Development Of Health Care Services Research Articles

Subjective Experiences of Spanish-Speaking Patients Residing in the United States With Low English Proficiency Learning to Manage Their Diabetes: A Qualitative Study.

Language discordance is a known barrier to diabetes care in patients with type 2 diabetes. This study aimed to better understand the subjective experiences of a group of Spanish-speaking study participants with low English proficiency who were learning to manage their diabetes using a language-concordant health coaching intervention. This qualitative exploratory study used structured interview data to understand subjective experiences among participants. Thematic content analysis was conducted from a subset of health coaching phone transcripts (n = 17) performed during a language-concordant health coaching intervention study. Among the 17 participants included in the study, even with language-concordant coaching, participants had challenges in managing their diabetes care. Participants described internal and external factors, such as socioeconomic instability, that complicated their behavior changes and self-management abilities. A health coaching intervention in patients with low English proficiency can help to improve health outcomes. Findings from this study can guide the development of health care services and the management of chronic diseases in diverse populations.

Healthcare for sex workers—access, barriers, and needs

BackgroundStigma has a significant impact on the health of different societal groups and contributes to inequalities in healthcare. Sex work is associated with significant social stigma, which has detrimental effects on sex workers’ access to healthcare. This exploratory study gives first insights into the perspectives of sex workers and counselors in Germany on sex workers’ access, needs, and barriers with respect to healthcare. We focused on an established network of services for sex workers in Bochum.MethodsWe conducted in-depth guideline-based interviews with four counselors at centers that provide social and medical support for sex workers and three sex workers who use these services. Interviews were analyzed using qualitative content analysis.ResultsThe main barriers reported with respect to sex workers’ access to healthcare were health insurance, language barriers, bureaucracy, mobility, and discrimination. Sex work stigma within healthcare was reported to intersect with other forms of discrimination, such as racism. Specific needs and barriers were reported regarding mental health, which emerged as an important topic for sex workers. Free and anonymous healthcare offers were evaluated positively. Interviewees noted a lack of services that address the needs of sex workers beyond sexually transmitted infections, such as mental healthcare.ConclusionSeveral barriers to accessing healthcare remain for sex workers, many of which are particularly relevant for migrant sex workers from Eastern European countries. The development of additional antidiscriminatory healthcare services is necessary and should give priority to sex workers’ perspectives.

Adults with Perinatally Acquired HIV; Emerging Clinical Outcomes and Data Gaps.

In resourced settings, adults living with perinatally acquired HIV are approaching the 5th decade of life. Their clinical and psychological outcomes highlight potential future issues for the much larger number of adolescents growing up with HIV in sub-Saharan Africa, and will inform the development of appropriate healthcare services. Lifelong exposure to HIV, and increasingly to antiretroviral therapy throughout growth and development, contrasts with adults acquiring HIV in later life. This review describes the clinical outcomes for adults living with perinatally acquired HIV including post transition mortality, morbidity and retention in care. Rates of viral suppression, drug resistance and immunological function are explored. Co-morbidities focus on metabolic, cardiovascular, respiratory and bone health with quality-of-life data including neurocognitive functioning and mental health. Sexual and reproductive health including vaccine-preventable disease and the prevention of onward transmission to partners and infants are considered. The data gaps and future research questions to optimise outcomes for this emerging adult cohort are highlighted.

A Patient Centred Hospital at Home: A qualitative study of patient collaboration in healthcare service development

A Patient Centred Hospital at Home: A qualitative study of patient collaboration in healthcare service development

Exploring Digital Health Horizons: A Narrative Review of E-Health Innovations in Poland, Spain, Romania and Estonia.

E-health offers new opportunities for self-management, health and social care and access to health information. Over the last decade, the use of e-health solutions by patients, healthcare providers, professionals and citizens has increased significantly. This article provides an overview of e-health innovations in Poland, Spain, Romania and Estonia, focussing on the digital development of healthcare services. It outlines the concept of e-health and the innovative solutions the countries listed have introduced in this area. They all face challenges such as the cost of implementing new technologies, data access and the security of patient data. As a result, there is a constant need for coordinated collaboration, legislation and clear guidelines for the use of technology in healthcare. The lessons learnt from these countries are helping to shape the digital future of healthcare in Europe. In Poland, the Ministry of Health oversees the eHealth Centre, which has made remarkable progress in the field of eHealth services such as the Internet patient account, electronic prescriptions and electronic referrals. The biggest challenges include financing innovation and improving digital skills. Poland has also recently introduced the no-fault system as an alternative compensation system for medical errors, modelled on similar systems in Denmark and Sweden. Technological progress is driving the transformation of the Spanish healthcare system, which is particularly evident in the area of telemedicine and innovative healthcare systems. The Spanish Digital Health Strategy lines up with broader national initiatives. Despite challenges such as underfunding, Romania has introduced digital healthcare with the Health Electronic Record since 2014. As an absolute pioneer in the digitalisation of healthcare in Europe, Estonia is proud of its achievements in the digitalisation of healthcare data and services. The Estonian eHealth Foundation and the nationwide health information system are an example of seamless integration and set a benchmark for comprehensive digital healthcare.

Toxicity evaluation of processing Evodiae fructus based on intestinal microbiota.

With the development of healthcare services, drug efficacy, and safety have become the focus of drug use, and processing alters drug toxicity and efficacy, exploring the effects of processing on Evodiae fructus (EF) can guide the clinical use of drugs. Fifty male Kunming mice were randomly divided into the control group (CCN), raw small-flowered EF group (CRSEF), raw medium-flowered EF group (CRMEF), processing small-flowered EF group (CPSEF), and processing medium-flowered EF group (CPMEF). The CRSEF, CRMEF, CPSEF, and CPMEF groups were gavaged with aqueous extracts of raw small-flowered EF dry paste (RSEF), medium-flowered EF dry paste (RMEF), processing small-flowered EF dry paste (PSEF) and processing medium-flowered EF dry paste (PMEF), respectively, for 21 days at 5 times the pharmacopeial dosage. Upon concluding the experiment, histopathological sections of liver and kidney tissues were examined. Additionally, levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), serum creatinine (SCr), and blood urea nitrogen (BUN) were determined. DNA from the intestinal contents of the mice was extracted, and 16S rRNA full-length high-throughput sequencing was performed. After fed EF 21 days, mice exhibited a decreasing trend in body weight. Comparative analysis with the CCN group revealed an upward trend in SCr, BUN, AST, and ALT levels in both CRSEF and CRMEF groups. The CRMEF group displayed notably elevated BUN and AST levels, with an observed increasing trend in Scr and ALT. Kidney sections unveiled cellular edema and considerable inflammatory cell infiltrates, whereas significant liver damage was not evident. Compared with CRSEF, Bun levels were significantly lower while AST levels were significantly higher in the CPMEF group. Additionally, the intestinal microbiota diversity and the relative abundance of Psychrobacter decreased significantly, and the relative abundance of Staphylococcus, Jeotgalicoccus, and Salinicoccus increased significantly in the CPMEF group. AST, ALT, and SCr were positively correlated with Staphylococcus, Jeotgalicoccus, and Salinicoccus. In conclusion, PMEF significantly increased harmful bacteria (Staphylococcus, Jeotgalicoccus, and Salinicoccu) and decreased beneficial bacteria. SEF with 5 times the clinical dose showed nephrotoxicity and SEF nephrotoxicity decreased after processing, but EF hepatotoxicity was not significant, which may be due to insufficient dose concentration and time.

Temporal topic model for clinical pathway mining from electronic medical records

BackgroundIn recent years, the discovery of clinical pathways (CPs) from electronic medical records (EMRs) data has received increasing attention because it can directly support clinical doctors with explicit treatment knowledge, which is one of the key challenges in the development of intelligent healthcare services. However, the existing work has focused on topic probabilistic models, which usually produce treatment patterns with similar treatment activities, and such discovered treatment patterns do not take into account the temporal process of patient treatment which does not meet the needs of practical medical applications.MethodsBased on the assumption that CPs can be derived from the data of EMRs which usually record the treatment process of patients, this paper proposes a new CPs mining method from EMRs, an extended form of the traditional topic model - the temporal topic model (TTM). The method can capture the treatment topics and the corresponding treatment timestamps for each treatment day.ResultsExperimental research conducted on a real-world dataset of patients’ hospitalization processes, and the achieved results demonstrate the applicability and usefulness of the proposed methodology for CPs mining. Compared to existing benchmarks, our model shows significant improvement and robustness.ConclusionOur TTM provides a more competitive way to mine potential CPs considering the temporal features of the EMR data, providing a very prospective tool to support clinical diagnostic decisions.

The Role of Pensioner Councils in Regional Healthcare Policy: A Holistic Perspective

AbstractTo ensure older individuals actively engage in healthcare service development and policymaking, it is crucial to counteract declining social and civic participation with age. It is also necessary to clarify the potential and impact of participatory activities. This study examines citizen participation among older adults in Swedish health policy development. Using Thurston et al.‘s (2005) holistic framework, the study analyzes pensioner councils (PCs) in politically governed healthcare regions. Through 13 interviews and six years of PC meeting minutes, findings from a deductive content analysis suggest that PCs build trust and foster deeper dialogues between older adults and politicians, due to their long-term nature. A trusting relationship between citizens and decision-makers may benefit society at large by enhancing the legitimacy of policy decisions. Although achieving direct policy impact is challenging, these councils serve vital participatory and deliberative democratic functions, contributing to a stronger policy community and increased transparency in the democratic process. This study highlights the complexities of assessing PCs solely based on policy influence and immediately evident outcomes, emphasizing their role in promoting democratic values, while also drawing attention to the tension between participatory and representative democracy.

Community prevalence of psychiatric disorders: Findings from a nationwide survey in Bangladesh

ObjectiveTo determine the community prevalence of psychiatric disorders in adult population and describe the prevalence by age, men-women, urban-rural strata. MethodsA nationwide household survey was conducted in 2019 where adults aged 18 years and above were selected by a multicentric, stratified, systematic random approach. The Self-Reporting Questionnaire (SRQ) was used for screening purpose and screened positive individuals were interviewed by research psychiatrists and diagnosed according the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. ResultsOverall adult response rate for this survey was 90.4%. In total, of the 7270 adults, 1570 (21.6%) came positive on the SRQ. Overall prevalence of mental disorders found was 18.7% ((95% CI: 17.4%−20.0%). Women reported higher prevalence of psychiatric disorders than men (21.5% vs 15.7%). No significant difference was observed between urban and rural residents (18.9% vs 18.7%). Most common psychiatric disorders found were depressive disorders (6.7%), anxiety disorders (4.7%), somatic symptom and related disorders (2.3%), sleep-wake disorders (1%) and schizophrenia spectrum disorders (1%). ConclusionsThe study revealed that a substatial proportion of adults received diagnoses for psychiatric disorders. Once again, our findings emphasize the need for development of comprehensive mental healthcare services.

Enhancing Patient Satisfaction in Cross-Regional Healthcare: a Cross-Sectional Study in the Knowledge-Based Healthcare Landscape

AbstractIn the wake of China’s monumental achievement in establishing the world’s most extensive social health insurance system, encompassing 1.4 billion individuals, a unique challenge known as the “siphoning effect” has emerged. This effect involves insured individuals seeking medical care predominantly in major urban centers, straining resources and hindering local healthcare service development. A policy innovation of cross-regional direct settlement of medical outpatient expenses has been implemented nationwide to address this. However, increased population mobility and urbanization have introduced new complexities, prompting insured individuals to seek healthcare beyond their home regions. This study explores the determinants of patient satisfaction in the context of cross-regional medical treatment, adopting a comprehensive approach across six independent dimensions. Findings indicate a 70% satisfaction rate, emphasizing room for improvement, particularly in communication and service efficiency. The study reaffirms the significance of medical competence and professionalism as primary determinants of patient satisfaction, highlighting their robustness in diverse healthcare contexts. Sociodemographic factors also play a crucial role, emphasizing the need for tailored services. Also, accessible information within hospital settings proves vital in enhancing patient satisfaction. This research calls for prioritizing investments in enhancing medical competence and professionalism among healthcare staff. It underscores the importance of adapting services to cater to specific patient groups’ characteristics and the need for standardization in medical insurance policies. A patient-centered approach is crucial to ensure comprehensive and easily understandable information, ultimately enhancing overall patient satisfaction in cross-regional medical treatment within China’s evolving healthcare system. These insights contribute to a broader understanding of healthcare management and services.

Co-designing Diabetes Care With Patients.

More than 537 million adults worldwide are living with diabetes and navigating its health and lifestyle impact. People living with diabetes face unique challenges in managing their diet and exercise, monitoring their blood glucose, self-administering medications, and effectively integrating their disease into their social activities. In addition to diabetes being a challenging multifactorial disease, these challenges arise in part from patients having to navigate a complex ecosystem where sectors are siloed and its services, products, and environments are not designed with the patient in mind. To address these challenges, the ecosystem of diabetes care, including researchers, healthcare professionals, product and service developers, and policymakers, can adopt co-design methodologies providing patients and caregivers a seat at the table when creating solutions. Co-design in healthcare is an approach to problem-solving where patients are viewed as equal partners providing their own unique perspective and expertise, to design and develop devices, services, and environments. Co-design emphasizes the value of the user's insights and expertise. Incorporating patient perspective has been shown to increase patient empowerment and satisfaction, enhance healthcare technology value, and strengthen the collaboration between the patient and their interprofessional ecosystem. We describe opportunity spaces, successful examples, and strategies to better engage patients in research, policymaking, and healthcare product, service, and environment development through co-design methods. By incorporating co-design, the ecosystem of diabetes care can deliver more effective, high-quality patient-centered care, products, and services.

Exploring Frontline Shelter Staff Perspectives on the Healthcare Needs of Clients Experiencing Homelessness

ABSTRACT Purpose To examine healthcare service development needs for persons experiencing homelessness from the perspective of frontline staff at a homeless shelter in Montreal, Quebec. Design Qualitative descriptive design. Methods Purposive sampling, semi-structured interviews with frontline shelter staff (n = 8), and thematic analysis. Findings Themes included: 1) Challenges meeting healthcare service needs in a shelter environment. 2) Visions for improving healthcare services while accounting for health issues and barriers to care. 3) Participants’ own knowledge gaps around health and healthcare services. Conclusions Future research should emphasize this group’s crucial role in homelessness healthcare services development.

A rapid expansion of hospitals: the adaptation of multi-campus hospitals under the Chinese healthcare system.

In recent years, China's healthcare system has undergone significant changes to meet the increasing demands of its growing population. One notable development is the rapid expansion of hospitals, particularly the adaptation of multi-campus hospitals. These multi-campus hospitals have become increasingly popular due to the many advantages that single-campus hospitals lack, including the ability to; improve medical service quality, reduce operating costs, and facilitate the development of healthcare services in rural areas. In this study, we discuss the advantages that this type of medical facility offers and identify existing and potential problems that could hinder the development of multi-campus hospitals. Additionally, we propose appropriate solutions to mitigate these problems. Overall, we propose that there should be more communication between multi-campus hospitals and other healthcare providers.

Healthcare services efficiency and its intrinsic drivers in China: based on the three-stage super-efficiency SBM model

BackgroundThe purpose of this study is to examine the development of healthcare services efficiency in China since the reform of the healthcare system. By examining the development environment of healthcare services in China and examining the driving factors affecting the efficiency of healthcare services, we provide a reference for the future high-quality development of healthcare services in China.MethodsA three-stage super-efficient slack-based measure (SBM) model with undesirable outputs was used to measure the efficiency of healthcae services in 31 Chinese provinces from 2009 to 2021, and a global Malmquist-Luenberger (GML) index was used to assess their spatiotemporal evolution characteristics and internal influencing mechanisms of healthcare services efficiency.ResultsThe empirical results showed that the efficiency of China's healthcare services changed significantly from 2009–2014 and then remained stable. During the study period, the efficiency of healthcare services in the eastern region was higher than the national level, while it was lower in the western region. The results of the analysis of environmental factors indicated that an increase in population density reduced the redundancy of healthcare input resources and that economic development as well as an increase in government subsidies, contributed to an increase in the redundancy of healthcare input resources. The main contribution to the growth of healthcare sercices efficiency in China came from the technological innovation effect, and the growth was most significant in the western region.ConclusionFrom 2009 to 2021, the efficiency of national healthcare services generally showed a slow upward trend, and the efficiency of healthcare services varied widely among regions. Under the existing environmental constraints, relevant departments in each region should strengthen technological innovation in healthcare services, completely focus on the regional catch-up effect, and promote the balanced development of regional health.

Patient engagement in the development and delivery of healthcare services: a systematic scoping review

BackgroundPatient engagement (PE) is required to improve future healthcare services. PE in the development and delivery of healthcare services is likely to be complex but is scarcely described.ObjectivesThe objective of...

Sexual healthcare and at-home STI test collection: attitudes and preferences of transgender women in the Southeastern United States.

HIV and sexually transmitted infections (STIs) disproportionally affect transgender women in the United States, particularly in the Southeast where rates of HIV and bacterial STIs are especially high. Despite the high HIV/STI burden among transgender women, their engagement in sexual healthcare services, including HIV/STI testing, is low. Understanding reasons for this disconnect is essential in developing HIV/STI prevention efforts for this population, especially in the Southeastern US, where access to affirming sexual healthcare providers and resources is limited. We aimed to perform an exploratory qualitative study to describe the attitudes and preferences of transgender women living in Alabama with regards to sexual healthcare and at-home STI test collection. Transgender women ≥18 years old residing in Alabama were invited to participate in virtual individual in-depth interviews via Zoom. The interview guide explored participant experiences engaging with sexual healthcare services as well as preferences related to extragenital (i.e., rectal, pharyngeal) and at-home STI testing for gonorrhea and chlamydia. A trained qualitative researcher coded transcripts after each interview and iteratively amended the interview guide as themes emerged. Data were coded and thematically analyzed using NVivo qualitative software. Between June 2021-April 2022, 22 transgender women were screened and 14 eligible women enrolled. Eight participants were white (57%), and six were black (43%). Five participants (36%) were living with HIV and engaged with HIV care services. Interview themes included preference for sexual healthcare environments specializing in LGBTQ+ care, enthusiasm toward at-home STI testing, an emphasis on affirming patient-provider interactions in sexual healthcare settings, a preference for sexual healthcare providers involved in STI testing who were not cisgender men, and gender dysphoria around sexual health discussions and testing. Transgender women in the Southeastern US prioritize affirming provider-patient interactions, however resources in the region are limited. Participants were enthusiastic about at-home STI testing options, which have the potential to mitigate gender dysphoria. Further investigation into development of remote sexual healthcare services for transgender women should be performed.

Lived experience of persons with multiple sclerosis: A qualitative interview study.

Multiple sclerosis (MS) is a chronic autoimmune disease with a substantial impact on quality of life and functional capability. The prognosis of MS has changed over time due to the development of increasingly effective therapies. As the knowledge and perceptions of persons living with chronic conditions increasingly have been acknowledged, it has become important to understand lived experiences with a focus on everyday events and experiences as a way of knowing and interpreting the world. Exploring context-specific lived experiences as a source of knowledge about the disease and care may contribute to more precision in designing care services. The aim of this study was to explore the lived experience of persons living with MS in a Swedish context. A qualitative interview study was conducted with both purposeful and random sampling strategies, resulting in 10 interviews. Data were analyzed using inductive thematic content analysis. The analysis generated 4 overarching themes with 12 subthemes, the 4 themes were: perspectives on life and health, influence on everyday life, relations with healthcare, and shared healthcare processes. The themes are concerned with the patients' own perspectives and context as well as medical and healthcare-related perspectives. Patterns of shared experiences were found, for example, in the diagnosis confirmation, future perspectives, and planning and coordination. More diverse experiences appeared concerning relations with others, one's individual requirements, symptoms and consequences, and knowledge building. The findings suggest a need for a more diverse and coproduced development of healthcare services to meet diverse needs in the population with greater acknowledgement of the person's lived experience, including consideration of the complexity of the disease, personal integrity, and different ways of knowing. Findings from this study will be further explored together with other quantitative and qualitative data.

A Conceptual Framework for Evaluating National Organ Donation and Transplantation Programs.

Conceptual frameworks are valuable resources that can be used to guide the planning, evaluation, and development of healthcare services. However, there are currently no comprehensive frameworks focused on organ donation and transplantation that identify the critical factors underlying a successful national program. To address this knowledge gap, we developed a conceptual framework that takes into account all major domains of influence, including political and societal aspects as well as clinical implementation. The framework was initially constructed based on a targeted review of the relevant medical literature. Feedback provided by a panel of international experts was incorporated into the framework via an iterative process. The final framework features 16 essential domains that are critical for initiating and maintaining a successful program and improving the health of patients with organ failure. Of particular note, these domains are subject to three overarching health system principles: responsiveness, efficiency, and equity. This framework represents a first attempt to develop a whole-system view of the various factors that contribute to the success of a national program. These findings provide a useful tool that can be adapted to any jurisdiction and used to plan, evaluate, and improve organ donation and transplantation programs.

Dawr al-ṣukūk al-murtabiṭah bi al-waqf al-naqdī fī taṭwīr mu'assasat al-ri‘āyah al-ṣiḥḥīyah bi Banten

This article aims to analyze the role of Cash Waqf Linked Sukuk (CWLS) in the development of healthcare services, particularly eye health, during the Covid-19 pandemic in Indonesia. The study adopts a descriptive qualitative approach, utilizing field research that involves analyzing social facts, expert opinions, and theoretical debates. The study findings indicate that the proceeds from CWLS, managed by the Indonesian Waqf Board (BWI) as the nāẓir (trustee), were used to purchase equipment for the retina and glaucoma center and provide patient transportation at Achmad Wardi Hospital. The utilization of CWLS proceeds significantly benefited 2,162 patients with retinal and glaucoma conditions, who faced challenges in accessing medical treatment and were at risk of blindness due to regional and social mobility restrictions during the pandemic. The model of utilizing CWLS proceeds for healthcare facility development at Achmad Wardi Hospital, implemented by BWI, can be replicated by other cash waqf trustees through collaboration with healthcare entities that cater to the community's needs.

What women want: A mixed-methods study of women's health priorities, preferences, and experiences in care in three Rwandan rural districts.

To explore Rwandan women's experiences, priorities, and preferences in accessing health care for non-pregnancy-related conditions and inform development of healthcare services related to these conditions among women of reproductive age at district hospitals and health centers in Rwanda. We used a mixed-methods, exploratory sequential design. Semi-structured qualitative interviews were conducted with Rwandan women and coded thematically. A cross-sectional quantitative survey based on the qualitative data was administered to women attending health centers. Seventeen interviews and 150 surveys were conducted. Women identified conditions including back pain, gynecologic cancers, and abnormal vaginal bleeding as concerns. They generally reported positive experiences while accessing health care and knowledge of accessing health care. Barriers to care were identified, including transportation costs and inability to miss work. Women expressed a desire for more control over their care and the importance of maintaining their dignity while accessing health care. These findings provide useful insights to inform development of non-pregnancy-related healthcare services for women in Rwanda according to their priorities and preferences. The reported end-user health concerns, barriers to care, and diminished control over their care point to a need to evolve health systems around user-tailored needs and design interventions optimizing access whilst promoting dignified care.