Different Types Of Healthcare Services Research Articles

Development and validation of a subjective end-of-life health literacy scale.

Personal health literacy is the ability of an individual to find, understand, and use information and services to inform health-related decisions and actions for oneself and others. The end of life is commonly characterized by the occurrence of one or several diseases, the use of many different types of healthcare services, and a need to make complex medical decisions that may involve challenging tradeoffs, such as choices between quality and length of life. Although end-of-life care issues concern most people at some point in life, individuals' competencies to deal with those questions have rarely been explored. This study aims to introduce, develop, and validate an instrument to measure individuals' self-assessed competencies to deal with end-of-life medical situations, the Subjective End-Of-Life Health Literacy Scale (S-EOL-HLS), in a sample of older adults aged 50+ living in Switzerland who participated in wave 8 (2019/2020) of the Survey of Health, Ageing, and Retirement in Europe. The S-EOL-HLS uses a series of questions on self-rated difficulties in understanding end-of-life medical jargon, defining in advance which end-of-life medical treatments to receive or refuse, and communicating related choices. Aside from conducting exploratory and confirmatory factor analysis to evaluate the construct validity, we compared measurements from the S-EOL-HLS to respondents' general health literacy measured with the European Health Literacy Survey questionnaire. We obtained a three-factor model with acceptable fit properties (CFI = 0.993, TLI = 0.992, RMSEA = 0.083, SRMR = 0.061) and high reliability (α = 0.93). The partial associations between the health literacy scores from the two scales and respondents' sociodemographic characteristics were similar; however, individuals with higher end-of-life health literacy scores appeared to have more positive attitudes towards end-of-life care planning outcomes. The S-EOL-HLS demonstrates reliable and consistent results, making the instrument suitable for older adults in population surveys.

A New Hybrid Model for Mapping Spatial Accessibility to Healthcare Services Using Machine Learning Methods

The unequal distribution of healthcare services is the main obstacle to achieving health equity and sustainable development goals. Spatial accessibility to healthcare services is an area of interest for health planners and policymakers. In this study, we focus on the spatial accessibility to four different types of healthcare services, including hospitals, pharmacies, clinics, and medical laboratories at Isfahan’s census blocks level, in a multivariate study. Regarding the nature of spatial accessibility, machine learning unsupervised clustering methods are utilized to analyze the spatial accessibility in the city. Initially, the study area was grouped into five clusters using three unsupervised clustering methods: K-Means, agglomerative, and bisecting K-Means. Then, the intersection of the results of the methods is considered to be conclusive evidence. Finally, using the conclusive evidence, a supervised clustering method, KNN, was applied to generate the map of the spatial accessibility situation in the study area. The findings of this study show that 47%, 22%, and 31% of city blocks in the study area have rich, medium, and poor spatial accessibility, respectively. Additionally, according to the study results, the healthcare services development is structured in a linear pattern along a historical avenue, Chaharbagh. Although the scope of this study was limited in terms of the supply and demand rates, this work gives more information and spatial insights for researchers, planners, and policymakers aiming to improve accessibility to healthcare and sustainable urban development. As a recommendation for further research work, it is suggested that other influencing factors, such as the demand and supply rates, should be integrated into the method.

Exploring underutilization of skilled maternal healthcare in rural Edo, Nigeria: A qualitative study.

IntroductionExisting studies have acknowledged the underutilization of skilled maternal healthcare services among women in rural Nigeria. Consequently, women in rural areas face a disproportionate risk of poor health outcomes including maternal morbidity and mortality. Addressing the challenge of non-use of skilled maternal healthcare in rural areas necessitates the involvement of multi-stakeholders across different sectors who have vital roles to play in improving maternal health. This study explores the factors contributing to the non-use of maternal healthcare services in rural areas of Edo, Nigeria from the perspectives of community elders and policymakers.MethodsIn this qualitative study, data were collected through 10 community conversations (group discussions) with community elders each consisting of 12 to 21 participants, and six key informant interviews with policymakers in rural areas of Edo State, Nigeria. Participants were purposefully selected. Conversations and interviews occurred in English, Pidgin English and the local language; lasted for an average of 9 minutes; were audio-recorded and transcribed to English. Data were manually coded, and data analysis followed the analytical strategies for qualitative description including an iterative process of inductive and deductive approaches.ResultsPolicymakers and community elders attributed the non-use of maternal health services to poor quality of care. Notions of poor quality of care included shortages in skilled healthcare workers, apathy and abusive behaviours from healthcare providers, lack of life-saving equipment, and lack of safe skilled pregnancy care. Non-use was also attributed to women’s complex utilization patterns which involved a combination of different types of healthcare services, including traditional care. Participants also identified affordability and accessibility factors as deterrents to women’s use of skilled maternal healthcare.ConclusionThe emerging findings on pregnant women’s combined use of different types of care highlight the need to improve the quality, availability, accessibility, and affordability of skilled maternal care for rural women in Nigeria.

The location of urban healthcare services: Evidence from Phoenix Yelp reviews

AbstractThe U.S. healthcare sector is a large and important industry. However, relatively little is known about the localization and colocalization patterns of healthcare services within an urban area. By using Yelp data from over 3000 healthcare service establishments in the Phoenix area, this paper applies a recent spatial econometric technique to the analysis of healthcare services. The results reveal that spatial concentration varies across distances and types of healthcare services. Localization is more prevalent at closer distances, and general practitioners tend to be more dispersed than specialists. Colocalization with hospitals is most likely for specialists while family practices and dentistry services tend to locate away from hospitals. Different types of location patterns across different types of healthcare services are relevant for informing policies addressing healthcare access and competition in healthcare markets.

Using the Moving to Opportunity Experiment to Investigate the Long-Term Impact of Neighborhoods on Healthcare Use by Specific Clinical Conditions and Type of Service

ABSTRACT We performed a secondary analysis of the Moving to Opportunity (MTO) social experiment to investigate the impact of different types of housing assistance and neighborhood environments on long-term patterns of healthcare use for specific conditions and across different types of healthcare services. MTO participants, who were randomized at baseline, were linked to up to 21 years’ worth of all-payer hospital discharge and Medicaid data. Among the 9,170 children at the time of randomization, those who received a voucher had subsequent hospital admissions rates that were 36% lower for asthma and 30% lower for mental health disorders compared with the control group; rates of psychiatric services, outpatient hospital services, clinic services, and durable medical equipment were also lower among the voucher groups. Findings for adults were not statistically significant. The results suggest that housing policies that reduce neighborhood poverty exposure as a child are associated with lower subsequent healthcare use for specific clinical conditions and types of services.

Water, sanitation and hygiene in health facilities and how they affect health in European countries

Abstract Background Water, sanitation and hygiene (WASH) are human rights as well as important targets of the Sustainable Development Goals and a key component of quality of healthcare. Poor access to safe WASH impacts patients' health as it increases the risk of contracting infectious diseases, mental distress or avoidance of WASH services with additional negative health consequences. Global statistics show that the greatest risk exists in developing countries, while there is little data available from the WHO European Region. Our research aims at gathering an up-to-date overview of WASH data and health consequences on the example of a number of districts from four middle- and high-income countries in the European Region. Methods A mixed-methods analysis was conducted, including literature review, one-shot surveys addressing different types of healthcare services and different socio-economical settings, policy analyses, expert interviews and desk-review of health statistics. Results Preliminary results show that differences and commonalities are observed with respect to the WASH provision and management in healthcare across the considered areas in the region. While basic drinking-water is widely provided, other aspects, such as sanitation, are in need of attention both at the regulatory and implementation level. Also within countries, local differences are observed. Conditions of WASH services in health care are linked with the spread of (resistant) nosocomial infections through many different pathogens with consequences for patients, mothers and children, and for the broader population, influencing morbidity and mortality. Conclusions New insights on the condition of WASH services in healthcare facilities and increasing relevance of WASH-related health outcomes, such as antimicrobial resistance and nosocomial infections, show the need for increased attention to basic services such as sanitation and hygiene in healthcare also in European countries and for locally-targeted interventions. Key messages Water, sanitation and hygiene are a critical component of quality of health care and severely affect staff’s performance and patients’ health, with consequences for the population. Water, sanitation and hygiene need more attention in middle- and high-income countries in the WHO European Region, both at the regulatory and implementation level.

Nurses’ Experiences of Documenting the Mental Health of Older Patients in Long-Term Care

Nursing documentation is repeatedly reported to be insufficient and unsatisfactory. Although nurses should apply a holistic approach, they tend to document physical needs more often than other caring dimensions. This study aimed to describe nurses’ experiences documenting mental health in older patients receiving long-term care. Individual interviews were conducted with nine nurses and were analyzed by content analysis. One main theme, two categories and seven sub-categories emerged. The findings showed that the nurses perceived mental health as an ambiguous phenomenon that could be difficult to observe, interpret, and agree upon. Thus, the nurses were uncertain about what concepts and words corresponded to their observations. They also struggled with finding the right words to create accurate and complete documentation without breaking confidentiality or diminishing the dignity of the patient. The findings are relevant for nurses in different types of healthcare services and in the educational context to ensure comprehensive nursing documentation.

Measuring diabetes guideline adherence with claims data: systematic construction of indicators and related challenges

ObjectivesIndicators of guideline adherence are frequently used to examine the appropriateness of healthcare services. Only some potential indicators are actually usable for research with routine administrative claims data, potentially leading...

Patient and Family Involvement: A Discussion of Co-Led Redesign of Healthcare Services.

The involvement of patients and their families in the redesign of healthcare services is an important option in providing a service that addresses the patients’ needs and improves health outcomes. However, it is a resource-intensive approach, and it is currently not clear when it should be used, and what should be the reasoning behind this decision. Some health systems of international standing have created a patient engagement program as a selling point. This paper discusses how co-led redesign can be beneficial in improving health service and more effectively engaging patients. Potential barriers for patient involvement are discussed. Patient involvement can be integrated into the health system at three main levels of engagement: direct care, organizational design and governance, and policy-making. The aim of this paper is to describe how co-led redesign is compatible with different levels of patient involvement and to address the challenges in delivering a co-led redesign in healthcare. Co-led redesign not only involves the collection of quantitative data for assessing the current systems but also the collection of qualitative data through patient, family, and staff interviews to determine the barriers to patient satisfaction. Co-led redesign is a resource-rich process that requires expertise in data collection and a clinical group that is devoted to implementing recommended changes. Currently, a number of countries have utilized co-led redesign for many different types of healthcare services. Resource availability and cost, process time, and lack of outcome measures are three major limiting factors.

A systematic review on the use of healthcare services by undocumented migrants in Europe

BackgroundUndocumented migrants face particular challenges in accessing healthcare services in many European countries. The aim of this study was to systematically review the academic literature on the utilization of healthcare services by undocumented migrants in Europe.MethodsThe databases Embase, Medline, Global Health and Cinahl Plus were searched systematically to identify quantitative, qualitative and mixed methods studies published in 2007–2017.ResultsA total of 908 articles were retrieved. Deletion of duplicates left 531. After screening titles, abstracts and full texts according to pre-defined inclusion and exclusion criteria, 29 articles were included in the review. Overall, quantitative studies showed an underutilization of different types of healthcare services by undocumented migrants. Qualitative studies reported that, even when care was received, it was often inadequate or insufficient, and that many undocumented migrants were unfamiliar with their entitlements and faced barriers in utilizing healthcare services.ConclusionsAlthough it is difficult to generalize findings from the included studies due to methodological differences, they provide further evidence that undocumented migrants in Europe face particular problems in utilizing healthcare services.

The impact of frailty on healthcare utilisation in Ireland: evidence from the Irish longitudinal study on ageing

IntroductionTo examine the impact of frailty on medical and social care utilisation among the Irish community-dwelling older population to inform strategies of integrated care for older people with complex needs.MethodsParticipants aged ≥65 years from the Irish Longitudinal Study on Ageing (TILDA) representative of the Irish community-dwelling older population were analysed (n = 3507). The frailty index was used to examine patterns of utilisation across medical and social care services. Multivariate logistic and negative binomial regression models were employed to examine the impact of frailty on service utilisation outcomes after controlling for other factors.ResultsThe prevalence of frailty and pre-frailty was 24% (95% CI: 23, 26%) and 45% (95% CI: 43, 47%) respectively. Frailty was a significant predictor of utilisation of most social care and medical care services after controlling for the main correlates of frailty and observed individual effects.ConclusionsFrailty predicts utilisation of many different types of healthcare services rendering it a useful risk stratification tool for targeting strategies of integrated care. The pattern of care is predominantly medical as few of the frail older population use social care prompting questions about sub-groups of the frail older population with unmet care needs.

Healthcare managers’ perception of economies of scale

PurposeThe purpose of this paper is to explore how healthcare managers perceive economies of scale and the underlying mechanisms for how scale/size affects performance.Design/methodology/approachData were collected in 20 in-depth interviews with healthcare professionals from 13 healthcare delivery organizations and from a public authority that finances and contracts healthcare services. Data were coded and analysed using content analysis.FindingsThe study concludes that the impact of scale on performance is perceived by healthcare professionals to be different for different types of healthcare services: For surgery, significant scale effects related to spreading of fixed cost, the experience curve, and potential for process improvement. For inpatient care, moderate scale effects related to spreading of fixed costs and costs of doctors on on-call duty. For outpatient care, small or no scale effects.Research limitations/implicationsThe small sample of interviewees from a single geographical region and healthcare system limits the applicability of the findings.Originality/valueThe paper provides insights into how healthcare managers experience scale effects and how they consider economies of scale when planning hospital configuration. Also, past studies of economies of scale in hospitals proffer mixed results and the findings in this paper indicate a possible explanation for this inconclusiveness, i.e. differences in service mix between different hospitals.

The role of aggressions suffered by healthcare workers as predictors of burnout

To examine the prevalence of aggression against healthcare professionals and to determine the possible impact that violent episodes have on healthcare professionals in terms of loss of enthusiasm and involvement towards work. The objective was to analyse the percentage of occupational assault against professionals' aggression in different types of healthcare services, differentiating between physical and verbal aggression as a possible variable in detecting burnout in doctors and nursing professionals. Leiter and Maslach have explored a double process model of burnout not only based on exhaustion by overload, but also based on personal and organisational value conflicts (community, rewards or values). Moreover, Whittington has obtained conclusive results about the possible relationship between violence and burnout in mental health nurses. A retrospective study was performed in three hospitals and 22 primary care centres in Spain (n = 1·826). Through different questionnaires, we have explored the relationship between aggression suffered by healthcare workers and burnout. Eleven percent of respondents had been physically assaulted on at least one occasion, whilst 34·4% had suffered threats and intimidation on at least one occasion and 36·6% had been subjected to insults. Both forms of violence, physical and non-physical aggression, showed significant correlations with symptoms of burnout (emotional exhaustion, depersonalisation and inefficacy). The survey showed evidence of a double process: (1) by which excess workload helps predict burnout, and (2) by which a mismatch in the congruence of values, or interpersonal conflict, contributes in a meaningful way to each of the dimensions of burnout, adding overhead to the process of exhaustion-cynicism-lack of realisation. Relevance to clinical practice. Studies indicate that health professionals are some of the most exposed to disorders steaming from psychosocial risks and a high comorbidity: anxiety, depression, etc. There is a clear need for accurate instruments of evaluation to detect not only the burnout but also the areas that cause it. Professional exhaustion caused by aggression or other factors can reflect a deterioration in the healthcare relationship.

Analysis of the impact of technological innovation on healthcare services

Technological innovation is generally recognised as an important driver of performance in major service sectors. This article argues that evidence of such a relationship is much more diffuse in healthcare services. Moreover, the concept of technological innovation in healthcare is very broad when new medical equipment, new pharmaceutical products, new forms of contact with patients and new work processes are considered. Therefore, this study contributes to the identification of technological innovation in healthcare. It also explores how to evaluate the impact of technological innovation in different sectors of the healthcare industry. The resulting identification of sources of technological innovation and their relationship with different types of healthcare services may lead to a better understanding of the relationship between technological innovation and performance.