Goal Of Health Care Research Articles

ANTIFUNGAL ACTIVITY AND SYNERGISM OF Allium sativum, Zingiber officinale, AND Citrus limon peel ESSENTIAL OILS AGAINST Tinea capitis

The burden of Tinea infections, common dermatologic fungal diseases remains high globally, especially in Africa. This is sustained mainly by the emergence of resistance to current antifungal drugs in use. Alternative treatment and preventive measures need to be sought to eradicate these infections. Antifungal activity and synergism of garlic in combination with ginger and lemon peel essential oils against Tinea capitis is assessed using inhibition assays. Ginger, lemons, and garlic samples were randomly collected from the Nakuru town market in Nakuru County, Kenya. They were identified by a botanist and then extracted and, analyzed. Antifungal activity against Tinea capitis and synergism among extracts were assessed by the disk diffusion method and minimum inhibitory concentration (MIC), respectively. The average essential oil yield for ginger, lemon, and garlic was 22%, 20%, and 16%, respectively. Ginger, lemon, and garlic essential oils depicted a comparable antifungal activity against Tinea capitis isolates (P value > 0.05). The combined essential oils formulation of ginger, lemon, and garlic showed the highest activity compared to single extracts (P > 0.05). The MIC for the combined essential oils was 6.25 mg/ml. A combination of the three extracts acts in synergy against the Tinea isolates. The rate of inhibition was directly proportional to the concentration of the extracts. Ginger, lemon, and garlic are sources of molecules that act in synergy in controlling Tinea spp infections. They can be leveraged to support the Ministry of Health in achieving its universal healthcare goal.

Computer Vision Tasks for Ambient Intelligence in Children’s Health

Computer vision is a powerful tool for healthcare applications since it can provide objective diagnosis and assessment of pathologies, not depending on clinicians’ skills and experiences. It can also help speed-up population screening, reducing health care costs and improving the quality of service. Several works summarise applications and systems in medical imaging, whereas less work is devoted to surveying approaches for healthcare goals using ambient intelligence, i.e., observing individuals in natural settings. Even more, there is a lack of papers providing a survey of works exhaustively covering computer vision applications for children’s health, which is a particularly challenging research area considering that most existing computer vision technologies have been trained and tested only on adults. The aim of this paper is then to survey, for the first time in the literature, the papers covering children’s health-related issues by ambient intelligence methods and systems relying on computer vision.

Decoding speech perception from non-invasive brain recordings

Decoding speech from brain activity is a long-awaited goal in both healthcare and neuroscience. Invasive devices have recently led to major milestones in this regard: deep-learning algorithms trained on intracranial recordings can now start to decode elementary linguistic features such as letters, words and audio-spectrograms. However, extending this approach to natural speech and non-invasive brain recordings remains a major challenge. Here we introduce a model trained with contrastive learning to decode self-supervised representations of perceived speech from the non-invasive recordings of a large cohort of healthy individuals. To evaluate this approach, we curate and integrate four public datasets, encompassing 175 volunteers recorded with magneto-encephalography or electro-encephalography while they listened to short stories and isolated sentences. The results show that our model can identify, from 3 seconds of magneto-encephalography signals, the corresponding speech segment with up to 41% accuracy out of more than 1,000 distinct possibilities on average across participants, and with up to 80% in the best participants—a performance that allows the decoding of words and phrases absent from the training set. The comparison of our model with a variety of baselines highlights the importance of a contrastive objective, pretrained representations of speech and a common convolutional architecture simultaneously trained across multiple participants. Finally, the analysis of the decoder’s predictions suggests that they primarily depend on lexical and contextual semantic representations. Overall, this effective decoding of perceived speech from non-invasive recordings delineates a promising path to decode language from brain activity, without putting patients at risk of brain surgery.

Machine learning identifies a COVID-19-specific phenotype in university students using a mental health app

BackgroundAdvances in smartphone technology have allowed people to access mental healthcare via digital apps from wherever and whenever they choose. University students experience a high burden of mental health concerns. Although these apps improve mental health symptoms, user engagement has remained low. Studies have shown that users can be subgrouped based on unique characteristics that just-in-time adaptive interventions (JITAIs) can use to improve engagement. To date, however, no studies have examined the effect of the COVID-19 pandemic on these subgroups. ObjectiveHere, we sought to examine user subgroup characteristics across three COVID-19-specific timepoints: during lockdown, immediately following lockdown, and three months after lockdown ended. MethodsTo do this, we used a two-step machine learning approach combining unsupervised and supervised machine learning. ResultsWe demonstrate that there are three unique subgroups of university students who access mental health apps. Two of these, with either higher or lower mental well-being, were defined by characteristics that were stable across COVID-19 timepoints. The third, situational well-being, had characteristics that were timepoint-dependent, suggesting that they are highly influenced by traumatic stressors and stressful situations. This subgroup also showed feelings and behaviours consistent with burnout. ConclusionsOverall, our findings clearly suggest that user subgroups are unique: they have different characteristics and therefore likely have different mental healthcare goals. Our findings also highlight the importance of including questions and additional interventions targeting traumatic stress(ors), reason(s) for use, and burnout in JITAI-style mental health apps to improve engagement.

Exploring Internal Conflicts and Collaboration of a Hospital Home Healthcare Team: A Grounded Theory Approach.

An aging society is on the rise, leading to a variety of caregiving issues. The Taiwanese government has been implementing a home healthcare integration plan since 2015, aimed at integrating and forming interdisciplinary care teams with medical institutions. This study explores the internal conflict factors among hospital home healthcare team members at a district teaching hospital in Taichung, Taiwan, and it seeks a better collaboration model between them. Semi-structured in-depth interviews were conducted with seven hospital home healthcare team members. Data analysis was based on grounded theory, with research quality relying on the triangulation and consistency analysis methods. The results show that "work overload", "resource overuse", "inconsistent assessment", "limited resources", "communication cost", and "lack of incentives" are the major conflicts among the team. This study proposed the following collaboration model, including "identifying the internal stakeholders of a home healthcare team" and "the key stakeholders as referral coordinators", "patient-centered resource allocation", and "teamwork orientation". The study recommends that within a teamwork-oriented home healthcare team, its members should proactively demonstrate their role responsibilities and actively provide support to one another. Only through patient-centered resource allocation and mutual respect can the goal of seamless home healthcare be achieved. The content of the research and samples were approved by the hospital ethics committee (REC108-18).

Moral Intuitions About Futility as Prompts for Evaluating Goals in Mental Health Care.

Mental health professionals' moral intuitions about futility should prompt reevaluation of goals of care and care plans. Mostly, it will suffice to improve the care plan and/or slightly adjust the goal of care (eg, lower expectations), which is standard practice. Sometimes, however, all care plans that seek to reduce core symptoms (ie, that pursue a curative goal) are most likely futile and thus should not be imposed. Here, it may be in the patient's best interest to change the goal of care toward palliation (ie, harm reduction, relief of suffering, and best possible quality of life). Thus, futility can function as a moral counterweight to the duty to treat, helping mental health professionals find the right balance between over- and undertreatment.

Role of Public-Private Partnerships in Strengthening Pakistan's Healthcare System

Pakistan's healthcare system stands at a critical juncture, facing challenges that demand innovative solutions. Among these, the role of public-private partnerships (PPPs) emerges as a promising avenue to bridge gaps, enhance service delivery, and transform the healthcare landscape. The collaboration between public and private sectors has the potential to bring together diverse expertise, resources, and perspectives, ultimately leading to a more resilient and effective healthcare system.
 In a country where public healthcare resources often struggle to meet the demands of a growing population, PPPs offer a strategic approach. Private sector entities, with their operational efficiency and investment capabilities, can inject vitality into the system. The provision of healthcare services, infrastructure development, and technology implementation are areas where PPPs can make a substantial impact. This synergy allows the public sector to leverage the strengths of the private sector while ensuring equitable access to quality healthcare services for all citizens.
 However, successful PPPs in healthcare necessitate careful planning, transparent frameworks, and clear delineation of roles and responsibilities. Balancing financial viability with social responsibility remains a challenge. It is essential to strike a harmonious equilibrium where the interests of both sectors converge for the greater good. Moreover, effective governance and regulatory oversight are crucial to prevent any compromise on healthcare quality or ethics.
 As Pakistan strives to achieve its healthcare development goals, lessons from successful PPP models globally can offer valuable insights. These models emphasize collaboration built on trust, open communication, and a shared vision. By fostering an environment that encourages innovation and collaboration, Pakistan can harness the full potential of PPPs to create a healthcare system that is robust, inclusive, and responsive to the needs of its citizens.
 In conclusion, the role of public-private partnerships in strengthening Pakistan's healthcare system is undeniable. By pooling resources, knowledge, and expertise, both sectors can collectively address the challenges that have long impeded the nation's healthcare progress. A well-structured and ethically sound approach to PPPs can pave the way for a future where quality healthcare services are accessible to all, setting Pakistan on a transformative path toward healthier communities and improved well-being.

Modern models of public administration in the system of healthcare and pharmacy

The evolution of the system of socio-economic relations determines the changes in public administration models in the direction of ensuring publicity and informatization. To achieve the key goals of healthcare, it is important to have a clear understanding of the management methodology, in particular, the conceptual and categorical apparatus. Currently, the terminology of public management and administration, governance, public administration and regulation, public management needs to be agreed. 
 Aim. To analyze modern models of public management and changes in the modern content of concepts of management theory in the healthcare and pharmacy system. 
 Materials and methods. Analysis and generalization of the legal framework and scientific publications on the theory and practice of public administration in the healthcare system and pharmacy. 
 Results. The theoretical and methodological principles of management in the healthcare system and the conceptual and categorical apparatus were studied. Modern concepts of public management and features of the implementation of the main principles of “Good Governance” in the system of healthcare and pharmacy were studied. The analysis of public management models in the healthcare system was carried out, the main characteristics and principles of implementation were determined. The priority areas of activity of state bodies in the direction of achieving the global goals of sustainable development regarding the universal coverage of the population with healthcare services were determined.
 Conclusions. At the current stage, it is important to search for the most socially effective model of public management in the healthcare system and pharmacy, which aims to timely and fully ensure the maximum coverage of the population with medical services of proper quality, requires a clear understanding of the complex of organizational principles, modern forms and means of influence.

Optimizing teleconsultation scheduling to make healthcare greener

Some international organizations have called for greener healthcare in the post-pandemic era. Telemedicine has made an important contribution to achieving the goal of green healthcare by reducing the travel distance of patients. From the perspective of operation management, we put forward the teleconsultation room scheduling problem to get a better scheduling scheme to make telemedicine more low-carbon and green. First, we propose a deterministic teleconsultation room allocation scheduling model and a stochastic teleconsultation room allocation scheduling model. Then, we utilize some transformation techniques to simplify the models and solve them through numerical experiments. Next, we put the obtained scheduling schemes into the actual situation and compare them with the staff scheduling scheme. The results show that the stochastic programming model performs the best. In addition, the instability of the teleconsultation service duration has a great impact on the scheduling scheme. The telemedicine center should encourage experts from higher-level hospitals to provide more stable service time.

Essential emergency skincare: a global health dermatology innovation for Myanmar and beyond.

Myanmar provides an exemplar framework whereby a global health dermatology partnership, developed during a time of political stability, has led to an innovative emergency essential skincare strategy to sustain its overarching mission of providing quality care for people with skin disease at times of conflict and instability. This framework, through multilevel integrated approaches such as education and service delivery, serves as a model for crisis-responsive healthcare and global health goals.

Comparison of pay-for-performance (P4P) programs in primary care of selected countries: a comparative study

BackgroundPay for performance (P4P) schemes provide financial incentives or facilities to health workers based on the achievement of predetermined performance goals. Various P4P programs have been implemented around the world. There is a question of which model is suitable for p4p implementation to achieve better results. The purpose of this study is to compare pay for performance models in different countries.MethodsThis is a descriptive-comparative study comparing the P4P model in selected countries in 2022. Data for each country are collected from reliable databases and are tabulated to compare their payment models. the standard framework of the P4P model is used for data analysis.Resultswe used the standard P4P model framework to compare pay for performance programs in the primary care sector of selected countries because this framework can demonstrate all the necessary features of payment programs, including performance domains and measures, basis for reward or penalty, nature of the reward or penalty, and data reporting. The results of this study show that although the principles of P4P are almost similar in the selected countries, the biggest difference is in the definition of performance domains and measures.ConclusionsDesigning an effective P4P program is very complex, and its success depends on a variety of factors, from the socioeconomic and cultural context and the healthcare goals of governments to the personal characteristics of the healthcare provider. considering these factors and the general framework of the features of P4P programs are critical to the success of the p4p design and implementation.

ICU stays that are judged to be non-beneficial: A qualitative study of the perception of nursing staff.

Non-beneficial stays in the intensive care unit (ICU) may have repercussions for patients and their families, but can also cause suffering among the nursing staff. We aimed explore the perceptions of nursing staff in the ICU about patient stays that are deemed to be "non-beneficial" for the patient, to identify areas amenable to intervention, with a view to improving how the nursing staff perceive the patient pathway before, during and after intensive care. Multicentre, qualitative study using individual, semi-structured interviews. All qualified nurses and nurses' aides who were full-time employees in the ICU of three participating centres were invited to participate. Interviews were recorded, transcribed and analyzed using textual content analysis. A total of 21 interviews were performed from February 2020 to October 2021, at which point saturation was reached in the data. Average age of participants was 38.5±7.5 years, and they had an average of 10.7±7.4 years of experience working in the ICU. Four major themes emerged from the interviews, namely: (1) the work is oriented towards life-threatening emergencies, technical procedures and burdensome care; (2) a range of specific criteria and circumstances influence the decisions to admit patients to ICU; (3) there are significant organisational, physical and psychological repercussions associated with a non-beneficial stay in the ICU; (4) respondents made some proposals for improvements to the patient care pathway. Nursing staff have a similar perception to physicians regarding admission decisions and non-beneficial ICU stays. The possibility of future ICU admission needs to be anticipated, discussed systematically with patients and integrated into healthcare goals that are consistent with the patient's wishes and preferences, in multi-professional collaboration including nursing and medical staff.

The value of nurse bioethicists

Background The field of nursing has long been concerned with ethical issues. The history of the nursing profession has a rich legacy of attention to social justice and to societal questions regarding issues of fairness, access, equity, and equality. Some nurses have found that their clinical experiences spur an interest in ethical patient care, and many are now nurse bioethicists, having pursued additional training in bioethics and related fields (e.g., psychology, sociology). Purpose The authors describe how the clinical and research experiences of nurses give them a unique voice in the field of bioethics. Results Authors present reasons for the relative invisibility of nurse bioethicists, compared with physician, theologian, or philosopher bioethicists, as well as current efforts to increase the visibility of nurse bioethicists. They also describe four specific areas where nurse bioethicists have made and continue to make important contributions: as ethics consultants to colleagues in hospitals and other settings; as bioethics researchers or as advisers to researchers conducting trials with human subjects; as educators of trainees, patients and families, healthcare providers, and the public; and in helping to draft humane and ethical policies for the care of vulnerable patients and underserved populations. Conclusion Nurse bioethicists are central to the future goals of healthcare bringing a unique perspective to the day-to-day ethical challenges of both clinical care and research, as well as to the education of health professionals and the public.

Conceptualization of patient-centered care in Latin America: A scoping review.

Patient-centered care (PCC) has been declared as a desirable goal for health care in Latin American countries, but a coherent definition of what exactly PCC entails for clinical practice is missing. This article's aim was to identify how PCC is conceptualized in Latin American countries. Scientific databases (MEDLINE, EMBASE, PsycINFO, CINAHL, Scielo, Scopus, Web of Science) and webpages of the ministries of health were searched, and experts were contacted for suggestions of literature. References were included if they contained one of a range of a priori defined keywords related to PCC in the title, were published between 2006 and 2021, and were carried out in or concerned Latin America. Definitions of PCC were extracted from the included articles and analyzed using deductive and inductive coding. Deductive coding was based on the integrative model of patient-centeredness, which unites the definitions of PCC in the international literature (mainly North America and Europe) and proposes 16 dimensions describing PCC. Thirty-two articles were included in the analysis and about half of them were from Brazil. Numerous similarities were found between the integrative model of patient-centeredness and the definitions of PCC given in the selected literature. The dimensions of the integrative model of patient-centeredness that were least and most prominent in the literature were physical support and patient information, respectively. A differentiation between PCC and family-centered care (FCC) was observed. Definitions of PCC and FCC as well as their cited references were diverse. A considerable overlap between the conceptualization of PCC in Latin America and the integrative model of patient-centeredness has been identified. However, there are substantial differences between countries in Latin America regarding the emphasis of research on PCC versus FCC and diverse conceptualizations of PCC and FCC exist. This scoping review takes the patient's perspective based on the integrative model of patient-centeredness. Due to the study being a review, no patients, neither caregivers, nor members of the public, were involved.

Solar powering public health centers: A systems thinking lens

Around 300,000 women around the world die every year due to complications during pregnancy and childbirth. An estimated 19.9 million children do not receive critical vaccinations putting them at serious risk of potentially fatal diseases. These risks and deaths are preventable with appropriate management and care. Access to healthcare in low resource settings requires a comprehensive approach that strengthens infrastructure, systems, and medical and human resources. The lack of access to energy within infrastructure strengthening dramatically contributes to the immense healthcare challenge faced by developing countries. Electricity is essential for access to health services, as essential as the healthcare center, human resources, equipment, medicines etc. Universal Health Coverage cannot be achieved without energy access in healthcare facilities.Healthcare today, without counting the potential services to the un-catered populations in the world, contributes to GHG emissions, equivalent to the 5th most polluting country in the world. Furthermore, if we must meet the goals of access to health today, it cannot be considered via traditional models of electrification, keeping both the health of the people andthe planetary boundaries in mind. Clean energy and particularly solar energy, if planned and deployed in a manner that is decentralized, need-based along with accounting for local capacities and conditions for sustenance - can become a ‘silver bullet’ in catalyzing healthcare access to under-resourced settings. Given low-resource settings and last mile healthcare requirements this article only takes into consideration off-grid solar systems, which could be one of the primary ways for health centers to become resilient and contribute to climate mitigation, irrespective of prevailing grid and on-grid conditions.With multiple similar programs for solar powering public health facilities over the past decade there are learnings that emerge from across the globe. One of the key learnings is the need for a system thinking lens while deploying decentralized solar for health programs that sustain from a long-term perspective. Systems thinking is an approach that enables one to consider the health system as a whole, while designing demand driven solar powering programs for driving access to healthcare goals. This can be done by breaking down all aspects of solar powering and ensuring that within each aspect, the need is well-understood, the key stakeholders and their priorities are considered and capacities and relationships are accounted for. Moreover, systems are put in place for customization, expansion, and maintenance over time. The suggestions and examples provided below prioritize healthcare needs while driving enabling conditions for design and sustenance of solar for meeting current and future healthcare challenges. While healthcare systems require multiple levels of both curative and preventative healthcare, the considerations below are primarily for last mile public health curative infrastructure. Below, some best practices are elaborated across the following aspects for solar powering health:1. Assessment2. Technical Design3. Financials and Budgeting4. Procurement5. Operations and Maintenance6. Capacity Building

Mediterranean diet and psychological well-being intervention to reverse metabolic syndrome in Chile (CHILEMED trial)

Psychosocial status and lifestyle are key risk factors of non-communicable diseases (NCDs), which, in turn, are main drivers of healthcare costs and morbimortality worldwide, including Chile. Mediterranean diet (MedDiet) is one of the healthiest dietary patterns under study. However, its impact on high-risk conditions, such as metabolic syndrome (MetS), and NCDs outside the Mediterranean Basin remains mostly unexplored. Even though Central Chile has an environment, food production, and culinary traditions comparable to those present in Mediterranean countries, few studies -some with significant methodological limitations- have evaluated the effect of MedDiet on health and/or disease in Chilean subjects. Importantly, a Mediterranean lifestyle is a modus vivendi that integrates physical health with mental and social well-being. Psychological well-being (PWB) is associated with healthy behaviors, positive health outcomes, and longevity, thereby emerging as a novel healthcare goal. We report here an ongoing randomized controlled clinical trial in Chilean patients with MetS seeking to test whether (1) a PWB theory-based intervention facilitates induction to and increases long-term adherence to a locally adapted MedDiet, and (2) a MedDiet intervention -implemented alone or combined with well-being promotion- is more effective at reversing MetS compared to individuals following a low-fat diet without psychological support. The CHILEan MEDiterranean (CHILEMED) diet intervention study is a 1-year trial including patients with MetS living in Chile. Participants will be assigned randomly by a computer-generated random number sequence to one of the three intervention arms: a) low-fat diet as control group, b) MedDiet alone, and c) MedDiet plus well-being support. Patients will be followed-up by individual and/or group online nutritional sessions or phone cal as well as 6- and 12-month in-person re-assessment of medical history, medication use, food intake, PWB, anthropometrics/physical exam, and blood collection for laboratory analysis. The primary outcome of the trial will be the effect of the MedDiet -with or without PWB intervention- on overall reversal of MetS compared to low-fat diet alone. Based on a statistical superiority trial, expected impact, and patient loss, the estimated study sample is 339 subjects (113 individuals per arm in 3 equal-sized groups). Currently, we have enrolled 179 patients, predominantly women, evenly distributed by age (group means ranging from 45.7 to 48,9 years-old), 3/4 are obese with almost all of them showing abdominal obesity, 70% are hypertensive, whereas <10% exhibit diabetes. If findings turn out as expected (e.g., MedDiet -with or without PWB intervention- is better than the low-fat diet for reversion of MetS at 1-year follow-up), CHILEMED will provide further beneficial evidence of the MedDiet on NCD risk conditions beyond the Mediterranean region.

Emergency care reconfiguration in the Netherlands: conflicting interests and trade-offs from a multidisciplinary perspective.

Many countries are reconfiguring their emergency care systems to improve quality and efficiency of care, and this often includes the concentration of emergency departments (EDs). This trend is evident in the Netherlands, but the best approach is the subject of debate among stakeholders. We (i) examined the views of stakeholders on the concentration of EDs in the Netherlands and (ii) identified the main conflicting interests and trade-offs that are relevant for health policy. To do this, we organised focus groups and semi-structured interviews with emergency care professionals, hospital executives and selected external stakeholders. First, the participants saw both advantages and disadvantages to concentration, but these were also contested and debated. Second, we found that - sometimes conflicting - public health care goals (i.e. quality, accessibility and affordability) and narrower interests (e.g. the interests of specific hospitals, insurers, medical specialists and local administrators) were both pointed out. Third, there was no clear preferred approach to the future organisation of EDs, although most stakeholders mentioned some form of centralised decision-making at the national level, combined with regional customisation. Our findings will facilitate health policy decision-making around the reconfiguration of emergency care with the long-term goal of achieving efficient and high-quality emergency care.

#6431 THE DEVELOPMENT OF AN INTEGRATED COMMUNITY, CONSERVATIVE KIDNEY CARE AND PALLIATIVE-RENAL CARE SERVICE

Abstract Background and Aims Conservative kidney care is the chosen therapeutic strategy for approximately 6% of renal patients. It is estimated that a third of renal units in the United Kingdom have a dedicated conservative kidney care service. Equally, other units manage this cohort of patients in general nephrology/ low-clearance clinics or alternatively, discharge to community services. Walsall Together, is a collaborative initiative between community and speciality services, driven to provide multi-agency, patient-focused care. By combining specialist input and community resources, we aimed to optimally manage individuals on the conservative kidney care and palliative-renal pathways at home. Method Community, nephrology and palliative care teams devised a service for those individuals identified for conservative kidney care or individuals with renal disease requiring palliative care management. Two separate, yet linked services; the community, conservative care pathway feeding into the community, palliative-renal pathway. Individuals suitable for community conservative care pathway were identified from routine nephrology inpatient and outpatient workstreams. Prior to a telephone consultation with a nephrologist, phlebotomy for routine bloods were performed at the GP surgery or at the patients home by the community phlebotomy service. Any alterations to medications would be performed directly by the community pharmacist. Symptoms were assessed using the integrated palliative outcome score (IPOS)-renal survey. The IPOS renal-survey asks individuals to rate symptom burden from; not at all, to slightly, moderately, severely and overwhelmingly. Home visits were offered to unwell or symptomatic patients. Individuals requiring palliative care were identified from both palliative and nephology services. A bi-weekly palliative-renal multidisciplinary team (MDT) meeting was established. Results To date 40 individuals have been managed on both the community conservative care and renal-palliative care pathway. 94% of patients felt that the community approach did not waste time waiting for appointments/treatments. 87% of patients felt that the community approach provided them with sufficient information to understand their healthcare condition and relevant management strategies. Patients reported pain, nausea and reduced appetite as the three most common symptoms that generated discomfort in the three days prior to taking the IPOS-renal survey. On detailed assessment; significant symptom burden was attributed to reduced mobility (82% scoring slightly to overwhelmingly), pain (65% scoring slightly to overwhelmingly) and bowel concerns (65% scoring slightly to overwhelmingly). Itching affected a third of the cohort, scoring moderately to overwhelmingly. Importantly, as a result of the service, patients reported that either all or most renal-related problems were addressed. To date all patients who died while under the renal-palliative care service, died in their chosen place of death, and not in hospital. Conclusion The Walsall Together initiative has demonstrated that utilising a collaborative approach to managing complications of advanced kidney disease can result in the reduction of hospital admissions, face-to-face hospital outpatient appointments and time wasted attending healthcare appointments. Furthermore, the cooperative multi-speciality approach, has led to improve patient satisfaction and the attainment of patient healthcare goals.

Портрет регионального министра здравоохранения – 2022

The heads of regional executive authorities in the sphere of health protection are key figures in the realization of the Russian Federation’s healthcare development strategy. Without qualified managers, it is difficult to achieve national goals and objectives of federal projects. The study of the qualifications, professional experience, and skills of the high leaders of regional health systems allows the evaluation of top personnel’s human potential and the successful implementation of steps to increase the efficiency of its administration. T h e a i m o f t h e s t u d y was to give a detailed information about regional health authorities managers in Russian Federation. M a t e r i a l s a n d m e t h o d s . A single-stage, continuous sociological study was planned and carried out using a specially developed questionnaire, which included a characterization of the accounting characteristics of participants’ age and demographic characteristic, level of basic and additional education, availability of professional competencies, and work experience in managerial positions. R e s u l t s . We achieved a response from 85 respondents. It was found that, as compared to 2021, there was a slowdown inside the process of rotation of regional ministers’ personnel and an increase in the degree of professional qualifications of managers in 2022. These trends were reflected in the increase in the average length of service in the position of regional minister (2021 2,1±1,9 years; 2022 2,6±2,5 years), the doubling of the number of managers with work experience of up to one year (2021 n = 42; 2022 n = 21), and the decrease in the number of managers with work experience of up to one year (2021 n = 42; 2022 n = 21). C o n c l u s i o n . The research allows for an assessment of the dynamics of changes in regional health care systems in terms of managerial human resources from 2021 to 2022. Positive declining trends in 2022 have been identified. The pace of rotation of regional ministers’ staff adds to the development of leaders’ professional abilities and experience and, eventually, will be the key to accomplishing strategic goals in health care.

Improving Patient Access to Primary Care Providers Using a Pharmacist-Physician Co-Visit Model.

Background: Implementation of a clinical pharmacist in the primary care setting can offset provider time spent managing chronic diseases using Collaborative Practice Agreements (CPAs). The pharmacist-physician co-visit model presents an opportunity for pharmacists to increase patient access to their primary care provider (PCP). Studies of the co-visit model show that co-visits increase clinic efficiency by allowing the PCP to see additional patients and achieve more health care goals compared with independent visits1-4. Objectives: The aim of this study was to increase patient access to their PCP by utilizing a pharmacist-physician co-visit model at the Madsen Health Center Family Medicine (MHC FM) Clinic. The primary outcome was to identify the number of co-visits completed compared to the number of possible co-visits, and the number of appointment slots made available. The secondary outcomes were to track the time spent with patients and to obtain provider feedback via a survey. Methods: The co-visit model was implemented as a 4-month pilot study at the MHC FM Clinic. Complex care appointments lasting 40 minutes were selected based on inclusion and exclusion criteria. Potential co-visit appointments were identified one week prior then provider consent was obtained to change the appointment into two separate 20-minute visits. Schedules were reviewed to determine if the appointment slot opened by the co-visit was filled by another patient. Upon completion of the study, a survey was distributed to providers to collect feedback. Results: A total of five co-visits were completed out of a possible 19 (26%). All the appointments made available were filled by another patient. On average, the provider and pharmacist spent 15 and 14 minutes with the patient, respectively. Conclusion: Implementation of the physician-pharmacist co-visit model increased the availability of the PCP to see more patients without disrupting clinic workflow and provider schedules.