Delivery Of Health Care Services Research Articles

Gender disparity in maintenance hemodialysis units in South India: a cross-sectional observational study.

Diseases manifest differently according to gender in many medical specialties. However, sex differences in kidney diseases have not been well explored worldwide, especially in India. These differences could also be attributed to sociocultural factors. Although CKD is more prevalent in women worldwide, most men are initiated on kidney replacement therapy (KRT). This study aimed to examine sex disparities in patients on maintenance hemodialysis. A cross-sectional observational study was conducted in two maintenance hemodialysis units at the Institute of Nephrourology, a tertiary care referral government center in Bengaluru, India. Demographic characteristics and laboratory parameters were also recorded. In total, 374 adult patients (aged >18 years) were included in the study. Most patients (72.7%) were men. Mean age in men was 46.95 ± 12.65 years, and women was 46.63 ± 13.66 years. There was no significant difference in marital status and the availability of caretakers between the groups. Spouses were the predominant caretakers for both sexes (64% men and 51% women, P = 0.14). Sons cared more for patients with mother than fathers (19.6% vs 8.8%, P = 0.074). Diabetic nephropathy was the most common cause of ESKD in both groups (33.1% vs 31.3%, P = 0.92). Men had a significantly longer duration of HTN and received more HD sessions per week than women. Mean hemoglobin (9.9 ± 1.79 vs 9.46 ± 1.47 g%) and mean serum creatinine (7.76 ± 2.65 vs 6.41 ± 2.27 mg/dl) were higher in men compared to women (P <0.002). Intradialytic complications, such as hypotension and cramps, were significantly more common in women than in men (P = 0.004). Most men (47.1%) were planning a kidney transplant (and were waitlisted) compared with fewer women (43%). There was no significant difference in the average number of hospitalizations per month or HD vintage. Women tend to initiate dialysis later, and a lesser number are waitlisted for kidney transplantation, which might be partly related to varying access to or delivery of health care services. Factors such as lack of education, insufficient identification of and strategies to address cultural obstacles to healthcare, and a shortage of financial means to afford medical care are potentially correctable elements that might explain this discrepancy.

The Wellbeing of Healthcare Workers during COVID-19 Era in Public Primary Health Facilities in Johannesburg, South Africa.

As the world grappled with the COVID-19 pandemic, healthcare workers (HCWs) continued to provide uninterrupted health care service delivery; therefore, this disproportionately affected their wellbeing. Our study explored the wellbeing of HCWs during the COVID-19 era in public health facilities in the City of Johannesburg, Gauteng province, South Africa. A qualitative study was conducted among twenty (20) HCWs through face-to-face in-depth interviews (IDIs) in the form of semi-structured interviews, audiotapes, and transcribed verbatim, and thematically analyzed with NVivo version 10. The findings showed that over half of HCWs (aged between 27 and 60 years) tested positive for COVID-19. Also, one third of HCWs' family members tested positive while some died due to COVID-19 infection. Informed by the workers' wellbeing framework, four themes emerged with fourteen sub-themes. Firstly, unsafe work environment was characterized by human resource related challenges such as increased workload; staff shortage; insufficient resources, e.g., personal protective equipment (PPE); poor policies in terms of compensation/allowance for being infected with COVID-19; poor health services; and death of colleagues. Secondly, poor health outcomes were described as strained emotional (psychosocial distress) and physical (respiratory related conditions) wellbeing. Thirdly, home and community environments were negatively impacted by interrupted relationships with family and friends, and experiences of deaths of loved ones. Finally, HCWs engaged personal wellbeing strategies through self-motivation; staying positive; family support; and participating in resilience-promoting extra mural activities to cope during the pandemic. In conclusion, the wellbeing of HCWs was aggravated during the COVID-19 era and led to low morale and compromised healthcare quality. This study advocates for promotion of greater resilience, and psychological and physical safety of HCWs through evidence-based, multilevel-multicomponent interventions at the workplace, home, and community environments in addition to strengthening public health policies and response to future pandemics.

Improving Healthcare Quality and Clinical Outcomes for Persons with Dementia in the Sub-Acute Hospital Through Person-Centered Care Practice.

Person-centered care is considered beneficial for persons with dementia. To evaluate the impact of a person-centered knowledge translation intervention on the quality of healthcare and outcomes for persons with dementia. Over nine months, sub-acute hospital nursing, allied health, and medical staff (n = 90) participated in online and/or face-to-face person-centered education and were supported by senior nursing, allied health, and medical staff champions (n = 8) to implement person-centered healthcare. The quality of healthcare service, ward climate and care delivery were evaluated pre/post study intervention. In the week following hospital admission (Time 1) and week of discharge (Time 3), agitation incidence (co-primary outcome) was assessed in participants with dementia (n = 80). Participant delirium (co-primary outcome), accidents/injuries, psychotropic medicines, length of stay, readmission and discharge destination (secondary outcomes) were compared with a retrospective group (n = 77) matched on demographics, cognition and function in activities of daily living. Improvements occurred post-intervention in service quality by 17.5% (p = 0.369, phi = 0.08), ward climate by 18.1% (p = 0.291, phi = 0.08), and care quality by 50% (p = 0.000, phi = 0.37). Participant agitation did not change from Time 1 to Time 3 (p = 0.223). Relative to the retrospective group, significant reductions occurred in participant delirium (p = 0.000, phi = 0.73), incidents/injuries (p = 0.000, phi = 0.99), psychotropic medicine use (p = 0.030, phi = 0.09), and hospital readmissions within 30 days (p = 0.002, phi = 0.25), but not in discharge to home (p = 0.171). When person-centered healthcare knowledge is translated through staff education and practice support, persons with dementia can experience improved healthcare services and clinical outcomes, while healthcare services can benefit through reductions in unplanned service use.

Challenges of Local Government in the Provision of Primary Health Care Services in Ebonyi State. Nigeria

Rural areas in Nigeria including Ebonyi State, suffer from development challenges. One of these challenges is inadequate provision of primary healthcare services to the people. This ugly condition has worsened the case of infant and maternal mortalities in Nigeria and Ebonyi State in particular and this demands urgent attention of the local governments as well as other key development partners in order to address the challenge and improve the standard of living of people at the grassroots. It is based on this that this study investigated the challenges of local government in the provision of primary healthcare services in Ebonyi State. Data were sourced from text books, journals, and internet and library materials. As a qualitative study, content and narrative techniques were adopted to analyze the study. The study revealed that minimum standards set for provision of primary healthcare service delivery have not been met in Ebonyi State; hence, local governments in the study area have not optimally contributed to reduction of infant and maternal mortalities due to certain factors which include: poor healthcare financing, dilapidated primary healthcare infrastructure, shortage of qualified healthcare personnel, corruption in the healthcare sector, and lack of broad-based data bank for beneficiaries of primary healthcare services in the area. The paper therefore recommended proper funding of primary healthcare centres in Ebonyi State in line with the international and national benchmarks. This can be achieved through increased budgetary allocations by granting financial autonomy to local governments; more hospitals and clinics should be provided to increase access to health care facilities; there is also urgent need for massive recruitment of qualified healthcare personnel in the study area to among other things improve the quality of healthcare services available to the people in the localities.

Client and provider experiences with, and approaches to sustain HIV care during the COVID-19 pandemic restrictions at two public hospitals in southwestern Uganda

IntroductionThe COVID-19 pandemic had far-reaching consequences on global health systems, disrupting the delivery of routine healthcare services, and posing new challenges to ongoing disease control efforts. In Uganda, where HIV is endemic, the pandemic threatened to reverse the gains in the country’s HIV response over the past decade. In this study, we explored the effects of the COVID-19 pandemic on the HIV cascade, focusing on the impact of pandemic-related disruptions on retention in HIV care among Persons with HIV (PWH). We further highlighted the key challenges and opportunities for mitigating the adverse effects.MethodsQualitative data were collected from January 2022 to March 2022 using in-depth interviews with PWH (n = 20) and healthcare workers (n = 4) and key informant interviews (n = 6) with healthcare managers. The interviews explored current and previous experiences with HIV care services, including experiences of healthcare providers and managers delivering and PWH receiving HIV care amidst the COVID-19 restrictions and recovery period, strategies implemented to ensure continuity of services and barriers to implementing these strategies. We coded data in Dedoose software and analyzed using the thematic analysis.ResultsThe qualitative findings highlight the effects of the COVID-19 pandemic, including restricted access to HIV care points, sub-optimal clinical management of persons with HIV, loss of livelihoods, and interruptions in adherence. Adaptations to ensure continuity of care included leveraging community-based drug delivery strategies, phone call consultations, modification of clinic workspaces, and linkages to nearby health facilities. Barriers to these adaptations included the increased cost of services, psychological challenges, fear and anxiety surrounding COVID infection, access to treatment, survival, loss to follow-up with no information on patient referral, COVID infection among health workers, depletion of drug stocks due to multi-month scripting, shortage of Personal protective equipment (PPE) supplies and other drugs.ConclusionThe COVID-19 pandemic had a significant impact on HIV care in Uganda, including reduced access to HIV care and support services, interruptions to ART adherence, and changes in HIV care delivery. Our findings highlight the barriers and enablers to HIV care delivery during the COVID-19 pandemic and lockdown and provide valuable lessons on efforts to mitigate interruptions in the future during periods of pandemics/lockdowns.

O6: Trends in the mortality, incidence, and disability-adjusted life-years of intestinal obstruction and paralytic ileus: an observational study of the Global Burden of Disease database

Abstract Background Intestinal obstruction and paralytic ileus place a substantial burden on global healthcare systems despite its aetiology often being amenable to preventative healthcare interventions. Further characterisation of the disease burden in EU15+ countries may help optimise the delivery of healthcare services. This observational analysis assessed the trends in mortality and incidence of intestinal obstruction and paralytic ileus in European Union (EU) 15+ countries between the years 1990 and 2019. Methods Sex-specific age-standardised mortality rates (ASMRs), age-standardised incidence rates (ASIRs) and disability-adjusted life years (DALYs) data for intestinal obstruction and paralytic ileus were extracted from the 2019 Global Burden of Disease (GBD) study. Temporal trends across the observation period were analysed using Joinpoint regression analysis. Results The median ASMRs across EU15+ countries in 2019 were 1.96/100,000 and 2.16/100,000 for females and males, respectively. Between 1990 and 2019 the median percentage change in ASMR was -8.11% for females and +5.50% in males. The median ASIRs in 2019 for females and males were 150/100,000 and 133/100,000, respectively, with a median percentage change of +18.7% for females and +15.3% for males during the observation period. Decreasing trends in DALYs were observed over the 30-year study period, with median percentage changes of -11.86% and -5.80% for females and males, respectively. Conclusion Overall, increasing ASIRs of intestinal obstruction/paralytic ileus were observed across EU15+ countries, with modest overall decreases in ASMRs. Variations in both diagnostic and management strategies for intestinal obstruction/paralytic ileus over the observation period are likely contributors to the changing disease burden.

TELEHEALTH FOR INDIA: A HEALTHCARE REVOLUTION

Telehealth, the delivery of healthcare services through digital communication tools, has seen significant growth in recent years. This article explores the rise of telehealth in India, its benefits, challenges, and the promising future it holds for healthcare delivery. Telehealth not only improves access to healthcare but also provides solutions to address various healthcare challenges in the country. Keywords: Healthcare Revolution, Remote Health Care, Accessibility Cost-Efficiency, digital health.

Generative AI in healthcare: an implementation science informed translational path on application, integration and governance

BackgroundArtificial intelligence (AI), particularly generative AI, has emerged as a transformative tool in healthcare, with the potential to revolutionize clinical decision-making and improve health outcomes. Generative AI, capable of generating new data such as text and images, holds promise in enhancing patient care, revolutionizing disease diagnosis and expanding treatment options. However, the utility and impact of generative AI in healthcare remain poorly understood, with concerns around ethical and medico-legal implications, integration into healthcare service delivery and workforce utilisation. Also, there is not a clear pathway to implement and integrate generative AI in healthcare delivery.MethodsThis article aims to provide a comprehensive overview of the use of generative AI in healthcare, focusing on the utility of the technology in healthcare and its translational application highlighting the need for careful planning, execution and management of expectations in adopting generative AI in clinical medicine. Key considerations include factors such as data privacy, security and the irreplaceable role of clinicians’ expertise. Frameworks like the technology acceptance model (TAM) and the Non-Adoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) model are considered to promote responsible integration. These frameworks allow anticipating and proactively addressing barriers to adoption, facilitating stakeholder participation and responsibly transitioning care systems to harness generative AI’s potential.ResultsGenerative AI has the potential to transform healthcare through automated systems, enhanced clinical decision-making and democratization of expertise with diagnostic support tools providing timely, personalized suggestions. Generative AI applications across billing, diagnosis, treatment and research can also make healthcare delivery more efficient, equitable and effective. However, integration of generative AI necessitates meticulous change management and risk mitigation strategies. Technological capabilities alone cannot shift complex care ecosystems overnight; rather, structured adoption programs grounded in implementation science are imperative.ConclusionsIt is strongly argued in this article that generative AI can usher in tremendous healthcare progress, if introduced responsibly. Strategic adoption based on implementation science, incremental deployment and balanced messaging around opportunities versus limitations helps promote safe, ethical generative AI integration. Extensive real-world piloting and iteration aligned to clinical priorities should drive development. With conscientious governance centred on human wellbeing over technological novelty, generative AI can enhance accessibility, affordability and quality of care. As these models continue advancing rapidly, ongoing reassessment and transparent communication around their strengths and weaknesses remain vital to restoring trust, realizing positive potential and, most importantly, improving patient outcomes.

Challenges to the delivery and utilisation of child healthcare services: a qualitative study of the experiences of nurses and caregivers in a rural district in Ghana

BackgroundSub-Saharan Africa has one of the poorest child health outcomes in the world. Children born in this region face significant health challenges that jeopardise their proper growth and development. Even though the utilisation of child healthcare services safeguards the health of children, the challenges encountered by nurses in the delivery of services, and caregivers in the utilisation of these services, especially in rural areas, have contributed to poor child health outcomes in this region.AimThis study explored the experiences of nurses and caregivers in respect of the nursing human resource challenges to the delivery and utilisation of child healthcare services in a rural district in Ghana.MethodsIndividual qualitative interviews were conducted with ten nurses, who rendered child healthcare services; nine caregivers, who regularly utilised the available child healthcare services; and seven caregivers, who were not regular users of these services. These participants were purposively selected for the study. Data were collected using individual semi-structured interview guides and analysed qualitatively using content analysis. Themes and sub-themes were generated during the data analysis. The Ghana Health Service Research Ethics Review Committee and the Nelson Mandela University’s Research Ethics Committee approved the study protocol prior to data collection.ResultsThree main themes emerged from the data analysis. Theme One focused on the shortage of nurses, which affected the quality and availability of child healthcare services. Theme Two focused on inexperienced nurses, who struggled to cope with the demands related to the delivery of child healthcare services. Theme Three focused on the undesirable attitude displayed by nurses, which discouraged caregivers from utilising child healthcare services.ConclusionNurses contribute significantly to the delivery of child healthcare services; hence, the inadequacies amongst nurses, in terms of staff numbers and nursing expertise, affect the quality and availability of child healthcare services. Also, caregivers’ perceptions of the quality of child healthcare services are based on the treatment they receive at the hands of nurses and other healthcare workers. In this respect, the bad attitude of nurses may disincentivise caregivers in terms of their utilisation of these services, as and when needed. There is an urgent need to comprehensively address these challenges to improve child healthcare outcomes in rural areas in Ghana. Relevant authorities should decentralise training workshops for nurses in rural areas to update their skills. Additionally, health facilities should institute proper orientation and mentoring systems to assist newly recruited nurses to acquire the requisite competences for the delivery of quality family-centred care child healthcare services.

Perceptions of Hearing Health Care: A Qualitative Analysis of Satisfied and Dissatisfied Online Reviews.

The aim of this study was to examine the hearing health care experience of satisfied and dissatisfied consumers as reported on Google reviews. Using qualitative thematic analysis, open-text responses from Google regarding hearing health care clinics across 40 U.S. cities were examined. During the original search, 13,168 reviews were identified. Purposive sampling led to a total of 8,420 five-star reviews and 321 one-star reviews. The sample consisted of 500 five-star (satisfied) and 234 one-star (dissatisfied) reviews, describing experiences with audiology clinics, excluding reviews related to ear, nose, and throat services; other medical specialties; and those not relevant to hearing health care. Satisfied and dissatisfied consumer reviews yielded nuanced dimensions of the hearing health care consumer experience, which were grouped into distinct domains, themes, and subthemes. Six and seven domains were identified from the satisfied and dissatisfied reviews, encompassing 23 and 26 themes, respectively. The overall experience domain revealed emotions ranging from contentment and gratitude to dissatisfaction and waning loyalty. The clinical outcomes domain highlights the pivotal contribution of well-being and hearing outcomes to the consumer experience, while the standard of care domain underscores shared expectations for punctuality, person-centered care, and efficient communication. Facility quality, professional competence, and inclusive care were also highlighted across positive and negative reviews. Findings indicate dimensions of satisfied and dissatisfied hearing health care consumer experiences, identifying areas for potential service refinement. These consumer experiences inform person-centric service delivery in hearing health care.

Engagement of private health care facilities in TB management in Lusaka district of Zambia: lessons learned and achievements

BackgroundGlobally, at least 3 million TB patients are missed every year. In Zambia, the TB treatment coverage increased from 66% in 2020 to 92% in 2022. Involvement of all levels of health care service delivery is critical to finding all the missing TB patients.MethodsA survey was undertaken in 15 private facilities in Lusaka district of Zambia using a structured tool administered by project team and a district health team member. Data collected during the survey was analysed and results were used to determine the type of TB services that were offered as well as barriers and enablers to TB service provision. This was followed by a set of interventions that included; training and mentorship on active case finding and systematic TB screening, increased diagnostic capacity, provision of national recording and reporting tools and provision of TB medication through linkage with the National TB program (NTP). We report findings from the baseline survey and changes in presumptive TB identification and notification following interventions.ResultsMajor barriers to TB service delivery were the high cost of TB diagnostic testing and treatment in facilities where services were not supported by the National TB program; the mean cost was 33 (SD 33) and 93 (SD 148) for GeneXpert testing and a full course of treatment respectively. Pre-intervention, presumptive TB identification appeared to increase monthly by 4 (P = 0.000, CI=[3.00–5.00]). The monthly trends of presumptive TB identification during the intervention period increased by 5.32 (P = 0.000, [CI 4.31–6.33. Pre-intervention, the notification of TB appeared to decrease every month by -4.0 (P = 0.114, CI=[-9.00-0.10]) followed by an immediate increase in notifications of 13.94 TB patients (P = 0.001, CI [6.51, 21.36] in the first month on intervention. The monthly trends of notification during the intervention period changed by 0.34 (P = 0.000 [CI 0.19–0.48]). Private facility contribution to TB notification increased from 3 to 7%.ConclusionEngagement and inclusion of private health facilities in TB service provision through a systems strengthening approach can increase contribution to TB notification by private health facilities.

Development of a Diabetes Mellitus Diagnostic System Using Self-Organizing Map Algorithm: A Machine Learning Approach

Delivery of Health care services in developing nations has posed a huge problem to the world at large. The United Nations and the World Health Organization have been on the front burner sorting for ways of improving these problems to abate the yearly mortality rates which are caused largely by inadequate health facilities, poor technical know-how, and poor health care administration. One disease that has a high number of patients is diabetes. In Nigeria, out of a population of 200 million, diabetes kills over 2% yearly. To reduce this menace, early diagnosis and awareness are important. And automation of the medical diagnostic system is one of the sure ways of achieving these feet. This paper explores the potential of a self-organizing map algorithm; a machine learning technique in the development of a diabetes mellitus diagnostic system (DMDS). Data collected from 120 patients from the University of Port Harcourt Teaching Hospital (UPTH) was used in the training and validation of the model. The confusion matrix formula was used in testing the sensitivity and accuracy of the model which yielded 75.63% and 87.2% respectively which are within the accepted range, predefined by expert physicians. Keywords Artificial Intelligence, self-organizing map, diagnosis, neural networks, diabetes mellitus

Public health insurance: An approach to mitigate the burden of diabetes in low resource settings

Background: Diabetes mellitus is a significant public health concern globally as well as in Owerri, Nigeria. The deleterious effects of diabetes have been linked to poor glycemic control. According to the International Diabetes Federation, poor glycemic control is reflected in glycosylated hemoglobin levels greater than 7.0%, which are associated with substantial morbidity and mortality. Studies have shown a dramatic rise in diabetic complications in Nigeria, particularly in Owerri. However, evidence is lacking on specific risk factors associated with poor glycemic control among diabetes mellitus patients in Owerri. There is a gap in the literature regarding the association between health insurance and glycemic control in diabetic patients in Owerri. With health insurance assuming a significant position in healthcare service delivery in Nigeria, addressing this gap is valuable. Methods: We performed a cross-sectional study of health insurance as a determinant of glycemic control among 160 type 2 diabetic patients attending the family medicine clinic at the Federal University Teaching Hospital, formerly the Federal Medical Center, Owerri. Participants were measured as not insured, insured-private, and insured-public/National Health Insurance Scheme. The dependent variable was glycemic control measured using glycosylated hemoglobin. We used ecosocial theory as the theoretical framework of this research. SPSS was used for data analysis; multiple logistic regression was applied to assess the association between insurance status and glycemic control in the participants. Results:In the patients without health insurance coverage, the prevalence of poor glycemic control was 93.8% whereas in those with health insurance coverage, the prevalence was 60.0%. Logistic regression analysis showed that lack of access to health insurance was a determinant of glycemic control, with uninsured subjects at 28 times and 6 times increased risk of poor glycemic control compared with insured-private and insured-public subjects, respectively. Conclusion: We have shown in our study that insured enrollees have an increased likelihood of good glycemic control relative to uninsured subjects. This finding has the potential to promote positive social change through optimization of the National Health Insurance Scheme. Enabling regulations and designing policies to explicitly cover diabetes preventive and control services in the scheme could lead to improved glycemic control, and, thus, reduce the burden of the disease.

Impact of the COVID-19 Pandemic on Latino Families With Alzheimer Disease and Related Dementias: Qualitative Interviews With Family Caregivers and Primary Care Providers.

Latino individuals experience disparities in the care of Alzheimer disease and related dementias (ADRD) and have disproportionately high COVID-19 infection and death outcomes. We aimed to gain an in-depth understanding of the impact of the COVID-19 pandemic among Latino families with ADRD in the United States. This was a qualitative study of 21 informal caregivers of Latino individuals with ADRD and 23 primary care providers who serve Latino patients. We recruited participants nationwide using convenience and snowball sampling methods and conducted remote interviews in English and Spanish. We organized the transcripts for qualitative review to identify codes and themes, using a pragmatic approach, a qualitative description methodology, and thematic analysis methods. Qualitative analysis of transcripts revealed eight themes, including (1) the pandemic influenced mental and emotional health; (2) the pandemic impacted physical domains of health; (3) caregivers and care recipients lost access to engaging activities during the confinement; (4) the pandemic impacted Latino caregivers' working situation; (5) the pandemic impacted health care and community care systems; (6) health care and community care systems took measures to reduce the impact of the pandemic; (7) Latino families experienced barriers to remote communication during the pandemic; and (8) caregiver social support was critical for reducing social isolation and its sequalae. Latino families with ADRD experienced similar but also unique impacts compared to those reported in the general population. Unique impacts may result from Latino individuals' underserved status in the United States, commonly held cultural values, and their intersectionality with ADRD-related disability. Family caregiver social support was crucial during this time of adversity. These findings suggest the need for more equitable access, culturally appropriate and trustworthy content and delivery of health care and community services, as well as stronger financial and social supports for family caregivers.

Web-Based Geographic Information System for Location Based Healthcare Service Delivery within Akure Metropolis

Purpose: This research project addresses the pressing issue of healthcare access within Akure Metropolis, Nigeria, through the development of a web-based Health Geoinformation System (HGS). Akure, like many urban centers in developing countries, faces significant challenges in healthcare delivery, including uneven distribution of facilities and limited access to reliable health information. In response to these challenges, this study leverages Geographical Information System (GIS) technology to create an innovative solution aimed at enhancing accessibility and information dissemination. Grounded in the context of Nigeria's healthcare system, the research identifies the need for an integrated approach to address the complex spatial dynamics of healthcare provision.&#x0D; Materials and Methods: Methodologically, the project combines primary data collection on the characteristics of health facilities in Akure with secondary data sources, including existing health records. A total of 100 healthcare facilities were located and identified for this study, with comprehensive information collected through three sets of questionnaires directed to healthcare facility managers and professionals, hospital management bodies, and the public. The data collection process employed Binary Logistic Regression to test research hypotheses, with charts utilized to represent public responses to the posed questions. Spatial representation and analysis were central to this study, with techniques such as Nearest Neighbor Analysis employed to assess the distribution and accessibility of health facilities.&#x0D; Findings: The results from this analysis revealed significant spatial patterns and disparities in healthcare facility distribution within Akure Metropolis. Notably, the study found that a developed web-based system having user-friendly functionalities like facility search, mapping, and route selection, among others, aids individuals in making informed decisions about their healthcare options.&#x0D; Implications to Theory, Practice and Policy: The results underline the potential of web-based systems to enhance healthcare access and decision-making processes in urban areas like Akure and further emphasize the significance of incorporating GIS technology into healthcare service delivery.

Community Survey of Awareness about the Knowledge of Physiotherapy Services amongst Health Care Profession Students

Physiotherapy is a health care profession. Physiotherapy plays a significant role in all levels of health. Interaction between various disciplines of medicine within a health care team is becoming recognized more and more as an effective method of improving the delivery of health care services. In order to achieve interdisciplinary teamwork, members of the health care team need to understand and respect each other’s professional abilities. It was aimed to find out the extent of knowledge about physiotherapy services among medical sciences students and to analyze the current level of awareness. 249 student’s participants were involved in the study using convenient sampling from SGT University. Students were involved from four different department viz. MBBS, BDS, BAMS, Nursing. Every student fills the structured questionnaire in the prescribed format. The data collected was analyzed by using frequency and percentage in Microsoft 2007. The respondents displayed that 63% of healthcare profession students had ‘Good’ awareness and 61% had ‘Good’ knowledge about physiotherapy. The study concluded that there is a good awareness and knowledge among health care profession students about physiotherapy. Lack of knowledge and awareness was also found which can be improved by educating them on different direction of physiotherapy to the students of health care profession. Among all the profession MBBS and BDS students are slightly more aware and have more knowledge regarding physiotherapy profession.

Analysis of patient flow and barriers to timely discharge from general medical wards at a tertiary academic hospital in Cape Town, South Africa

BackgroundMovement of patients through a health establishment is a complex activity reliant upon multi-actor co-ordination across departments. The challenge of enhancing service delivery to meet the needs of a growing and aging population, whilst minimizing expense, is a global concern. There is an urgent need to understand and quantify systemic gaps in the efficient delivery of healthcare services. Stagnation of patient flow has negative impacts on both staff and patients by increasing risks of adverse outcomes, staff frustration and job dissatisfaction. An inefficient discharge process can be a significant barrier to timely patient movement.MethodsA retrospective cohort study was conducted at a tertiary, academic hospital in the Western Cape, South Africa to assess the journey of medical patients from admission to discharge across the five different medical teams (firms) within the general medicine department. Consecutive sampling was used to capture all eligible adult medical in-patients admitted from the emergency department (ED) to general medicine from the 11th – 20th April 2023 and discharged up until the 30th of April 2023.We reviewed the patient notes (folders) of these individuals using a data-extraction tool to ascertain reasons for admission and barriers to timely discharge.ResultsAmong 86 patient folders reviewed, cumulatively accounting for 596 in-patient days, a difference in the median length of in-patient stay between medical firms (p = 0.042) was noted. The shortest length of stay corresponded to firms with the greatest proportion of daily senior staff oversight (defined as documented patient reviews by a registrar, medical officer and/or consultant independently or in addition to reviews done for the day by interns and/or students). While 52% of patients vacated their beds between 14:00 and 17:00, 66% of patients were admitted after 20:00. Reasons for prolonged admission were variable, and attributable to a range of different disciplines across the multidisciplinary team.ConclusionWhilst this study did not evaluate the appropriateness of chosen medical management but rather systemic drivers affecting patient movement and barriers to timely discharge, the delays in discharge were noted to be multi-factorial including facets across the efficient delivery of medical care, availability of resources and the internal operational frameworks for the institution. Understanding the need to optimize internal process efficiencies with regards to prompt acquisition of investigations, improvement of senior staff oversight and the creation of a standardized discharge process, could enhance efficient patient movement.

Escape Rooms in Medical Education: Unlocking Realistic Simulated Clinical Scenarios Using Interprofessional Education.

The delivery of medical education is a complex process, considering the vast nature of the syllabus, and multiple competencies are needed to be attained by medical students. Escape rooms are an innovative approach to delivering medical education and provide an enriching learning experience for students. These rooms are designed to replicate clinical scenarios, and they provide a platform for students to apply their theoretical knowledge to clinical practice. The employment of escape rooms in medical education has been linked with multiple merits for the students and helps them to attain multiple competencies. The participants in escape rooms are generally from different disciplines, and as mentioned above, it gives a chance to students from varied disciplines to acknowledge the role of each specialty and understand the need that for successful healthcare delivery, all professionals have to work as a team. In other words, these room offers a wonderful opportunity for students to come out of discipline-level segregation and work together to ensure the delivery of comprehensive healthcare services. In conclusion, escape rooms have the potential to deliver experiential and contextual learning for students from different disciplines. As healthcare delivery is a multidisciplinary approach, there is an immense need to explore the possibility of running escape rooms along with students from other disciplines and together move forward across the complexities of clinical practice.

The Effects of Central Government Financial Allocation on the Provision of Quality Maternal Health Care in Kampala City

The relationship between devolution and service delivery has been a matter of inquiry for the past three decades. This paper aimed to examine the impact of Central Government financial allocation on the quality of delivery of maternal healthcare services in Kampala City, Uganda. To achieve this, a case study design incorporating both qualitative and quantitative methods was employed. Data collection involved the use of questionnaires and interviews conducted among healthcare professionals, KCCA (Kampala Capital City Authority) staff, and mothers receiving maternal healthcare at selected public health centers. The gathered data underwent both qualitative and quantitative analyses using measures of central tendency such as mean, standard deviation, correlation, and regression analysis. The results of regression analysis indicated that Central Government financial allocation had a significant influence on the provision of quality maternal healthcare. In light of these findings, it is recommended that steps be taken to enhance Central Government financial allocation. Additionally, the administration of KCCA should consider implementing anti-corruption measures as part of their best practices. Furthermore, healthcare center leadership and KCCA leadership should prioritize effective planning, good governance, and transparency in their financial expenditure and operations.

The Nigerian Health System and mHealth Philosophy: Weighing the Balance

The appalling state of the Nigerian healthcare system has drawn a lot of attention from scholars, medical experts, and free thinkers. To these people, it is baffling why despite Nigeria’s political and economic relevance in Africa; the country suffers a great deal of health insecurity. It is against this backdrop that this paper sought to examine and ascertain the balance between the Nigerian healthcare system and the mobile health philosophy (the process whereby mobile health devices and applications are used to carry out healthcare services delivery). Relying on the descriptive survey research design and method of analysis, the study examined healthcare procedures that provide prompt mobile health services to Nigerians. It finds that although the concept of mHealth is new to Nigerians, nonetheless, both medical experts and end users have taken advantage of it to maintain good health by seeking and providing solutions to health concerns and challenges. Other outstanding challenges that hamper the mHealth philosophy in Nigeria are epileptic power supply, poor internet coverage, lack of finance to acquire mobile health devices, security of peoples’ private information and many others. The paper condemned the lack of sustainable government (Federal, State and Local) support for primary, secondary and tertiary healthcare systems in the country. It is the conclusion of the paper that despite these challenges, the benefits of mHealth remain overwhelming especially as it makes healthcare service delivery proactive and easily accessible by everyone anywhere and anytime. Therefore, it should be integrated into the policy and health care delivery system in Nigeria.