Evaluation Of Health Services Research Articles

Navigating Informed Consent Requirements and Expectations in Cluster Randomized Trials: Research Ethics Board Members' and Researchers' Views.

Informed consent is a cornerstone of ethical human research. However, as cluster randomized trials (CRTs) are increasingly popular to evaluate health service interventions, especially as health systems aspire toward the learning health system, questions abound how research teams and research ethics boards (REBs) should navigate intertwining consent and data-use considerations. Methodological and ethical questions include who constitute the participants, whose and what types of consent are necessary, and how data from people who have not consented to participation should be managed to optimize the balance of trust in the research enterprise, respect for persons, the promotion of data integrity, and the pursuit of the public good in the research arena. In this paper, we report the findings and lessons learned from a qualitative study examining how researchers and REB members consider the ethical dimensions of when data can be collected and used in CRTs in the evolving research landscape.

Application of single anterior teeth defect with computer-aided design and computer-aided manufacturing polymethyl methacrylate single-retainer resin-bonded fixed dental prosthesis in children

Objective: To explore the clinical effect of computer-aided design and computer-aided manufacturing (CAD/CAM) polymethyl methacrylate (PMMA) single-retainer resin-bonded fixed dental prosthesis (RBFDP) for single anterior teeth defect. Methods: A total of 14 children between 10-14 years old (male 8, female 6) who visited the Department of Pediatric Dentistry, School of Stomatology, The Fourth Military Medical University from March to December 2022 with single anterior teeth loss were enrolled in this study. The intraoral scanner was used to obtain their digital impressions, and then the data were imported into CAD software. The single-retainer RBFDP was designed by the CAD software and was manufactured by milling equipment using CAD/CAM PMMA disk. The prosthesis was then tried-in and bonded to the abutment teeth with resin cement and evaluated in a 12 month follow-up observation. The marginal discoloration, marginal adaptation, color match, secondary caries, the occurrence of fractures and loose of abutment tooth were examined on the basis of the modified United States Public Health Services evaluation system. The evaluation was divided into three scores, in which score A indicated ideal restoration effect, score B means that the restoration effect was acceptable (evaluation of restoration integrity, loose of abutment teeth and secondary caries excluded), and score C indicates that the restoration effect is not good. Results: All the 14 CAD/CAM PMMA single-retainer RBFDP had good marginal adaptation and color match with no marginal discoloration, no secondary caries, no fracture of restorations and no abnormal loose of the abutment teeth. All of the six criteria achieved score A evaluation after a three month follow-up observation. One restoration was classified as score B for fracture after a six month follow-up observation, while two restoration were classified as score B for marginal discoloration after 12 month follow-up observation. Conclusions: The CAD/CAM PMMA single-retainer RBFDP was clinically effective in restoration of single anterior teeth defect in children.

Integration of prison health care into national disease surveillance and health informatic systems: opportunities and challenges for Europe and beyond

Abstract Approximately six million people are incarcerated annually in the WHO EURO region. The majority of these people spend only a minority of their lives in prison. Many people living in prison (PLP) experience significant health & social care inequalities/inequities and have higher levels of health & care needs than their peers in the community. Imprisonment can represent a public health opportunity to identify and address such needs. Programmes delivered in prisons targeting infectious diseases like HBV, HCV, HIV and tuberculosis (TB) can improve active case finding specifically in prison settings but can also impact on elimination and control targets for whole populations by addressing high risk transmission networks centred in and around prison associated populations. But too often prisons represent a ‘black hole’ for health & care data flows, neither receiving health information from community-based health systems nor providing, in an accessible way, details of health interventions delivered in prisons. The result is discontinuity of care and inefficiencies (economic&clinical) in treatment and care programmes. For example, people being screened multiple times for an infection (e.g. HCV) but not receiving treatment, or starting and stopping multiple courses of treatment in a chaotic way which could add to public health risks, e.g. multi-drug resistant TB. National disease surveillance systems missing data on prison populations also risk health security given the ability of prisons to amplify infectious diseases which could pose health threats to wider communities. Significant efforts are required to ensure that national disease surveillance and health information systems routinely include PLP to improve health intelligence, health security and continuity of care. This can support delivery of screening, diagnostic and therapeutic services. But can also enable health service evaluation, health & care needs assessment, and quality improvement programmes.

A co-produced service evaluation of ethnic minority community service user experiences of a specialist mental health service during the COVID-19 pandemic

BackgroundFor ethnic minority communities in the UK, the COVID-19 pandemic amplified existing health inequalities and created other consequential disadvantages like increased vulnerability to COVID-19, higher rates of hospital admissions, increased mortality and poorer mental health outcomes. While longer-term impacts of COVID-19 are considered, it is crucial for NHS mental health services to understand the specific barriers and needs of ethnic minority communities to provide consistent and equitable access to mental health services. These aspects were the focus of a service evaluation of a Sussex-wide mental health service conducted in co-production with experts-by-experience, public members, health professionals and researchers from ethnic minority communities.MethodsCo-designed creative workshops (n = 13) and semi-structured qualitative interviews (n = 13) were used to explore experiences of accessing specialist mental health services during the COVID-19 pandemic. Participants were: Sussex Partnership NHS Foundation Trust (SPFT) service users recruited between October 2021 and January 2022; aged 16+; from ethnic minority community backgrounds. Data was analysed using Thematic Analysis.ResultsThe analysis yielded five overarching themes contextualising service users’ experiences: (1) limited awareness of SPFT mental health services; (2) effects of COVID-19 in gaining access to SPFT; (3) SPFT reaching out to ethnic minorities; (4) being supported, 4a) hiding my mental health status from friends and families, 4b) lack of ethnic diversity in services, and 4c) better provision of information and support services, (5) relationship between childhood experiences and current mental health. These findings led to seven key recommendations for future service developments within SPFT.ConclusionsAlthough this evaluation was set in the context of COVID-19, findings have highlighted specific mental health service needs for ethnic minorities that are applicable beyond the confines of the pandemic. Many benefited from online sessions seen as more inclusive. Mental health advocates, outreach and joint working with communities could help further reduce stigmatising attitudes and improve engagement with mental health services. Improved service awareness of the impact of childhood or historical traumas experienced by ethnic minority communities on current mental health, the role of cultural awareness training and availability of culturally adapted therapies is also needed. Many service improvement recommendations provided could impact all service users.

Analysis of the feelings of patients with HIV/AIDS and HCV in contact with health professionals. Assessment based on cases of stigmatisation and discrimination.

This study aimed to investigate incidences of stigmatisation and discrimination by selected health professionals against patients with HIV/AIDS and HCV, and to assess how these affected feelings in both groups. The study involved 160 patients - 80 diagnosed with HIV/AIDS in the baseline group and 80 with HCV in the comparison group. Patients were recruited from among patients treated in two outpatient clinics of the University Hospital in Krakow. Incidents of stigmatisation and discrimination were observed significantly more often in the HIV/AIDS group compared to the HCV group. According to the patients, incidents of stigmatisation and discrimination on the part of medical staff occur due to fear and a sense of threat from infection with the viruses. The experience of stigmatisation and discrimination by patients manifests itself in the impediment or denial of healthcare services by medical professionals. Some of the medical staff blamed the patients for the infection, expressed disrespect and verbal aggression towards them, and treated them worse when they found out about the infection. Their emotional state depended on the nature of the relationship with the medical staff triggered by stigmatisation and discrimination. Stigmatisation and discrimination by medical staff against patients were, according to the respondents, linked to fear of infection but confirmation of this relationship would require further research. In the course of these cases, patients experienced pejorative verbal evaluation, impediment or denial of health services, which could have specific health consequences. These types of attitudes had a negative impact on their emotional state.

Tools and methods for evaluating the change to health service delivery due to pandemics or other similar emergencies: A rapid evidence review

The novel coronavirus, SARS-CoV-2 and its associated disease COVID-19, were declared a pandemic in March 2020. Countries developed rapid response activities within their health services to prevent spread of the virus and protect their populations. Evaluating health service delivery change is vital to assess how adapted practices worked, particularly during times of crisis. This review examined tools and methods that are used to evaluate health service delivery change during pandemics and similar emergencies. Five databases were searched, including PubMed, CENTRAL, Embase, CINAHL, and PsycINFO. The SPIDER tool informed the inclusion criteria for the articles. Articles in English and published from 2002 to 2020 were included. Risk of bias was assessed using the Mixed-Methods Appraisal Tool (MMAT). A narrative synthesis approach was used to analyse the studies. Eleven articles met the inclusion criteria. Many evaluation tools, methods, and frameworks were identified in the literature. Only one established tool was specific to a particular disease outbreak. Others, including rapid-cycle improvement and PDSA cycles were implemented across various disease outbreaks. Novel evaluation strategies were common across the literature and included checklists, QI frameworks, questionnaires, and surveys. Adherence practices, experience with telehealth, patient/healthcare staff safety, and clinical competencies were some areas evaluated by the tools and methods. Several domains, including patient/practitioner safety and patient/practitioner experience with telemedicine were also identified in the studies.

A Service Ecosystem Model for Improving Healthcare Service Accessibility in Primary Care: A Micro Level Perspective

Access to healthcare is one of the fundamental aspects of the health system. Everyone has the basic right to access the best possible health services without any form of discrimination. Accessibility is one of the measures in the context of social sustainability in healthcare, which refers to the capacity of a healthcare system to promote a better quality of life and enhance the overall well-being of a community (Mehra & Sharma, 2021). In a large developing country like Indonesia, the difficulties surrounding healthcare services are significantly intensified. Extensive and widespread healthcare access disparities pose significant challenges. These include inefficiency, limited accessibility, a lack of interoperability among relevant stakeholders, and various other obstacles. Despite recent efforts to enhance healthcare access, substantial factors remain contributing to the inconsistent delivery of services. These encompass fragmented and silos healthcare systems and a lack of integration (Kementerian Kesehatan Indonesia, 2021). Access is a concept that encompasses multiple dimensions. Various aspects of access can be evaluated in relation to the availability of health services, the utilization of health services, or the outcomes derived from health services (Gulliford et al., 2002). However, the conceptualization of access to healthcare services in Indonesia remains unclear, highlighting the challenges in measuring the health service monitoring and evaluation system. Not all aspects are measurable and have suitable measures (Kementerian Kesehatan Republik Indonesia, 2021). To assess access accurately, it is essential to consider a comprehensive set of measures that encompass the characteristics of services, providers, and systems, aligning them with the capabilities of individuals, households, and communities (Levesque et al., 2013). Keywords: Service Ecosystem, Value Co-Creation, Healthcare Services, Healthcare Accessibility.

Analysis of Community Satisfaction Index on Health Service Quality: CFA and Gap Analysis

The Community Satisfaction Index is the focus of attention because it is a reference in evaluating health service policies on the quality of hospital services. Service quality is a determinant factor of patient safety to reduce the incidence of mortality in hospitals. Crossectional is the research design used. The study was conducted from April to June 2023, the population is all patients in the hospital in 2023, and Simple random side as a sampling technique of 136 research subjects. The research variables are performance, expectations, and the Community Satisfaction Index which consists of nine elements, namely requirements; systems, mechanisms, and procedures; turnaround time; cost; product specification type of service; competence of the executor; executor behavior; handling of complaints, suggestions, and inputs. Data collection using questionnaires that have previously been tested for confirmatory factor analysis. Test questionnaires and analyze research results with gap analysis using Wilcoxon in the STATA program. The test results of confirmatory factor analysis showed that RMSEA values = 0.04, CFI = 0.99, χ2 / df = 1.05, and TLI = 0.99 showed that the model met goodness-of-fit. The gap analysis shows that in the 9 elements of the Community Satisfaction Index, 2 elements are not different, namely the competence of the implementer (z = -1.570, p = 0.116) and the behavior of the implementer (z = -1.414, p = 0.157). It is hoped that the results of the research can be used as material for the evaluation of hospital policies.

Evaluasi Kebijakan Pelayanan Kesehatan Oleh Puskesmas Sebagai Street Level Bureaucracy di Masa Pandemi Covid-19

Policy evaluation is an effort to provide an assessment of policy results to become input and recommendations for policymakers. The Covid-19 pandemic has brought about significant changes in the implementation of policies, especially health service policies. Health care policies need to adapt to pandemic conditions and social restrictions. Puskesmas as a street-level bureaucracy play an important role to carry out health services optimally. The Cipocok Jaya Health Center as the locus of this research experienced a decline in the quality of health services based on the community satisfaction index during the Covid-19 pandemic. The purpose of this study was to evaluate health services at the Cipocok Jaya Public Health Center as a street-level bureaucracy. The method used in this research is the qualitative method. The results showed that the health services provided by the Cipocok Jaya Health Center had not been running effectively due to the unpreparedness of human resources at the Puskesmas to adapt to the service model following the pandemic conditions. Other factors are the inadequate budget, facilities and infrastructure and the number of health workers as well as public awareness and readiness in adapting to services during the Covid-19 pandemic.

Barriers and Enablers to Evaluating Outcomes From Public Involvement in Health Service Design: An Interpretive Description.

While health services are expected to have public involvement in service (re)design, there is a dearth of evaluation of outcomes to inform policy and practice. There are major gaps in understanding why outcome evaluation is under-utilised. The aims of this interpretive descriptive study were to explore researcher participants' experiences of and/or attitudes towards evaluating health service outcomes from public involvement in health service design in high-income countries. Additionally, the aims were to explore barriers and enablers of evaluation, and reasons for the use of evaluation tools or frameworks. Semi-structured interviews (n = 13) were conducted with researchers of published studies where the public was involved in designing health services. Using framework analysis, four themes were developed that captured participants' experiences: Public involvement is hard - evaluation is harder; power, a diversity of agendas, and the invisible public; practical and methodological challenges; and genuineness and authenticity matter. Evaluation is driven by stakeholder requirements, including decision-makers, funding bodies, researchers, and academics, and evaluation tools are rarely used. The public is largely absent from the outcome evaluation agenda. There is a lack of commitment and clarity of purpose of public involvement and its evaluation. Outcome evaluation must be multi-layered and localised and reflect the purpose of public involvement, what constitutes success (and to whom), and use the most appropriate methods. Multi-level supports should include increased resources, such as funding, time, and expertise. Without improved evaluation, outcomes of investment in public involvement in health service design/redesign remain unknown.

Tele-psychotherapy during the COVID-19 pandemic: a mini-review.

The COVID-19 pandemic has dramatically changed psychotherapy practices. Psychotherapy around the world has shifted from predominantly face-to-face settings to overwhelmingly online settings since the beginning of the pandemic. Many studies have been published on this topic, but there has been no review of the literature focused on the experience of psychotherapists. Our goal was to identify the challenging issues of teletherapy, including the efficiency of online consultations and the extent to which they are accepted by therapists and patients. A PubMed literature search using the [("Teletherapy" OR "Telebehavioral health" OR "telepsychotherapy") AND ("COVID-19")] search string retrieved 46 studies focused on mental health professionals, as detailed in a PRISMA flow diagram. Two reviewers independently screened the abstracts and excluded those that were outside the scope of the review. The selection of articles kept for review was discussed by all three authors. Overall, the review contributes to the description and evaluation of tele mental health services, including teletherapy, online counseling, digital mental health tools, and remote monitoring.

Prevalence of malocclusion and orthodontic treatment needs among 12–15 years old schoolchildren in Imphal East, Manipur by using Dental Aesthetic Index (DAI)

Abstract Background: Epidemiologically, the prevalence of malocclusion varies from country to country. Studies of occlusion and malocclusion not only help in orthodontic treatment planning and evaluation of dental health services but also offer a valid research tool for ascertaining the operation of distinct environmental and genetic factors in the etiology of malocclusion. Aim: The present study aims to assess the prevalence of malocclusion and orthodontic treatment needs among 12–15 years old schoolchildren of Imphal East, Manipur by using the Dental Aesthetic Index (DAI). Result: Among 12 years old the mean DAI score was 22.69 ± 6.518, among 13 years old it was 21.98 ± 5.965, among 14 years old it was 22.13 ± 5.364 and among 15 years old it was 21.93 ± 5.811. About the gender-wise distribution of DAI score among school children. The mean value for male is 21.95 ± 5.819 and for female is 22.56 ± 5.975 with no significant difference between them. Conclusion: The DAI was found to be reproducible and valid. The finding of the present study remains significant in providing one of the first baseline data on the malocclusion status of school-going children of Manipur.

How can practitioner action research support the design, implementation, and evaluation of on-campus mental health and addiction services?

ABSTRACT In every sector, the COVID-19 pandemic has highlighted the importance of mental health resources for wellbeing. Although scholars have long recognized the interdependent relationship between academic success and positive mental health, research that can be used to guide mental health service design and delivery in post-secondary institutions is relatively unexplored. Further, the experiences of practitioners, in their day-to-day operations toward understanding and responding to student mental health problems, are an under-recognized source of data that can contribute to more effective planning and implementation. The objective of this project is to use practitioner action research principles to design, implement, and evaluate a mental health and addiction services plan at Brock University in Ontario, Canada. This paper details what occurred in the plan-act-observe-reflect cycles as practitioners gathered qualitative data using interviews and the World Café methodology. Results show improvement in student satisfaction ratings with on-campus mental health services. Our experience reveals that practitioner action research is a useful framework for practitioners seeking a systematic process to contribute to both fields of knowledge and fields of practice.

Evaluation of outpatient health services in diabetes mellitus in a middle-income setting: a retrospective cohort study involving secondary care

In Brazil, it is necessary to assess the different levels of health care in diabetes mellitus (DM) in order to integrate them. In this retrospective cohort study, we analyzed 1,122 medical records of patients with DM from specialized services with interdisciplinary health teams (IHT) in the city of Ourinhos, São Paulo state, Brazil, to assess the impact of secondary care on glycemic control in patients with DM in those places and to compare baseline and follow-up DM care indicators concerning clinical evaluation and drug treatment regimens in the aforementioned health services. The study covered consultations carried out from September/2013 to September/2017. Data were collected from initial and final appointments in medical records and revealed an increase of 31.21% in insulin introduction and of 73.53% in regimens with three or more non-insulin antidiabetic (NIA) medications. Among the 570 patients with at least two glycated hemoglobin (A1C) measurements in the aforementioned review, 146 did not require any therapeutic adjustment between initial and final appointments, 123 required a subtle adjustment, 95, a moderate adjustment, and 206, an intense adjustment. There was a noticeably higher A1C reduction between initial and final appointments when patients who required an intense drug adjustment were compared to those who did not need any different NIA drug (p-value < 0.0001). In addition to optimizing drug treatment, essential exams in DM were performed with higher frequency, with an increase of 63% in ophthalmology evaluation performed during secondary care approach and 60.65% more individuals being screened for diabetic chronic kidney disease. IHT secondary care considered in this study, therefore, not only improved glycemic control of patients with DM, especially by optimization of NIA regimens and timely prescription of insulin, but also increased the screening for microvascular complications.

Evaluation of Health Services in Vocational School Students’ Enjoying Level of Physical Activities in Terms of Various Variables

Evaluation of Health Services in Vocational School Students’ Enjoying Level of Physical Activities in Terms of Various Variables

Evaluation of the Health Services at Private Hospitals in the Context of Neoliberal Policies: A Field Study

The regulation of health policies within the scope of neoliberal policies caused the private sector in healthcare to be supported by the states and this led to a significant increase in the number of private hospitals. Increasing the role of private hospitals and the private sector in health services, has moved away from providing health services as a basic social policy and has transformed this area into a commercial area. By commercializing health services and transforming them into a tradable commodity that can be bought and sold, has caused many problems and causing service providers to evaluate health services through market dynamics and this brought the field away from its original purpose. The purpose of this research is to determine the changes in the service quality of health services and to reveal the reasons that transform this area into an area dominated by economic relations. The stage of the research consists of patients who were treated in private hospitals in Ağrı, Muş and Patnos and benefited from the health services of these hospitals. The patient groups who benefited health services from private hospitals in Muş, Ağrı and Patnos, which are believed to represent the stage; 10 from Ağrı, 15 from Muş and 10 from Patnos, were reached using the purposeful qualitative sampling technique. The patients who constitute the sample of the study, were asked conducted questions and interviews by using semi-structured in-depth interview technique according to the subject and purpose of the research. The findings were analyzed and interpreted according to the purpose and subject of the research by using the descriptive analysis method.

Reprint of: Satisfaction with life and perception of healthcare services

Healthcare institutions regularly evaluate consumers’ service experience as a measure of quality. This study considers patients’ well-being as an antecedent of service evaluations. In this cross-sectional study, 336 participants rated their satisfaction with life (SWL) and perceptions about the health institution regarding results, procedures, and interactions with personnel. Three independent regression models were developed, one for each dimension that predicted satisfaction with healthcare. Findings show that the participants’ SWL is related to their health service evaluation. An increase in SWL results in better evaluations regarding results (β = 0.15 **), procedures (β = 0.16 **), and interactions with personnel (β = 0.20 **). Moreover, on the three dimensions, the service evaluation differs by area; those attending outpatient consultations have better evaluations than those in the emergency department. This study confirms the importance of differentiating patient satisfaction by area and suggests controlling patients’ SWL as a subjective component that influences healthcare evaluations.

Evaluation of a new Perinatal Mental Health Service in a University Maternity Hospital.

Specialist Perinatal Mental Health Services (SPMHS) are a new development in Ireland. This service evaluation examined the impact of the introduction of a SPMHS multidisciplinary team (MDT) on prescribing practices and treatment pathways in an Irish maternity hospital. Clinical charts were reviewed to collect data on allreferrals, diagnoses, pharmacological and non-pharmacological interventions delivered in a SPMHS over a 3-week period in 2019. The findings were compared to the same 3-week period in 2020 following the expansion of the SPMHS MDT. In 2019 (n = 32) and 2020 (n = 47), most (75 and 79%, respectively) assessments were antenatal. The proportion of patients prescribed psychotropic medication within the SPMHS was not significantly different from 2019 (31%) to 2020 (23%), though more patients were already prescribed psychotropic medications at the time of referral (22% in 2019 v. 36% in 2020). There was an increase in MDT interventions in 2020 with more input from psychology, clinical nurse specialist (CNS), and social work intervention. Adherence to prescribing standards improved from 2019 to 2020. Prescribing patterns remained unchanged between 2019 and 2020. Improvement was observed in adherence to prescribing standards and there wasincreased provision of MDT interventions in 2020. Broader diagnostic categories were also used in 2020, possibly suggesting that the service is now providing more individualized care.

An asset-based evaluation of a novel New Zealand rural health service

This article describes the background behind the development of a novel evaluation approach of an Aotearoa New Zealand rural health service using an equity-focused, strengths-based approach to complement the traditional audit process. This approach avoids a deficit-based, gap-analysis of service shortcomings in favour of a strengths-based model through which services can draw on identified assets in planning future service initiatives. The approach discussed aims to identify and mobilise assets and strengths of people and services that promote quality outcomes, with a particular focus on those that address the deeply embedded health inequities for Māori (the indigenous people of Aotearoa). The asset model will be used to evaluate a rural service that is uniquely co-located with other health-related hospital services. This article aims to provide a commentary on the benefits of an asset-based approach to rural general practice evaluation.

What are the views and experiences of consumers and health providers regarding formal partnership approaches aimed at improving planning, delivery, or evaluation of health services?

What are the views and experiences of consumers and health providers regarding formal partnership approaches aimed at improving planning, delivery, or evaluation of health services?