Health Coordination Research Articles

Evaluation of managers’ perspectives on secondary dental care in Endodontic in Minas Gerais, Brazil

The aim of this study was to evaluate the perceptions of Municipal Oral Health Coordinators (MOHCs) of endodontic services in Dental Specialty Centers (DSCs) of Minas Gerais, Brazil. A questionnaire was sent to the MOHCs of municipalities that had DSCs. Endodontic productivity data were collected from the Health System database. Descriptive analysis and Spearman’s correlation were performed (p≤0.05). Most cities had one DSC operating (92.4%) with two endodontists (30.3%). Endodontic treatments (ETs) were performed exclusively in a DSC (87.9%). There were referral protocols for primary to secondary care in endodontics in 87.9%. Most of the DSCs had a target (84.8%); 60.6% followed the targets recommended by the Brazilian Ministry of Health (MofH), but 53.0% complied with the goal in less than 25% of the months. Technological auxiliary resources for endodontics were not present in 42.0% of the DSCs. Positive correlation was found between the number of dentists who performed ETs in DSCs with fulfillment of monthly targets (p=0.029), and a negative correlation between the availability of technological resources for the fulfillment of monthly targets (p=0.012). Some MOHCs were unaware of the principles of the MofH, suggesting that management measures and targets should be reevaluated.

An Outbreak Investigation of a Cluster of Gastroenteritis Following a Marriage Function in Wayanad District, Kerala, India

Foodborne diseases are a significant cause of morbidity and mortality, especially in low-resource settings. This paper describes the investigation conducted in response to a cluster of acute gastroenteritis outbreak in the Wayanad district of Kerala. House-to-house visits were undertaken to identify the case patients, along with laboratory and environmental investigations. The attack rate was 41.2% among those who consumed chicken biriyani compared to 6.9% among those who consumed vegetarian meals. The risk difference (95% CI) was 34.34 % (22.8-45.6), and the risk ratio (95% CI) was 6 (1.6-23) for chicken biriyani compared to vegetarian meals. The attributable fraction (95% CI) among those who ate chicken biriyani was 83.3% (35.6-95.6), and the population attributable fraction was 81.2%. We recommend strengthening of laboratory capacity for detecting foodborne pathogens and active surveillance of all food handlers and food preparation areas with the coordination of food safety, health and local self government departments.

Obituary Dr Alexandre Berlin, 28 September 1935 – 11 August 2022

The death of Dr Alexandre Berlin on 11 August 2022 Europe has lost a great advocate and protagonist for health. Dr Berlin had 35 years of work and service at the Directorate General for Health and Consumer Protection of the European Commission, including as the Director General of Health, and he had a profound influence on the development of the health dimensions of the European Union Acquis Communitaire which were developed under his leadership and management, as well as public health development across Europe more generally. He retired from the EC as an Honorary Director General in 2002. Prior to working for the European Commission Dr Berlin had been a Professor of Physics with education and training at several very prestigious universities in the USA. Widely respected at the highest level internationally for his knowledge and experience, he was a polymath of immense culture, yet humble with a sense of humor, and gentle and supportive of all those with whom he came into contact. A famous polyglot, he was fluent in 7 languages and understanding two more. Dr Berlin worked collaboratively with many organizations influential in health across Europe. For example, with the WHO European Regional Office he was involved in the preparation and organization of the two Environmental Health European Conferences in Helsinki in 1994 and then in London in 1999, strongly supporting the development of National Environmental Action Plans across the European Region. After retirement he never stopped working and helping. Between 2002 and 2017 he worked hard to support the South-eastern Europe Health Network, opening the door of the European Commission to the Network through the EC TAIEX Programme. Learning lessons from this process the SEEHN established a major planning meeting with the leaders of the TAIEX Programme and were able to submit to the EC a proposed annotated list of future technical meetings approved by the EC and the SEEHN National Health Coordinators. In 2017 he withdrew with high recognition and honors from the SEEHN during the 4th Forum of the Ministries of Health. He was also a founder and the Honorary President of a non-governmental organization, the International Health Partnership Association (IHPA) committed to strengthening public health across Europe, between 2014 -2020. In retirement he was always travelling, to help, or meet his family. He loved art and he had rich knowledge about it. He was collecting good pieces of art from all over the world, which he displayed in his homes in Paris and Brussels. To friends he was very generous, providing hospitality and gifts of pieces of art. Dr Alexandre Berlin was very devoted to his daughters and their kids. He visited his daughter Angela and her family often in Canada and enjoyed seeing his grandkids grow up. They always knew they could count on him. They miss his visits and his burned toast! His daughter Olivia Berlin recalls: “My relationship with my father was troubled while growing up, which led to major acting out in my teenage years. But when I look back, no matter what I did, he was always there for me. In the last few years of his life, I had the honor to be able care for him. Through this process, our relationship healed. I now remember him as a KIND man, always ready to help, anywhere he was in the world. I now think of him as well as of my mother, with a warm smile. It is with deep love and a great sense of peace that I let him go. Farewell and Bon Voyage, you who loved travelling ....” Olivia Berlin Dr Berlin stayed sharp and active until the last years. He died peacefully in Sardinia, Italy, with his daughter, Olivia, at his side. He will be missed by many. He is survived by his family to whom he was devoted, including his daughters Olivia and Angela, his grandchildren, Catherine, Julia, Alberto and Sara and his great-grandchild, Jaxon. To celebrate his life, it is hoped to make a compilation of Dr Berlin’s life. Please send any stories and pictures you may have to Angela Tancon (his daughter) at angelatancon116@gmail.com, where these will be graciously received.

Implementation of distance learning IMCI training in rural districts of Tanzania

BackgroundThe standard face-to-face training for the integrated management of childhood illness (IMCI) continues to be plagued by concerns of low coverage of trainees, the prolonged absence of trainees from the health facility to attend training and the high cost of training. Consequently, the distance learning IMCI training model is increasingly being promoted to address some of these challenges in resource-limited settings. This paper examines participants’ accounts of the paper-based IMCI distance learning training programme in three district councils in Mbeya region, Tanzania.MethodsA cross-sectional qualitative descriptive design was employed as part of an endline evaluation study of the management of possible serious bacterial infection in Busokelo, Kyela and Mbarali district councils of Mbeya Region in Tanzania. Key informant interviews were conducted with purposefully selected policymakers, partners, programme managers and healthcare workers, including beneficiaries and training facilitators.ResultsAbout 60 key informant interviews were conducted, of which 53% of participants were healthcare workers, including nurses, clinicians and pharmacists, and 22% were healthcare administrators, including district medical officers, reproductive and child health coordinators and programme officers. The findings indicate that the distance learning IMCI training model (DIMCI) was designed to address concerns about the standard IMCI model by enhancing efficiency, increasing outputs and reducing training costs. DIMCI included a mix of brief face-to-face orientation sessions, several weeks of self-directed learning, group discussions and brief face-to-face review sessions with facilitators. The DIMCI course covered topics related to management of sick newborns, referral decisions and reporting with nurses and clinicians as the main beneficiaries of the training. The problems with DIMCI included technological challenges related to limited access to proper learning technology (e.g., computers) and unfriendly learning materials. Personal challenges included work-study-family demands, and design and coordination challenges, including low financial incentives, which contributed to participants defaulting, and limited mentorship and follow-up due to limited funding and transport.ConclusionDIMCI was implemented successfully in rural Tanzania. It facilitated the training of many healthcare workers at low cost and resulted in improved knowledge, competence and confidence among healthcare workers in managing sick newborns. However, technological, personal, and design and coordination challenges continue to face learners in rural areas; these will need to be addressed to maximize the success of DIMCI.

A strategic action plan to enhance the accessibility of healthcare in rural areas of Zimbabwe

ABSTRACT Objective To identify strategies and develop a strategic action plan to enhance accessibility to healthcare in rural areas of Zimbabwe. Methods A cross sectional research approach with four (4) phases. Phase one (1) (quantitative), data was collected from professional nurses using self-administered questionnaires, healthcare users using interview questionnaires. Phase two (2) (qualitative), information was collected from a nominal group of national health directors leading to development strategic action plan in Phase three (3) informed by Phases 1 and 2, systems model and literature control. Strategic action plan was finalised and validated by members of the Parliamentary Portfolio Committee on Health in Phase 4. Settings Two districts (Masvingo and Chegutu) in two provinces (Masvingo and Mashonaland West) were involved. Participants Conveniently sampled professional nurses (90) and healthcare users (445) using the sampled public health facilities (Phase 1); conveniently sampled national health coordinators (five) (Phase 2); and all five members of the Parliamentary Portfolio Committee on Health (Phase 4). Research findings The strategic action plan focused on improving the health infrastructure; providing medical drugs, health workers and medical equipment; addressing shortages; and improving the capacity of the healthcare system. Conclusion Active participation at all levels (professional nurses, healthcare users, national health directors and members of parliament) allowed the development of a strategic action plan.

Territory, coordination and cooperation in health: an approach using geographical mental maps

Territory, coordination and cooperation in health: an approach using geographical mental maps

Perceived facilitators and barriers to the provision of sexual and reproductive health services in response to the Syrian refugee crisis in Lebanon.

The Syrian crisis has resulted in one of the worst humanitarian disasters in modern history. Inadequate access to and use of sexual and reproductive health services is a prevailing issue among adolescent girls and young refugee women in humanitarian settings. This article aimed to explore and describe the perceived extent of implementation of the different objectives and activities outlined within the minimum initial service package for reproductive health in crisis services in Lebanon, from the perspectives of a diverse set of stakeholders from leading organizations (public, private, primary health centers, nongovernmental organizations) that were directly engaged with the Syrian refugee crisis response. This study is a cross-sectional survey conducted using a standardized and validated questionnaire. Centers that provided sexual and reproductive health services to Syrian refugees in Lebanon were mapped. The study was based on a purposive sampling approach, retrieving 52 eligible organizations to cover most areas in the country. A total of 43 centers accepted to take part in the study. The head of the center was then asked to identify one person in their center who holds adequate knowledge of the explained objectives of the survey. Accordingly, the identified person was asked to fill out the survey. A considerable portion of the respondents had limited knowledge about the specific minimum initial service package objectives and related sexual and reproductive health services. The study found the presence of a leading reproductive health agency, the Lebanese MoPH, as an essential facilitating factor for sexual and reproductive health service provision in Lebanon and has helped in overseeing the overall sexual and reproductive health coordination response for Syrian refugees (76.74% of all respondents). The identified challenges impeding adequate sexual and reproductive health services provision for Syrian refugees included (1) insufficient supplies (46.51%); (2) insufficient funds (39.53%); and (3) shortage of staff (39.53%). The recommendations for improved sexual and reproductive health service provision include the need for (1) enforcing the lead minimum initial service package agency for adequate and effective coordination, reporting, and accountability and (2) increasing funding for training staff and healthcare workers, as well as improving the overall quality of services available with the inclusion of family planning services, purchasing the necessary commodities, supplies and equipment, and covering fees associated with the different sexual and reproductive health services.

CURSO DE QUALIFICAÇÃO PRÉ-NATAL: CONSTRUÇÕES E RECONSTRUÇÕES INTERPROFISSIONAIS

ABSTRACT Objective: to understand the perception of health professionals regarding the implementation of a prenatal qualification course from an interprofessional perspective. Method: action research conducted from August to November 2022, with the participation of 47 professionals from Primary Health Care and hospital institutions from 33 cities that make up a Regional Health Coordination in southern Brazil. Results: data analysis allowed the delimitation of two thematic categories: Training: professional constructions and reconstructions; and Network articulation: weaknesses and perspectives. The prenatal course, with an interprofessional focus, was a driving tool for integration, dialogue and enhancement of initiatives aimed at qualifying prenatal care. Conclusion: the implementation of the prenatal qualification course enabled the expansion of knowledge and the (re)construction of interprofessional practices capable of inferring in the maternal and child health care network.

Trends in hospital admissions and mortality from diabetes mellitus in Rio Grande do Sul: historical series 2000-2020.

To analyze the trends of hospital admissions and deaths from diabetes mellitus in the 18 host municipalities of the 19 regional health coordination offices and in Rio Grande do Sul, 2000-2020. Ecological study with secondary data collected in the Hospital Information System, the Mortality Information System, and the Brazilian Institute of Geography and Statistics, from 2000-2020. Coefficients were standardized using the direct method and Prais-Winsten regression analysis. A downward trend wasfound in the coefficients of hospitalizations for diabetes mellitus in most cities and states. In 2020, for both areas, hospitalizations for diabetes mellitus were below the average of the period. The mortality trend remained stationary in almost all municipalities and in the state. There was evidence of a decrease in hospitalizations and stationary mortality by DM in most municipalities analyzed, possibly due to the policies and actions implemented in the period, despite the aging of the population.

Toward contraception education in basic schools: Teachers' knowledge, perceptions, and attitudes regarding contraceptive use by basic school pupils in a Ghanaian Municipality.

We examined teachers' knowledge, perceptions, and attitudes regarding contraception by basic school pupils in a Ghanaian Municipality. This was an explorative, analytical cross-sectional study using the mixed-method approach. Participants comprised 183 public and private basic school teachers and 20 school health coordinators in the study area. The statistical tests carried out were in two folds. Quantitative data were analyzed with a statistical package for social sciences version 20 to generate tables. A logistic regression model was used to examine associations between the predictor and the binary response variables. Adjusted odds ratio accounted for other predictor variables in the model. For the qualitative data, recorded interviews were transcribed and content analysis was done to identify themes, subthemes, and results presented as participants' direct quotations/paraphrased statements. Knowledge, perceptions, and attitudes were assessed using 3-Likert scale type questions developed by the author. Participants' sociodemographic characteristics were associated with perceptions and attitudes toward contraception in basic schools. At 95% confidence intervals, the p-values were not significant for any of the variables tested. However, the adjusted odds ratio (aOR) showed positive perceptions among participants aged 35-39 (aOR = 7.24; p = 0.35), women (aOR = 4.22; p = 0.25), higher educated (aOR = 4.32; p = 0.56), work experience between 16 and 20 years (aOR = 6.65; p = 0.96), four or more children (aOR = 6.35; p = 0.96); divorcee (aOR = 10.12; p = 2.92); intrauterine contraceptive device (IUD) (aOR = 5.02; p = 2.43); or condoms users (aOR = 7.09; p = 0.32). Negative perceptions were noted among affiliates of other religions compared to Christians (aOR = 0.19; p = 0.01) and subject teachers (aOR = 0.39; p = 0.01). Participants' perceptions were directly influenced by attitudes toward contraception and knowledge (p = 0.081). The qualitative findings showed mixed feelings about contraceptive education in basic schools. Basic school teachers have challenges with contraceptive education which have implications for comprehensive sex education in Ghanaian basic schools. We recommend a similar study among parents of the pupils and a nationwide study to examine this concept further.

Best selected forecasting models for COVID-19 pandemic

Abstract This study sought to identify the most accurate forecasting models for COVID-19-confirmed cases, deaths, and recovered patients in Pakistan. For COVID-19, time series data are available from 16 April to 15 August 2021 from the Ministry of National Health Services Regulation and Coordination’s health advice portal. Descriptive as well as time series models, autoregressive integrated moving average, exponential smoothing models (Brown, Holt, and Winters), neural networks, and Error, Trend, Seasonal (ETS) models were applied. The analysis was carried out using the R coding language. The descriptive analysis shows that the average number of confirmed cases, COVID-19-related deaths, and recovered patients reported each day were 2,916, 69.43, and 2,772, respectively. The highest number of COVID-19 confirmed cases and fatalities per day, however, were recorded on April 17, 2021 and April 27, 2021, respectively. ETS (M, N, M), neural network, nonlinear autoregressive (NNAR) (3, 1, 2), and NNAR (8, 1, 4) forecasting models were found to be the best among all other competing models for the reported confirmed cases, deaths, and recovered patients, respectively. COVID-19-confirmed outbreaks, deaths, and recovered patients were predicted to rise on average by around 0.75, 5.08, and 19.11% daily. These statistical results will serve as a guide for disease management and control.

National bill to address maternal mental health passes Congress

The TRIUMPH for New Moms Act (H.R.4217/S.2779) passed by Congress in its end‐of‐year omnibus, creates the first national Task Force on Maternal Mental Health — 2020 Mom — a nonprofit organization, announced in a Dec. 26 news release. The bipartisan TRIUMPH for New Moms Act (“TRIUMPH”) was introduced by Sens. Maggie Hassan (D‐NH) and Thom Tillis (R‐NC), and Reps. Nanette Diaz Barragán (D‐CA‐44), Larry Bucshon (R‐Ind.‐08), Young Kim (R‐CA‐39) and Lisa Blunt Rochester (D‐DE‐AL) to create a national strategy to address maternal mental health disorders, and coordination and integration of maternal mental health into existing maternal, infant and mental health activities at the federal level. More specifically, TRIUMPH promotes federal collaboration among agencies and departments to protect and address the mental health of new mothers and creates recommendations to state governors, House and Senate committees, and relevant federal agencies to improve maternal mental health outcomes.

Breast Cancer and Women Veterans: What Is the Impact of Mental Health on Screening Rates?

Background: The proportion of women Veterans are increasing and, as such, access to high-quality breast cancer care is important. Prior studies have shown that rural location, age, and a mental health diagnosis negatively impact breast cancer screening rates. Methods: We aimed to retrospectively assess the impact of these risk factors on breast cancer screening adherence rates among Veterans at our institution. Women who were eligible for breast cancer screening per the United States Preventative Services Taskforce guidelines were included. Results: Of 2321 women, overall adherence was 78.2%. There were no significant differences in screening rates between races, various age groups, geographical distribution, and having anxiety or post-traumatic stress disorder (PTSD). However, Veterans with a diagnosis of depression were more likely to adhere to screening guidelines. Having multiple mental health diagnoses was also not a negative risk factor. Conclusions: Our Veteran population's adherence rates are higher than the national average and rural location, race, age, and certain mental health disorders did not negatively affect adherence to screening mammography. Though more research is needed, screening reminders from our women's health coordinator may have improved adherence rates and lowered disparities.

Peer support and whole health coaching to address the healthcare needs of homeless veterans: a pilot study

BackgroundHomelessness is a robust social determinant of acute care service utilization among veterans. Although intensive outpatient programs have been developed for homeless veterans who are high utilizers of acute care (“super utilizers”), few scalable programs have been implemented to address their needs.ObjectiveDescribe the development and pilot testing of a novel intervention that integrates the roles of a peer and whole health coach (“Peer-WHC”) in coordination with primary care teams to reduce homeless veterans’ frequent use of acute care.DesignSingle-arm trial in three outpatient primary care clinics at a Veterans Health Administration (VHA) medical center; pre/post design using mixed-methods.ParticipantsTwenty veterans from VHA’s homeless registry who were super-utilizers of acute care and enrolled in primary care.InterventionWeekly health coaching sessions with a peer over 12 weeks, including discussions of patients’ health care utilization patterns and coordination with primary care.Main measuresRates of session attendance and intervention fidelity, patient-reported satisfaction and changes in patient engagement and perceptions of health, pre/post utilization of acute and supportive care services, and qualitative interviews with multiple stakeholders to identify barriers and facilitators to implementation.Key resultsOn average, patients attended 6.35 sessions (SD = 3.5, Median = 7). Satisfaction scores (M = 28.75 out of 32; SD = 2.79) exceeded a priori benchmarks. Patients’ perceptions of health improved from pre to post [t(df)=-2.26(14), p = 0.04]. In the 3-months pre/post, 45% (n = 9) and 15% (n = 3) of patients, respectively, were hospitalized. Qualitative feedback from patients, providers, and peers and fidelity metrics suggested value in increasing the length of the intervention to facilitate goal-setting with patients and coordination with primary care.ConclusionFindings support the feasibility, acceptability, and utility of Peer-WHC to address the healthcare needs of homeless veterans. A future trial is warranted to test the impact of Peer-WHC on reducing these patients’ frequent use of acute care.

Collaboration and coordination of health and care services for older people with dementia by multidisciplinary health and care providers: a scoping review protocol

IntroductionCollaboration and coordination of health and care services are key to catering for the diverse needs of a growing population of older people with dementia. When multidisciplinary health and care...

Community pharmacy and general practice collaborative and integrated working: a realist review protocol

IntroductionIncreasing collaborative and integrated working between General practice (GP) and Community pharmacy (CP) is a key priority of the UK National Health Service and has been proposed as a solution...

Assessment of formats and completeness of paper-based referral letters among urban hospitals in Rwanda: a retrospective baseline study

BackgroundPatient referral is a process in which a healthcare provider decides to seek assistance due to the limitations of available skills, resources and services offered locally. Paper-based referrals predominantly used in low-income countries hardly follow any procedure. This causes a major gap in communication, coordination, and continuity of care between primary and specialized levels, leading to poor access, delay, duplication and unnecessary costs. The goal of this study is to assess the formats and completeness of existing paper-based referral letters in order to improve health information exchange, coordination, and continuity of care.MethodsA retrospective exploratory research was conducted in eight public and three private healthcare facilities in the city of Kigali from May to October 2021. A purposive sampling method was used to select hospitals and referral letters from patients’ files. A data capture sheet was designed according to the contents of the referral letters and the resulting responses were analyzed descriptively.ResultsIn public hospitals, five types of updated referral letters were available, in total agreement with World Health Organization (WHO) standards of which two (neonatal transfer form and patient monitoring transfer form) were not used. There was also one old format that was used by most hospitals and another format designed and used by a district hospital (DH) separately. Three formats were designed and used by private hospitals (PH) individually. A total of 2,304 referral letters were perused and the results show that “external transfer” forms were completed at 58.8%; “antenatal, delivery, and postnatal external transfer” forms at 47.5%; “internal transfer” forms at 46.6%; “Referral/counter referral” forms at 46.0%; district hospital referrals (DH2) at 73.4%. Referrals by private hospitals (PH1, PH2 and PH3) were completed at 97.7%, 70.7%, and 0.0% respectively. The major completeness deficit was observed in counter referral information for all hospitals.ConclusionWe observed inconsistencies in the format of the available referral letters used by public hospitals, moreover some of them were incompatible with WHO standards. Additionally, there were deficits in the completeness of all types of paper-based referral letters in use. There is a need for standardization and to disseminate the national patient referral guideline in public hospitals with emphasis on referral feedback, referral registry, triage, archiving and a need for regular training in all organizations.

A human centred approach to digital technologies in health care delivery among mothers, children and adolescents

Background:Healthcare outcomes in child, adolescent and maternal in Tanzania are poor, and mostly characterised by fragmentary service provision. In order to address this weakness, digital technologies are sought to be integrated in the milieu of health as they present vast opportunities especially in the ability to improve health information management and coordination. Prior to the design and implementation of the Afya-Tek digital intervention, formative research was carried out to ensure that the solution meets the needs of the users. The formative research aimed to examine: the burden of disease and related health seeking behaviour; workflow procedures and challenges experiencing healthcare actors; adolescent health and health seeking behaviour; and lastly examine technological literacy and perceptions on the use of digital technologies in healthcare delivery. This paper therefore, presents findings from the formative research.Methods:The study employed exploratory design grounded in a qualitative approach. In-depth interview, focus group discussion, participant observation and documentary review methods were used for collecting data at different levels. The analysis was done thematically, whereby meaning was deduced behind the words which the participants used.Results:Findings suggest that the perceived burden of diseases and health seeking behaviour differ across age and social group. Multiple work-related challenges, such as lack of proper mechanism to track referrals and patient’s information were noted across healthcare actors. There was a keen interest in the use of technologies shown by all study participants to improve care coordination and health outcomes among health system actors. Participants shared their views on how they envision the digital system working.Conclusion:The formative research provided insightful background information with regard to the study objectives. The findings are used for informing the subsequent phases of the co-development and implementation of the Afya-Tek digital health intervention; with a view to making it relevant to the needs of those who will use it in the future. As such, the findings have to a large extent met the purpose of the current study by envisaging the best ways to design digital intervention tailored to meet the needs of those who will be using it.

COSSAD: Social and Health Coordination in Home Care

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.

Health and Social Care coordination in Andalusia within the European project VIGOUR

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.