system conditions more easily and efficiently. The developed expert system for diagnosing digestive diseases in humans has succeeded in helping many local people in finding information on digestive diseases and providing time efficiency that is useful for people who live far from the clinic. Therefore, the expert system for diagnosing digestive diseases in humans can be a very useful alternative to improve the current health system.
 
 Keywords: Expert System, Digestion, Digestive Disease, Certainty Factor, Web

INTUITION: a data platform to integrate human epilepsy clinical care and support for discovery.

To make appropriate clinical decisions, clinicians consider many types of data from multiple sources to arrive at a diagnosis and plan. However, the current health systems have siloed data, making it challenging to develop information platforms that integrate this process into a single place for comprehensive clinical evaluation and research. INTUITION is a human brain integrative data system that facilitates multimodal data integration, unified storage, cohort selection, and analysis of multidisciplinary datasets. In this article, we describe the use of INTUITION to include electronic health records together with co-registered neuroimaging and EEG from patients who undergo invasive brain surgery for epilepsy. In addition to providing clinically useful visualizations and analytics to help guide surgical planning, INTUITION also links a bank of human brain epileptic tissues from specific brain locations to quantitative EEG, imaging, histology, and omics studies in a unique, completely integrated informatics platform. Having a clinically useful platform for integrating multimodal datasets can not only aid in clinical management decisions but also in creating a unique resource for research and discovery when linked to spatially mapped tissue samples.

Scaling-up Evidence-based Interventions for Communities of Color With Marked Health Disparities: Lessons Learned From COVID-19 Can Be Applied to Reduce Morbidity and Mortality and Achieve Health Equity.

Scaling-up Evidence-based Interventions for Communities of Color With Marked Health Disparities: Lessons Learned From COVID-19 Can Be Applied to Reduce Morbidity and Mortality and Achieve Health Equity.

A Critical Review of the Sustainability of South Africa's Health System, User’s Satisfaction and Key Performance Scores

The South African Government has made accessibility and equity the primary focus of its health policy objectives since 1994. However, the extent to which these policies achieve their aims of lessening inequality is not synthetically documented. This study critically reviews and synthesises the literature on the nature of the South African health system, user’s satisfaction and key performance scores. The study conducted a content analysis of several research papers and policy papers in the South African health sector. The review showed that the current health system is dualistic, indicating that the public health system is not living up to the National Core Scores and that this has impacted negatively on the level of satisfaction of households. The evidence demonstrated ongoing discrepancies in access to and use of health services, notwithstanding legislative initiatives. Moreover, the review showed that user’s perceptions of the quality of public healthcare services are deteriorating in South Africa. There is evidence of treatment delays, long waiting times, acute shortages of doctors, specialists and nurses, a lack of appropriate medication and poor health services delivery. The evidence provided about the South African health system can contribute to global policy discussions about health equity on the use of health services by households from different socioeconomic backgrounds and how policies can increase access to quality health care for low-income households.
 

Study design and protocol of a stepped wedge cluster randomized trial using a practical implementation strategy as a model for hypertension-HIV integration — the MAP-IT trial

BackgroundAs people living with HIV (PLWH) experience earlier and more pronounced onset of noncommunicable diseases (NCDs), advancing integrated care networks and models in low-resource-high-need settings is critical. Leveraging current health system initiatives and addressing gaps in treatment for PLWH, we report our approach using a late-stage (T4) implementation research study to test the adoption and sustainability of a proven-effective implementation strategy which has been minimally applied in low-resource settings for the integration of hypertension control into HIV treatment. We detail our protocol for the Managing Hypertension Among People Living with HIV: an Integrated Model (MAP-IT) trial, which uses a stepped wedge cluster randomized trial (SW-CRT) design to evaluate the effectiveness of practice facilitation on the adoption of a hypertension treatment program for PLWH receiving care at primary healthcare centers (PHCs) in Akwa Ibom State, Nigeria.DesignIn partnership with the Nigerian Federal Ministry of Health (FMOH) and community organizations, the MAP-IT trial takes place in 30 PHCs. The i-PARiHS framework guided pre-implementation needs assessment. The RE-AIM framework will guide post-implementation activities to evaluate the effect of practice facilitation on the adoption, implementation fidelity, and sustainability of a hypertension program, as well as blood pressure (BP) control. Using a SW-CRT design, PHCs sequentially crossover from the hypertension program only (usual care) to hypertension plus practice facilitation (experimental condition). PHCs will recruit and enroll an average of 28–32 patients to reach a maximum of 960 PLWH participants with uncontrolled hypertension who will be followed longitudinally for BP outcomes.DiscussionGiven the need for integrated NCD-HIV care platforms in low-resource settings, MAP-IT will underscore the challenges and opportunities for integrating hypertension treatment into HIV care, particularly concerning adoption and sustainability. The evaluation of our integration approach will also highlight the potential impact of a health systems strengthening approach on BP control among PLWH.Trial registrationClinicaltrials.gov (NCT05031819). Registered on 2nd September 2021.

Mental Health Prescribers' Perceptions on the Use of Pharmacogenetic Testing in the Management of Depression in the Middle East and North Africa Region.

A wide variety of commercial pharmacogenetic (PGx) tools are available worldwide to guide treatment selection for depression based on individuals' genetic profiles. However, the use of genetic testing to inform psychiatric care has faced challenges due to the limited training and education for mental health clinicians. The aim of this study was to explore the knowledge, level of engagement, and perspectives on the use of PGx testing when making depression management decisions among practicing psychiatrists within the Middle East and North Africa (MENA) region. This is a qualitative study using semi-structured interviews. Consenting psychiatrists were interviewed through an online platform (SkypeTM or Microsoft TeamsTM). Interviews were audio recorded, transcribed, and thematically analyzed with the assistance of NVivo® software. Eighteen interviews from 12 countries have been conducted. Analysis of the current interviews produced five major themes including: (1) Overall perceptions and attitudes; (2) Knowledge and awareness; (3) Education, training, and professional experience; (4) Facilitators and barriers; and (5) Ethical dilemmas. These themes support the notion that there is limited, mostly basic, education, knowledge, and training regarding genetic testing in the management of depression, although there is significant interest and willingness in the part of prescribers to adopt this strategy in their practice. The findings of the study suggest that psychiatrists practicing in the MENA region appear to be interested in implementing PGx testing when managing people with depression. However, it is also important to recognize that this cannot be achieved unless more supporting strategies are implemented within their current health system environment.

Understanding Health Seeking Behavior and Evaluating Adequacy of Health System for Catering to Health Needs of Hard-to-Reach Tribal Populations in a North Indian Hilly Province

Background: In India, tribal communities constitute about 8.6% of total population, residing mainly in isolated and hard-to-reach regions. Considering the lack of knowledge of local health needs, nonspecific health policies, far-flung inhabitation, sociocultural peculiarity, and challenges of local health system; the present study tried to explore the health-care behavior, needs of the tribal communities in a North Indian State, simultaneously evaluating the adequacy of local health system addressing those needs. Materials and Methods: A qualitative approach (Focus Group Discussions, In-Depth Interviews) was adopted for understanding health care of tribal communities. Issues such as prevailing health problems, risk factors, difficulties faced accessing healthcare, preference of health system, shortcomings of the current health system, and expectations from service providers were discussed with the natives. Regional health-care administrators, managers, and providers were also interviewed. Results: The study identified noncommunicable diseases as a common health problem in these communities and locals could associate lifestyle behavior with these. Poor all-weather road connectivity, lack of transport facilities, unavailability of doctors (especially specialists), frequent referral to distantly located higher-level institutions, and incurring high out-of-pocket expenditure were the common difficulties cited by the locals while accessing health care. Conclusions: The study highlighted a mismatch between the health-care needs of the indigenous communities and service provision. These observations warrant the aligned effort of various stakeholders of tribal health to realize the vision of sustained development.

Mental Health Impacts of Climate Change for Birthing People and the Provider's Role.

Mental Health Impacts of Climate Change for Birthing People and the Provider's Role.

Adolescents and oral health service utilization in Canterbury, New Zealand: A geospatial cross-sectional study.

Non-utilization of dental care during adolescence can result in poorer oral health and subsequently higher expenditures on dental services. This study examined the geospatial and epidemiological factors associated with utilization of the publicly funded Adolescent Oral Health Services (AOHS) in Canterbury, Aotearoa New Zealand (NZ). A secondary analysis of prospectively collected routine data from AOHS visits of adolescents in school Year 9 (13-14 years) for the financial year 2019-2020. Geographic information systems examined distance from home to dental practices. Multilevel mixed-effects Poisson regression models investigated associations between geospatial, demographic and clinical factors and non-utilization of dental services. Models were adjusted for sex, ethnicity, area-level deprivation, rural/urban classification, previous caries experience and the distance from home address to dental practice referred. Dental practices were concentrated in large urban areas and in the least deprived neighbourhoods, with several service area gaps identified. Rural areas and the most deprived areas of Christchurch City had the highest non-utilization rates. After adjustment, adolescents residing in the most deprived areas had a higher risk of non-utilization (adjusted risk ratio [aRR] = 1.38; 95% CI 1.26-1.51) compared to adolescents in the least deprived areas. Adolescents in remote areas also had an increased risk of non-utilization (aRR = 1.36; 95% CI 1.20-1.54) compared to adolescents in urban core areas. Finally, Māori (aRR = 1.37; 95% CI 1.29-1.46) and Pasifika (aRR = 1.46; 95% CI 1.35-1.59) adolescents had significantly higher risks of non-utilization compared to their NZ European counterparts. Inequitable utilization of dental services exists among adolescents in Canterbury, NZ, and is associated with Māori, Pasifika and those living in rural and most deprived areas. Adolescents at the greatest oral health risk are geographically underserved by current oral health services. The current health system should also explore the possibility of partnering with Māori and Pasifika communities to provide services within culturally appropriate settings.

The Impacts of the COVID-19 Pandemic on Pregnant Women

The COVID-19 pandemic has many impacts on the society, such as the inadequacies and shortcomings of the current health system. There have been many reports pointing out that pregnant women are a vulnerable group to the severe COVID-19. Their bodies are more sensitive to the virus, that's for sure. According to a report from the University of Washington, the tissue structure of the placenta is vulnerable to the new coronavirus. And its role in the process of gestation is crucial. In addition, the physiological changes in pregnant women make it important for them to get enough oxygen. And it is the respiratory system that the novel coronavirus attacks. Early indiscrimination between COVID-19 and influenza also lead to worsening of illness caused by delayed treatment. Pregnant women, a vulnerable group, should be taken seriously and cared about in this environment, so that the health system needs to be changed. This article focuses on some severe cases of pregnant women caused by the novel coronavirus and the psychological and social pressure that pregnant women suffer in this environment.

Examining the gaps in perinatal mental health care: A qualitative study of the perceptions of perinatal service providers in Canada.

In Canada, access to perinatal mental health services is disparate across districts, regions, provinces, and territories. Questions remain as to how gaps in service are being experienced by Canadian service providers and clinicians. This paper examines three key questions: 1) What are the experiences of care providers with respect to the screening, identifying, and managing perinatal mental health disorders? 2) What gaps in perinatal mental health care have been identified? and 3) What approaches have been taken by providers, communities, and regions in addressing the needs of their populations? To address these questions, 435 participants from across Canada were surveyed using an online survey constructed by the research members of the CPMHC. A qualitative analysis of the data revealed three key themes: groups marginalized by the current perinatal mental health system, gaps and supports identified by communities; and systemic and policy issues. From these three themes we have identified the key components of changes required in the national approach to perinatal mental health disorders. We identify key resources that could be utilized to create policy change and provide recommendations for change.

Using Socialist Ideas to Help the World Health Organization Deal with International Relations and Develop New Policies to Improve the Health Care System

This paper is a detailed analysis of how socialist thinking can help International Health Organizations. WHO's health system is of great importance to people all over the world, and it holds a key position in the deal with international relations. But judging from the examples of the effects of various transnational epidemics discussed in this article, the current WHO health system is inadequate for this vital responsibility and fails to handle international relations well. This paper will give a detailed explanation of why WHO needs to apply socialist thought and argue the excellence of socialist thought in helping WHO better deal with international relations and international health issues. The deficiencies of WHO's health system are directly reflected in its policies. This paper will demonstrate how reforming WHO's policies with socialist ideology will improve international relations and better deal with international health issues.

The Impact of Westernization on the Insulin/IGF-I Signaling Pathway and the Metabolic Syndrome: It Is Time for Change.

The metabolic syndrome is a cluster of overlapping conditions resulting in an increased incidence of type 2 diabetes, cardiovascular disease, and cancer. In the last few decades, prevalence of the metabolic syndrome in the Western world has reached epidemic proportions and this is likely due to alterations in diet and the environment as well as decreased physical activity. This review discusses how the Western diet and lifestyle (Westernization) has played an important etiological role in the pathogenesis of the metabolic syndrome and its consequences by exerting negative effects on activity of the insulin-insulin-like growth factor-I (insulin-IGF-I) system. It is further proposed that interventions that normalize/reduce activity of the insulin-IGF-I system may play a key role in the prevention and treatment of the metabolic syndrome. For successful prevention, limitation, and treatment of the metabolic syndrome, the focus should be primarily on changing our diets and lifestyle in accordance with our genetic make-up, formed in adaptation to Paleolithic diets and lifestyles during a period of several million years of human evolution. Translating this insight into clinical practice, however, requires not only individual changes in our food and lifestyle, starting in pediatric populations at a very young age, but also requires fundamental changes in our current health systems and food industry. Change is needed: primary prevention of the metabolic syndrome should be made a political priority. New strategies and policies should be developed to stimulate and implement behaviors encouraging the sustainable use of healthy diets and lifestyles to prevent the metabolic syndrome before it develops.

Open Dialogue as a cultural practice - critical perspectives on power obstacles when teaching and enabling this approach in current psychiatry.

Building on both therapeutic and organizational principles, adopting Open Dialogue (OD) calls various routines of the current mental health system into question, resulting in potential obstacles with implementation. This perspective paper aims to reflect on power relations as potential disruptive factors in enabling the OD approach in mental health care. Drawing on data from a small implementation study, followed by reflections from three perspectives, we conclude with a discussion exploring the potential of understanding OD as a fundamental human practice to reduce these power-related obstacles.