Effective Health Care Delivery Research Articles

Urbanization factors and the vagaries of the rural health care industry in Nigeria: an analysis of the accessibility of healthcare services by older adults in the Nsukka Local Government Area

This study sought to determine the effects of urbanization on access to healthcare services by older adults in Nsukka Local Government Area. The Nigerian healthcare industry is organized under the three tiers of government: Federal, State and Local governments. As such, most of the healthcare facilities are located in urban areas while majority of older adults reside in different local governments in rural communities where there are a few of the facilities. This has led to poor utilization of medical services by older adults in rural areas. This study adopted a mixed method approach. While questionnaire was used to collect quantitative data, interviews were used to collect qualitative data for the study. Questionnaire survey was used to collect data from 1180 older adults between the ages of 60 years and above from six communities in the study area. Descriptive statistics and Chi square were used to analyze the data while frequency distribution tables and percentages were used to present the results. The research showed that there are inadequate health facilities for the older adults in rural communities in Nsukka LGA. It also found that the older adults suffered challenges arising from lack of medical doctors, nurses, equipments, and drugs for effective healthcare delivery. It is recommended that more efforts should be geared towards providing adequate health facilities and health workers by government at public hospitals in rural communities to increase accessibility and adequate utilization by the older adults.

Transition and change: opportunities and challenges of CHW programme reform for community health systems and vertical disease programmes in Liberia

BackgroundGlobally, community health worker (CHW) programmes are critical to addressing health worker shortages and have been recognised as critical pillars within the drive towards universal health coverage (UHC). In 2016, the Liberian Ministry of Health launched the National Community Health Services Policy 2016–2021, which included significant CHW programme reform to address ongoing health workforce capacity gaps in the country. However, little consideration was given to the impact of such reforms on ongoing health interventions that rely heavily on the use of CHW cadres. Our study explores how CHW programme reform in Liberia influenced performance of CHWs involved in the delivery of Neglected Tropical Disease (NTD) programmes to elucidate how health systems reform can impact the delivery of routine health interventions and vice versa.MethodsWe used a qualitative case study approach conducted between March 2017 and August 2018. Our instrumental case study approach uses qualitative methods, including document review of five CHW and NTD program-related policy documents; 25 key informant interviews with facility, county, and national level decision-makers; and 42 life and job histories with CHWs in Liberia. Data were analysed using a thematic framework approach, guided by Kok et al. framework of CHW performance. Data were coded in QRS NVIVO 11 Pro.ResultsOur findings show that CHW programme reform provides opportunities and challenges for supporting enhanced CHW performance. In relation to health system hardware, we found that CHW programme reform provides better opportunities for: formal recognition of CHWs; strengthening capacity for effective healthcare delivery at the community level through improved and formalised training; a more formal supervision structure; and provision of monthly incentives of 70 US dollars. Efficiency gaps in routine intervention delivery can be mitigated through the strengthening of these hardware components. Conversely, supervision deficits in routine CHW functioning can be supported through health interventions. In relation to systems software, we emphasise the ongoing importance of community engagement in CHW selection that is responsive to gendered power hierarchies and accompanied by gendered transformative approaches to improving literacy.ConclusionsThis study shows how CHW programme reform provides opportunities and challenges for health system strengthening that can both positively and negatively impact the functioning of routine health interventions. By working together, CHW programmes and routine health interventions have the opportunity to leverage mutually beneficial support for CHWs, which can enhance overall systems functioning by enhancing CHW performance.

Effectiveness of Community-Based Multidisciplinary Integrated Care for Older Adults with General Practitioner Involvement: A Systematic Review and Meta-Analysis

Abstract Background Changing demographics has led to healthcare systems reorientating healthcare delivery towards the community setting and implementing integrated models of care worldwide. A knowledge gap exists with regards to what elements of integrated care facilitate effective age-attuned healthcare delivery. This systematic review examines the effectiveness of community-based multidisciplinary integrated care strategies with General Practitioner (GP) participation for community-dwelling older adults and describes the level of care integration in each study. Methods PUBMED, EMBASE, CINAHL, Central Register of Controlled Trials in the Cochrane Library and MEDLINE were systematically searched in April 2023. Randomised controlled trials (RCTs) or cluster RCTs that focused on interventions for community-dwelling older adults delivered by health and social care professionals with GPs were included. Two reviewers independently conducted the risk of bias assessment, applied the GRADE tool to quantify the certainty of evidence and used the Rainbow Model of Integrated Care taxonomy to describe the elements of integrated care used within studies. The primary outcome was functional status. Meta-analyses were performed using Review Manager 5.4. Results Twelve trials (14 reports) recruiting 8069 participants across 8 countries were included. Community-based multidisciplinary team (MDT) integrated care demonstrated significant improvements in functional status (standardised mean difference (SMD) 0.21, 95% confidence interval (CI) 0.05-0.37; low certainty evidence), hospitalisation (risk ratio (RR) 0.77, 95% CI 0.63-0.95; very low certainty evidence) and participant satisfaction with care (SMD 0.46, 95%c CI 0.15-0.76; low certainty evidence) from 12-36 months. No statistically significant effects favouring community-based MDT interventions for functional status at 6-month follow-up, Emergency Department presentation, mortality, health-related quality of life, or nursing home admission were established. Conclusion Community-based MDT integrated care with GP participation improves clinical and process outcomes for community-dwelling older adults. Future research should focus on models of integrated care that respond to the needs and preferences of older adults.

Abstract A154: Mammograms Across Missouri: A Qualitative Evaluation among Healthcare Providers to Improve Breast Cancer Screening in Rural Communities

Abstract Introduction: Breast cancer is the leading cause of cancer-related deaths among women, with rural communities having the highest rates of breast cancer mortality. Despite this burden, many women begin mammography later than recommended and the mammography screening rate remains low, with a previously reported declining trend, particularly among rural women compared to urban women. This study seeks to identify barriers to breast cancer screening and examine strategies to overcome these barriers in rural Missouri. Methods: In partnership with the Missouri Cancer Consortium and the Missouri Comprehensive Cancer Control Programs, we conducted key informant interviews with mammography health providers at health centers in each of ten counties with the highest breast cancer mortality and lowest screening mammography rates in Missouri. Semi-structured interviews included questions about seeking and delivering breast cancer screening as well as provider experiences with patient navigation, mobile mammography, and the CDC’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Data were analyzed using a deductive-inductive thematic approach in NVivo 14. Results: We conducted 14 interviews with health providers across 12 health sites. The majority of these sites used patient navigation (67%), mobile mammography (80%), and the CDC NBCCEDP (67%) as strategies to improve access to breast healthcare. Health providers frequently mentioned “no-shows” as a major challenge to providing breast healthcare, along with limited transportation, cost, fear, and competing work priorities as the major barriers faced by patients in seeking breast healthcare. Patient navigation and mobile mammography were beneficial in bringing breast healthcare closer to the community, while the CDC NBCCEDP covered screening and follow-up costs. The main facilitating factors to implementing these strategies were having dedicated staff and funding for patient navigation, and existing partnerships with other health institutions for mobile mammography. However, health providers identified several implementing challenges for the strategies. This included limited staff capacity and difficulty contacting or following up patients to schedule appointments for patient navigation and mobile mammography. For the CDC NBCCEDP, the challenges included difficulty identifying eligible patients and extensive paperwork in the enrollment process. Providers recommended increasing staff capacity to support patient navigation, using digital technology in identifying and enrolling women for the CDC NBCCEDP, and integrating mobile mammography with the CDC NBCCEDP to improve implementation efficiency. Discussion: The integration of multiple component strategies within breast healthcare may address the multi-level barriers women face in accessing breast cancer screening. This study contributes to the identification of organizational supports and informs development of policies needed to enhance the adoption and implementation of strategies that support the effective delivery of breast healthcare. Citation Format: Thembekile Shato, Carmen Vardeman, Sarah J. Chavez, Ashley C. Holmes, Joann Lee, Xarria Lewis, Katie Manga, Misty Phillips, Keisha Windham, Bettina F. Drake. Mammograms Across Missouri: A Qualitative Evaluation among Healthcare Providers to Improve Breast Cancer Screening in Rural Communities [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A154.

Abstract B029: Communication barriers: The role of medical mistrust in patient-centered communication in cancer care among Black and White older patients with cancer receiving treatment

Abstract Introduction: Medical mistrust, characterized by distrust in healthcare providers, institutions, and systems, can hinder effective Patient-Centered Communication (PCC) — a method of healthcare interaction that ensures patients (pts) voices, needs, and values guide clinical decisions and care planning. Medical mistrust can impede effective healthcare delivery, particularly to those from historically marginalized backgrounds. We aimed to explore the effect of race on the association of mistrust with PCC among older Black and White pts with cancer. Methods: Pts were aged 65+, 50% Black, receiving any cancer treatment and were recruited from July 2022 to August 2023. Pts perception of providers’ PCC was assessed using the Patient-Centered Communication in Cancer Care-36 (range: 1-5; higher score=better PCC), and medical mistrust using the Group Based Medical Mistrust Scale (range 12-60; higher score=greater mistrust) which includes subdomains of discrimination, suspicion, and low support. Multivariable linear regression models examined the association of mistrust with PCC separately among Black and White pts controlling for education, income, depression, and anxiety. The interaction of race on the association of mistrust with PCC was also explored. Beta (β) coefficients, 95% Confidence Intervals (CI), and p-values are reported. Results: Forty-three (21 Black) pts, mean age=73.6 years (range 65-86) completed the study. Sociodemographic and psychosocial characteristics was similar, except income <$50,000 was more common among Black than White pts (48% vs 27%; p=0.005) as was unmarried status (57% vs 27%; p=0.020). Between Black and White pts there were no significant differences in the median levels of mistrust (22.5 vs 20.0; p=0.34) and PCC (4.6 vs 4.5; p=0.82). Among Black pts increased overall mistrust and all mistrust subdomains were associated with decreased PCC [Overall Score: (β=-0.06; 95% CI=-0.09 to - 0.02; p=0.003), discrimination (β=-0.20; 95% CI=-0.30 to -0.11, p<0.001); suspicion (β=-0.14; 95%CI=-0.25 to -0.02; p=0.022) and low support (β=-0.15; 95% CI=-0.27 to -0.03; p=0.017)]. Among White pts, only the mistrust domain of low support was negatively associated with PCC (β=-1.21; 95%CI=-0.25 to -0.02; p=0.028). Exploration of racial differences in the association of mistrust and its subdomains and PCC revealed that the association of the discrimination subdomain and PCC varied between Black and White pts at the 9.5% significance level; p=0.095. Conclusion: Black pts with diminished trust in healthcare providers, institutions, and systems, may be less inclined to actively participate in open and collaborative communication with healthcare providers, which could adversely affect their clinical outcomes. Furthermore, considering the trending difference in mistrust domain of discrimination between Black and White pts, developing communication strategies tailored to address discrimination might be key to mitigating mistrust, cultivating strong patient-provider bonds, and advancing health equity among older Black pts with cancer. Citation Format: Nikesha Gilmore, Nikesha Jean, Nikesha Loh, Nikesha Strawderman, Rev Patrina Freeman, Elizabeth Diaz Fontanez, Marquita Thames-Lewis, Lee Kehoe, Marie Flannery, Ronald Epstein, Supriya Mohile, Charles Kamen. Communication barriers: The role of medical mistrust in patient-centered communication in cancer care among Black and White older patients with cancer receiving treatment [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B029.

Defining minimum workforce standards for intensive care physiotherapy in Australia and New Zealand: A Delphi study

BackgroundIntensive care staffing guidelines provide recommendations for the safe and effective delivery of health care while recognising professional requirements of the workforce. To guide recommendations for physiotherapy staffing guidelines, profession-specific consultation is needed. ObjectivesThe objective of this study was to develop consensus-based recommendations for minimum workforce standards for physiotherapy in intensive care. MethodsA Delphi survey process was conducted involving physiotherapists from Australia and New Zealand. ResultsThe panel consisted of 65 physiotherapists in the first round and 60 in the second round (92% retention). Respondents were from both Australia (49, 76%) and New Zealand (16, 24%) who had been physiotherapists for an average of 18.8 ± 9.0 years and were primarily senior intensive care physiotherapists (44, 68%). Respondents had experience across level 3 (50, 77%), level 2 (18, 28%), and level 1 (5, 8%) adult intensive care units (ICUs), adult high-dependency units (27, 42%), and paediatric intensive care (6, 9%). A total of 42 statements were presented, with 37 reaching consensus after two rounds. After two rounds, consensus was achieved for a minimum staffing ratio in paediatric ICUs of one physiotherapist per six (1:6) beds. For adult ICUs, use of the median value of the participant's responses was supported to establish minimum staffing ratios of 1:8, 1:7, 1:6, and 1:8 for levels 1, 2, and 3 ICUs and high-dependency units, respectively. The requirement for an additional allocation for senior physiotherapist staffing for each ICU level was also established. Statements that also gained consensus included recommendations for access to on-call and weekend services for all ICU settings and the consideration of evening shifts specifically for level 3 and paediatric ICUs. ConclusionsRecommendations for minimum staffing for physiotherapy in intensive care settings were achieved and supported requirements for clinical service delivery, supervision, and training.

Bibliometric Analysis of Factors Affecting Performance and Completeness of Electronic Medical Records (EMR) in Primary Health Services

ABSTRACT Electronic Medical Records (EMR) completeness and accuracy are fundamental to effective patient care, clinical decision-making, and overall healthcare management. In recent years, there has been increasing attention to improving EMR documentation by healthcare professionals to improve data quality and patient care outcomes. This bibliometric study aimed to explore the trends, research focus, and gaps in the literature regarding EMR completeness from 2019 to 2024. The study used Publish or Perish software to collect data from Google Scholar with specific keywords such as Performance, Factors, Electronic Medical Record (EMR), EMR Completeness, Primary Healthcare, Filling, Documentation, and Medical Record Accuracy. The analysis included the 30 highest ranked journals. In addition, VOS Viewer was used for network visualization, overlay, and density to analyze thematic linkages and identify potential research gaps. Bibliometric analysis showed that Indonesia, the United States, and Ethiopia were the main contributors in EMR-related publications. Frequent themes such as data completeness, quality, and accuracy, emphasize their crucial role in the EMR research field. These findings emphasize the importance of continuously improving EMR data completeness and accuracy, which are critical for reliable clinical decision making and effective healthcare delivery. Future research should focus on developing methodologies to improve data quality and integration of EMR systems with other health information systems. In addition, exploration of policy and regulatory implications related to EMR completeness may provide valuable insights for healthcare practice. Keywords: EMR Completeness, Data Quality, Bibliometric Analysis, Health Documentation, VOS Viewer.

Knowledge, attitude, and practice of Iranian health care workers about infodemic management: a cross-sectional descriptive study

BackgroundMisinformation (infodemics) can hinder effective healthcare delivery. This study assessed Iranian healthcare workers’ (HCWs) knowledge, attitude, and practice (KAP) regarding infodemic management (IM).MethodA cross-sectional survey using a self-reported questionnaire (KAPIM) distributed via convenience sampling to 1890 HCWs across all Iranian Medical Sciences Universities.ResultsThe results showed that healthcare workers demonstrated overall KAP scores with a mean of 3.38 out of 5. Knowledge scores were 63.01%, attitude scores were 74.23%, and practice scores were lower at 55.76%. There were positive correlations between age and work experience with both knowledge and attitude scores.ConclusionThese findings suggest a gap between HCWs’ knowledge/attitude and practice regarding IM. Targeted interventions emphasizing practical skills are needed. Considering demographics and regional variations is crucial when developing training programs for enhanced infodemic preparedness across the Iranian healthcare system.

Closing the gap? Results-based financing and socioeconomic-related inequalities in maternal health outcomes in Zimbabwe.

The results-based financing (RBF) program, first implemented in Zimbabwe in 2011 and gradually expanded to other districts, aimed to address disparities in maternal health outcomes by improving the utilisation of health services. This study leverages the staggered rollout of the program as a quasi-experimental design to assess its impact on asset wealth-related inequalities in selected maternal health outcomes. The objective is to determine whether RBF can effectively reduce these disparities and promote equitable healthcare access. We employ an extended two-way fixed effects (ETWFE) model to exploit temporal variation in RBF implementation as well as individual-level variation in birth timing for identification. Utilising pooled cross-sectional and nationally representative data from the Zimbabwe demographic and health surveys collected between 1999 and 2015, our analysis reveals significant reductions in relative and absolute maternal health inequalities, especially in the frequency and timing of prenatal care, delivery by caesarean section, and family planning. Specifically, the RBF program is associated with reductions in disparities for completing at least four or more prenatal care visits (-0.026, p < 0.01), first-trimester prenatal care (-0.033, p < 0.01), delivery by caesarean section (-0.028, p < 0.005), and family planning (-0.033, p < 0.005). Additionally, the program is associated with improved prenatal care quality, as evidenced by progress on the prenatal care quality index (-0.040, p < 0.01). These effects are more pronounced among lower socioeconomic groups in RBF districts, highlighting RBF's potential to promote equitable healthcare access. Our findings advocate for targeted policy interventions prioritising expanding access to critical maternal health services in underserved areas and incorporating equity-focused measures within RBF frameworks to ensure inclusive and effective healthcare delivery in Zimbabwe and other low-income countries.

Evaluating outcomes of transjugular intrahepatic portosystemic shunt procedure among Native Americans

BackgroundThis study aims to explore racial disparities in immediate outcomes of Transjugular Intrahepatic Portosystemic Shunt (TIPS) among Native Americans, a group that have higher prevalence of liver cirrhosis but were the “invisible group” in previous TIPS studies due to their small population size. MethodsThe study identified Native Americans and Caucasians who underwent TIPS in National/Nationwide Inpatient Sample (NIS) database from Q4 2015–2020. Preoperative factors, including demographics, indications for TIPS, comorbidities, etiologies for liver disease, primary payer status, and hospital characteristics, were matched by 1:5 propensity score matching. In-hospital post-TIPS outcomes were then compared between the two cohorts. ResultsThere were 6,658 patients who underwent TIPS, where 101 (1.52 %) were Native Americans and 4,574 (68.70 %) were Caucasians. Native Americans presented as younger, with a lower socioeconomic status, and displayed higher rates of alcohol abuse and related liver diseases. After propensity-score matching, Native Americans had comparable in-hospital post-TIPS outcomes including mortality (8.33% vs 9.09 %, p = 1.00), hepatic encephalopathy (18.75% vs 25.84 %, p = 0.19), acute kidney injury (28.13% vs 30.62 %, p = 0.71), and other adverse events. Native Americans also had similar wait from admission to operation (2.15 ± 0.30 vs 2.87 ± 0.21 days, p = 0.13), hospital length of stay (7.43 ± 0.63 vs 8.62 ± 0.47 days, p = 0.13), and total costs (158,299 ± 14,218.2 vs 169,425 ± 8,600.7 dollars, p = 0.50). ConclusionNative Americans had similar immediate outcomes after TIPS compared to their propensity-matched Caucasians. While these results underscore effective healthcare delivery of TIPS to Native Americans, it is imperative to pursue further research for long-term post-procedure outcomes.

Personalized diabetes diagnosis using machine learning and electronic health records

Diabetes mellitus (DM) poses a significant health challenge globally, necessitating accurate and timely diagnosis for effective management. Conventional diagnostic methods often struggle to address the multifaceted nature of diabetes and the requisite lifestyle adjustments. In this study, we propose a data-driven approach utilizing machine learning techniques to enhance diabetes diagnosis. By leveraging extensive patient attributes and medical records, machine learning algorithms can uncover intricate patterns and correlations. Our methodology, validated on the PIMA India dataset, demonstrates promising results. The random forest model achieved the highest accuracy of 87%, followed closely by gradient boost at 90%. Notably, XGBoost and CATBoost models attained a peak accuracy of 90.9%. These findings underscore the potential of machine learning in transforming diabetes diagnosis. Beyond improving diagnostic accuracy, our approach aims to guide individuals towards healthier lifestyles. Intelligent systems driven by machine learning hold promise for revolutionizing diabetes management, ultimately leading to better patient outcomes and more effective health care delivery.

Improving Medical and Surgical Care: A Qualitative Study of Medical Students' Experience With Language Barriers in Healthcare.

Objective This study aims to investigate the experiences of medical students in teaching and practice concerning communication with patients exhibiting limited English proficiency (LEP). With a growing population in the United Kingdom facing language barriers, this research explores the challenges encountered by medical students, emphasizing the need for enhanced medical education in this domain. Methods A qualitative technique was used to recruit 20 medical students enrolled in a Medicine MBBS degree program at a UK institution. Convenience sampling was utilized, and five separate focus groups were conducted. Semi-structured interview schedules guided discussions surrounding encounters with patients necessitating the use of interpreters. Thematic analysis was employed to identify recurring patterns and themes. Results Three primary themes emerged from the data analysis: interpersonal relations, feasibility, and duties and responsibilities. The findings underscore the challenges faced by medical students when communicating with patients having LEP. The study provides valuable insights into the nuanced aspects of these encounters, shedding light on the complex interplay between language barriers and effective healthcare delivery. Conclusion This research contributes to the limited body of qualitative literature on medical students' experiences in managing language barriers with patients. The identified themes provide a foundation for modifying medical education curricula to better equip students to address communication challenges associated with linguistic diversity. The study advocates for the integration of these experiences into medical training, emphasizing the broader implications for healthcare delivery and the reduction of health inequalities in linguistically diverse patient populations. The study also recommends the usage of up-to-date translation services built into the electronic healthcare records. This relationship minimizes inaccuracy in presenting the results of patient diagnostic films and tests, reduces wait times for treatment, and contributes to an overall cost reduction within this healthcare sector.

Applied artificial intelligence for global child health: Addressing biases and barriers.

Given the potential benefits of artificial intelligence and machine learning (AI/ML) within healthcare, it is critical to consider how these technologies can be deployed in pediatric research and practice. Currently, healthcare AI/ML has not yet adapted to the specific technical considerations related to pediatric data nor adequately addressed the specific vulnerabilities of children and young people (CYP) in relation to AI. While the greatest burden of disease in CYP is firmly concentrated in lower and middle-income countries (LMICs), existing applied pediatric AI/ML efforts are concentrated in a small number of high-income countries (HICs). In LMICs, use-cases remain primarily in the proof-of-concept stage. This narrative review identifies a number of intersecting challenges that pose barriers to effective AI/ML for CYP globally and explores the shifts needed to make progress across multiple domains. Child-specific technical considerations throughout the AI/ML lifecycle have been largely overlooked thus far, yet these can be critical to model effectiveness. Governance concerns are paramount, with suitable national and international frameworks and guidance required to enable the safe and responsible deployment of advanced technologies impacting the care of CYP and using their data. An ambitious vision for child health demands that the potential benefits of AI/Ml are realized universally through greater international collaboration, capacity building, strong oversight, and ultimately diffusing the AI/ML locus of power to empower researchers and clinicians globally. In order that AI/ML systems that do not exacerbate inequalities in pediatric care, teams researching and developing these technologies in LMICs must ensure that AI/ML research is inclusive of the needs and concerns of CYP and their caregivers. A broad, interdisciplinary, and human-centered approach to AI/ML is essential for developing tools for healthcare workers delivering care, such that the creation and deployment of ML is grounded in local systems, cultures, and clinical practice. Decisions to invest in developing and testing pediatric AI/ML in resource-constrained settings must always be part of a broader evaluation of the overall needs of a healthcare system, considering the critical building blocks underpinning effective, sustainable, and cost-efficient healthcare delivery for CYP.

Prescription Precision: A Comprehensive Review of Intelligent Prescription Systems.

Intelligent Prescription Systems (IPS) represent a promising frontier in healthcare, offering the potential to optimize medication selection, dosing, and monitoring tailored to individual patient needs. This comprehensive review explores the current landscape of IPS, encompassing various technological approaches, applications, benefits, and challenges. IPS leverages advanced computational algorithms, machine learning techniques, and big data analytics to analyze patient-specific factors, such as medical history, genetic makeup, biomarkers, and lifestyle variables. By integrating this information with evidence-based guidelines, clinical decision support systems, and real-time patient data, IPS generates personalized treatment recommendations that enhance therapeutic outcomes while minimizing adverse effects and drug interactions. Key components of IPS include predictive modeling, Drug-Drug Interaction detection, adverse event prediction, dose optimization, and medication adherence monitoring. These systems offer clinicians invaluable decision-support tools to navigate the complexities of medication management, particularly in the context of polypharmacy and chronic disease management. While IPS holds immense promise for improving patient care and reducing healthcare costs, several challenges must be addressed. These include data privacy and security concerns, interoperability issues, integration with existing electronic health record systems, and clinician adoption barriers. Additionally, the regulatory landscape surrounding IPS requires clarification to ensure compliance with evolving healthcare regulations. Despite these challenges, the rapid advancements in artificial intelligence, data analytics, and digital health technologies are driving the continued evolution and adoption of IPS. As precision medicine gains momentum, IPS is poised to play a central role in revolutionizing medication management, ultimately leading to more effective, personalized, and patient-centric healthcare delivery.

Knowledge Domain and Emerging Trends in Internet-based diagnosis and treatment services：A Scientometric Review Based on CiteSpace V Analysis

Background: In the battle against the COVID-19 pandemic, Internet-based diagnosis and treatment services offer a promising technological avenue for effective healthcare delivery. However, there remains a scarcity of bibliometric analyses on Internet-based diagnosis and treatment services within the healthcare domain. This study aims to address this gap by conducting a comprehensive examination of research advancements, highlighting prevalent themes, and delineating emerging trends in Internet-based diagnosis and treatment research using CiteSpace V. Methods: The Web of Science Core Collection (WoSCC) was utilized to gather literature on Internet-based diagnosis and treatment within the healthcare sector spanning from 2001 to 2021. CiteSpace V facilitated keyword analysis, created dual-map overlays of journals, generated timeline views of co-cited references, and analyzed literature information. This encompassed variables such as involved countries and institutions, journals publishing relevant research, authors and cited authors, cited references, highly cited works, H-index, average citations, prevalent subjects of interest, and emerging frontiers in the field. Results: WoSCC identified a total of 1259 papers on Internet-based diagnosis and treatment for bibliometric analysis. Annual publications generally exhibited an upward trend. The United States contributed the most publications (465 papers) and the highest number of highly cited papers (9). Poland had the highest average citations per item (42.12). Gerhard Andersson emerged as the most influential author, with 16 publications and a co-citation count of 216. The six primary topics in Internet-based diagnosis and treatment services were health anxiety, randomized controlled trials, IoT platforms, health-related quality, Chinese men, and Internet gaming disorder. The eight emerging topics were medical devices, artificial intelligence, health-related quality, breast cancer, prostate cancer, patient care, treatment decisions, and HIV. With the development of Internet-based diagnosis and treatment technology, major ongoing research trends include the deep application of artificial intelligence in the medical field, enhancing patient satisfaction in clinical practice, improving health-related quality, and treating breast cancer patients. Conclusions: This study provides a comprehensive examination of Internet-based diagnosis and treatment services within the healthcare sector, offering valuable insights that provide significant guidance for future development in the field.

Engaging with the public on their views on the collection, use and sharing of personal health information: Development of a scenario-based survey instrument

Background Members of the public differ regarding their views on the use and sharing of personal health information. Objective This paper describes the methodology employed to develop a telephone-based survey tool to capture views of the public on the collection, use and sharing of personal health information. Method A rigorous methodology comprising multiple stages was undertaken to develop a vignette/scenario-based survey instrument. These steps included a review of instruments used in other jurisdictions, focus groups, engagement meetings with healthcare professionals, cognitive testing and piloting the final instrument. Informed by the findings of each survey development phase, draft scenarios and accompanying questions were developed. Results The following scenarios were developed: ‘Circle of care,’ ‘Use of information beyond your direct care’ and ‘Digital records.’ Conclusion The findings from this survey will inform national policy in relation to health information and will inform the development and implementation of eHealth initiatives. In turn, this should support the delivery of high-quality, effective health and social care. The learnings from the development of this survey will contribute to future health information policy and governance in countries or jurisdictions considering the development of a national electronic health record system. Moreover, this research will support public and population health management by encouraging public engagement to support successful implementation of new health information systems.

Towards Effective Healthcare Delivery: An Assessment of Public Perception of Pharmacist’s Role in Nigeria

Towards Effective Healthcare Delivery: An Assessment of Public Perception of Pharmacist’s Role in Nigeria

Perceptions of followership among nurses: A qualitative study

BackgroundFollowership is defined as the role individuals play in supporting, contributing to, and realizing the vision and directives set by their leaders. Such a role is indispensable in healthcare, facilitating effective team dynamics and healthcare delivery. Within the nursing field, it encompasses nurses' active engagement and participation in healthcare delivery, ensuring safety, fostering teamwork, and enhancing patient outcomes. Despite its significance, the exploration of followership within the nursing context of Saudi Arabia remains limited. ObjectiveThis study aims to explore how followership is perceived and practiced by nurses in this unique cultural and professional setting, and its implications for healthcare delivery. MethodsWe conducted a qualitative inquiry involving seven registered nurses working in hospitals affiliated with the Saudi Arabian Ministry of Health. Semi-structured interviews were conducted, and a thematic analysis was utilized to extract key findings. ResultsOur thematic analysis identified four main themes and several sub-themes that encapsulate the participants' perspectives on followership. The themes include: (1) Understanding of followership, where a predominant lack of clarity about the concept was observed, often conflating it with teamwork; (2) Followers' involvement in decision-making, highlighting the limited participation of nurses in decision-making processes due to hierarchical and autocratic leadership structures; (3) Barriers to followership, which encompassed issues such as poor leadership, the undervaluation of the follower role, lack of training and development opportunities, challenges in collaboration, and language barriers; and (4) Facilitators of followership, identified as effective leadership, followership training, communication skills, positive relationships, respect, collaboration, understanding of roles, commitment, and flexibility. These findings elucidate the complex landscape of followership within the nursing profession in Saudi Arabia, revealing both the challenges and pathways to fostering effective followership in healthcare settings. Conclusion and ImplicationsThis study reveals a widespread lack of awareness about followership among nurses in Saudi Arabia, highlighting significant challenges related to hierarchy and the undervaluation of the follower role in nursing practice and education. It underscores the need for educational and training interventions that redefine and elevate the role of followership in clinical settings to enhance collaboration, assertiveness, and decision-making skills. Moreover, the study advocates for the re-evaluation of leadership practices to better acknowledge and value followership, promoting a more flattened hierarchy that encourages active participation in patient care and organizational development. Implementing these changes could improve patient outcomes and increase nurse satisfaction by effectively addressing the identified barriers related to hierarchy and leadership.

Optimizing Telehealth: Leveraging Key Performance Indicators for Enhanced TeleHealth and Digital Healthcare Outcomes (Telemechron Study).

Over the past decade, the use of telehealth has garnered increasing attention. The focus on quality aspects has seen significant growth in tandem with the telehealth expansion. Having useful indicators in this area is becoming increasingly strategic for fully integrating the technology into the health domain. These indicators can help monitor and evaluate the quality of telehealth services, guiding improvements and ensuring that these digital solutions meet the necessary standards for effective healthcare delivery. The purpose of this study is to analyze Key performance indicators (KPIs) in telehealth within institutional websites and the scientific dissemination world by means of a narrative review. A narrative review was proposed with these two specific points of view based on a standardized checklist and a quality control procedure for including scientific papers in the analysis. Results from scientific studies emphasize KPIs such as patient outcomes, operational efficiency, technical reliability, and cost-effectiveness. These include measures like improvements in condition management, patient satisfaction, consultation numbers, waiting times, and cost savings. Institutional documents from entities like the WHO also show diverse perspectives, focusing on equitable access, clinical excellence, patient prioritization, response times, and patient and staff satisfaction. The findings suggest that adopting a comprehensive set of KPIs and continuously monitoring and evaluating telehealth services can enhance their effectiveness, efficiency, and equity, ultimately improving healthcare outcomes and accessibility.

Relationship of burnout with empathy dimensions in healthcare workers in Poland during the COVID-19 pandemic

BackgroundBurnout and empathy are distinct but related constructs essential to effective healthcare delivery. Although their relation-ship is widely acknowledged, existing research shows inconclusive findings regarding the direction and the nature of this association. The predominant evidence supports a negative correlation, but studies usually did not take into account that the empathy construct is multidimensional. Little is known about the interplay of empathy and burnout dimensions in healthcare workers (HCWs), especially during the COVID-19 pandemic times. The present study was intended to fill the above-mentioned gaps.Participants and procedureA total of 412 HCWs (nurses – 47.3%, physicians – 28.4%, psychologists – 13.6%, and other health care professionals – 10.7%), aged 21 to 69 years (M = 36.63, SD = 11.76) took part in a web-based cross-sectional study from June to November 2020. The participants filled out a survey with measures assessing two dimensions of burnout (exhaustion and disengage-ment), three dimensions of empathy (empathic concern – EC, personal distress – PD and perspective taking – PT), depres-sion and anxiety symptoms.ResultsWe found a negative association between the disengagement dimension of burnout with EC and PT and a positive associa-tion with PD, whereas exhaustion was positively related to EC and PD. Hierarchical regression analysis, however, revealed that EC, PT, and PD are predictors of disengagement, whereas exhaustion is predicted exclusively by PD. We also found no evidence that working in a place dedicated to COVID-19 moderated the relationships between dimensions of empathy and burnout.ConclusionsPrevious studies suggested a negative relationship between empathy and burnout. We found, however, evidence for both positive and negative correlations between different aspects of the empathy and burnout dimensions, with positive associa-tions of personal distress with burnout being stronger than negative associations of PT and EC with disengagement, sug-gesting that the relationship between empathy and burnout is more complex.