Different Levels Of Health Care Research Articles

Perspectives of Policy Makers and Service Users Concerning the Implementation of eHealth in Sweden: Interview Study.

BackgroundIncreasing life spans of populations and a growing demand for more advanced care make effective and cost-efficient provision of health care necessary. eHealth technology is often proposed, although research on barriers to and facilitators of the implementation of eHealth technology is still scarce and fragmented.ObjectiveThe aim of this study is to explore the perceptions concerning barriers to and facilitators of the implementation of eHealth among policy makers and service users and explore the ways in which their perceptions converge and differ.MethodsThis study used interview data from policy makers at different levels of health care (n=7) and service users enrolled in eHealth interventions (n=25). The analysis included separate qualitative content analyses for the 2 groups and then a second qualitative content analysis to explore differences and commonalities.ResultsImplementation barriers perceived by policy makers were that not all service users benefit from eHealth and that there is uncertainty about the impact of eHealth on the work of health care professionals. Policy makers also perceived political decision-making as complex; this included problems related to provision of technical infrastructure and lack of extra resources for health care digitalization. Facilitators were policy makers’ conviction that eHealth is what citizens want, their belief in eHealth solutions as beneficial for health care practice, and their belief in the importance of health care digitalization. Barriers for service users comprised capability limitations and varied preferences of service users and a mismatch of technology with user needs, lack of data protection, and their perception of eHealth as being more time consuming. Facilitators for service users were eHealth technology design and match with their skill set, personal feedback and staff support, a sense of privacy, a credible sender, and flexible use of time.There were several commonalities between the 2 stakeholder groups. Facilitators for both groups were the strong impetus toward technology adoption in society and expectations of time flexibility. Both groups perceived barriers in the difficulties of tailoring eHealth, and both groups expressed uncertainty about the care burden distribution. There were also differences: policy makers perceived that their decision-making was very complex and that resources for implementation were limited. Service users highlighted their need to feel that their digital data were protected and that they needed to trust the eHealth sender.ConclusionsPerceptions about barriers to and facilitators of eHealth implementation varied among stakeholders in different parts of the health care system. The study points to the need to reach an enhanced mutual understanding of priorities and overcome challenges at both the micro and macro levels of the health care system. More well-balanced decisions at the policy-maker level may lead to more effective and sustainable development and future implementation of eHealth.

Implementation of the Flexible Assertive Community Treatment (FACT) Model in Norway: eHealth Assessment Study.

BackgroundFlexible Assertive Community Treatment (FACT) is a model for treatment of long-term severe mental disorders. This method has become more widespread in Norway.ObjectiveThe objective of our study was to examine how the implementation of FACT teams in Norway has been affected by eHealth policy, infrastructure, and regulations. Another objective was to examine existing literature on eHealth interventions and challenges within FACT teams.MethodsWe have examined Norwegian policy regulating mental health services, laws and regulations, eHealth infrastructure, relevant literature on FACT teams, and current implementation of FACT in Norway.ResultsFACT teams are a wanted part of the Norwegian service system, but the current eHealth infrastructure makes sharing of data within teams and levels of health care challenging, even if eHealth regulations allow such sharing. This has been shown to be an issue in the current implementation of FACT teams in Norway. There is little or no existing research on the eHealth challenges facing FACT teams.ConclusionsWeaknesses in the Norwegian eHealth infrastructure have been a barrier for an easy implementation of FACT teams in Norway. It is difficult to share information between the different levels of health care. We need systems that allow for easy, secure sharing of health information to and between the FACT team members and other involved health care workers.

ПРАВОВИЙ СТАТУС І КВАЛІФІКАЦІЙНІ ВИМОГИ ДО ФАХІВЦІВ З НАДАННЯ РЕАБІЛІТАЦІЙНОЇ ДОПОМОГИ У СФЕРІ ОХОРОНИ ЗДОРОВ'Я

The article examines the features of the legal status of specialists in the field of rehabilitation and determines the place of rehabilitation services within the scope of health care. Rehabilitation professionals are seen as a separate category of health professionals who, on the one hand, provide care that differs in content from medical care, but on the other hand is in many cases inseparable from medical care and is provided by rehabilitation professionals along with the medical staff. The qualification requirements to rehabilitation specialists established by the legislation are determined depending on the sphere and type of rehabilitation activity. Rehabilitation workers include professionals and specialists who work on the basis of an employment contract in the field of medical and social rehabilitation, which are: doctors of physical and rehabilitation medicine, physical therapists, occupational therapists, speech and language therapists, prosthetic and orthotic specialists, psychologists, psychotherapists, physical rehabilitation nurses, assistants to physical therapists and occupational therapists. Health care reform has led to the formation of a new system of rehabilitation services, the introduction of new approaches to rehabilitation care, improving skills and other requirements for rehabilitation professionals, which should improve the quality of such care and improve the situation in health care and social protection. The procedure for providing different types of rehabilitation care, mechanisms of interaction between specialists of different specializations and specialties, responsibility for the results of the multidisciplinary rehabilitation team, detailing the conditions for providing rehabilitation care at different levels of health care and to different categories of citizens need further study. Keywords: rehabilitation services, rehabilitation assistance, specialists in the field of rehabilitation, qualification characteristics, professional activity in the field of rehabilitation

Strengthening Fetal Heart Rate Monitoring during Labor with a Standard Handheld Doppler - Implementation Experience from India.

India's neonatal and perinatal mortality is among the highest in the world. Intrapartum-related conditions contribute to a significant proportion of neonatal deaths and stillbirths. Fetal heart rate monitoring, a recommended norm to assess fetal well-bring, is not practiced as per standard guidelines in public health facilities. A standardized Doppler along with training on fetal heart rate monitoring was implemented across different levels of healthcare in three states. Facilities were selected purposively to implement the Doppler. Baseline data for 3 months were collected. Interviews of health providers and observation of labor were conducted quarterly. Data were analyzed through a comparison of baseline and intervention on a number of delivery and monitoring indicators. Among 22,579 total deliveries, monitoring frequency increased along with increase in detection of abnormal fetal heart rate (FHR) while cesarean section and stillbirths reduced slightly. Cases never monitored reduced in the District Hospitals (7.98-2.07, P < 0.01) and in Community Health Centers (14.7-1.67, P < 0.001). Stillbirth rate reduced at the medical college (3.6-1.1, P < 0.001). Interviews with providers revealed acceptance of the device due to its reliable readings. The Doppler demonstrates acceptability and serves as a useful aid to improve intrapartum FHR monitoring.

Onco-epidemiological features of head and neck tumors within the competence of the otorhinolaryngological service across the regions of the Republic of Belarus

Objective. To analyze the onco-epidemiological features of head and neck tumors within the competence of the otorhinolaryngological service across the regions of the Republic of Belarus.Materials and methods. The material for the study was data on 21,533 cases of malignant neoplasms of the head and neck (including laryngeal tumors) registered in the Belarusian Cancer Registry from 2009 to 2018.Results. Significant changes have occurred in the structure of the incidence of head and neck malignant neoplasms over the past decade. The leading positions are occupied by such tumors of visual localization as cancer of the oropharynx (14.9 %), the floor of the oral cavity (12.4 %), tonsils (11.4 %) and tongue (excluding the root of the tongue) (11.4 %), which are available for diagnosis during routine clinical examination.Conclusion. The analysis of newly diagnosed cases of malignant neoplasms depending on the localization has showed that regardless of the availability of otorhinolaryngologists and staffing levels, patients with primary manifestations of the tumor process are not timely referred to the health experts for morphological verification, which requires further organizational decisions on patient referral at different levels of health care and defining the role and scope of responsibility of subject-matter primary care specialists.

Training, Attitudes, and Practice (TAP) among healthcare professionals in the Nelson Mandela Bay municipality, South Africa: A health promotion and disease prevention perspective.

Healthcare professionals (HCPs) play a pivotal role in ensuring access to quality healthcare of patients. However, their role in health promotion (HP) and disease prevention (DP) has not been fully explored. This study aimed at determining how training, attitude, and practice (TAP) of HCPs influence their practice of HP and DP. Data on TAP regarding HP and DP were collected from 495 HCPs from twenty-three hospitals in the study area using a standardized questionnaire. Bivariate, univariate, and multivariate analyses were conducted to describe how the TAP of HCPs influence their HP and DP practices. The analysis was further desegregated at the three levels of healthcare (primary, secondary and tertiary levels). Most of the medical doctors 36.12% (n = 173), registered nurses 28.39% (n = 136), and allied health professionals (AHPs) 11.27% (n = 54) indicated the absence of coordinated HP training for staff in their facilities. Similarly, 32.93% (n = 193) of the HCPs, indicated having participated in HP or DP training. Among those that had participated in HP and DP training, benefits of training were positive behaviour, attributions, and emotional responses. When compared at the different levels of healthcare, enhanced staff satisfaction and continuing professional development for HP were statistically significant only at the tertiary healthcare level. Multivariate analysis showed a likelihood of reduced coordinated HP training for staff among medical doctors (Coef 0.15; 95% CI 0.07-0.32) and AHPs (Coef 0.24; 95% CI 0.10-0.59) compared to nurses. Furthermore, medical doctors (Coeff: 0.66; 95% CI: 0.46-0.94) were less likely to agree that HCPs should model good health behavior to render HP services as compared to nurses. Training in HP and DP empowers HCPs with the requisite knowledge and attitude necessary for effective practice. Several HCPs at different levels of care had limited knowledge of HP and DP because of inadequate training. We recommend a strategy aimed at addressing the knowledge and attitudinal gaps of HCPs to ensure effective HP and DP services to patients.

Position statement of the Latin American Dysphagia Society for the management of oropharyngeal and esophageal dysphagia during the COVID-19 pandemic

IntroducciónEl virus SARS-CoV-2, que causa la enfermedad COVID-19, se transmite por inhalación de pequeñas gotas o aerosoles e inoculación por vía oronasal u ocular, lo cual hace del manejo de la deglución para los equipos de salud un desafío, dada su proximidad al tracto aerodigestivo y la alta probabilidad de generar aerosol durante la evaluación y tratamiento de los pacientes.ObjetivoBrindar orientación esencial a los equipos de salud multidisciplinarios de Latinoamérica para la evaluación y tratamiento de la disfagia orofaríngea y esofágica en los diferentes niveles de atención en salud. Este posicionamiento fue realizado con el propósito de mantener la continuidad de los servicios médicos en el contexto de una pandemia y minimizar los riesgos de propagación y contagio del virus.MétodosCon base en la evidencia disponible y la experiencia clínica alcanzada hasta la fecha, 13 expertos en deglución convocados por la Sociedad Latinoamericana de Disfagia formularon una serie de sugerencias clínicas para el manejo de la disfagia, considerando las características de los sistemas de salud latinoamericanos.ResultadosEl posicionamiento de la Sociedad Latinoamericana de Disfagia brinda a los equipos multidisciplinarios una serie de sugerencias clínicas para el manejo de personas con disfagia orofaríngea y esofágica y ofrece lineamientos para su evaluación y tratamiento en diferentes contextos, desde la hospitalización hasta la atención domiciliaria.ConclusionesEste posicionamiento debe ser analizado por cada equipo o profesional de la salud, para reducir el riesgo de contagio por COVID-19 y lograr los mejores resultados terapéuticos, considerando siempre la realidad de cada país latinoamericano.

Occupational psychosocial stressors and mental distress among healthcare workers during COVID-19 pandemic.

ABSTRACTObjective To analyze the factors associated with mental distress among health workers who cared for patients with a suspected or confirmed diagnosis of coronavirus disease 2019 (COVID-19).Methods A cross-sectional analytical study of national scope, carried out between in the second quarter of 2020. A total of 437 health professionals, who filled out an electronic form about sociodemographic data, occupational aspects, psychosocial characteristics of work and mental distress. Multiple logistic regression was performed to analyze the covariables associated with mental distress.Results There was a predominance of workers on the nursing team (65.0%), female (71.0%), from Southeastern region of the country (68.6%) and with no morbidities (36.2%). The prevalence of mental distress was 61.6%. Job strain was reported by 24% of participants, and the perception of low support from coworkers was described by 52.9%. The final multiple regression model showed that mental distress was associated with females (odds ratio - OR: 1.93; 95%CI: 1.22-3.07), age up to 40 years (OR: 1.64; 95%CI: 1.07-2.52), weekly working hours equal or over 60 hours (OR: 1.87; 95%CI: 1.15-3.11), job strain (OR: 2.45; 95%CI: 1.41-4.40) and low support from co-workers (OR: 3.47; 95%CI: 2.26-5.38).Conclusion Six out of ten participants presented mental distress, which was associated to both individual characteristics and factors related to the work carried out during the pandemic. There is an urgent need to map services that have such characteristics, to outline actions to promote mental health and prevent emotional distress at different levels of health care.

An equity and efficiency integrated grid-to-level 2SFCA approach: spatial accessibility of multilevel healthcare

BackgroundEquity of healthcare spatial access is essential for the health outcomes of medical investments and the welfare of populations, and efficiency of medical resource allocation is important for obtaining a supply-demand equilibrium with lower cost and higher outputs with limited inputs. However, the literature that involves both equity and efficiency in its analysis of healthcare spatial allocation is rare, and the spatial accessibility of multilevel healthcare is difficult to measure by traditional methods in a large region with diversified population distribution.MethodsTo assist in solving these issues, this paper aims to build an equity and efficiency integrated analytical framework by proposing a new “GTL-2SFCA” approach to analyze the spatial accessibility of multilevel healthcare; maximum and minimum floating catchments of different levels of healthcare were assigned to ensure a combination of universal search coverage and efficient hospitalization behavior simulation.ResultsThe analytical framework was applied and tested in Hubei, China. Almost half of the residents (47.95%) and townships (44.98%) have access to both public general hospitals (PGHs) and primary healthcare centers (PHCs) services, 36.89% of the residents enjoy only one sufficient service, either PGHs or PHCs, and the remaining residents (15.16%) are faced with the risk of lacking access to both services. The results reveal that there are core-periphery effects of multilevel healthcare throughout Hubei and isolate clusters that have adequate access in the western region. The polarization effect of higher-level healthcare and the polycentric pattern of lower-level healthcare coexist. The multilevel healthcare shortage was identified in some areas in boundary and peripheral regions.ConclusionsThis study integrates equity and efficiency into the GTL-2SFCA framework, enriches the FCA series methodologies and provides a more operational solution for evaluating the access of residents in more sophisticated spatial units to each level of healthcare. By more significantly differing and quantifying the catchment area and distance decay effect, this methodology avoids overestimating or underestimating accessibility and discovers some imperceptible spatial inequities. This study has application value for researchers and decision-makers in other scenarios and regions with significant heterogeneity in medical resources and where the population has greater mobility.

COVID-19 Death in Novi Pazar - "Serbian Bergamo".

Serbia was one of the countries in Europe and the world that were most affected by the coronavirus disease 2019 (COVID-19) pandemic. City Novi Pazar was the greatest coronavirus hotspot in Europe on July 1, 2020, due to several hundred infected people. Even though united data were published at the state level, there are no data by region or city, so the interpretation of the COVID-19 epidemic in Serbia at the regional level is difficult. Different levels of health care and health education of citizens and the degree of respect for the proposed epidemiological measures have led to significant differences in the number of tests, a large number of infected, and several deaths by regions and cities. Insufficiently precise and up-to-date keeping of records and statistical data on COVID-19 at the state and local level also complicates the pandemic's scientific and epidemiological analysis. Novi Pazar is a city in southwestern Serbia with a population of 100,000. It is similar in population to the city of Bergamo, in northern Italy in the Lombardy region. As of July 1, 2020, Novi Pazar had 300% higher mortality per 100,000 population compared with the same month last year, and almost 10 times higher mortality than the rest of Serbia.

Subjective Evaluation of Health Care Services Provided at Outpatient Clinics of Different Levels of Health Care in Cairo

Subjective Evaluation of Health Care Services Provided at Outpatient Clinics of Different Levels of Health Care in Cairo

Occurrence, Antibiotic Resistance, Virulence Factors, and Genetic Diversity of Bacillus spp. from Public Hospital Environments in South Africa.

This study aimed to assess the molecular dissemination of Bacillus species in public hospitals in South Africa. The study conducted over 3 months during 2017 involved representative samples obtained from three wards (general ward, intensive care unit, and pediatric unit) from four public hospitals denoted as A (Central), B (Tertiary), C (Regional), and D (District). Swabs collected from 11 distinct hospital surfaces were screened using selective media, biochemical testing, and molecular methods. Overall, 17% (135/777) isolates were identified with a prevalence of 24% (32/135) for central, 33% (45/135) for tertiary, 27% (36/135) for regional, and 16% (22/135) for district hospital. Bacillus species were further confirmed to belong to Bacillus cereus (129/135; 96%) and Bacillus subtilis (6/135; 4%). Prevalence was similar across the wards, averaging 33.3% (45/135). The highest prevalence of Bacillus isolates was found on the drip stands (11.8%), sink (11.8%), ward phone (11.5%), and nurses' tables (10.3%). Minimum inhibitory concentration analyses revealed high resistance to β-lactams, fluoroquinolones, and tetracyclines. The most common resistance genes detected were ermB (56%) and tetM (5%). Enterotoxin virulence genes hblA (77%) and hblD (88%) associated with the diarrheal syndrome were most detected; however, no ces genes (cereulide toxin) for emetic syndrome was found. The enterobacterial repetitive intergenic consensus PCR revealed considerable diversity at the different levels of health care, although the clonal spread of strains between the sites/wards within each specific hospital was revealed. The study highlighted the dissemination of drug-resistant Bacillus spp. in public hospital environments and calls for the design of optimal strategies to curb their spread.

Strengthening Healthcare Referral Systems In Nigeria Using The Medical Referral Information Management System

The challenges faced by physicians and medical practitioners in referring patients to an appropriate healthcare provider for continuation of care, have been a major discourse in healthcare services. Most referral actions by physicians and practitioners are a mere handover of patients because of the inability of most receiving facilities to provide feedback to the initiating facility. These challenges have often led to delay in commencement of treatment and decreased collaboration between the different levels of healthcare – primary, secondary and tertiary. In this work, a system that enhances the referral process by aiding healthcare providers in establishing a connection with an appropriate healthcare provider for outpatient referrals was developed. The system enables patients establish first contact with a suitable primary healthcare provider. The methodology adopted is Object Oriented Hypermedia Design Methodology; it is one of the first methods to postulate the separation of concerns that defines its various models: requirements, conceptual, navigation, abstract interface and implementation. The system provides interfaces through which a healthcare provider can establish connection with another healthcare provider for purpose of referral. The results obtained using the system includes the recommendation of healthcare providers upon a specialty, care level and location based search request by a health provider. With the developed system, healthcare providers can easily reach nearby or far away healthcare facilities of varying specialties; this improves collaboration in healthcare services and strengthens the referral process.

Lessons learned from the COVID-19 pandemic: Why we need to invest in advanced practice nurses.

Dear Editor: In recognition of the newly gained prominence and visibility of health professionals in the fight against the COVID-19 pandemic, the World Health Organization has made 2021 the International Year of Health and Care Workers, after having designated 2020 as the International Year of the Nurse and the Midwife. Nurses are essential at the different levels of health care, following best practices, offering timely information and action in health, and coordinating and managing care and services. However, investment in nursing professionals has proven to be insufficient; efforts must be made to strengthen leadership and optimize this workforce for an effective response to the health needs of the population.

Itinerário terapêutico de pessoas com tuberculose resistente e em retratamento

Objetivo: analisar a percepção de pessoas com tuberculose sobre o itinerário terapêutico da tuberculose resistente e em retratamento. Materiais e método: pesquisa descritiva, com abordagem qualitativa, realizada com pessoas com tuberculose resistente ou em retratamento por abandono ou recidiva. Os dados foram coletados por meio de entrevistas semiestruturadas, que, depois de transcritas, foram submetidas à análise de conteúdo e, posteriormente, analisadas à luz do referencial teórico sobre itinerário terapêutico. Resultados: na percepção das pessoas com tuberculose resistente ou em retratamento, evidenciou-se o pouco entendimento sobre a doença e a recidiva, principalmente quanto à causa. No itinerário terapêutico em busca dos serviços paraatender às necessidades de saúde apontarama centralização do atendimento no serviço hospitalar. A adesão esteve remetida ao abandono do tratamento anterior, à necessidade de voltar à rotina e ao medo de transmissão para os familiares. As ações de autocuidado se relacionaram à adesão aotratamento, ao uso de equipamentos de proteção individual e à adoção de hábitos de vida mais saudáveis. Conclusões: os itinerários terapêuticos de pessoas com tuberculose aconteceram em diferentes níveis da atenção à saúde, especialmente nos centros especializados. Em cada serviço, analisaram-se diferentes experiências quanto ao entendimento sobre a doença, ao tratamento e aos diferentes sentimentos durante o percurso do tratamento. Diante disso, os profissionais necessitam fazer uso de estratégias que considerem a complexidade do uso de múltiplos medicamentos, a necessidade de monitoramento da adesão e da atenção às comorbidades.

Respiratory Tract Infection Management and Antibiotic Prescription in Children: A Unique Study Comparing Three Levels of Healthcare in The Netherlands.

Respiratory tract infections (RTIs) are common in children with febrile illness visiting the general practitioner (GP) or emergency department. We studied the management of children with fever and RTI at 3 different levels of healthcare in The Netherlands, focusing on antibiotic prescription. This prospective observational study is part of the Management and Outcome of Febrile children in Europe study. Data were used from face-to-face patient contacts of children with febrile illness in three healthcare settings in Nijmegen, The Netherlands during 2017. These settings were primary (GP), secondary (general hospital) and tertiary care (university hospital). Of 892 cases with RTI without complex comorbidities, overall antibiotic prescription rates were 29% with no differences between the 3 levels of healthcare, leading to an absolute number of 5031 prescriptions per 100,000 children per year in primary care compared with 146 in secondary and tertiary care combined. The prescription rate in otitis media was similar in all levels: 60%. In cases with lower RTI who received nebulizations prescription rates varied between 19% and 55%. Antibiotic prescription rates for RTIs in children were comparable between the 3 levels of healthcare, thus leading to a majority of antibiotics being prescribed in primary care. Relatively high prescription rates for all foci of RTIs were found, which was not in agreement with the national guidelines. Antibiotic stewardship needs improvement at all 3 levels of healthcare. Guidelines to prescribe small spectrum antibiotics for RTIs need to be better implemented in hospital care settings.

Sociodemographic profile of beneficiaries and comparative evaluation of ante natal care services under JSY at different health care delivery system

Introduction: Janani Suraksha Yojana (JSY) is a safe Motherhood intervention proposed by the Government of India to decrease the neo-natal and maternal deaths by promoting institutional delivery of babies. About 56,000 women in India die every year due to pregnancy related complications. Similarly, every year more than 13 lakh infants die within 1year of the birth. MP classified under low performing states & JSY has completed more than seven years. So, there is a need of evaluation of demographic profile of the JSY beneficiaries and antenatal services under JSY. Materials and Methods: It is a Health Care Institute based observational cross-sectional study including randomly selected 200 JSY beneficiary mothers from the different health care delivery System i.e. PHC,CHC, District Hospital & Medical College Hospital; of Rewa district, Madhya Pradesh. JSY beneficiary mothers were interviewed and data collected and analyzed using epi info 2000. Chi square test was applied to assess the association between different levels of health care and quality of services. Results: Age at marriage of JSY beneficiary mothers was seen to be gradually increasing from rural to urban area. ASHA provided ANC, TT & IFA tablets in majority of study subjects as 39 (78%) in PHC & 44 (88%) in CHC while in urban areas, ‘other than ASHA’ were also arranging such services. Increasing the level of health care system the number of ANC provided to the JSY beneficiary mothers were improved and it was statistically significant (x2=24.46, p=0.0001). It was seen that the number of ANC, number of TT & IFA tabs were provided more as shifting towards PHC Health care settings to Medical College Hospital Settings. Conclusion: JSY has definitely impacted upon the maternal and child health by providing health care to pregnant mother during ANC at different levels of Health Care Settings but uptake of JSY services are comparatively less at rural area. Keywords: JSY, ASHA, Antenatal care, IFA tablets,

Clinical, psychological and quality of life differences in fibromyalgia patients from secondary and tertiary healthcare.

The 'funnel effect' of Fibromyalgia (FM) assumes that as patients access healthcare services, they present greater severity and a more complex clinical situation than individuals with FM from the general population, but the studies comparing patients treated in different levels of healthcare are scarce. The aim of this study was to analyse the 'funnel effect' hypothesis by comparing patients from secondary and tertiary healthcare services. A cross-sectional sample of female patients was selected in secondary (rheumatology practices - RP) and in tertiary healthcare (chronic pain clinics - CPC). Information about sociodemographic, clinical and psychological characteristics was collected and health related quality of life (HRQL) was assessed. In total, 55 patients from RP and 60 patients from CPC were included in the comparison. Patients from CPC revealed a worst clinical status (higher number of tender points, medical visits and comorbidity), more somatic symptoms (pain and daytime dysfunction levels) and worst emotional status (more anxiety) than patients from RP. Patients attending CPC also revealed a worst HRQL than RP patients although this difference was mediated by the differences in clinical and psychological variables. Our study supports the 'funnel effect' hypothesis among patients of different healthcare levels, with patients from tertiary healthcare services revealing worst clinical status, more somatic and psychological symptoms, and worst HRQL than patients from secondary healthcare services. The worst clinical and psychological status and poorer quality of life in the patients from tertiary healthcare (chronic pain clinics) in relation to the patients from secondary healthcare (rheumatology practices) must be taken into account to design studies that assess any of these aspects, to a proper analysis and interpretation of the data, and to define the scope of its generalization, as data from different clinical settings are not directly comparable.

Formalization of Technological Processes for Accounting and Storage of Information in a Healthcare Institution

Introduction. To ensure the effective delivery of health services, it is important to provide accessible mechanisms for interaction between different levels of health care and patients. mHealth, eHealth and other technological developments, such as telemedicine, constitute a new digital health paradigm. The purpose of the paper is to develop the formalized components of the digital medicine integrating environment to ensure effective interaction between patients, family physicians and health care workers at various levels. Results. The general structure of information flows of the integrative environment of digital medicine is described and the formalized representation of health care business processes are developed.An analysis of the characteristics of the main actors actively involved in medical care was provided, and the access level to medical information of each participant, which is an obligatory condition, in particular in the case of mobile medicine, was determined. To ensure the storage of this information, an infologicalmodel of the database was developed, indicating the internal links between the blocks of the database. Model elements are defined for each block: classes, attributes and operations (using UML). Conclusions. Formalized representation of eHealth business processes using mHealth reflects the interaction of participants in these processes (patient and different groups of health professionals) and information flows that arise in this interaction. To ensure reliable mechanisms for the digital medical data exchange, access levels were prescribed for each participant included in the eHealth system.

Collection and use of EQ-5D for follow-up, decision-making, and quality improvement in health care - the case of the Swedish National Quality Registries

BackgroundThe Swedish National Quality Registries (NQRs) contain individual-level health care data for specific patient populations, or patients receiving specific interventions. Approximately 90% of the 105 Swedish NQRs include any patient-reported outcome measure, with EQ-5D being the most common. As there has been no general overview of EQ-5D data within the NQRs, this study fills a knowledge gap by reporting how the data are collected, presented, and used at different levels of the Swedish health care system.MethodsAll 46 NQRs with a license for the use of EQ-5D were included. Information was retrieved from the registries’ annual reports or from websites, using a template that was subsequently sent to each registry for completion and confirmation. If considered necessary, the contact was followed-up with an interview, either in-person or over the telephone. The uses of EQ-5D were categorised as denoting usage for follow-up, decision-making, or quality improvement in Swedish health care.ResultsIn total, 41 of the 46 licensed registries reported collection of EQ-5D data. EQ-5D is most commonly collected within registries related to the musculoskeletal system, but it has a wide application also in other disease areas. Thirty-six registries provide EQ-5D results to patients, clinicians, or other decision-makers. Twenty-two of the registries reported that EQ-5D data are being used for follow-up, decision-making or quality improvement. The registries most commonly reported use of data for assessing interventions, and in quality indicators to follow-up the quality of care at a national level.ConclusionCollection and use of EQ-5D data vary across the Swedish NQRs, which may partly be accounted for by the different purposes of the registries. The provided examples of use illustrate how EQ-5D data can inform decisions at different levels of the health care system. However, there is potential for improving the use of EQ-5D data.