Domain Of Health Services Research Articles

Standardization of Dental Vulnerability Scale scores (EVO-BR)

BackgroundDental Vulnerability Scale (EVO-BR) is an instrument developed to help identifying oral health-vulnerable individuals. This scale comprises 15 items distributed into 4 dimensions. It is the first instrument with the potential to guide clinical and managerial decisions in the oral health field. The aim is to validate a score to enable using EVO-BR in Primary Health Care (PHC).MethodThe investigated sample included PHC users in five Brazilian regions. Data were collected at two different stages: in 2019 (São Paulo) and in 2022 (Minas Gerais, Mato Grosso, Roraima, Pernambuco e Paraná). Exploratory descriptive study of this scale scores was carried out to create classification ranges. Subsequently, discriminant analysis was performed to assess the accuracy of the established classification. Boosting regression was carried out to check items’ weight for the instrument score.ResultsEVO-BR score ranged from 0 (highest vulnerability) to 15 (lowest vulnerability). Four (4) classification configurations were tested. Score equal to 12 points was the one presenting the best classification of the assessed individuals (100% were correctly classified). Boosting regression has evidenced that items 1 and 2 (Overall health domain) and 14 and 15 (Health Services domain) had the strongest influence on this instrument’s score.ConclusionThe process to standardize the EVO-BR score and, consequently, to develop assessment ranges, is an important step in the fight against health inequalities, since it provides a tool to help planning actions and interventions aimed at meeting specific needs of the population in the Primary Health Care context.

Mapping models of care for children, adolescent and young adult cancer survivors: A scoping review.

e13793 Background: Young cancer survivors, with decades of life ahead, encounter substantial risks for treatment-related late effects. Achieving optimal outcomes requires a comprehensive multi-dimensional approach. This scoping review aimed to systematically map the evidence on models of survivorship care for Child (0-14) and Adolescent and Young Adult (AYA, 15-39) cancer survivors aligning with the Framework for Quality Cancer Survivorship. Methods: Conducted according to PRISMA extension for scoping reviews, this study systematically searched MEDLINE, CINAHL and Embase for English articles from Jan 2006 to Jan 2024. Inclusion criteria were studies describing patient and health service domain for Child and AYA cancer survivorship models of care. Dual processes were used for article screening, selection, and data extraction. A deductive analysis, using Content Analysis informed results, presented in a narrative synthesis. Results: Of the 5,298 records screened 38 described Child and 10 described AYA models of care. The majority were cohort and cross-sectional studies from the USA, Canada, and the UK representing 6,101 Child and 5,283 AYA cancer survivors. Across these diverse studies, a broad range of outcomes were identified with most domains of the Framework represented. No model of care described more domains than another. Across the 13 possible elements of care and outcomes, most (68%) reported on less than five of these. The domains most represented included elements of care rather than outcomes at the service level such as the clinic structure (52%), communication and decision making (52%) and patient/carer satisfaction (50%). At the patient level, quality of life outcomes and assessment and management of physical symptoms were represented in 40% of studies. There were few studies reporting on health promotion (23%), chronic conditions (13%), mortality and healthcare utilization (5% each) and none reported on costs. In terms of outcomes, oncologist long-term follow up care showed higher adherence to risk-based recommendations compared to primary care models in some studies. Other studies suggest a shared care model increases adherence and decrease lost to follow-up. At the service level, high satisfaction with care was common in all models. Overall, there was not enough to evidence to support one model over another in either Child or AYA survivorship care. Conclusions: Despite decades of research in survivorship care, there is not enough evidence about the effectiveness and efficiency of different models of care. No single model stands out as superior, and there are notable gaps in understanding the economic and value proposition of different models. Addressing these gaps is crucial for the future development, and provision of quality survivorship care tailored for this patient population.

A Two-Stage Image Frame Extraction Model -ISLKE for Live Gesture Analysis on Indian Sign Language

The new industry revolution focused on Smart and interconnected technologies along with the Robotics and Artificial Intelligence, Machine Learning, Data analytics etc. on the real time data to produce the value-added products. The ways the goods are being produced are aligned with the people’s life style which is witnessed in terms of wearable smart devices, digital assistants, self-driving cars etc. Over the last few years, an evident capturing of the true potential of Industry 4.0 in health service domain is also observed. In the same context, Sign Language Recognition- a breakthrough in the live video processing domain, helps the deaf and mute communities grab the attention of many researchers. From the research insights, it is clearly evident that precise extraction and interpretation of the gesture data along with an addressal of the prevailing limitations is a crucial task. This has driven the work to come out with a unique keyframe extraction model focusing on the preciseness of the interpretation. The proposed model ISLKE deals with a clustering-based two stage keyframe extraction process. It has experimented on daily usage vocabulary of Indian Sign Language (ISL) and attained an average accuracy of 96% in comparison to the ground-truth facts. It is also observed that with the two-stage approach, filtering of uninformative frames has reduced complexity and computational efforts. These key leads, help in the further development of commercial communication applications in order to reach the speech and hearing disorder communities.

Exploring public opinion about telehealth during COVID-19 by social media analytics

While COVID-19 catalyzed the acceptance and use of telehealth, our understanding of how it is perceived by multi-stakeholders such as patients, clinicians, and health authorities is limited. Drawing on social media analytics, this research examines social media discourses and users’ opinions about telehealth during the COVID-19 pandemic. It applies natural language processing and deep learning to explore word of mouth on telehealth with a contextualized focus on the COVID-19 pandemic. We conducted topic modeling, sentiment analysis, and emotion analysis (fearful, happy, sad, surprised, and angry emotions). The topic modeling analysis led to the identification of 18 topics, representing 6 themes of digital health service delivery, pandemic response, communication and promotion, government action, health service domains (e.g. mental health, cancer, aged care), as well as pharma and drug. The sentiment analysis revealed that while most opinions expressed in tweets were positive, the public expressed mostly negative opinions about certain aspects of COVID-19 such as lockdowns and cyberattacks. Emotion analysis of tweets showed a dominant pattern of fearful and sad emotions in particular topics. The results of this study that inductively emerged from our social media analysis can aid public health authorities and health professionals to address the concerns of telehealth users and improve their experiences.

Environmental sustainability and quality care: Not one without the other

Contributorship: N.P. and M.N. contributed equally to the inception, development and writing of this comment. There are increasing calls for attention to environmental sustainability within health systems and healthcare. This is essential given their environmental impact, their need for climate resilience and their role in managing climate-mediated conditions [1]. Quality of care, or the ‘degree to which health services for individuals and populations increase the likelihood of desired health outcomes’, is similarly a key health systems goal given the huge human suffering and mortality associated with care that is not effective, safe or people-centred [2, 3]. As health systems pursue these dual objectives, we must understand the interface between them, conceptually and operationally. Environmental sustainability and quality of care are extensively linked. As health services are scaled up in pursuit of Universal Health Coverage, it is vital that they are both high quality and sustainable. The health sector is a major polluter, generating an estimated 4.6% of global emissions [4]. Improving quality of care has potential bidirectional impacts on pollution: improving quality can reduce adverse impacts, for example, as preventative and patient safety measures reduce unnecessary hospital procedures [5]. Conversely, if quality improves without attention to environmental factors, this may increase adverse impacts on the environment, for example, as improved access to chronic disease medication increases pharmaceutical pollution [6] or as enhanced Infection Prevention and Control (IPC) increases the use of single-use personal protective equipment, especially apparent during the corona virus disease 2019 (COVID-19) pandemic [7, 8]. An increase in healthcare-mediated pollution as quality services are scaled up is not a certainty: these footprints vary considerably by country, with many countries expanding healthcare while maintaining or decreasing carbon outputs [9]. Efficiency is already a widely recognized domain of quality health services [10]; as the costs of inaction on environmental sustainability become ever more stark, the case for its inclusion as a key determinant of efficiency is clear.

The impact of organizational culture and leadership climate on organizational attractiveness and innovative behavior: a study of Norwegian hospital employees

BackgroundIn the domain of health services, little research has focused on how organizational culture, specifically internal market-oriented cultures (IMOCs), are associated with organizational climate resources, support for autonomy (SA), and whether and how IMOCs and SA are either individually or in combination related to employee perceptions of the attractiveness of the organization and their level of innovative behavior. These knowledge gaps in previous research motivated this study.MethodsA conceptual model was tested on a sample (N = 1008) of hospital employees. Partial least-squares structural equation modeling (PLS–SEM) was employed to test the conceptual models, using the SmartPLS 3 software. To test the mediator effect, a bootstrapping test was used to determine whether the direct and indirect effects were statistically significant, and when combining two tests, to determine the type of mediator effect.ResultsThe results can be summarized as four key findings: i) organizational culture (referring to an IMOC) was positively and directly related to SA (β = 0.87) and organizational attractiveness (β = 0.45); ii) SA was positively and directly related to both organizational attractiveness (β = 0.22) and employee individual innovative behavior (β = 0.37); iii) The relationships between an IMOC, SA, and employee innovative behavior were all mediated through organizational attractiveness; and iv) SA mediated the relationship between the IMOC and organizational attractiveness as well as that between the IMOC and employee innovative behavior.ConclusionsOrganizational culture, IMOC, organizational climate resources, and SA were highly correlated and necessary drivers of employee perceptions of organizational attractiveness and their innovative behavior. Managers of hospitals should consider IMOC and SA as two organizational resources that are potentially manageable and controllable. Consequently, managers should actively invest in these resources. Such investments will lead to resource capitalization that will improve both employee perceptions of organizational attractiveness as well as their innovative behavior.

Situational analysis of Forensic Mental Health in Bangladesh

Forensic Mental Health in Bangladesh is an unattended domain of mental health services. With about 17% of the population suffering from mental disorders per year and more than 80 thousand prisoners in the country, there have not been any studies to look into forensic mental health situations. This research has given an overview of the health and legal systems through qualitative research focusing on a desk review and key informant interviews. Findings show that though there are guidelines in the law and regulatory codes in the judicial systems, implementing those guidelines is not seen in many cases. There are several areas in the health system in terms of capacity, service and resources which needs to be addressed by the government for supporting the healthcare providers, lawyers, judges and mentally ill or disabled people. Our study also portrayed the current referral mechanisms connecting both legal and health systems while addressing different cases of forensic mental health. Finally, discussing the implications of the findings, we presented recommendations from our study and other literature.

Regional health care profiles \u2013 an improved method for generating case studies on the catchment areas of envisaged primary health care units in Austria: a report to the InfAct Joint Action

BackgroundThe recent Austrian Primary Care Act established new primary health care units (PHCUs) and obliged them to draw up a “care strategy” specifying their focal care tasks and objectives and emphasizing the health care needs of the population in their catchment area with its specific local health and epidemiological profile. The main purpose of these care strategies is thus to ensure that care-providers meet the local needs, but they also provide a rationale for evaluation and organizational development. To assist new PHCUs in establishing care strategies it was necessary to develop a method for automatically generating comprehensive local case studies for any freely definable location in Austria.ResultsWe designed an interactive report generator capable of producing location-specific regional health care profiles for a PHCU located in any of Austria’s 2122 municipalities and of calculating the radius of its catchment area (defined by different levels of maximum car-travelling times). The reports so generated, called “regional health care profiles for primary health care” (RHCPs/PHC), are in comprehensive PDF report format. The core of each report is a set of 35 indicators, classified under five health and health service domains. The reports include an introductory text, definitions, a map, a graphic and tabular presentation of all indicator values, including information on local, supra-regional and national value distribution, a ranking, and numbers of service providers (e.g. pharmacies, surgeries, nursing homes) located within the catchment area.ConclusionsThe RHCPs/PHC support primary health care planning, efforts to improve care-effectiveness, and strategic organizational development by providing comprehensive information on the health of the population, the utilization of health services and the health care structures within the catchment area. In addition to revealing the scope and nature of the health care needed, they also provide information on what public health approaches are necessary. RHCPs/PHC for different locations have already been distributed to numerous stakeholders and primary health care providers in Austria.

Challenges and possible solutions in cross-disciplinary and cross-sectorial research teams within the domain of e-mental health

PurposeMental illness presents a huge individual, societal and economic challenges, currently accounting for 20% of the worldwide burden of disease. There is a gap between the need for and access to services. Digital technology has been proven effective in e-mental health for preventing and treating mental health problems. However, there is a need for cross-disciplinary efforts to increase the impact of e-mental health services. This paper aims to report key challenges and possible solutions for cross-disciplinary and cross-sectorial research teams within the domain of e-mental health.Design/methodology/approachThe key challenges and possible solutions will be discussed in light of the literature on effective cross-disciplinary research teams.FindingsSix topics have been key challenges in our cross-disciplinary and cross-sectorial research team: to develop a shared understanding of the domain; to establish a common understanding of key concepts among the project participants; to involve the end-users in the research and development process; to collaborate across sectors; to ensure privacy and security of health data; and to obtain the right timing of activities according to project dependencies.Research limitations/implicationsThis study focuses to increase knowledge and training in cross-disciplinary and cross-sectorial research, as this is often referred to as an important tool when developing sustainable solutions for major societal challenges.Practical implicationsThis study needs to include theory and skills training in cross-disciplinary research in research training.Social implicationsCross-disciplinary teams have the potential to address major societal challenges, including more perspectives and more stakeholders than single disciplinary research teams.Originality/valueMajor societal challenges require complex and sustainable solutions. However, there is a lack of knowledge about how cross-disciplinary and cross-sectorial research teams may work productively to solve these challenges. This paper shares experiences regarding the challenges and possible solutions for productive collaboration in cross-disciplinary and cross-sectorial research teams within the domain of e-mental health services.

Effect of health systems context on infant and child mortality in sub-Saharan Africa from 1995 to 2015, a longitudinal cohort analysis

Each year, > 3 million children die in sub-Saharan Africa before their fifth birthday. Most deaths are preventable or avoidable through interventions delivered in the primary healthcare system. However, evidence regarding the impact of health system characteristics on child survival is sparse. We assembled a retrospective cohort of > 250,000 children in seven countries in sub-Saharan Africa. We described their health service context at the subnational level using standardized surveys and employed parametric survival models to estimate the effect of three major domains of health services—quality, access, and cost—on infant and child survival, after adjusting for child, maternal, and household characteristics. Between 1995 and 2015 we observed 13,629 deaths in infants and 5149 in children. In fully-adjusted models, the largest effect sizes were related to fees for services. Immunization fees were correlated with poor child survival (HR = 1.20, 95% CI 1.12–1.28) while delivery fees were correlated with poor infant survival (HR = 1.11, 95% CI 1.01–1.21). Accessibility of facilities and greater concentrations of private facilities were associated with improved infant and child survival. The proportion of facilities with a doctor was correlated with increased risk of death in children and infants. We quantify the impact of health service environment on survival up to five years of age. Reducing health care costs and improving the accessibility of health facilities should remain a priority for improving infant and child survival. In the absence of these fundamental investments, more specialized interventions may not achieve their desired impact.

Can a formalised model of co-production contribute to empowering indigenous communities in decisions about land use?

PurposeCo-production has been used in public services in the UK areas such as mental health to improve the participation of service users in decisions made about the services traditionally provided for them and done to them. It has also been used in areas such as mental health and to address concerns about the quality of services provided to members of minority communities. Western Australia is currently passing legislation to address the issue of aboriginal cultural heritage management in the context of recent adverse incidents such as the incident where Rio Tinto was responsible for the destruction of the site. This paper aims to show how a formalised model of co-production can assist in the implementation of this legislation.Design/methodology/approachThis paper considers how effective co-production has been within the domain of mental health services in the UK and then considers whether they are lessons that may be learnt in other contexts. It considers whether concepts from co-production have a role to play in ensuring that the legislation and its implementation are not seen as actions done to or on behalf of the aboriginal communities and if a more structured approach to coproduction can produce a model, which facilitates genuinely collaborative aboriginal heritage management.FindingsThe approach has facilitated the development of a model to monitor and improve collaboration within aboriginal cultural heritage management, which complements existing participatory approaches and enables businesses to demonstrate their legislatory compliance.Social implicationsThe study offers an approach, which may be used globally to empower indigenous communities in decision-making in other contexts, such as deforestation in South America and oil and gas exploitation on Inuit and First Nations land in Canada.Originality/valueThe use of co-production concepts and capability modelling is novel in this space.

What matters to patients? A timely question for value-based care.

BackgroundOur healthcare system is moving towards patient-centered and value-based care models that prioritize health outcomes that matter to patients. However, little is known about what aspects of care patients would prioritize when presented with choices of desirable attributes and whether these patient priorities differ based on certain demographics.ObjectiveTo assess patients’ priorities for a range of attributes in ambulatory care consultations across five key health service delivery domains and determine potential associations between patient priorities and certain demographic profiles.MethodsUsing a What Matters to You survey patients ranked in order of importance various choices related to five health service domains (patient-physician relationship, personal responsibility, test/procedures, medications, and cost). Subjects were selected from two Johns Hopkins affiliated primary care clinics and a third gastroenterology subspecialty clinic over a period of 11 months. We calculated the percentage of respondents who selected each quality as their top 1–3 choice. Univariate and multivariate analyses determined demographic characteristics associated with patient priorities.ResultsHumanistic qualities of physicians, leading a healthy lifestyle, shared decision making (SDM) for medications and tests/procedures as well as knowledge about insurance coverage were the most frequently ranked choices. Privately insured and more educated patients were less likely to rank humanistic qualities highly. Those with younger age, higher educational attainment and private insurance had higher odds of ranking healthy lifestyle as a top choice. Those with more education had higher odds of ranking SDM as a top choice.ConclusionsIdentifying what matters most to patients is useful as we move towards patient-centered and Value Based Care Models. Our findings suggest that patients have priorities on qualities they value across key health service domains. Multiple factors including patient demographics can be predictors of these priorities. Elucidating these preferences is a challenging but a valuable step in the right direction.

Laws and Policies Related to the Health of US Immigrants: A Policy Scan.

We conducted a policy scan of state and local laws and policies across the United States related to social determinants of health among immigrants. We collected all state and municipal laws and policies in 10 domains that had potential to affect immigrant health from all 50 U.S. states and the 30 most populous U.S. metropolitan statistical areas. We coded these laws and policies and created an index of restrictiveness and supportiveness of immigrants. We identified 539 state and 322 municipal laws and policies. The most common restrictive state laws and policies were in the domains of identification requirements and driver's license access. The most common supportive state laws and policies were in the domains of health services and higher education access. The most common restrictive municipal laws and policies were in the domains of identification requirements and immigration policy enforcement. The most common supportive municipal laws and policies were in the domains of immigration policy enforcement and health services access. Most states had index scores reflecting policy environments that were primarily restrictive of immigrants, indicating potential negative impacts on social determinants of health. Further research examining the impact of these on health behaviors is warranted.

Understanding ageing well in Australian rural and regional settings: Applying an age-friendly lens.

This study investigates how rural community-dwelling older adults' views on what is important in maintaining health and wellbeing align with the eight age-friendly domains proposed by the World Health Organisation, and which domains are most salient. Data were gathered through open-ended response postcards distributed using a whole-of-community approach. The Rural City of Wangaratta, a rural local government area located in north-east Victoria. 262 postcards were returned by rural older adults, carers and family members. Thematic analysis of open-ended responses to the following question: what is important to you as you grow older (or your loved one), in terms of keeping healthy and well? Even though all eight age-friendly domains were identified as important for health and wellbeing, community and health services was the most frequently discussed domain, followed by transportation and access to outdoor spaces and buildings. However, individual-level factors, inclusive of personal activities, attitudes and capacities, were also identified as important to rural older adults. Findings support the use of the World Health Organization's age-friendly city framework in assessing what is important to rural older adults' health and wellbeing, with the community and health services domain most salient. However, individual-level activities, attitudes and capacities must also be considered.

Structural challenges in the health domain of the health system reform: A qualitative study.

BACKGROUND AND AIM:Considering that the Qom University of Medical Sciences was a pioneer to implement the health system reform (HSR) in the domain of health services and the lack of a study that has addressed the challenges and strategies to promote the HSR in the health domain, this study was designed to explain the structural challenges and its solutions in the health domain of the HSR in the city of Qom, Iran, 2017.MATERIALS AND METHODS:This study was a qualitative research. The health managers, the health-care providers, and the recipients of health services referring to the health centers in Qom were the participants in this study who were selected using the convenience sampling method. The data were collected using individual interviews and with the guidance of a semi-structured questionnaire. Collected data were analyzed by the qualitative content analysis method with an inductive approach. After extracting the challenges of the HSR in the health domain through a qualitative approach, these challenges were prioritized through Delphi's technique in terms of relevance and resolving strategies.RESULTS:From the perspective of the study participants, the structural challenges of HSR in the health domain in order of importance and priority included problems due to the SIB system, defects in the instructions, the disruptions caused by multitasking, poor service coverage, incomplete health-care packages, and the shortage of resources.CONCLUSION:According to the findings of this study, we hoped that the HSR in the health area can be improved to increase its success by modifying the guidelines and the coverage of services, modifying the SIB system, providing requires resources, completing the service packages, and solving the multitasking problem.

Aboriginal life pathways through multiple human service domains; administrative data linkage for policy

Aboriginal children and families face the highest levels of disadvantage of any population group in Australia across health, education, child protection, justice and other human service domains, but longitudinal data to inform policy is scant. The Western Australian Aboriginal Child Health Survey (WAACHS) is a population representative cross-sectional child development study of over 5,000 randomly selected children aged 0-17 years, plus their families and schools, conducted between 2000 and 2002. This project seeks to leverage the WAACHS by linking the survey data for all participants with State administrative human services data registers from the previous 30+ years, to develop a major program of work in Aboriginal Human Development that would be unique in the world. This presentation describes the project history, novel survey linkage methodology, and project aims in the policy domain.

保健・医療・福祉・介護政策の「地域包括化」と社会イノベーション・パラドクス( 現代日本の社会政策の評価と将来選択-社会政策学会第121回大会共通論題)

保健・医療・福祉・介護政策の「地域包括化」と社会イノベーション・パラドクス( 現代日本の社会政策の評価と将来選択-社会政策学会第121回大会共通論題)

Comprehensive unmet needs and correlations with quality of life in Chinese cancer patients.

Increasing evidence indicates unmet supportive need as a detrimental effect on patients' well-being. However, the unmet needs and correlations with quality of life (QOL) in mainland Chinese cancer patients remain unclear. This study aimed to assess the unmet needs and QOL in Chinese cancer patients, and further explore the influencing factors. A cross-sectional descriptive study design was applied. Using a convenience sampling method, 300 cancer patients, including 176 females and 124 males were recruited from five tertiary hospitals in Xi'an city during April to July 2015. Self-administered questionnaires including general information, Comprehensive Needs Assessment Tool (CNAT) and the 36-item Short-Form Health Survey (SF-36) were used for data collection. The mean age of the participants was 52.96±13.45years. The total score of CNAT was 46.37±21.87, and the most unmet comprehensive needs were healthcare staff, information and health facilities and services domain. The total score of QOL was 48.95±18.80 and 50.35±19.77 for physical and mental QOL respectively. Multiple regression analysis revealed that age, employment status (employed), marital status (unmarried/divorced/widowed) and high needs in physical symptoms were associated with physical QOL. In addition, gender (female), marital status (unmarried/divorced/widowed), and needs in health and psychological problem and physical symptoms domains are significant factors to the mental QOL. These findings from the study provide useful information for care providers to identify and meet specific needs for cancer patients to improve QOL.

The high societal costs of childhood conduct problems: evidence from administrative records up to age 38 in a longitudinal birth cohort.

Children with conduct problems that persist into adulthood are at increased risk for future behavioral, health, and social problems. However, the longer term public service usage among these children has not been fully documented. To aid public health and intervention planning, adult service usage across criminal justice, health care, and social welfare domains is compared among all individuals from a representative cohort who followed different conduct problem trajectories from childhood into adulthood. Participants are from the Dunedin Multidisciplinary Health and Development Study, a prospective, representative cohort of consecutive births (N=1,037) from April 1972 to March 1973 in Dunedin, New Zealand. Regression analyses were used to compare levels of public service usage up to age 38, gathered via administrative and electronic medical records, between participants who displayed distinct subtypes of childhood conduct problems (low, childhood-limited, adolescent-onset, and life-course persistent). Children exhibiting life-course persistent conduct problems used significantly more services as adults than those with low levels of childhood conduct problems. Although this group comprised only 9.0% of the population, they accounted for 53.3% of all convictions, 15.7% of emergency department visits, 20.5% of prescription fills, 13.1% of injury claims, and 24.7% of welfare benefit months. Half of this group (50.0%) also accrued high service use across all three domains of criminal justice, health, and social welfare services, as compared to only 11.3% of those with low conduct problems (OR=7.27, 95% CI=4.42-12.0). Conduct problems in childhood signal high future costs in terms of service utilization across multiple sectors. Future evaluations of interventions aimed at conduct problems should also track potential reductions in health burden and service usage that stretch into midlife.

Assessment of Rehabilitation Infrastructure in Peru

ObjectiveTo assess rehabilitation infrastructure in Peru in terms of the World Health Organization (WHO) health systems building blocks. DesignAnonymous quantitative survey; questions were based on the WHO's Guidelines for Essential Trauma Care and rehabilitation professionals' input. SettingLarge public hospitals and referral centers and an online survey platform. ParticipantsConvenience sample of hospital personnel working in rehabilitation and neurology (N=239), recruited through existing contacts and professional societies. InterventionsNot applicable. Main Outcome MeasuresOutcome measures were for 4 WHO domains: health workforce, health service delivery, essential medical products and technologies, and health information systems. ResultsRegarding the domain of health workforce, 47% of physical therapists, 50% of occupational therapists, and 22% of physiatrists never see inpatients. Few reported rehabilitative nurses (15%) or prosthetist/orthotists (14%) at their hospitals. Even at the largest hospitals, most reported ≤3 occupational therapists (54%) and speech-language pathologists (70%). At hospitals without speech-language pathologists, physical therapists (49%) or nobody (34%) perform speech-language pathology roles. At hospitals without occupational therapists, physical therapists most commonly (59%) perform occupational therapy tasks. Alternate prosthetist/orthotist task performers are occupational therapists (26%), physical therapists (19%), and physicians (16%). Forty-four percent reported interdisciplinary collaboration. Regarding the domain of health services, the most frequent inpatient and outpatient rehabilitation barriers were referral delays (50%) and distance/transportation (39%), respectively. Regarding the domain of health information systems, 28% reported rehabilitation service data collection. Regarding the domain of essential medical products and technologies, electrophysical agents (88%), gyms (81%), and electromyography (76%) were most common; thickened liquids (19%), swallow studies (24%), and cognitive training tools (28%) were least frequent. ConclusionsRehabilitation emphasis is on outpatient services, and there are comparatively adequate numbers of physical therapists and physiatrists relative to rehabilitation personnel. Financial barriers seem low for accessing existing services. There appear to be shortages of inpatient rehabilitation, specialized services, and interdisciplinary collaboration. These may be addressed by redistributing personnel and investing in education and equipment for specialized services. Further examination of task sharing's role in Peru's rehabilitation services is necessary to evaluate its potential to address deficiencies.