Health Care Services In Europe Research Articles

Diversity of kidney care referral pathways in national child health systems of 48 European countries.

Primary, secondary and tertiary healthcare services in Europe create complex networks covering pediatric subspecialties, sociology, economics and politics. Two surveys of the European Society for Paediatric Nephrology (ESPN) in 1998 and 2017 revealed substantial disparities of kidney care among European countries. The purpose of the third ESPN survey is to further identify national differences in the conceptualization and organization of European pediatric kidney health care pathways during and outside normal working hours. In 2020, a questionnaire was sent to one leading pediatric nephrologist from 48 of 53 European countries as defined by the World Health Organization. In order to exemplify care pathways in pediatric primary care nephrology, urinary tract infection (UTI) was chosen. Steroid sensitive nephrotic syndrome (SSNS) was chosen for pediatric rare disease nephrology and acute kidney injury (AKI) was analyzed for pediatric emergency nephrology. The care pathways for European children and young people with urinary tract infections were variable and differed during standard working hours and also during night-time and weekends. During daytime, UTI care pathways included six different types of care givers. There was a shift from primary care services outside standard working hours to general outpatient polyclinic and hospital services. Children with SNSS were followed up by pediatric nephrologists in hospitals in 69% of countries. Patients presenting with community acquired AKI were admitted during regular working hours to secondary or tertiary care hospitals. During nights and weekends, an immediate shift to University Children's Hospitals was observed where treatment was started by intensive care pediatricians and pediatric nephrologists. Gaps and fragmentation of pediatric health services may lead to the risk of delayed or inadequate referral of European children with kidney disease to pediatric nephrologists. The diversity of patient pathways outside of normal working hours was identified as one of the major weaknesses in the service chain.

The need for recognition of core professional groups in genetics healthcare services in Europe.

The need for recognition of core professional groups in genetics healthcare services in Europe.

Understanding the Effect of Economic Recession on Healthcare Services: A Systematic Review.

Background:We aimed to examine the available evidence about the impact of the crisis on the use of healthcare services in Europe.Methods:We developed a systematic review of scientific literature for the period 2008–2017. The researchers searched three databases Medline/PubMed, Scopus and Web of Knowledge. For manual searching, several specialized journals of related scope as well as the finalized articles’ reference list were searched. Descriptive and thematic analyses were carried out. PRISMA quality criteria and the recommendations of the Centre for Reviews and Dissemination were followed.Results:Of 3,685 studies, 35 met inclusion criteria. Regarding “Effects of the social structure” healthcare accessibility inequalities increased by socioeconomic levels, especially in unemployed, people with low educational levels and migrants. Regarding “Healthcare effect”, the impact of the recession was observed in unmet needs, pharmaceutical spending containment, reduction of hospital beds, and privatization of services.Conclusion:Austerity policies have contributed to increasing inequalities in the use of health services during the economic downturn. In the current economic climate, new management and health planning strategies such as hospitalisation at home, new models of integrated care and pharmaceutical management are needed to help achieve greater equity and equality in health.

EoE CONNECT, the European Registry of Clinical, Environmental, and Genetic Determinants in Eosinophilic Esophagitis: rationale, design, and study protocol of a large-scale epidemiological study in Europe.

Background:The growing prevalence of eosinophilic esophagitis (EoE) represents a considerable burden to patients and health care systems. Optimizing cost-effective management and identifying mechanisms for disease onset and progression are required. However, the paucity of large patient cohorts and heterogeneity of practice hinder the defining of optimal management of EoE.Methods:EoE CONNECT is an ongoing, prospective registry study initiated in 2016 and currently managed by EUREOS, the European Consortium for Eosinophilic Diseases of the Gastrointestinal Tract. Patients are managed and treated by their responsible specialists independently. Data recorded using a web-based system include demographic and clinical variables; patient allergies; environmental, intrapartum, and early life exposures; and family background. Symptoms are structurally assessed at every visit; endoscopic features and histological findings are recorded for each examination. Prospective treatment data are registered sequentially, with new sequences created each time a different treatment (active principle, formulation, or dose) is administered to a patient. EoE CONNECT database is actively monitored to ensure the highest data accuracy and the highest scientific and ethical standards.Results:EoE CONNECT is currently being conducted at 39 centers in Europe and enrolls patients of all ages with EoE. In its aim to increase knowledge, to date EoE CONNECT has provided evidence on the effectiveness of first- and second-line therapies for EoE in clinical practice, the ability of proton pump inhibitors to induce disease remission, and factors associated with improved response. Drug effects to reverse fibrous remodeling and endoscopic features of fibrosis in EoE have also been assessed.Conclusion:This prospective registry study will provide important information on the epidemiological and clinical aspects of EoE and evidence as to the real-world and long-term effectiveness and safety of therapy. These data will potentially be a vital benchmark for planning future EoE health care services in Europe.

Anything New about Paternal Contribution to Reproductive Outcomes? A Review of the Evidence.

Paternal health and behavioral lifestyles affect reproductive and neonatal outcomes and yet the magnitude of these effects remain underestimated. Even though these impacts have been formally recognized as a central aspect of reproductive health, health care services in Europe often neglect the involvement of fathers in their reproductive programs. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for systematic reviews, a literature search was carried out to assess the possible impact of paternal health on reproductive outcomes. The comprehensive strategy included cohort studies and meta-analysis available on PubMed, Web of Science, CINAHL, and Google scholar. Cross-referencing of bibliographies of the selected papers ensured wider study capture. Paternal factors were grouped into two categories respectively identified with the terms “Biological Paternal Factors” and “Lifestyle Paternal Factors”. Advanced age may impair male fertility and affect early pregnancy stages. Increased body mass index, smoking, alcohol and recreational drugs, all alter seminal fluid parameters. Hazardous alcohol use correlates with low birthweight in pregnancy and harmful behavioral lifestyles have been linked to congenital heart defects, metabolic and neurodevelopmental disorders in the offspring. Measures targeting paternal health and lifestyle within the first 1,000 days' timeframe need to be implemented in couples undergoing reproductive decisions. Health professionals, as well as future fathers, must be aware of the benefits for the offspring associated with correct paternal behaviors. More research is needed to build guidelines and to implement specific programs aiming at reproductive health promotion.

Predictions concerning the use of health care services in Europe by migrants/refugees and the Mig-HealthCare Roadmap & Toolbox

Abstract Based on the multiple levels of research conducted within the project the consortium developed a roadmap & toolbox which includes the following categories: Continuity of information, Language Culture & Communication, Mental Health, Vaccinations, Maternal/child health, Health promotion, Oral health/Dental Care and NCDs while the Toolbox contains tools on these categories in different languages. The roadmap & toolbox is accessible through the project website. In addition, different scenarios, giving a comprehensive picture of the foreseen situation and the evidence-based policies and actions needed to maximize the effective delivery and sensitivity in the service of care to culturally diverse population groups were developed focusing on mental health, chronic disease management and oral health. Refugees and migrants tend to have a higher prevalence of mental distress compared to non-refugees. For the challenge of lack of recording mental health of migrants/refugees, improving the collaboration between ‘migrant-specific’ organizations is needed. Health care systems in Europe will have to accommodate the high demand for health care services for chronic conditions among migrants/refugees in the coming years. Implications such as the impact of poverty, level of health literacy and/or the cultural adaption of the measures need to be considered when planning to address future trends related to non-communicable diseases including diabetes among migrants/refugees. The provision of oral care presents great variability across the European countries, but in most cases, it is characterized by high cost and restricted range of services if offered within the state health systems. Migrants /refugees will not be able to meet the high cost of private dental care. Local community interventions have been proven very effective.

Complementarity between medical geneticists and genetic counsellors: its added value in genetic services in Europe.

Clinical genetic services have progressed significantly the last few decades. This has led to the need for non-medical health-care professionals working as genetic counsellors in Europe and worldwide. However, there is no unified approach to genetic counsellors' role in health-care services in Europe, as in most countries the profession is still emerging and the educational backgrounds diverge noticeably, within and between countries. This qualitative study aims to describe the potential added value of genetic counsellors in clinical genetics teams and to explore their tasks and responsibilities in different European countries. A total of 143 participants providing genetic counselling in Europe at the time of the survey responded. The results show differences in activities of genetic counsellors, although there is a wide range of roles, which are similar. The ability to establish a quality relationship with consultands was frequently mentioned as one of the strengths of genetic counsellors, as well as a patient-centred approach. It is believed that genetic counsellors add a more holistic approach of psychosocial and familial dimensions of genetic concerns to the multidisciplinary teams. This study provides examples of successful integration of genetic counsellors in teams, as complementariness with medical geneticist became clear in several cases. Although the added value of genetic counsellors was manifested, professional recognition of genetic counsellors across Europe is still needed in order to support the quality of patients care and safety of practice.

Development of a registration system for genetic counsellors and nurses in health-care services in Europe.

Development of a registration system for genetic counsellors and nurses in health-care services in Europe

Transnational healthcare practices of Romanian migrants in Ireland: Inequalities of access and the privatisation of healthcare services in Europe

This article deals with the transnational healthcare practices of Central and Eastern European migrants in Europe, taking the case of Romanian migrants in Ireland. It explores the implications of migrants' transnational healthcare practices for the transformation of citizenship in Europe, more particularly in terms of access to free public healthcare. The article places these practices in the larger perspective of global care chains, seen as including transnational flows of healthcare seekers and healthcare workers that link distant healthcare systems in an emerging European healthcare assemblage.The study adopted a holistic perspective, taking into account both formal and informal practices, as well as the use of healthcare services in both the host and the origin countries of migrants. These were explored during multi-sited fieldwork in Romania and Ireland, conducted between 2012 and 2013, and combining a variety of sources and methods (semi-structured interviews, informal conversations, documentary analysis, etc.).The article explores the links between migrants' transnational healthcare practices and two other important processes: 1) inequalities in access to healthcare services in migrants' countries of origin and of destination; and 2) the contribution of healthcare privatisation to these inequalities. It shows that Romanian migrants' transnational healthcare practices function as strategies of social mobility for migrants, while also reflecting the increasing privatisation of healthcare services in Ireland and Romania. The article argues that these processes are far from specific to Ireland, Romania, and the migration flows uniting them. Rather, they draw our attention to the rise of an unevenly developed European healthcare assemblage and citizenship regime in which patients' movements across borders are closely interlinked with diminishing and increasingly unequal access to public healthcare services.

Emergency department utilization rates and modalities among immigrant population. A 5-year survey in a large Italian urban emergency department

The rates and modalities of healthcare services utilization for migrant population may differ from natives, since the health needs of the former are influenced by some factors such as health status, self-perceived needs, healthseeking behavior, language barriers and cultural differences. Only scarce and often conflicting data have been published so far on migrants’ utilization of healthcare services in Europe, and even less data are available on emergency departments (EDs). The aim of this cross-sectional study was to compare utilization rates and modalities of presentation to the large urban ED of the University Hospital of Parma, Italy (averaging 85,000 visits per year), by Italian native and foreign-born populations during 2008-2012. Throughout the study period 424,466 ED visits were recorded, 64,435 (15.4%) of which by foreign-born patients. A significant difference between utilization rates was observed for all the triage-codes, with higher rates for foreign-born low-acuity codes (green plus white codes: 87.5 vs 73.9, P<0.0001) and lower rates for high-acuity codes (yellow plus red codes: 12.5 vs 26.1%, P<0.0001). The utilization rate was 253.9 visits per 1000 inhabitants for the Italian-native group and 309.7 per 1000 for the foreign-born group (odds ratio 1.23; 95% CI: 1.01-1.48; P=0.034). Different modalities of presentation were also observed, with a high rate of selfreferrals (82.3 vs 71.4%, P<0.001). The results of this study suggest that a better knowledge of available Italian healthcare services among immigrants is advisable and should be encouraged.

The central role of laboratory medicine as the integrating element in healthcare services

The central role of laboratory medicine as the integrating element in healthcare services

Migrants' utilization of somatic healthcare services in Europe--a systematic review

Utilization of services is an important aspect of migrants' access to healthcare. The aim was to review the European literature on utilization of somatic healthcare services related to screening, general practitioner, specialist, emergency room and hospital by adult first-generation migrants. Our study question was: 'Are there differences in migrants' utilization of somatic healthcare services compared to non-migrants?' Publications were identified by a systematic search of PUBMED and EMBASE. Appropriateness of the studies was judged independently by two researchers based on the abstracts. Additional searches were conducted via the references of the selected articles. The final number of studies included was 21. The results suggested a diverging picture regarding utilization of somatic healthcare services by migrants compared to non-migrants in Europe. Overall, migrants tended to have lower attendance and referral rates to mammography and cervical cancer screening, more contacts per patient to general practitioner but less use of consultation by telephone, and same or higher level of use of specialist care as compared to non-migrants. Emergency room utilization showed both higher, equal and lower levels of utilization for migrants compared to non-migrants, whereas hospitalization rates were higher than or equal to non-migrants. Our review illustrates lack of appropriate epidemiological data and diversity in the categorization of migrants between studies, which makes valid cross-country comparisons most challenging. After adjusting for socio-economic factors and health status, the existing studies still show systematic variations in somatic healthcare utilization between migrants and non-migrants.

Digestive health in the elderly: faecal incontinence in adults.

Digestive health in the elderly: faecal incontinence in adults.

Oral health care services in Europe

Health care is being reformed in Europe. Comparative analyses of oral health care services are scarce. Little is known about the relationship between organisation and financing of services and the effectiveness, efficiency and equity of the services. The purpose of the paper is to present some features of the delivery of oral health care services and to discuss some recent changes in a public health perspective. Some of the recent changes in oral health care are: Decentralisation of management in the public services, less third party payment and higher patient charges, more emphasis on free consumer choice. The dominant model of delivery of oral health care is the single private practitioner. The traditional structure of delivery of dental services is challenged by the demands of societies. There seems to be a trade-off between simplicity and the tailor-made mixed payments: gains in degree of freedom through the use of mixed payment systems have to be balanced against losses in terms of simplicity of implementation and equality of the oral health outcome. The roles of the provider, the consumer and the financing institutions are imbedded in trust and regulation. There is therefore a growing recognition of the necessity for a strong role of public health.