Health Service Managers Research Articles

Towards an AI-Enhanced sustainable health system: inferences from healthcare management research

Health management literature is critical in facilitating effective leadership and management in the health sector by imparting the knowledge and understanding required in health service planning, organization, coordination, and management. Through an exhaustive bibliometric examination, the current state of the “healthcare management” literature was assessed in this study, illuminating potential future developments in the field. By utilizing an extensive compilation of articles from the Web of Science (WoS) database, this study endeavors to scrutinize patterns in scientific inquiry, assess advancements made on subjects, and underscore significant fields of cooperation and scholarly input. An in-depth, extensive analysis revealed that three decades of research yielded over 46,000 publications; the number of publications has increased by six, particularly in the last ten years, and the United States and the United Kingdom produced most of the publications. Analysis identifying influential journals and authors in the field revealed that it is the focus of attention of health professionals, especially nurses. Although the COVID-19 pandemic has been recognized as the primary public health concern, scholarly attention has shifted towards a sustainable health system incorporating technology-supported preventive health practices and intelligence. To thoroughly comprehend the theoretical progression of health management research, its capacity to tackle worldwide issues, and its growth potential, the study’s findings are a valuable scholarly resource that offers practitioners, policymakers, and researchers a comprehensive overview.

The Integrated Care Programme for the Prevention and Management of Chronic Disease: implementing a population health approach in Ireland.

The Integrated Model of Care for the Prevention & Management of Chronic Disease (MoC) provides a population health approach to the prevention & management of chronic disease (CD). This model is currently being rolled out across Ireland at scale. This workshop aims to explore the Irish experience of implementing integrated care as part of a population health approach to the prevention and management of CD.
 Our current, hospital-centric method of delivering health services is not sustainable, nor is it patient-centred. The MoC takes a generic, multi-morbidity approach to the prevention and management of four major CDs: type 2 diabetes; asthma; COPD; cardiovascular disease. It aims to shift care to the left by enabling GP-led primary care and empowering patients to self-manage their CDs.
 Aim: To describe our real-world experience of implementing at scale a MoC that places an emphasis on the delivery of a person-centred, equitable health service as we work to improve population health in Ireland
 Objectives:
 1. To describe our MoC, and the evidence underpinning it, which is currently being implemented across Ireland 
 2. To discuss our successes
 3. To discuss our challenges and potential solutions
 4. To describe importance of involving patients as partners in care 
 5. To discuss the future of integrated care in Ireland
 We anticipate that this workshop will appeal to a broad international audience and range of integrated care professionals (from primary care, community care to acute care, public health physicians, commissioners and health service managers) – as well as to patients themselves. It may be particularly relevant to those working in CD care.
 
 A.Presentations & Speakers (7 mins per presentation: 50% of workshop)
 1.Overview of the Integrated Model of Care for the Prevention & Management of CD (Dr. Sarah O'Brien) 
 2.Ensuring a population health approach to the delivery of care: delivering direct GP access to diagnostics as part of the Integrated MoC (Dr. Maria O'Brien) 
 3.The first report from the Structured CD Management Programme in General Practice (Dr. Orlaith O'Reilly) 
 4.Staff recruitment, retention and development: how to support the workforce in delivering integrated care (Maireád Gleeson)
 5.Involving patients in care: identifying and implementing PROMs as part of the MoC (Dr. Ellen Cosgrave)
 6.Building on the model: the development of an integrated virtual case management service for multimorbid patients with CD (Margaret Curran)
 B.Interactive discussion (50% of workshop): How can we ensure a population health approach to the prevention & management of CD to ensure no one gets left behind? (All)
 23 min small group work using post-its and flip charts, 20 min feedback and large group discussion
 C.Sum up of learning and closing remarks (5 min)
 •We are implementing an integrated MOC that takes a population health approach to the prevention and management of chronic disease
 •This model is already demonstrating evidence of positive impact
 •We must now build on this model, using data to support population profiling, stratification and the identification of unmet need, to deliver an integrated health service that is responsive to population need

Integrated care for children in rural Australia: Barriers and enablers during early implementation

Introduction: Children and young people (CYP) with medical complexity, have high levels of healthcare needs and utilisation, representing 10% of patients attending children’s hospitals, and accounting for 60% of healthcare expenditure in the state of New South Wales (NSW), Australia. Furthermore, 30% of children in NSW live outside major cities and require enhanced local health solutions to manage healthcare needs, reduce travel and family disruptions and limit out-of-pocket expenses. The Rural Kids Guided Personalised Service (RuralKidsGPS) is a co-designed innovative integrated model of care coordination for CYP living with medical complexity, modelled on the successfully implemented and sustained KidsGPS program in tertiary children’s hospitals in Sydney. RuralKidsGPS is being implemented into four rural local health districts (LHDs) across NSW. This study explores early implementation barriers and enablers to inform contextual adaption and ensure scalability across diverse health settings.
 Methods: The implementation evaluation is informed by qualitative methods using semi-structured interviews and focus groups, with children and families, healthcare providers embedded researchers, and health service managers. Adopting an inductive approach underpinned by the Consolidated Framework for Implementation Research (CFIR), we identify implementation strategies, barriers and enablers influencing adoption, delivery, and sustainability of RuralKidsGPS. In this early phase of implementation evaluation (6-12 month after commencement) we have focused on implementation outcomes based on Proctor’s framework, including acceptability, appropriateness, adaptability, fidelity, and feasibility. 
 Results: The interviews demonstrated the variations in setting and context across the LHDs and the adaption of RuralKidsGPS to meet local needs. Different levels of service demand, the time required for engagement with families from diverse socio-economic and cultural backgrounds and different levels of pre-existing service, and staff changes, contribute to the complexity of service implementation and delivery. All four LHDs share borders with jurisdictions outside of NSW, resulting in some children traveling across state or territory borders to access specialist health services. The complexities of sharing and gaining access to healthcare information across jurisdictions has impacted the timely delivery of care coordination and shared care plan development. RuralKidsGPS builds local healthcare capacity to manage CYP living with medical complexity but requires commitment and effort to build relationships with established local services and understanding of processes, and values, whilst conserving local resources. The perceived value and commitment to RuralKidsGPS by nurse care coordinators who leverage local knowledge and networks to deliver family-centred care, is a key enabler. Importantly, reciprocal support from health managers and health care professionals, and access to resources and networks is providing nurse coordinators the power to adapt and implement RuralKidsGPS. During this period, all LHDs were impacted by natural disasters (floods, bushfires) and COVID-19 creating barriers that required those implementing the RuralKidsGPS to flex and adapt.
 Conclusion: Early findings highlight the importance of adaptation to local contexts, the challenges and barriers and the resilience of the care coordinators implementing RuralKidsGPS. Care coordination enables families to navigate fragmented, complex health care systems, more efficiently and effectively. This research will inform the development of an implementation guide to support scaling and sustaining similar models of paediatric integrated care. 

Implementing national care coordination guidelines for people with complex care needs: evidence from a pilot study

In 2018, The Norwegian Directorate of Health launched an integrated care pilot project aiming to implement national guidelines for a person-centered and coordinated follow-up of people with complex care needs in six municipalities.
 Core measures of the pilot are implementing systems for identifying persons in need of interdisciplinary and intersectoral follow-up, implementing structured interdisciplinary follow-up teams as care approach in all services, strengthening the role of care coordinators, and strengthening user involvement and adaption to user needs. The national guidelines are generic and target all services for people with complex needs independent of age and diagnosis. The municipalities participating in the pilot receive financial and process support, and the pilot is monitored closely by the Norwegian Directorate of Health. Initially the pilot was planned to last until 2021 but has been extended until 2023. Two of the six municipalities did not apply for continuation of the pilot from 2022.
 This study report results from a process evaluation of the pilot. The evaluation takes a mixed-methods approach, comprising qualitative interviews and survey data with managers, care coordinators, other municipal employees, as well as service users in the target group. The experiences in putting the national guidelines into practice are discussed based on implementation theory.
 The implementation has taken considerably longer time than first planned, and the complexity of the intervention (variety of user groups and services/sectors involved, system change requirements etc.) seems to have been underestimated. The municipalities had different starting points regarding which elements were already in place, which again affected their prioritisations in the first phase of the pilot project. Important implementation barriers were a lack of understanding of the intervention among managers and employees in the municipalities, and ambiguity related to the novelty in the work approaches described in the national guidelines. Furthermore, the COVID-19 pandemic as well as processes of municipal amalgamation in four of the pilot municipalities have drawn attention and resources from the pilot project. Implementation facilitators seems to be having a recognised and dedicated implementation team that knows the organisation well. Strong grounding in all levels of the organisation and having a competent and interdisciplinary coordinating unit in the municipality, with authority to delegate coordination tasks via managers of health and welfare services, is key. A shared understanding and acceptance of the role and responsibility of care coordinators and the follow-up team, within and between sectors, is also important.
 To implement new guidelines, structures and work approaches for follow-up of persons with complex care needs constitute a complex intervention that requires thorough preparations and anchoring, understanding and commitment among managers of the services. Employees’ and leaders’ understanding of the usefulness of the intervention and how it differs from existing practice is an important success criterion in the implementation process. While the main focus the first three years has been on getting the necessary structures and systems in place, the emphasis in the last phase of the pilot project is on gaining experiences from structured interdisciplinary follow-up teams as care approach for different user groups.

The VALUECARE Model for value-based, integrated health and social care services delivery supported by ICT for older adults: participatory research in 6 European countries

Introduction: In 2006, Michael Porter and Elizabeth Teisberg introduced the concept of value-based health care delivery by presenting a new framework for health system design. They proposed a fundamental unifying goal for health care: maximizing value for patients. Value is defined as the health outcomes achieved in response to the needs of a patient relative to the costs of delivering these outcomes. Consequently, understanding patient goals and values is integral to delivering high value. Participatory approaches are a key element in defining the care delivery model according to the patients’ needs and contribute to the sustainability of the care delivery. This study presents the VALUECARE model co-designed with older adults, care team members, health and social service managers and ICT experts to adapt the ValueCare concept supported by technology to the community context and end-users needs.
 Target group: Older people 65 years and older with comorbidity from 6 European countries (Croatia, Ireland, Portugal, Italy, Spain & The Netherlands) facing different health challenges (cardiovascular disease, cognitive decline, frailty, and stroke).
 Participants engaged in the co-design of the value based integrated care: A total of 369 participants were involved in participatory activities with the purpose of co-designing the VALUECARE care model and supportive digital solution (n= 127 older adults, n=86 caregivers, n=109 health and social care practitioners, n=7 ICT experts, n=34 service managers, n=3 policy makers, n=3 municipality providers).
 Co-design activities implemented: Qualitative data was collected using focus groups and interviews, combining face-to-face and online means with the participants trying to adapt the methodology foreseen in the project to the pandemic situation. The eHealth Enhanced Chronic Care Model was used as a heuristic tool to integrate the discourses of the different stakeholders including older adults and those involved in the delivery of health and social care for them and featuring the guiding principles and the core elements for value-based, integrated health and social care for this group supported by ICT solutions. 
 Results: VALUECARE model highlights best practice value-based, integrated care delivery through the application of a set of 6 guiding principles for the model (i.e. quality and safety, technology as supportive tool) across 7 different key core elements (i.e. health and care decision support, comprehensive support and monitoring). Applying these principles and elements, better health outcomes and care experience for older adults are expected and an improvement in the care team wellbeing. 
 Next steps: Based on the co-design sessions, the co-designed VALUECARE model is being implemented and tested in 6 pilot sites. Continuous and periodic feedback is being collected from participants (older people and care team members) to refine the model and ensure quality care delivery, at the end of the project, a validated model of value-based and integrated care supported by technology.

Increased patient, public involvement in locality planning - the use of patient’s narratives to support service design and continuous improvement – An evaluation from the Northwest of England

People’s narratives on their experience of health and social care can be powerful drivers for change however, Ledema (2012) found that most patients and family members felt that the health service incident disclosure rarely met their needs and expectations (1). For people to feel confident in sharing the experiences they also need to be assured that the sharing of their stories will lead to change (2).
 Rochdale is a multi-ethnic (1 in 5 of the population coming from a black or minority background) locality within Greater Manchester. Around a quarter of local people have at least one or more long term conditions and a third of residents live within 10% of the most deprived neighbourhoods nationally (3). As part of the development of a system and place-based approach, Rochdale has developed system wide learning events. These events bring together partners from across NHS, local authorities, voluntary, community and faith sectors and communities. The uniqueness of these events is that they are led by a narrative of experience of services. A person, carer, or family who have had complex experience within services is invited and supported to share their story at a themed event. Then the patient’s story is contextualised within the wider system to provide an understanding of how services can support care, where gaps exist, where there are opportunities for integration, and where there are areas that require improvement. Linking the actualities of people's experience of service to the quality improvement programme is an important feature, as are the resulting action plans which are monitored and reported through the integrated boards. To ensure agreed on plans progress and as their impact on quality improvement is realised a co-production philosophy is adopted and the events are seen as a journey rather than one off event.
 Development of the evaluation approach has been used to grow and advance the events as this has enabled the impact of the events to be monitored and the events themselves to be modified and improved to ensure that they provide a unique and valuable resource in the boroughs journey to meaningful and impactful integration, which is based on peoples experience and centred on reducing the inequalities that people across the system.
 1)Piper, D., Iedema, R., Gray, J., Verma, R., Holmes, L., & Manning, N. (2012). Utilizing experience-based co-design to improve the experience of patients accessing emergency departments in New South Wales public hospitals: an evaluation study. Health services management research, 25(4), 162-172.
 2)Hanna, E., & Robert, G. (2021). Understanding amputation care in England and Scotland: a qualitative exploration of patient stories posted on an online patient feedback site. Disability and Rehabilitation, 1-9.
 3)Rochdale Borough Council (2020) Co-operating for better health and well-being Rochdale Borough -Locality Plan 2020-2024 retrieved https://www.rochdale.gov.uk/downloads/file/879/rochdale-borough-locality-plan

Healthy life expectancy for 202 countries up to 2030: Projections with a Bayesian model ensemble.

Healthy life expectancy (HLE) projections are required for optimising social and health service management in the future. Existing studies on the topic were usually conducted by selecting a single model for analysis. We thus aimed to use an ensembled model to project the future HLE for 202 countries/region. We obtained data on age-sex-specific HLE and the sociodemographic index (SDI) level of 202 countries from 1990 to 2019 from the Global Burden of Disease (GBD) database and used a probabilistic Bayesian model comprised of 21 forecasting models to predict their HLE in 2030. In general, HLE is projected to increase in all 202 countries, with the least probability of 82.4% for women and 81.0% for men. Most of the countries with the lowest projected HLE would be located in Africa. Women in Singapore have the highest projected HLE in 2030, with a 94.5% probability of higher than 75.2 years, which is the highest HLE in 2019 across countries. Maldives, Kuwait, and China are projected to have a probability of 49.3%, 41.2% and 31.6% to be the new entries of the top ten countries with the highest HLE for females compared with 2019. Men in Singapore are projected to have the highest HLE at birth in 2030, with a 93.4% probability of higher than 75.2 years. Peru and Maldives have a probability of 48.7% and 35.3% being new top ten countries in male's HLE. The female advantage in HLE will shrink by 2030 in 117 countries, especially in most of the high SDI and European countries. HLE will likely continue to increase in most countries and regions worldwide in the future. More attention needs to be paid to combatting obesity, chronic diseases, and specific infectious diseases, especially in African and some Pacific Island countries. Although gender gaps may not be fully bridged, HLE could partially mitigate and even eliminate them through economic development and improvements in health care.

Inequalities in non-communicable disease management in China and progress toward universal health coverage: an analysis of nationwide household survey data from 2004 to 2018

Prevention and control of non-communicable diseases (NCDs) become a policy priority in Universal Health Coverage (UHC) in China, while NCD management has never been comprehensively estimated at national and subnational levels. We aimed to assess NCD management in China nationally and in key subpopulations, investigate inequalities from multidimensions, and further examine its association with health financing and resources. Data included were from China Chronic Disease and Risk Factors Surveillance (CCDRFS) and China Health and Nutrition Survey (CHNS). Following the WHO recommended frameworks, we selected eight NCD health service and risk management indicators and used meta-analysis to construct the composite NCD index. We explored the trends in and projections of NCD management index and indicators at national and subnational levels by using Bayesian regression models with average annual percentage change (AAPC) from 2004 to 2018 and probability of reaching the UHC target by 2030. We further conducted comprehensive inequality analyses of NCD indicators from multidimensions with patterns of changes over time using absolute difference and relative ratio. Finally, we quantified the associations between NCD management performance with health financing and resources using stochastic frontier analysis. In China, the NCD management index increased slowly from 62.0% (95% CI 36.0 to 84.0) in 2004 to 64.3% (95% CI 44.0 to 82.2) in 2018, with lagging performance being observed in prevention domain (AAPC-0.1%, 95% CrI-1.0 to 0.8). And all management indicators presented low probabilities of accomplishing 2030 targets in China. Notably, based on subnational analysis, diverse tendency and magnitude of inequalities in multiple NCD indicators were identified with widening gaps between genders (non-overweight, diabetes treatment), age groups (non-use of tobacco), urban-rural areas (non-use of alcohol, non-use of tobacco), regions (sufficient physical activity), and wealth quintiles (non-overweight, sufficient physical activity). Additionally, it was observed that compared with urban area, rural area had constantly lower health resources and presented 2.2% lower NCD management performance in 2018. Importantly, we found that health financing and resources especially distributed in primary health care (PHC) facilities were closely and positively associated with NCD management performance. A 1000 yuan increase of government health expenditure (GHE) per capita and a 10 increase of medical beds per 1000 capita in PHC facilities were associated with a 4.0% (95% CI 2.0 to 6.0) and 6.8% (95% CI 0.2 to 13.5) increase of NCD management index, respectively. The progress towards NCD management is slow at national level and in key subpopulations in China, with great challenges of existing and widening inequalities between genders, age groups, urban-rural areas, regions and socioeconomic groups. Rural and old people were still vulnerable populations who were lagging behind in NCD prevention and control. Optimising resource allocation by strengthening PHC especially in rural area, developing tailor-made programmes targeting specific populations such as old individuals, simultaneously integrating gender, education, and economic interventions to reduce inequalities should be prioritised to help China tackle NCDs during the progress towards UHC. National Natural Science Foundation of China.

Hajj during the Dutch East Indies Pandemic in the 19th–20th Centuries

This paper discusses about the phenomenon of Hajj during the pandemic in the XIXth to mid-XXth centuries in the Dutch East Indies with a focus on the governance of health services carried out by the Dutch East Indies government. This research uses historical research methods to explore various relevant primary and secondary sources, such as historical archives, government documents, travel records, and historical literature. The main finding of this research is that the pandemic that occurred during that time, such as the cholera outbreak, had a significant impact on the Hajj journey and the welfare of the pilgrims. The Dutch East Indies government undertook various efforts to manage health services during the Hajj journey, including the provision of medical facilities and quarantine. The results of this study provide a deeper understanding of how the Dutch East Indies government dealt with the pandemic during that time and how it affected the Hajj experience and health care governance efforts in the context of Dutch East Indies history. The findings can provide valuable insights for understanding the history and context of the pandemic in global and regional history.

Cost Control Strategy in Covid-19 Pandemic Using Balanced Scorecard at Yogyakarta Islamic Hospital PDHI

<p><em>The hospital is at the forefront to overcome the covid outbreak but the personal protective equipment (APD) is getting rare. This makes health service management more ineffective and efficient. The purpose of this study is to develop a cost control strategy to maintain and even improve hospital performance during Pandemi Covid-19. This research is a qualitative research with a case study approach conducted at PDHI Yogyakarta Islamic Hospital. The research design uses an approach to explore and understand the organization by presenting a comprehensive picture and reporting a detailed description of the source of information and preparing it without the intervention of the researchers. The interview was conducted to the Chairperson of the PDHI Foundation, the Chairperson of the Supervisory Board, and the Hospital Director. The data analysis used includes compaction, coding, and identification of themes to get a deeper understanding of strategic planning at RSIY PDHI. The overall strategic objective of the organization is categorized into 4 (four) perspectives, namely financial goals, customer goals, internal business processes, and the purpose of growth and learning. In terms of financial, three strategic objectives are set, namely income growth, cost reduction, and increased profitability. From the customer side, four strategic objectives are set, namely improving the quality and quality of service, increasing customer satisfaction, improving the quality of customer relations, and improving the image of the hospital. In terms of internal business processes, three strategic objectives are set, namely the integration of internal service processes, improving the quality of service processes to customers, and increasing the speed of the service innovation process. PDHI Yogyakarta Islamic Hospital is advised to improve a strategic plan with a framework of the Balanced Scorecard that has been previously created</em><em>.</em></p><p> </p><strong><em>Keywords:</em></strong> <strong><em>Balanced Scorecard,</em> <em>Cost Control Strategy, PDHI Islamic Hospital Yogyakarta</em></strong>

Soluciones digitales y las ciencias de la salud

Digitalization is the conversion of analog data and information to a digital format based on bits. Digitalization allows managing information in a simple and standardized way. Digital health solutions are technologies that use the digitalization of data and information to improve the health sector in various aspects, such as prevention, diagnosis, treatment, monitoring, research, innovation, training, management and evaluation of health services. These technologies range from mobile applications and telemedicine to artificial intelligence and blockchain, with advantages, barriers, and risks for their application in health care.

UTILIZATION OF COMMUNITY CARE SERVICE AND SUBJECTIVE WELL-BEING OF OLDER PEOPLE: EVIDENCE FROM WEIFANG, CHINA

Abstract Many developed countries have established community-based care systems to address care needs of older people. However, community-based care in China is still in an early stage, some of its shortcomings are highlighted under the COVID-19 pandemic. Studying the wellbeing effect of community care in China could provide policy reference for developing countries. Based on the Elderly Health Survey in Weifang, China, using the two-stage least squares method, the effect and mechanism of the utilization of community care services on the subjective wellbeing of elder people were evaluated. Results show that: first, the utilization of community care services could promote the subjective wellbeing of older people and has a stronger effect on people with a higher level of subjective wellbeing. Second, the utilization of different types of community elderly care services has different effects on the subjective wellbeing of older people. When receiving a single type of community elderly care services, medical care services have the strongest promotion effect, while taking spiritual and cultural services and other types of services together will be a stronger synergistic effect on subjective wellbeing. Third, with the support of various community service subjects, the utilization of community care services could improve the subjective wellbeing by improving their health status, sleep quality and declining feeling of pain. In this regard, this study proposes policy suggestion in optimizing the types of community care service projects, building elderly care service consortiums, and improving community health management service capabilities to coping with deep aging and fewer birth.

Australian Health Services Management Courses: A discussion on syllabus

Objective: The aim of this research was to understand core knowledge areas offered by Masters courses in health services management in Australian universities. Design: A Google search identified relevant Masters’ degrees in health services management. Course syllabus was then extracted from each university’s website. Common core subjects were then collated and compared. Setting: Data for this study was collected from Australian university websites.Main outcome measures: Findings were compared with those presented in a similar study conducted in 2013. Interpretation was also informed by an appraisal of key issues that characterise the current context of health care in Australia. Results: Masters’ degrees in health services management were offered by 18 universities. Common core subjects included management, evaluation, evidence, health system, governance, law and human resource management. A comparison with an earlier study conducted by Ritchie and Yen [1] found an increase in the following subjects: health system, quality management, health economics, policy and research, and a decrease in health information, epidemiology and resourcing. New knowledge areas included leadership, planning and project management, change management, and strategy. Conclusions: This paper presents a discussion on knowledge areas that comprise syllabus in masters level health services management education nationally. Key findings revealed differences between courses and the responsiveness of core syllabus to the current health care environment. The emergence of leadership, planning and project management was unsurprising while an absence of subjects that gave explicit reference to First Nations peoples was a notable finding.

The Role of the Health Services Management Programme in Zimbabwe’s Health Sector-an Inquiry into the Demand Drivers and Quality of the Health Services Management Program Offered by Africa University

Since information on the actual market position of the Bachelor of Health Service Management (BHSM) program is not easily accessible, a study was commissioned to determine the dynamics of the demand and supply side. The sustainability of the BHSM may be a concern due to the low number of students enrolling in the program and the costs associated with the university’s delivery of the program, which includes qualified professors and learning resources. Thus, the study’s primary goal was to comprehend the factors that influence supply and demand for the BHSM program in Zimbabwe’s health sector to enhance the program’s quality and increase job prospects for BHSM graduates also know how the Africa University BHSM program curriculum review process is established, planned, and carried out. This evaluation research was directed by a mixed-method approach that included a desk review, in-depth interviews, key informant interviews, focus group discussions, and a quantitative skills assessment to produce evidence to support the results, analysis, and recommendations. The study recommended that the university should work towards striking a balance between commercial and clinical courses to meet the requirements of the government and private sector and to have curriculum reviews of the program on a more regular basis.

Perspectives of community pharmacists on extended pharmacy services and value-added services in Malaysia: a cross-sectional survey.

This study aimed to investigate patterns of extended pharmacy services (EPS) provided by Malaysian community pharmacists and their willingness to provide value-added services (VAS) in addition to EPS. Additionally, this study examined the barriers to the effective implementation of these two services. A cross-sectional survey was conducted using a self-administered questionnaire among community pharmacists in Selangor and Kuala Lumpur. Convenience sampling was done, and descriptive statistics and correlation analysis were performed. Two hundred and thirty-six pharmacists participated. The most rendered EPS were nutritional supplements, hypertension management, and diabetic management, while chronic kidney disease management, smoking cessation, and mental health services were the least rendered. Pharmacists were willing to provide medication waste management and vaccination as VAS but were less inclined towards therapeutic drug monitoring and sterile compounding. Barriers included limited access to medical records of patients, lack of designated counselling areas, and concerns about remuneration. High sales pressure and busy workloads were additional barriers to providing VAS. Continuous professional development (CPD) positively influenced pharmacists' engagement in EPS and VAS. This study highlights service provision trends and areas for improvement. Addressing identified barriers, such as enhancing access to patient records and establishing designated counselling areas, can improve service delivery. Remuneration models and workload management strategies should be considered to alleviate barriers related to sales pressure and time constraints. Promoting CPD opportunities is crucial for enhancing pharmacist engagement and optimizing EPS and VAS.

USING DATA WAREHOUSE TO MANAGE HEALTH FACILITY DATA

Managing a complete master list of public health facility data is deemed important in coordinating and planning of health services and achieving better service delivery. The master lists allow stakeholders to share a uniform operational health services data and ensuring availability and reliable data. This will able to support and manage patients clinical data and other health management services such as disease monitoring, facility management and monitoring service performance. However, most health facilities do not have accurate and informed data, this can affect monitoring of infrastructure and services provided. Various facilities have multiple and redundant lists of health data, the lists differ not only in the information they contain but also in the way they are named and identified. Existing studies state that the development of health facility registries store information mostly using conventional two-dimensional table methods or relational databases as in the case at the Health Informatics Center (HIC), Ministry of Health Malaysia. Hence, they faces the challenges in managing the data since it contains diverse data sources, the absence of uniform data standards and the dependence on manual processes and human intervention. To overcome the current problems, a dimensional modeling technique has been developed in an effort to design a Health Facility Data Warehouse. The proposed design of the data warehouse has been verified by the expert and they agrees that it is suitable for HIC to manage information related to health facilities due to its ability to deal with data sources, able to generate strategic information, as well as the ability to obtain a historical view of facility data. This study shows dimensional modeling techniques are effective in analyzing and designing data warehouse and can be a possible method in managing the master list of health facilities in Malaysia as well as other countries.

Process improvement of a paediatric feeding clinic

PurposeThe purpose of this study is to identify opportunities to improve processes within a paediatric feeding clinic to enhance timely patient access to healthcare through effective and efficient resource use. Design/methodology/approachThe study involved three interrelated methods. First, de-identified feeding clinic data, collected over seven years, were analysed to understand patient appointments. Second, clinician workshops and the swim lane method were used to map feeding clinic processes. Third, root cause analysis was conducted to identify bottlenecks and identify improvement opportunities. FindingsThe results revealed three, poorly connected sub-processes within the feeding clinic – namely: the patient triaging and appointment scheduling or allocation process; the clinic reporting process; and the cancellation and rescheduling process. These sub-processes were poorly connected because of inadequate resources, few standardised processes, and limited coordination between the different processes. Consequently, patient appointments were typically delayed, and patient reports were not always completed in a timely manner. Processes within the paediatric feeding clinic could therefore be improved by using digital tools, patient portals and telehealth, online interventions, an automated appointment confirmation system, and/or an automated transcription of each appointment. Originality/valueThis is the first published study to apply business process management to a paediatric feeding clinic. By using three methods to clarify opportunities to improve clinic processes, it highlights the potential value of health information technology in this context. This evidence will enable health service managers to ensure that children with feeding difficulties have timely access to appropriate care.

Abstract A107: The role of social network and provider support on access to care in Puerto Rican and US Virgin Islands gynecologic cancer patients post-Hurricanes Maria and Irma

Abstract Background: Hurricanes Irma and Maria touched down on Puerto Rico (PR) and the US Virgin Islands in 2017 with devastating impacts. Essential infrastructure, services, and the overall environment were impacted, forcing residents to adapt or migrate amid these natural disasters. With Gynecologic cancers representing over 15% of all cancer in Puerto Rican women, these patients were at a high risk of experiencing challenges and barriers detrimental to their health outcomes. This study assessed how social networks (i.e., immediate family, friends, and neighbors) and provider (i.e., oncologists, oncology associations, and hospitals) support played a role in accessing health services by gynecologic cancer patients in the aftermath of the hurricanes. Methods: In-depth interviews were conducted to assess hurricane-related stressors and disaster responses. PR (n=24) and US Virgin Island (n=2) gynecologic cancer patients participated across 4 focus groups (December 2018-April 2019). Key cancer stakeholders were individually interviewed, consisting of oncology care providers and administrators (n=23) providing services in PR. All interviews were recorded, transcribed (verbatim), and coded with emerging themes using inductive methods. Results: The analysis highlighted the impact of stressors and multi-level responses on health outcomes for the patients. The identified emerging themes and subcodes included: 1) Health Access; 2) Stressors; 3) Emergency Response to Communication methods. Participants highlighted how their health needs were satisfied or not during the aftermath of the disasters primarily based on the availability of support from their social network and on recorded responses of available providers and clinics. They also detailed the expression of diverse stressors (i.e., primary, secondary, psychosocial, environmental) experienced while searching for health services. Regarding communications, patients and providers detailed several mechanisms of non-traditional patient-provider communication, such as WhatsApp group messaging, telephone robocalls for texting, leaving written notes at clinics or homes, and traveling outside PR to communicate with outside and local resources. Conclusion: The study demonstrated that social and provider support was critical in patients accessing care. A supportive social network facilitated access to health management, treatments, and primary service (i.e., water and electricity). Conversely, patients with minimal to no social support expressed difficulty improving these areas. Health providers also played an essential role with their patients and in the community by providing innovative alternative resources beyond planned emergency response. Implications for safety data management and sharing are in place when managing adverse outcomes in emergency planning. These results are imperative to include in future emergency preparedness plans for PR to prevent and mitigate the effects of natural disasters among vulnerable populations, such as cancer patients. Citation Format: Celeste M. Charchalac-Zapeta, Edna Acosta-Perez, Sandra I Garcia-Camacho, Mirza Rivera, Ana Patricia Ortiz Martinez. The role of social network and provider support on access to care in Puerto Rican and US Virgin Islands gynecologic cancer patients post-Hurricanes Maria and Irma [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A107.

Environmental educational activities in hospitals for health personnel: An integrative review EDUCATIONAL ACTIVITIES IN HOSPITALS FOR HEALTH PERSONNEL: AN INTEGRATIVE REVIEW

Introduction: Among the fastest growing initiatives relating the health sector with the environment are green hospitals, sustainable hospitals, which seek to mitigate the social, environmental, economic and health impacts caused by the permanent operation of these institutions in the world. Objective: Synthesize the evidence of environmental educational interventions in hospitals for health personnel worldwide. Methodology: An integrative review was carried out on the advances related to environmental educational activities in health institutions aimed at health personnel. For the search, 7 databases were used: Pubmed, Virtual Health Library, Scopus, EMBASE, Plos One, EBSCO and Cochrane, from January 2011 to May 2021. The search terms were selected based on the question of research and the PICO strategy. Results: Of 3,246 documents, 11 were retained for the study, finding the main results of the review in 4 categories: 1) educational interventions in waste management of health services in hospitals; 2) interventions in pharmaceutical waste management; 3) interaction activities with the local community and; 4) educational strategies for the clinical and environmental approach. Conclusions: Environmental educational activities for health personnel in hospitals should be connected with an expansion of professional training in sustainability issues, linking environmental variables with the strategies of health institutions in search of an environmental culture.

Clinical yarning education: development and pilot evaluation of an education program to improve clinical communication in Aboriginal health care - participant, and health manager perspectives

BackgroundEffective communication between health care clinicians and Aboriginal patients is critical to delivering high quality, accessible, culturally secure health care. Despite this, ineffective communication is a well-documented barrier, and few studies have reported interventions to improve communication. Clinical Yarning is a patient centred communication framework for Aboriginal health care. Building on this framework, this study reports the development and evaluation of a Clinical Yarning education program.MethodsA Clinical Yarning education program was developed, underpinned by the principles of cultural security and adult learning, informed by a behavioural skills approach. The program was delivered in five health/education settings in one rural Western Australian region. Mixed-methods evaluation included a retrospective pre/post questionnaire to ascertain changes in participants’ knowledge, confidence, competence and their perceptions about communication in Aboriginal health care, and the program. Qualitative semi-structured interviews were undertaken with health service managers who oversaw each health care setting and who had not participated in the education program, to explore perceptions about the program and implementation considerations.ResultsTwenty-eight health care clinicians and six students completed training and the evaluation survey. There were significant improvements in self-rated communication skills, ability, confidence, knowledge, and perceived importance of communication training from pre to post-program. Participants strongly recommended the program to others, and most commonly valued the simulation/interactive learning activities. Health service managers acknowledged the limitations in most existing cultural training, and felt Clinical Yarning addressed a need; both the concept of Clinical Yarning and the education program provided were valued. Considerations identified for future implementation included: building multilevel partnerships within health services, offering alternate training options such as eLearning or train-the-trainer approaches, and integrating into existing development programs. Workforce transiency and availability were a barrier, particularly in remote areas.ConclusionsThis study offers preliminary support for the Clinical Yarning education program and provides a foundation for further development of this training approach. A future priority is implementation research to investigate the impact of the Clinical Yarning education program on health care and patient outcomes.