Health Service Encounters Research Articles

“Feeling Like You Matter:” LGBTQ + Young Adult Perspectives on Affirmative Mental Healthcare

The purpose of this study was to explore the experiences of LGBTQ + young people in mental healthcare and to understand their perspectives on what affirmative mental healthcare practice should look like. Between June and September of 2023, interviews were conducted with LGBTQ + young people ages 18–26 years in Los Angeles and Seattle. Interviews lasted 30 to 60 min and were transcribed verbatim for thematic analysis (N = 28). Four themes were developed from analysis of the interviews: (1) disconnection from community and self as an impetus for seeking formal mental healthcare; (2) marginalization during mental health service encounters; (3) the therapeutic power of belonging and mattering in the mental healthcare system; and (4) mutual human connection as the foundation for affirming mental healthcare experiences. Affirmative mental healthcare was defined by LGBTQ + young adults as free of judgment with priority placed on the therapeutic power of genuine human connection. The need for trans-specific mental healthcare was also highlighted. Participants also expressed a preference for providers with shared identities and experiences to alleviate feelings of isolation and increase feelings of connectivity. Mental health providers should emphasize connectivity and empathy to offer affirming care with LGBTQ + clients, such asking about client preferences for care, developing knowledge about sexuality and gender identity, and acknowledging provider limitations or knowledge gaps. Improving access to affirmative mental healthcare for LGBTQ + young adults (e.g., workforce development, training requirements) is needed to address the disparities in mental healthcare.

Changes in health service use due to alcohol during the COVID-19 pandemic among individuals with and individuals without pre-existing alcohol-related medical diagnoses.

To compare changes in outpatient and acute care visits due to alcohol during the COVID-19 pandemic between individuals with and those without a history of alcohol-related health service use (AHSU). We conducted a cross-sectional analysis of health administrative data in Ontario, Canada. The Ontario population was stratified into those with and those without 1+ health service encounter(s) due to alcohol in the past 2 years. We compared age- and sex-standardized rates of alcohol-related outpatient visits, emergency department (ED) visits, and hospitalizations during the first 15 months of the pandemic (March 2020-May 2021) to those during the same 15-month period prior to the pandemic (March 2018-May 2019). Of 13,450,750 eligible Ontarians on March 11, 2022, 129,434 (1.0%) had AHSU in the previous 2 years. Overall, rates of alcohol-related outpatient visits and hospitalizations increased, while rates of alcohol-related ED visits decreased during the pandemic. There was a similar relative increase in rates of alcohol-related outpatient visits and hospitalizations between those with and those without prior AHSU. However, the absolute increase in rates of alcohol-related outpatient visits and hospitalizations was higher among those with prior AHSU (outpatient rate difference (RD) per 10,000 population: 852.3, 95% confidence interval (CI): 792.7, 911.9; inpatient RD: 26.0, 95% CI: -2.3, 54.2) than among those without (outpatient RD: 6.5, 95% CI: 6.0, 6.9; inpatient RD: 0.4, 95% CI: 0.2, 0.7). Rates of alcohol-related outpatient and inpatient care increased during the COVID-19 pandemic, and high rate of recurrent harm among individuals with pre-pandemic AHSU was an important contributor to this trend.

Exploring the Relationship Between Hospital Service Quality, Patient Trust, and Loyalty From a Service Encounter Perspective in Elderly With Chronic Diseases.

Based on the service encounter perspective, this study combines theoretical foundations for such factors as service quality and the characteristics of the hospital service industry to develop a research model scale to investigate whether the quality of hospital services affects patients' perceptions of health service encounters, trust, and loyalty. Nowadays, with the advancement of medical technology, patients pay more attention to the quality of medical services and good service encounters provided by healthcare professionals in order to establish positive patient relationships; hospitals need to improve their own service quality and establish good patient trust relationships so that doctor-patient satisfaction and loyalty can be improved. In a review of related literature, this study found that most past studies focused on issues related of quality of medical services and patient satisfaction, but ignored those related to the relationship between medical service encounters and patient trust and loyalty, as well as the lack of scientific measurement markers for service encounters in the Chinese medical service industry. Therefore, this study uses the Service Encounter Perspective and Service Quality Theory Development Research Scale to collect and analyze data for a typical case of a Chinese tertiary hospital. Finally, this study explores the relationship between the four variables of service quality, service encounter, trust, and loyalty by means of a questionnaire and statistical analysis of the data. Finally, it is concluded that the higher the service quality of the hospital, the higher the customer trust, the higher the service encounter, and in the greater the doctor-patient loyalty.

Missed opportunities for vaccination among children aged 0–23 months visiting health facilities in a southwest State of Nigeria, December 2019

BackgroundDespite efforts to improve childhood immunization coverage in Nigeria, coverage has remained below the national acceptable level. In December 2019, we conducted an assessment of Missed Opportunities for Vaccination (MOV) in Ondo State, in Southwest Nigeria. The objectives were to determine the magnitude of, explore the reasons for, as well as possible solutions for reducing MOV in the State.MethodsThis was a cross-sectional study using a mixed-methods approach. We purposively selected 66 health facilities in three local government authorities, with a non-probabilistic sampling of caregivers of children 0–23 months for exit interviews, and health workers for knowledge, attitudes, and practices (KAP) surveys. Data collection was complemented with focus group discussions and in-depth interviews with caregivers and health workers. The proportion of MOV among children with documented vaccination histories were determined and thematic analysis of the qualitative data was carried out.Results984 caregivers with children aged 0–23 months were interviewed, of which 869 were eligible for inclusion in our analysis. The prevalence of MOV was 32.8%. MOV occurred among 90.8% of children during non-vaccination visits, and 7.3% during vaccination visits. Vaccine doses recommended later in the immunization series were given in a less timely manner. Among 41.0% of health workers, they reported their vaccination knowledge was insufficient. Additionally, 57.5% were concerned about and feared adverse events following immunization. Caregivers were found to have a low awareness about vaccination, and issues related to the organization of the health system were found to contribute towards MOV.ConclusionsOne in three children experienced a MOV during a health service encounter. Potential interventions to reduce MOV include training of health workers about immunization policies and practices, improving caregivers’ engagement and screening of vaccination documentation by health workers during every health service encounter.

Public involvement and engagement in primary and emergency care research: the story from PRIME Centre Wales.

BackgroundPolicy throughout the United Kingdom promotes involvement of patients and public members in research to benefit patient care and health outcomes. PRIME Centre Wales is a national research centre, developing and coordinating research about primary and emergency care which forms 90% of health service encounters. In this paper, we describe our approach to public involvement and engagement in PRIME Centre Wales (hereafter called PRIME), in particular: how this approach has developed; ways in which public members contribute to PRIME activity; the strengths and limitations of our approach, challenges and future opportunities. PRIME ensures work is relevant to service users, carers, the public and policy makers by incorporating comprehensive patient and public involvement in every phase of our work.ApproachPRIME has policies and processes to enable and promote successful public involvement and engagement across research activities. This ensures public perspectives and patient experiences are integrated throughout research development, implementation and dissemination and in managing and delivering PRIME strategy over a 10 year timescale. A public/patient group called SUPER is a key resource providing wide-ranging perspectives via email and face-to-face discussion. We collect information on processes and experiences to assess value and impact, to guide ongoing involvement and engagement. A funded post provides leadership and support to staff and to public/patient contributors to facilitate collaborations.DiscussionA stable, well-resourced structure has provided the timescales to build strong relationships and embed diverse approaches to public involvement and engagement within PRIME. Researchers and public contributors have committed to collaborations, developed knowledge and skills and sustained relationships. Effective approaches incorporate values and actions which, when operating together, strengthen processes and outcomes of public involvement and engagement.ConclusionSupportive context, motivation and time are necessary to foster values and practices that enable effective public involvement and engagement. PRIME has embedded public involvement and engagement across research activities and structures. Central is the public/patient group SUPER offering experience-based expertise to add value to the research cycle. This innovative model, aligned with best practice, enhances relevance and quality of primary and emergency care research to benefit patients and the general population.

Companion cocreation: improving health service encounters of the elderly

PurposeThe increase of life expectancy leads to the elderly living with one or more chronic illnesses. Communication between the elderly and the health-care professional is fundamental but can be difficult. For that reason, it is common to find the patient with an accompanying family member in the doctor’s surgery. The purpose of this paper is to analyze one of the possible actions of the companion during the provision of the medical service: the co-creation of value (through its two dimensions: coproduction and value-in-use) and its effects on the satisfaction of both the companion and the elderly patient.Design/methodology/approachA model has been tested through a system of structural equations using the statistical package EQS 6.2. The sample used is made up of 1,814 informants (907 companions and 907 patients).FindingsThe importance of coproduction between the accompanying person and the health-care professional is shown, to obtain greater levels of satisfaction (of the companion and the patient), whereas a negative role is conferred to the dimension value-in-use. This paper shows a positive impact of the satisfaction of the companion on that of the patient.Practical implicationsIt is necessary to have health-care professionals who play a proactive role when facilitating the participation in the appointment with the doctor so as not to leave the initiative of participation in the hands of the companions.Originality/valueChronic illnesses are an important focal point of medical attention. Good management of the relations between those involved is fundamental for the diagnosis and adherence to treatment.

How did the introduction of mifepristone impact the availability of abortion care in Ottawa? A qualitative study with abortion patients

In 2017, mifepristone and misoprostol became available for early pregnancy termination as the combination pack Mifegymiso® in Ottawa, Ontario, Canada. We conducted 40 semi-structured telephone interviews with Ottawa residents who had abortions before mifepristone’s introduction ( n = 20) and after mifepristone–misoprostol became available ( n = 20) to explore their experiences obtaining care. We audio-recorded and transcribed all interviews and analyzed these data for content and themes using deductive and inductive techniques. Prior to the introduction of mifepristone, our participants reported obtaining abortion care at two facilities and many faced long wait times. Those who had an abortion after mifepristone became available reported obtaining care from a wider array of providers and few waited more than two weeks. However, several mifepristone–misoprostol users reported having to go through a process that involved as many as 10 health service encounters. Both groups reflected positively on their abortion experiences, but some patients who obtained mifepristone–misoprostol outside of an abortion clinic did not feel as well informed as they would have liked. The introduction of mifepristone appears to have expanded the number of service delivery points and reduced wait times for those seeking abortion care in Ottawa. Identifying ways to expand access to medication abortion information and streamline services appears warranted.

Association between body mass index (BMI) percentile and asthma in children of 5–12 years old: A case–control study using electronic medical records in Primary Health Care Corporation, Qatar 2016–2017

ABSTRACT Background: Over the last several decades, obesity and asthma prevalence have risen among children. The increase in overweight and obesity has been associated with an increased risk of asthma in children. Most epidemiological studies have proposed that a high body mass index (BMI) at infancy and early childhood increases the risk of asthma in children. A recently adopted electronic recording system for health service encounters in Primary Health Care Corporation of Qatar has provided a convenient opportunity to assess the possible link between asthma and obesity in children aged 5–12 years. Objectives: To calculate the prevalence rate of overweight and obesity among asthmatic children aged 5–12 years using primary health care centers during 2016–2017. To measure the strength of the association between BMI and asthma in children aged 5–12 years after adjusting for age, gender, and nationality. Methodology: This was a case–control study on the electronic health records of children aged 5–12 years who visited one of the primary health care centers during the two-year study period (2016–2017). A total of 9889 children with a diagnosis of asthma and valid BMI measurements were included in the case group, and an identical number of children who visited the health care centers for other reasons and had valid BMI measurements were randomly enrolled in the control group. Results: The prevalence of obesity (BMI-for-age Z-score >2) was significantly higher among asthmatics (24.9%) compared with non-asthmatic controls (17.7%). Asthma significantly increased the risk of being obese by 41% in bivariate analysis. The calculated risk estimate for the association between asthma and obesity increased to 70% after adjusting for the confounding effect of age, gender, and nationality. Conclusions: The present observational study based on a large sample of 5 to 12-year-old children documented a strong association between asthma and obesity (BMI-for-age Z-score 2 or above). This positive association between asthma and high BMI was stronger among older children, females, and Qatari nationals.

Opportunities to improve vaccination coverage in a country with a fledgling health system: Findings from an assessment of missed opportunities for vaccination among health center attendees—Timor Leste, 2016

IntroductionSince its independence in 2002, Timor Leste has made significant strides in improving childhood vaccination coverage. However, coverage is still below national targets, and children continue to have missed opportunities for vaccination (MOV), when eligible children have contact with the health system but are not vaccinated. Timor Leste implemented the updated World Health Organization methodology for assessing MOV in 2016. MethodsThe MOV data collection included quantitative (caregiver exit interviews and health worker knowledge, attitudes, practices surveys (KAP)) and qualitative arms (focus group discussions (FGDs) with caregivers and health workers and in-depth interviews (IDIs) with health administrators). During a four-day period, health workers and caregivers with children <24 months of age attending the selected eight facilities in Dili Municipality were invited to participate. The researchers calculated the proportion of MOV and timeliness of vaccine doses among children with documented vaccination histories (i.e., from a home-based record or facility register) and thematically analyzed the qualitative data. ResultsResearchers conducted 365 caregiver exit interviews, 169 health worker KAP surveys, 4 FGDs with caregivers, 2 FGDs with health workers, and 2 IDIs with health administrators. Among eligible children with documented vaccination histories (n = 199), 41% missed an opportunity for vaccination. One-third of health workers (33%) believed their knowledge of immunization practices to be insufficient. Qualitative results showed vaccines were not available at all selected health facilities, and some facilities reported problems with their cold chain equipment. ConclusionThis study demonstrates that many children in Timor Leste miss opportunities for vaccination during health service encounters. Potential interventions to reduce MOV include training of health workers, improving availability of vaccines at more health facilities, and replacing unusable cold chain equipment. Timor Leste should continue to scale up successful MOV interventions beyond Dili Municipality to improve vaccination coverage nationally and strengthen the health system overall.

Global, regional, and national burden of Alzheimer's disease and other dementias, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

SummaryBackgroundThe number of individuals living with dementia is increasing, negatively affecting families, communities, and health-care systems around the world. A successful response to these challenges requires an accurate understanding of the dementia disease burden. We aimed to present the first detailed analysis of the global prevalence, mortality, and overall burden of dementia as captured by the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016, and highlight the most important messages for clinicians and neurologists.MethodsGBD 2016 obtained data on dementia from vital registration systems, published scientific literature and surveys, and data from health-service encounters on deaths, excess mortality, prevalence, and incidence from 195 countries and territories from 1990 to 2016, through systematic review and additional data-seeking efforts. To correct for differences in cause of death coding across time and locations, we modelled mortality due to dementia using prevalence data and estimates of excess mortality derived from countries that were most likely to code deaths to dementia relative to prevalence. Data were analysed by standardised methods to estimate deaths, prevalence, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs; computed as the sum of YLLs and YLDs), and the fractions of these metrics that were attributable to four risk factors that met GBD criteria for assessment (high body-mass index [BMI], high fasting plasma glucose, smoking, and a diet high in sugar-sweetened beverages).FindingsIn 2016, the global number of individuals who lived with dementia was 43·8 million (95% uncertainty interval [UI] 37·8–51·0), increased from 20.2 million (17·4–23·5) in 1990. This increase of 117% (95% UI 114–121) contrasted with a minor increase in age-standardised prevalence of 1·7% (1·0–2·4), from 701 cases (95% UI 602–815) per 100 000 population in 1990 to 712 cases (614–828) per 100 000 population in 2016. More women than men had dementia in 2016 (27·0 million, 95% UI 23·3–31·4, vs 16.8 million, 14.4–19.6), and dementia was the fifth leading cause of death globally, accounting for 2·4 million (95% UI 2·1–2·8) deaths. Overall, 28·8 million (95% UI 24·5–34·0) DALYs were attributed to dementia; 6·4 million (95% UI 3·4–10·5) of these could be attributed to the modifiable GBD risk factors of high BMI, high fasting plasma glucose, smoking, and a high intake of sugar-sweetened beverages.InterpretationThe global number of people living with dementia more than doubled from 1990 to 2016, mainly due to increases in population ageing and growth. Although differences in coding for causes of death and the heterogeneity in case-ascertainment methods constitute major challenges to the estimation of the burden of dementia, future analyses should improve on the methods for the correction of these biases. Until breakthroughs are made in prevention or curative treatment, dementia will constitute an increasing challenge to health-care systems worldwide.FundingBill & Melinda Gates Foundation.

Person-centred approaches: emerging theories of terms of engagement

Background: The growing number of people living with multiple long-term conditions is increasing demand on Global Health Systems at a time of fiscal constraint [1]. To meet this challenge, new models of primary care aiming at enhanced coordination and person centred care have been proposed to improve efficiency and patient outcomes by breaking with paternalistic models of health and encouraging increased self-management within the community [2]. Lack of implementable evidence and guidance has led to the development of local ‘implementation experiments’. We evaluated a number of these ‘experiments’ across southwest England against four routines for practice developed by the Gothenburg centre for person centred care [3]. Methods: To develop theory about how best to engage people in new interventions for the development of person centred coordinated care we conducted a secondary, inductive analysis of qualitative data. This comprised of data generated from structured interviews, focus groups and observations with patients and practitioners that formed part of our service evaluations. Theory was co-produced in workshops involving patients and practitioners. Results: Our data revealed that initially some patients were suspicious of the motives for their inclusion in novel interventions, or did not understand the new model’s rationale. In these cases participants found it difficult to develop a narrative routine one and some individuals declined participation. This was due to underdevelopment of programme theory and inexperience of practitioners in articulating programme aims when introducing the intervention. Evidence suggested that older individuals with more complex care needs may find it more difficult to engage with the new approach, resulting in lack of shared decision making during subsequent goal setting and care planning routines two and three. Co-production was an unintended consequence of bringing participant groups together which produced mechanisms reframing interactions and further developing participants’ narratives. Developing a trusting relationship with practitioners over time also promoted engagement and was more likely to result in development of authentic, holistic narratives and goals. Discussion: Evidence shows that person centred care increases wellbeing and self-management in patients and co-production supports personalised practice [4]. This study gives exemplars of how these principles operate in practice. Personal narrative development is a significant departure from traditional health service encounters in which topics and solutions are defined by practitioners. It may be challenging for patients and practitioners. Conclusions: The establishment of a meaningful patient narrative depends on clear explanations of new interventions and the formation of relationships with practitioners trained in eliciting these conversations. This ‘pre-context’ is fundamental to person centred care since it establishes rules of engagement for the subsequent routines of decision-making and care planning. Lessons learned: Clarity of programme theory and staff training on effective communication and narrative development are imperative to the delivery of person centred care. Limitations: Data was limited to those agreeing to be interviewed, observed, or take part in focus groups; the views and experiences used to develop theory may not be wholly representative of more marginalised individuals. Suggestions for future research: Testing the developed theory in controlled or other well-designed research programmes.

HEALTHCARE RESOURCE UTILIZATION AMONG CHILDREN WITH CONGENITAL HEART DISEASE: A POPULATION-BASED STUDY

Data regarding healthcare resource utilization (HRU) in early childhood among children with congenital heart disease (CHD) are scarce. Therefore, we sought to describe the extent of HRU incurred among children with CHD in the first five years of life and examine the extent to which it is modulated by the severity of the disease. In this population-based retrospective cohort study, all children born alive between January 2005-March 2014 in Alberta, Canada were included and followed from birth until five years of age. We linked inpatient, outpatient, practitioner claims, and drug dispensing databases with vital statistics (birth and death registries). Children were grouped by CHD severity level as follows: single ventricle (SV), moderate-complex, simple, and non-CHD. Primary outcomes were the number and rate of health service encounters. HRU rate was compared across CHD groups using a univariate Poisson regression model. Among 448,527 children, 223 (0.1%) children had SV lesions, 2,094 (0.5%) had moderate-complex CHD, and 4,690 (1.1%) simple CHD. In the first year of life, the cumulative hospitalization rate/100 children was 335 (95% CI: 312-360) for SV children, 200 (194-206) for moderate-complex CHD, 152 (149-156) for simple CHD vs. 109 (108-109) among non-CHD children (p<0.001). The ambulatory-care visit rate/100 children was 4,871 (4,780-4,963) for SV, 2,278 (2,258-2,299) for moderate-complex, 1,416 (1,405-1,426) for simple CHD vs. 246 (246-247) for non-CHD children (p<0.001). The rates of physician claims and drug-dispensing also demonstrated similar patterns. The median total hospitalization length of stay during the first year of life was 54 days (IQR: 26-95) in SV, 15 (4-39) in moderate-complex, and 6 (2-26) in simple CHD compared with 2 (1-3) among non-CHD children (p<0.001). These differences remained throughout the first five years of life, with CHD children having consistently higher hospitalization rates and ED visit rates in every year of age compared to non-CHD children. In the first year of life, median (IQR) cost per child, excluding drug costs, was $224,324 ($127,596-$312,077) in the SV group, $51,514 ($12,992-$123,332) in moderate-complex CHD, $16,274 ($6,921-$60,069) in simple CHD, and $2,918 ($1,937-$5,480) for non-CHD children (p<0.001). Hospitalizations accounted for the majority of total cost (79.2-84.4% in CHD children vs. 56.4% in non-CHD children). Cumulative HRU is high among CHD children in the first five years of life and increases with increasing CHD severity. As survival rates of children with SV lesions improve, health care systems will require increasing resource allocation to this group.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

FA05.01: NON-ONCOLOGICAL PULMONARY MORTALITY IS ASSOCIATED WITH OESOPHAGECTOMY FOR CANCER

Abstract Background Improvements in oesophageal cancer care have meant ever more patients are being declared cured. Whether oesophagectomy itself causes long-term non-cancer mortality is not known. This study was conducted to assess the timing and frequency of non-cancer causes of death after oesophagectomy in the UK with a population-based survey. Methods Hospital Episode Statistics provides contemporaneous admission data for all inpatient National Health Service encounters since 2000. A linked database was constructed of all HES encounters with oesophagectomy treatment codes, with Office for National Statistics mortality data, which included cause and date of death. Minimum follow-up was to 5 years. Independent variables potentially predictive of cause of death were entered into logistic regression analyses. Results There were 7204 oesophagectomy patients for which linked mortality data was available. A total of 302 died within 90 days, and a further 5874 died of primary cancer recurrence. Of the remaining 908 non-index-cancer deaths, 238 (26.2%) died of respiratory causes, 210 (23.1%) died of other cancers, 158 (17.4%) died of cardiac diagnoses and 64 (7%) died of cerebrovascular diagnoses. Survival patterns for those dying of cardiac and primary cancer recurrence were similar, with 80% occurring within 2 years of surgery. Non-cancer respiratory mortality was a later occurrence, with 80% occurring by 6 years. A pre-operative pulmonary diagnosis was associated with pulmonary mortality (OR 2.66 95% C.I. 1.49–4.77, P &lt; 0.001), and a pre-operative ischaemic heart disease diagnosis were associated with post-operative cardiac death (OR 2.28 95% C.I. 1.13–4.59, P = 0.021). Long-term respiratory mortality was associated with inpatient respiratory complications in the index encounter (OR 2.60 95% C.I. 1.36 to 4.98, P = 0.004). Comparison to mortality rates after colectomy for cancer revealed 2-fold increased risk of non-cancer pulmonary death after oesophagectomy. Conclusion Oesophagectomy may increase the risk of non-cancer respiratory death in oesophageal cancer survivorship, with implications for peri-operative pathways and follow-up programs. Further work is needed to test whether this is a consequence of reconstruction, peri-operative complications, or progression of pre-morbid diagnoses. Disclosure All authors have declared no conflicts of interest.

The Health Needs and Experiences of Trans Residents in Small and Rural Areas

This brief paper summarizes the findings from a community-based research project examining the health needs and experiences of trans-identified people in small and rural communities as presented at the 9th annual Laurentian University Faculty of Health conference. This study involved residents who identify as transgender living in North Simcoe/Muskoka, an area comprised of small, rural, suburban and remote communities. It employed a mixed method design, with quantitative findings derived from a comprehensive online survey and qualitative findings from a series of community focus groups. A sample of findings related to health care experiences grounded in the voices of participants was presented. These findings included several common themes that characterize the health service encounter of residents who are transgender. The health care experience of trading off competent trans-specific health care provision for respect and willingness on behalf of the health care practitioner was common, and provides evidence for the lack of trans-specific health care available in these areas. Experiences of service denial or rejection as a result of their trans identities or gender expression were also common. Residents who are transgendered in areas where there is a lack of service infrastructure are also forced to become their own health care experts, a necessary and distressing reality of accessing health care as a transgender individual in small and rural areas.&#x0D;

Assessing the Impact of Technology Adoption on Human Touch Aspects in Healthcare Settings in Mauritius

Abstract This paper investigates the impact of technology adoption on human touch aspects in healthcare settings in Mauritius. Unstructured interviews, focus group discussions and overt observations were carried out in two phases with 27 healthcare professionals and 42 healthcare customers in the private sector over a period of five months as part of an exploratory study, followed by a pilot study where a survey was carried out among 31 participants who have also been exposed to private healthcare services in Mauritius. Survey findings have depicted that technology implementation in healthcare settings can represent a direct threat to human touch aspects. Although the outcome of service remains very important, the delivery of same service in terms of how, when and by whom it was delivered has been seen to be as important. Healthcare customers are normally in a vulnerable state requiring appropriate human touch in the service delivery. Moreover, they also expect fast, efficient and effective services which eventually create a pressing need for consequent use of technology. Therefore, the balance between technology and human touch aspects was found to be a determinant of service quality enforcement and customer satisfaction for healthcare customers. This paper demonstrates that implementing technology in healthcare nowadays is inevitable for proper service delivery, however, it is imperative to preserve human touch aspects at all times during health service encounters. This pioneer study also acts as a guide for health care practitioners to derive the best strategies to maintain a good equilibrium between technology adoption and human touch aspects in all healthcare services in the context of developing state such as Mauritius.

Unit Costing of Health Extension Worker Activities in Ethiopia: A Model for Managers at the District and Health Facility Level.

Background: Over the last decade, Ethiopia has made impressive national improvements in health outcomes, including reductions in maternal, neonatal, infant, and child mortality attributed in large part to their Health Extension Program (HEP). As this program continues to evolve and improve, understanding the unit cost of health extension worker (HEW) services is fundamental to planning for future growth and ensuring adequate financial support to deliver effective primary care throughout the country. Methods: We sought to examine and report the data needed to generate a HEW fee schedule that would allow for full cost recovery for HEW services. Using HEW activity data and estimates from national studies and local systems we were able to estimate salary costs and the average time spent by an HEW per patient/community encounter for each type of services associated with specific users. Using this information, we created separate fee schedules for activities in urban and rural settings with two estimates of non-salary multipliers to calculate the total cost for HEW services. Results: In the urban areas, the HEW fees for full cost recovery of the provision of services (including salary, supplies, and overhead costs) ranged from 55.1 birr to 209.1 birr per encounter. The rural HEW fees ranged from 19.6 birr to 219.4 birr. Conclusion: Efforts to support health system strengthening in low-income settings have often neglected to generate adequate, actionable data on the costs of primary care services. In this study, we have combined time-motion and available financial data to generate a fee schedule that allows for full cost recovery of the provision of services through billable health education and service encounters provided by Ethiopian HEWs. This may be useful in other country settings where managers seek to make evidence-informed planning and resource allocation decisions to address high burden of disease within the context of weak administrative data systems and severe financial constraints.

Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

SummaryBackgroundChronic obstructive pulmonary disease (COPD) and asthma are common diseases with a heterogeneous distribution worldwide. Here, we present methods and disease and risk estimates for COPD and asthma from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) 2015 study. The GBD study provides annual updates on estimates of deaths, prevalence, and disability-adjusted life years (DALYs), a summary measure of fatal and non-fatal disease outcomes, for over 300 diseases and injuries, for 188 countries from 1990 to the most recent year.MethodsWe estimated numbers of deaths due to COPD and asthma using the GBD Cause of Death Ensemble modelling (CODEm) tool. First, we analysed data from vital registration and verbal autopsy for the aggregate category of all chronic respiratory diseases. Subsequently, models were run for asthma and COPD relying on covariates to predict rates in countries that have incomplete or no vital registration data. Disease estimates for COPD and asthma were based on systematic reviews of published papers, unpublished reports, surveys, and health service encounter data from the USA. We used the Global Initiative of Chronic Obstructive Lung Disease spirometry-based definition as the reference for COPD and a reported diagnosis of asthma with current wheeze as the definition of asthma. We used a Bayesian meta-regression tool, DisMod-MR 2.1, to derive estimates of prevalence and incidence. We estimated population-attributable fractions for risk factors for COPD and asthma from exposure data, relative risks, and a theoretical minimum exposure level. Results were stratified by Socio-demographic Index (SDI), a composite measure of income per capita, mean years of education over the age of 15 years, and total fertility rate.FindingsIn 2015, 3·2 million people (95% uncertainty interval [UI] 3·1 million to 3·3 million) died from COPD worldwide, an increase of 11·6% (95% UI 5·3 to 19·8) compared with 1990. There was a decrease in age-standardised death rate of 41·9% (37·7 to 45·1) but this was counteracted by population growth and ageing of the global population. From 1990 to 2015, the prevalence of COPD increased by 44·2% (41·7 to 46·6), whereas age-standardised prevalence decreased by 14·7% (13·5 to 15·9). In 2015, 0·40 million people (0·36 million to 0·44 million) died from asthma, a decrease of 26·7% (−7·2 to 43·7) from 1990, and the age-standardised death rate decreased by 58·8% (39·0 to 69·0). The prevalence of asthma increased by 12·6% (9·0 to 16·4), whereas the age-standardised prevalence decreased by 17·7% (15·1 to 19·9). Age-standardised DALY rates due to COPD increased until the middle range of the SDI before reducing sharply. Age-standardised DALY rates due to asthma in both sexes decreased monotonically with rising SDI. The relation between with SDI and DALY rates due to asthma was attributed to variation in years of life lost (YLLs), whereas DALY rates due to COPD varied similarly for YLLs and years lived with disability across the SDI continuum. Smoking and ambient particulate matter were the main risk factors for COPD followed by household air pollution, occupational particulates, ozone, and secondhand smoke. Together, these risks explained 73·3% (95% UI 65·8 to 80·1) of DALYs due to COPD. Smoking and occupational asthmagens were the only risks quantified for asthma in GBD, accounting for 16·5% (14·6 to 18·7) of DALYs due to asthma.InterpretationAsthma was the most prevalent chronic respiratory disease worldwide in 2015, with twice the number of cases of COPD. Deaths from COPD were eight times more common than deaths from asthma. In 2015, COPD caused 2·6% of global DALYs and asthma 1·1% of global DALYs. Although there are laudable international collaborative efforts to make surveys of asthma and COPD more comparable, no consensus exists on case definitions and how to measure disease severity for population health measurements like GBD. Comparisons between countries and over time are important, as much of the chronic respiratory burden is either preventable or treatable with affordable interventions.FundingBill & Melinda Gates Foundation.

Postpartum Health Services Requested by Mothers with Newborns Receiving Intensive Care.

Objectives Our pilot study aimed to build knowledge of the postpartum health needs of mothers with infants in a newborn intensive care unit (NICU). Methods Between May 2008 and December 2009, a Certified Nurse Midwife was available during workday hours to provide health care services to mothers visiting their infants in the NICU at a large tertiary care center. Results A total of 424 health service encounters were recorded. Maternal requests for services covered a wide variety of needs, with primary care being the most common. Key health concerns included blood pressure monitoring, colds, coughs, sore throats, insomnia and migraines. Mothers also expressed a need for mental health assessment and support, obstetric care, treatment for sexually transmitted infections, tobacco cessation, breastfeeding assistance, postpartum visits, and provision of contraception. Conclusions Our study suggests that mothers with babies in the NICU have a host of health needs. We also found that women were receptive to receiving health services in a critical care pediatric setting. Intensive care nurseries could feasibly partner with in-patient mother–baby units and/or on-site obstetric clinics to increase access to health care for the mothers of the high-risk newborns in their units. Modifications should be made within health care systems that serve high-risk infants to better address the many needs of the mother/baby dyad in the postpartum period.

Developing a public health-tracking system for follow-up of newborn screening metabolic conditions: a four-state pilot project structure and initial findings

The aim of this study was to describe the methods, cases, and initial results of a pilot project using existing public health data collection programs (birth defect surveillance or newborn screening) to conduct long-term follow-up of children with metabolic disorders. California, Iowa, New York, and Utah expanded birth defect surveillance or newborn screening programs to collect long-term follow-up data on 19 metabolic disorders. Data elements to monitor health status and services delivered were identified, and record abstraction and data linkages were conducted. Children were followed up through to the age of 3 years. A total of 261 metabolic cases were diagnosed in 1,343,696 live births (19.4 cases/100,000; 95% confidence interval = 17.1-21.8). Four deaths were identified. Children with fatty acid oxidation disorders had a higher percentage of health service encounters compared with children with other disorders of at least one health service encounter (hospitalization, emergency room, metabolic clinic, genetic service provider, or social worker) except for hospitalizations; children with organic acid disorders had a higher percentage of at least one hospitalization during their third year of life than children with other disorders. Existing public health data programs can be leveraged to conduct population-based newborn screening long-term follow-up. This approach is flexible according to state needs and resources. These data will enable the states in assessing health burden, assuring access to services, and supporting policy development.

Internet forums and negotiation of healthcare knowledge cultures

Purpose– Internet forums are an important arena for information exchange between consumers. Despite healthcare being one of the most accessed information categories on the internet, knowledge of exchange between patients in online communities remains limited. Specifically, little is known about how patients negotiate knowledge in online forums to understand and manage their diseases. This paper aims to illustrate this by presenting data that demonstrate the construction of tacit knowledge within online health communities, and how consumers exercise their “voice” within complex professional services.Design/methodology/approach– This paper reports an exploratory single case study of an online discussion forum for breast cancer sufferers, in which participants discuss their experience with healthcare services and related pharmaceutical products. Textual data were collected and analysed from the forum retrospectively from an 11-month period, entailing contributions from 252 participants.Findings– The paper challenges prevalent managerial and professional perspectives that evaluate online health information in terms of its correspondence with conventional medical information. In the absence of normative assumptions that broadly guide health service encounters, forum participants negotiate their understandings in the context of their personal experience.Practical implications– This novel culture offers potential for developing rich and sometimes more appropriate understandings of health than available from the medical establishment. It discusses how service providers can exploit such opportunities towards improving service provision, facilitating the consumer voice within a complex service.Originality/value– Re-evaluating the value of online forums, the paper identifies the mechanisms through which health consumers co-create knowledge within online communities, and how these mechanisms can inform and complement future service provision.