Effective Health Service Delivery Research Articles

Gender equity and public health outcomes: The COVID-19 experience

This paper extends the growing research on the impact of gender equity on public health outcomes using the ongoing Covid-19 pandemic as its research setting. Specifically, it introduces a conceptual model incorporating the impact of gender equity and human development on women’s representation in legislature and public health expenditure, and their combined impact with human environment (population density, aging population and urban population) on important public health outcomes in the Covid-19 context, including the total number of tests, diagnosed, active and critical cases, and deaths. Data from 210 countries shows support for many of the hypothesized relationships in the conceptual model. The results provide useful insights about the factors that influence the representation of women in political systems around the world and its impact on public health outcomes. The authors also discuss implications for public health policy-makers to ensure efficient and effective delivery of public health services in future.

Utilisation of the PRECEDE-PROCEED model in community pharmacy for health needs assessment: A narrative review.

Health needs assessment tools such as the PRECEDE-PROCEED model (PPM) identify the key health concerns of communities, and may increase the capacity for community pharmacies to address these needs. A narrative review was conducted to investigate to what extent the PPM has been used to guide pharmacy service development and evaluation. A systematic search of six databases was conducted for peer-reviewed papers published from January 2000 to August 2019 that described the application of the PPM within the community pharmacy context. Search terms included variations of the following: 'pharmacists', 'precede proceed', 'pharmaceutical services', and 'community pharmacies'. Data extracted and analysed included study design, objectives, population, utilisation of the PPM, and outcomes. Fourteen eligible papers were identified, most of which were cohort or cross-sectional studies and utilised at least one element of the PPM to design or evaluate interventions that targeted either patient behaviours or pharmacist behaviours, or evaluated population health needs or programs. The range of behaviours assessed was limited to patient medication adherence, and billing behaviours, readiness for expanded scope of practice, and communication for pharmacists. None of the studies prioritised community health needs, actively engaged all relevant stakeholders, or utilised every element of the PPM. The PPM has been underutilised in community pharmacy research and represents an effective method for the assessment of health priorities for communities and the development and evaluation of health services targeted at addressing these priorities. Further research needs to demonstrate how key health needs assessment principles such as stakeholder engagement and a population-centred approach can influence effective health service delivery.

Using Apriori Algorithm to Determine Investigation Templates Specific to Intensive Care Units

Objective: The development of new technologies, the improvements in the quality of health care provision and competition among health institutions are constantly increasing the expenditures in the field of health. It has become compulsory for health institutions, with their existing financial resources, to take serious measures to meet this increasing spending in order to sustain their existence. The aim of this study is to propose test templates suitable for the patient's profile in intensive units, to help physicians in diagnosis and treatment. This will help increasing service speed as well as quality and also reducing the laboratory expenditures, an important component of health expenditures. Method: Laboratory test results, which health institutions refer to for diagnosis, are an intense and important data source of hospital information management systems. These data, when analyzed by data mining methods, can provide information to support healthcare professionals in their decisions and help the effective management of the health institutions. For this study, a data set containing examinations during the diagnosis/treatment processes and the demographic information of patients hospitalized in intensive care units in the year 2018 was created. The data set was initially analyzed with the Apriori Algorithm included in the open source WEKA program. Afterwards, laboratory tests and their rules of association suggested by the Apriori algorithm were determined. Laboratory test templates were then shaped according to the common characteristics of the medical and demographic information of the patients. Results: First of all, data including 63686 records laboratory examinations of patients hospitalized in intensive care in 2018 were prepared. Using the Apriori Algorithm, the laboratory tests for which the confidence value was greater than or equal to 0.95 and the lift values indicating the importance of the rule were large were determined. From these tests, 17 rules that match the conditions of coexistence were formed, and a new data set containing 15785 records providing the rules was created. Templates specific to intensive care units were then created according to the results of the K-mean clustering algorithm applied on the data set. Conclusion: Decision support systems, which are designed to help physicians to make more effective and correct decisions in their health care services are a part of hospital information management systems. Test templates that can be a module for these systems are defined in this study. Providing physicians with an intensive care unit specific template determined according to the patient's department and demographic characteristics will support the effective health service delivery. These templates will at the same time support the demand for rational orders be made by clinicians. This overall can reduce the laboratory test and treatment costs. Keywords: Apriori algorithm, intensive care units, laboratory tests, templates Special Issue of Health Sciences DOI: 10.7176/JSTR/6-03-08

A review of pediatric mortalities in the emergency units of Nigerian tertiary hospitals

Background: Information on causes of death is needed to assess trends in disease burden, prioritize interventions, plan for their delivery, and ascertain the effectiveness of disease-specific interventions. The aim of this study was to review the postneonatal mortality pattern in the different pediatric emergency units of the tertiary hospitals across the country, and to propose ways of strengthening the emergency units for more effective health service delivery. Materials and Methods: Available literature on mortality in pediatric emergency units across the tertiary health institutions in Nigeria was reviewed. Neonates as well as studies that combined ward admissions with emergency room admissions were excluded. Analysis was mainly descriptive and results presented using prose, tables, and charts. Results: A total of 11 studies were analyzed. The crude mortality rate was 82 per 1000 admissions. Approximately 60% of the deaths occurred within the first 24h of presentation. The major causes of death were severe malaria (17.9%), sepsis (14.5%), acute gastroenteritis (13.7%), pneumonia (8.9%), and protein-energy malnutrition (97.7%). Sepsis and severe anemia had the highest case fatality rates, with 20.0% and 19.6%, respectively. Late presentation, unconsciousness, seizure, and severe pallor were some of the identified risk factors. Conclusion: Communicable diseases remain the major cause of mortality in our emergency units. Strengthening and restructuring of the emergency units in terms of manpower and services will help in lowering the mortality rates.

Demand for health care and utility maximization model

Sağlık, toplumsal refahın merkezi ayrıca ekonomik ve sosyal gelişmenin önemli bir unsurudur. Toplumsal refah ise sağlıklı bireylerle mümkün olacağından sağlık hizmetleri toplumdaki tüm bireylere etkinlik ve eşitlik ilkesi çerçevesinde sağlanmalıdır. Dolayısıyla sağlık hizmetlerinin etkin sunumu bireyin ve toplumun sağlık düzeyinin iyileştirilmesinin yanında verimli işleyen bir sağlık sektörünü de beraberinde getirmektedir. Bu aşamada sektörün incelenmesinde etkili araçlardan olan arz ve talep unsurlarının ele alınması ve bu yönde bölgesel ve ülke çapında çalışmalar yaparak elde edilen sonuçlara göre sağlık hizmetlerinin ve kaynaklarının planlanması, sistemin düzenlenmesi, politikaların biçimlendirilmesi gerekmektedir. Ancak sağlık sektöründe incelemelerin yapılabilmesi için öncelikle talebi etkileyen faktörlerin belirlenmesi ve ortaya koyulması gerekmektedir. Dolayısıyla sağlık alanında birey ve toplum bazında maksimum iyileşme sağlayabilmek için sağlık hizmetleri talebine yönelik analizin yapılması önem arz etmektedir. Bu çalışmada öncelikle sağlık hizmetleri talebi kavramsal olarak açıklanmış daha sonra talebe yönelik geliştirilen modellerden bahsedilerek bu yönde geliştirilen fayda maksimizasyonu modeli ele alınmıştır. Bu çalışmanın amacı sağlık hizmetleri talebini ve bu yönde geliştirilen modellerden fayda maksimizasyonu modelini açıklamak ve modele yönelik literatürü inceleyerek bu konudaki çalışmalara yardımcı olmaktır.

Environmental Health Practice Challenges and Research Needs for U.S. Health Departments.

Background:Environmental health (EH) professionals, one of the largest segments of the public health workforce, are responsible for delivery of essential environmental public health services. The challenges facing these professionals and research needs to improve EH practice are not fully understood, but 26% of EH professionals working in health departments of the United States plan to retire in 5 y, while only 6% of public health students are currently pursuing EH concentrations.Objectives:A groundbreaking initiative was recently launched to understand EH practice in health departments of the United States. This commentary article aims to identify priority EH practice challenges and related research needs for health departments.Methods:A horizon scanning approach was conducted in which challenges facing EH professionals were provided by 1,736 respondents working at health departments who responded to a web-based survey fielded in November 2017. Thematic analyses of the responses and determining the frequency at which respondents reported specific issues and opportunities identified primary EH topic areas. These topic areas and related issues informed focus group discussions at an in-person workshop held in Anaheim, California. The purpose of the in-person workshop was to engage each of the topic areas and issues, through facilitated focus groups, leading to the formation of four to five related problem statements for each EH topic.Discussion:EH professionals are strategically positioned to diagnose, intervene, and prevent public health threats. Focus group engagement resulted in 29 priority problem statements partitioned among 6 EH topic areas: a) drinking water quality, b) wastewater management, c) healthy homes, d) food safety, e) vectors and public health pests, and f) emerging issues. This commentary article identifies priority challenges and related research needs to catalyze effective delivery of essential environmental public health services for common EH program areas in health departments. An unprecedented initiative to revitalize EH practice with timely and strategic recommendations for student and professional training, nontraditional partnerships, and basic and translational research activities is recommended. https://doi.org/10.1289/EHP5161

Health worker resourcing to meet universal health coverage in Africa

ABSTRACT Health workers enable service delivery by providing care to patients. Universal health coverage (UHC) aims for equitable access to decent, affordable healthcare. There are barriers in health service delivery, which will be more challenging to navigate as nations set out to achieve UHC. Africa has a major health worker shortage, limited infrastructure, is under-resourced financially and has the highest burden of disease, which constrains its ability to deliver quality, affordable, and equitable healthcare. Given the short supply, health workers must therefore be optimally resourced for effective health service delivery to impoverished, vulnerable, and underserved people particularly the most afflicted in rural communities. Motivating health workers, identifying the right skills mix and training, configuring teams, and effectively leveraging nurses and midwives for health service delivery are some key elements for optimal resourcing of the limited health workforce. As a scarce and critical resource, health workers require good management, training, infrastructure, and supplies to enable them to perform their duties. Motivated health workers will deliver quality, affordable, and equitable healthcare to advance UHC.

Bringing greater transparency to health workforce planning in Tajikistan: using the WISN approach

Abstract Background For many countries, overcoming problems related to human resources is critical for progress towards Universal Health Coverage. Planning the workforce means to make decisions on required number, qualification and distribution of health workers. In Tajikistan, despite significant reforms, the health workforce is unequally distributed with physicians being mainly specialized and concentrated in urban areas. Description Using the Tajik case, we present a first comprehensive assessment of the Primary Health Care (PHC) staffing situation in a Central Asian setting applying and critically discussing the Workload Indicators of Staffing Need (WISN) method developed by the World Health Organization. Staffing requirements were derived using annual service statistics, obtained from a re-count of monthly routine data from registration books at facility level in the year 2016. Available health cadres in PHC at district and facility level were compared to the according staffing needs. Sensitivity analysis was performed to test the robustness of the predictions, and to identify the main contributors to uncertainty in the predicted staff requirements. Results For doctors performing general tasks in the PHC, there is currently an excess of full time equivalents. Moreover, health centres are overstaffed in terms of nurse positions. If the various speciality doctors currently working at rural health centres are not included, there is a shortage of family doctors in place. Sensitivity analysis revealed that staffing requirements in the PHC sector in Tajikistan are most importantly influenced by antenatal care visits. Lessons The present study concludes that there is an oversupply of doctors and nurses at PHC and a shortage of family doctors working at the level of health centres. Consequently, a more rational health workforce planning based on well-grounded methodology such as WISN has potential to contribute to more efficient and effective health service delivery in Tajikistan. Key messages Countries shifting towards a family medicine model face challenges like an oversupply of specialists performing general medical tasks and a lack of general/family doctors in the transition phase. To identify staffing requirements a transparent and reproducible approach, such as the WISN methodology, is required to steer future staffing needs and possible re-training of current staff.

Analysis of health seeking behaviour on effective delivery of health services under capitation scheme in Kenya

Under capitation health scheme, a member freely selects a health facility from which to seek health services. There is no restriction of the number of times a member seeks health services from the facility within the contract period. This has affected delivery of health service under capitation contracting. This paper documents a quantitative analysis of the effect of health seeking behaviour on effective delivery of health services. Since human behaviour is assumed to be a natural phenomena, a philosophical view of positivism w?s ?dopted in this research. Accordingly, a scientific approach was used to deduce the influence of health seeking behaviour on the metrics of effectiveness. Out of 1152 health facilities accredited to offer primary healthcare in Kenya, data was collected from a sample of 297 health units using closed ended questionnaires. Logit regression analysis on the data revealed that congestion in out-patient department had a negative effect on quality of health services delivered but a positive effect on accessibility and affordability of the services. Increased frequency of consultation had a negative effect on all the three measures of effectiveness; quality, accessibility and affordability of health service delivery. Corresponding odds ratios were 0.173, 1.105 and 1.295 respectively.

Building resilience of health systems to climate change in Pacific Least Developed Countries: implementation science

BackgroundThe Pacific Least Developed Countries (LDCs)—Kiribati, the Solomon Islands, Tuvalu, and Vanuatu—are among the countries most vulnerable to climate variability and change. Key climate change risks include loss of livelihoods, coastal settlements, infrastructure, ecosystem services, and economic stability; and interaction of sea level rise with high-water-level events, threatening low-lying coastal areas. These risks result in increased health impacts, including deaths and injuries from extreme events (eg, heatwaves, storms, and floods); increased risks of infectious diseases (including food-borne, water-borne, and vector-borne); food insecurity and malnutrition; and diffuse impacts from loss of livelihoods and migration. The young, older adults, women of reproductive age, and people with disabilities are most vulnerable. MethodsBuilding resilience to climate change requires that these countries develop National Climate Change and Health Action Plans, including Vulnerability and Adaptation assessments. FindingsTemperature, precipitation, and extreme weather events can influence the incidence, geographic distribution, and seasonality of climate-sensitive health outcomes. In addition, many hospitals and community health centres are highly vulnerable to cyclones, floods, storm surges, sea level rise, and disturbances in water supply caused by drought or salination of aquifers. The capacity to provide health services, particularly in emergency situations, is substantially affected if buildings and essential supplies and amenities are damaged. The majority of health facilities are not resilient to climate-induced pressures in terms of structural, non-structural, and functional safety. InterpretationThe most effective measures to reduce vulnerability are (i) short-term programmes that implement and improve basic public health measures, including the provision of safe water and improved sanitation, secure essential health care, and increase capacity for disaster preparedness and response; and (ii) longer-term programs that enhance national health systems and institutions with climate change-related risks integrated into health governance, strengthen health information management systems, and ensure effective and accessible delivery of health services. FundingLeast Developed Countries Fund under the United Nations Framework Convention on Climate Change.

Commentary: A pathway forward for implementation science in the search to accelerate the delivery of effective mental health treatment and services for youth: reflections on Williams and Beidas (2019).

Over the past several decades, implementation science has emerged as a promising new field designed to reduce the gap between research and practice. One population that has not fully benefitted from recent efforts to implement evidence-based mental health treatment and services are children and adolescents. In the review by Williams and Beidas, the authors provide a thoughtful discussion on where the implementation science field has previously been within the area of child psychology and psychiatry, identified the scientific limitations of prior phases or 'waves' in the historical development of implementation science, and recommend where the field needs to go - by underscoring the importance of developing and testing multilevel, integrated causal theories and mechanism-based approaches. This commentary draws attention to the importance of the perspectives and recommendations proposed in this review, which offer the potential to generate new advances in the field of implementation science that will ultimately, improve mental health care and clinical outcomes for youth.

Service Providers' Perception of Barriers to Access Mental Health Services

Background: The literature shows that mental health services are yet not adequate and whatever is available is underutilized in India. The aim of the study was to identify the available mental health services; barriers to utilize and deliver mental health service and explore the strategies for effective delivery of mental health services. Methodology: The Expert Interview and Key Informant Interview were the methods of data collection. A standardized script for conducting the interviews was developed based on literature review and discussion with experienced qualitative researchers as per the objectives of the study. Results: The main themes identified under the study were - mental health services, services & facilities under District Mental Health Programme, mental health services in primary health centres, barriers to utilizing mental health services, policy-level barriers to provide mental health services, recommendations and suggestions from service providers to improve mental health service system. Conclusion: There are multiple barriers, which need to be addressed effectively. There is a need to create a network among all stakeholders. Keywords: Mental health service, district mental health programme, India

Government expenditure on health and maternal mortality in México: A spatial-econometric analysis.

To assess the relationship between government expenditure on maternal health (GE) and maternal mortality (MM) in Mexican poor population between 2000 and 2015 in the 2457 Mexican municipalities. Using administrative data, we performed the analysis in three stages: First, we tested the presence of selection bias in MM. Next, we assessed the presence of spatial dependence in the incidence and severity of MM. Finally, we estimated a spatial error model considering the correction of estimates for the spatial dependence and selection bias assessed before. MM and GE were not randomly distributed throughout the Mexican territory; the most socially vulnerable municipalities exhibited the highest levels of MM severity but the lowest levels of GE and available human and physical resources for maternal health; the incidence of MM was independent of GE; elasticity of GE-severity in MM was -4% (P<0.01). Resource allocation for maternal health must move towards a more comprehensive vision, and efforts to achieve an effective delivery of universal health services must improve, particularly regarding the most vulnerable municipalities.

Measuring management practices in India's district public health bureaucracy

Weak management is widely recognised as a key impediment to scaling-up coverage of health interventions and ensuring health systems are responsive to population needs. Yet there is scant evidence linking management practices in the public administration to effective health service delivery. We report on the development of a tool to measure management practices in India's district health bureaucracy. We first developed a conceptual framework based on a review of the literature and qualitative interviews with district public health managers. Across 16 management practices, we then drafted and piloted questions to be used with a scoring grid to evaluate process-orientated management practices. We implemented the tool in 34 districts of Maharashtra between April and July 2016, interviewing up to three district public health managers per district (n = 99). Using rigorous psychometric methods, we assessed the acceptability, reliability and validity of the tool. We present three key findings. First, the tool was feasible to implement, response rates were high, and there were no missing data. Second, internal consistency of the tool was high and test-retest reliability was comparable with other management tools used in the literature. Third, there was evidence of validity. The number of staff with a management qualification was positively associated with better management practices. Factor analysis showed that one principal component loaded positively on all the management practices although there was little support for management sub-scales. These findings provide novel evidence on the psychometric properties of a tool designed to measure management practices in the public administration of a developing country. Our framework and tool provide the basis to examine associations between district health management practices and health service delivery, and test the effectiveness of management strengthening interventions in India's public health sector.

Implications of Outbound Medical Tourism on Public Health Care Development in Nigeria

Medical tourism is the practice of patients travelling out of their country of origin or residence for the purpose of getting access to medical care services abroad. Outbound medical tourism is a phenomenon in Nigeria thereby contributing to the growth of the health care industry in destination countries. The paper examines the implications of outbound medical tourism on public health care development in Nigeria and reinforces the need for the Federal Government of Nigeria to restructure and reposition the health sector in the country towards effective and efficient health service delivery. The study employs secondary source of data. Public administrators and health care practitioners concerned about transforming Nigeria into a centre of medical tourist attraction may find it suitable to start by examining the issues raised in this study to initiate a good policy framework for the health sector. The study concludes that huge investment in the health sector can drastically reduce outbound medical tourism, make health care services affordable to all Nigerians and utilising foreign exchange to develop other relevant sectors of the Nigerian economy.

Best Practices in Videoconferencing-Based Telemental Health April 2018.

Telemental health, in the form of interactive videoconferencing, has become a critical tool in the delivery of mental health care. It has demonstrated the ability to increase access to and quality of care, and in some settings to do so more effectively than treatment delivered in-person. This article updates and consolidates previous guidance developed by The American Telemedicine Association (ATA) and The American Psychiatric Association (APA) on the development, implementation, administration, and provision of telemental health services. The guidance included in this article is intended to assist in the development and delivery of effective and safe telemental health services founded on expert consensus, research evidence, available resources, and patient needs. It is recommended that the material reviewed be contemplated in conjunction with APA and ATA resources, as well as the pertinent literature, for additional details on the topics covered.

Treatment for Anxiety and Depression via Clinical Videoconferencing: Evidence Base and Barriers to Expanded Access in Practice.

This review summarizes six decades of clinical outcome research relevant to evidence-based practices for depression and anxiety delivered via clinical videoconferencing. The authors conducted a literature search of previous systematic reviews and an updated search of publications specific to anxiety and depression. Overall, strong evidence supports the safety and clinical effectiveness of administering evidence-based psychotherapy for anxiety and depression via clinical videoconferencing among heterogeneous populations and age ranges, and in multiple care settings, with similar outcomes to in-person care. Despite the overall clinical effectiveness of the modality, the authors discuss common logistical and institutional barriers to long-term effective implementation. Future systems-level research is required to investigate replicable and sustainable models for implementing and expanding access to evidence-based psychotherapies via clinical videoconferencing.

‘To show or No-show’? Therapist Racial-ethnic Disparities in Clients’ Nonattendance in Therapy

ABSTRACTClients’ nonattendance in therapy poses a significant threat to the effective delivery of mental health services at university counseling centers. As such, researchers have investigated processes related to clients’ nonattendance in an effort to increase treatment utilization and treatment outcomes. However, there is a paucity of research testing the impact of the therapist on clients’ nonattendance patterns. Additionally, it is unknown whether therapists vary in the nonattendance of their racial/ethnic minority (REM) and White clients. Therefore, the present study sought to identify therapist effects in client nonattendance rates, and examine between-therapist disparities in REM and White clients’ nonattendance patterns. Data for this study consisted of 275 REM and 341 White clients seen by 21 therapists at a large university counseling center. Results indicated that therapists accounted for 14% of the variability in clients’ nonattendance. Additionally, therapist effects in nonattendance due to clients’ REM status were identified, suggesting that therapists are a significant source of racial/ethnic disparities in clients’ nonattendance. REM clients’ nonattendance rates were higher compared to White clients for some therapists, but not others. Clinical implications and future research are discussed.

Improving the efficacy of healthcare services for Aboriginal Australians.

Objective The aim of the present systematic review was to examine the enablers for effective health service delivery for Aboriginal Australians. Methods This systematic review was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Papers were included if they had data related to health services for Australian Aboriginal people and were published between 2000 and 2015. The 21 papers that met the inclusion criteria were assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Seven papers were subsequently excluded due to weak methodological approaches. Results There were two findings in the present study: (1) that Aboriginal people fare worse than non-Aboriginal people when accessing usual healthcare services; and (2) there are five enablers for effective health care services for Australian Aboriginal people: cultural competence, participation rates, organisational, clinical governance and compliance, and availability of services. Conclusions Health services for Australian Aboriginal people must be tailored and implementation of the five enablers is likely to affect the effectiveness of health services for Aboriginal people. The findings of the present study have significant implications in directing the future design, funding, delivery and evaluation of health care services for Aboriginal Australians. What is known about the topic? There is significant evidence about poor health outcomes and the 10-year gap in life expectancy between Aboriginal and non-Aboriginal people, and limited evidence about improving health service efficacy. What does this paper add? This systematic review found that with usual health care delivery, Aboriginal people experience worse health outcomes. This paper identifies five strategies in the literature that improve the effectiveness of health care services intended for Aboriginal people. What are the implications for practitioners? Aboriginal people fare worse in both experience and outcomes when they access usual care services. Health services intended for Aboriginal people should be tailored using the five enablers to provide timely, culturally safe and high-quality care.

Development of a Budget Management Model for Managers in Public Hospitals in the Limpopo Province, South Africa

Budget management remains a challenge in public hospitals with regard to the delivery of cost effective health services. This article is based on a study undertaken to develop a budget management model for managers in public hospitals in the Limpopo Province of South Africa. The question is: How can the management of the budget in public hospitals be improved? The study investigates budget management in the public hospitals. The research methodology used for this study is both quantitative and qualitative research design to generate data required to achieve its aim and objectives. The targeted population for the study was all public hospitals in the Limpopo Province, which comprises 40 public hospitals. The findings showed that, as there is improvement in budget management, much needs to be done to improve budget management in the public hospitals. In this study a budget management model is recommended for consideration by managers.