Delivery Of Health Care Services Research Articles

Maintaining the Psychological Well-Being of Physicians in the Uncertain Work Environment: A Practitioners Perspective

COVID-19 significantly altered the healthcare ecosystem and forced us to stretch the capacity to ensure healthcare delivery services. Physicians were on the frontline and acted as an important cog in the wheel of healthcare delivery. This unprecedented situation forced them to adopt to a new norm amidst uncertainty, potentially impacting their mental well-being and overall health. The study aims to investigate the coping strategies for physicians to maintain their psychological well-being during uncertain events such as COVID-19. By employing Analytic Hierarchy Process (AHP), the research prioritizes coping strategies that can improve physicians’ psychological well-being. This study affirms that the physicians working in healthcare during pandemic preferred adaptive strategies over maladaptive strategies. Maintained exercise, yoga/meditation (or similar), and behavioral disengagement are the three most preferred coping strategies. The study will benefit physicians and the policy makers, to achieve their agenda of enhancing physicians’ psychological resilience during uncertain events, ultimately contributing to the continuity and quality of healthcare delivery.

Human-Human vs Human-AI Therapy: An Empirical Study

In many nations, demand for mental health services currently outstrips supply, especially in the area of talk-based psychological interventions. Within this context, chatbots (software applications designed to simulate conversations with human users) are increasingly explored as potential adjuncts to traditional mental healthcare service delivery with a view to improving accessibility and reducing waiting times. However, the effectiveness and acceptability of such chatbots remains under-researched. This study evaluates mental health professionals’ perceptions of Pi, a relational Artificial Intelligence (AI) chatbot, in the early stages of the psychotherapeutic process (problem exploration). We asked 63 therapists to assess therapy transcripts between a human client and Pi (human-AI) versus traditional therapy transcripts between therapists and clients (human-human). Therapists were unable to reliably discriminate between human-AI and human-human therapy transcripts. Therapists were accurate only 53.9% of the time, no better than chance, and rated the human-AI transcripts as higher quality on average. This study has potentially profound implications for the treatment of mental health problems, adding tentative support for the use of relational AI chatbots in providing initial assistance for mild to moderate psychological issues, especially when access to human therapists is constrained.

Community-Based Health Information Systems in Africa: A Scoping Review of Data Generation, Utilization, and Community Empowerment.

The community-based health information system (CBHIS) is a vital component of the community health system, as it assesses community-level healthcare service delivery and generates data for community health programme planning, monitoring, and evaluation. CBHIS promotes data-driven decision-making, by identifying priority interventions and programs, guiding resource allocation, and contributing to evidence-based policy development. This scoping review aims to comprehensively examine the use of CBHIS in African countries, focusing on data generation, pathways, utilisation of CBHIS data, community accessibility to the data and use of the data to empower communities. We utilised Arksey and O'Malley's scoping review methodology. We searched eight databases: PubMed, EMBASE, HINARI, Cochrane Library, Web of Science, Scopus, Google Scholar, and grey literature databases (Open Grey and OAIster). We synthesised findings using a thematic approach. Our review included 55 articles from 27 African countries, primarily in Eastern and Southern Africa, followed by West Africa. Most of the studies were either quantitative (42%) or qualitative (33%). Paper-based systems are primarily used for data collection in most countries, but some have adopted electronic/mobile-based systems or both. The data flow for CBHIS varies by country and the tools used for data collection. CBHIS data informs policies, resource allocation, staffing, community health dialogues, and commodity supplies for community health programmes. Community dialogue is the most common approach for community engagement, empowerment, and sharing of CBHIS data with communities. Community empowerment tends towards health promotion activities and health provider-led approaches. CBHIS utilises both paper-based and electronic-based systems to collect and process data. Nevertheless, most countries rely on paper-based systems. Most of the CBHIS investments have focused on digitisation and enhancing data collection, process, and quality. However, there is a need to shift the emphasis towards enabling data utilisation at the community level and community empowerment.

Resources to Support Canadian Nurses to Deliver Virtual Care: Environmental Scan.

Regulatory and professional nursing associations have an important role in ensuring that nurses provide safe, competent, and ethical care and are capable of adapting to emerging phenomena that influence society and population health needs. Telehealth and more recently virtual care are 2 digital health modalities that have gained momentum during the COVID-19 pandemic. Telehealth refers to telecommunications and digital communication technologies used to deliver health care, support health care provider and patient education, and facilitate self-care. Virtual care facilitates the delivery of health care services via any remote communication between patients and health care providers and among health care providers, either synchronously or asynchronously, through information and communication technologies. Despite nurses' adaptability to delivering virtual care, many have also reported challenges. This study aims to describe resources about virtual care, digital health, and nursing informatics (ie, practice guidelines and fact sheets) available to Canadian nurses through their regulatory and professional associations. An environmental scan was conducted between March and July 2023. The websites of nursing regulatory bodies across 13 Canadian provinces and territories and relevant nursing and a few nonnursing professional associations were searched. Data were extracted from the websites of these organizations to map out educational materials, training opportunities, and guidelines made available for nurses to learn and adapt to the ongoing digitalization of the health care system. Information from each source was summarized and analyzed using an inductive content analysis approach to identify categories and themes. The Virtual Health Competency Framework was applied to support the analysis process. Seven themes were identified: (1) types of resources available about virtual care, (2) terminologies used in virtual care resources, (3) currency of virtual care resources identified, (4) requirements for providing virtual care between provinces, (5) resources through professional nursing associations and other relevant organizations, (6) regulatory guidance versus competency in virtual care, and (7) resources about digital health and nursing informatics. Results also revealed that practice guidance for delivering telehealth existed before the COVID-19 pandemic, but it was further expanded during the pandemic. Differences were noted across available resources with respect to terms used (eg, telenursing, telehealth, or virtual care), types of documents (eg, guideline vs fact sheet), and the depth of information shared. Only 2 associations provided comprehensive telenursing practice guidelines. Resources relative to digital health and nursing informatics exist, but variations between provinces were also noted. The use of telehealth and virtual care services is becoming mainstream in Canadian health care. Despite variations across jurisdictions, the existing nursing practice guidance resources for delivering telehealth and virtual care are substantial and can serve as a beginning step for developing a standardized set of practice requirements or competencies to inform nursing practice and the education of future nurses.

Impact of a health system vertical integration program on patient expenditures and healthcare utilization: Evidence from county hospitals in East China

In 2009, China launched a vertical integration pilot program to promote collaboration between tertiary and county hospitals to reduce rural-urban disparities and strengthen capacity building in healthcare services delivery in county healthcare facilities. Through the program, tertiary hospitals implemented a workforce mobility program to temporarily assign selected physicians and healthcare staff to paired county hospitals. This study uses hospital-level data from 2009 to 2015 to investigate the program's impact on medical expenditures and healthcare utilization among patients visiting the paired county hospitals. A difference-in-differences method with hospital and year-fixed effects is used to address the unobservable heterogeneity of hospitals and the potential impact of national healthcare reform. We find that the average outpatient expenditure experienced a 4.0% decline after the county hospitals received paired assistance from tertiary hospitals. The decline is mainly driven by a reduced proportion of diagnostic testing expenditures. However, there is no evidence that the program affected inpatient expenditures. In addition, county hospitals had 5.1% more outpatient visits after receiving paired assistance, while the average length of stay remains stable. These results are robust when we control the effect of the Zero-Markup drug policy and conduct permutation tests of sample assignment. We conclude that the paired assistance program has successfully improved hospital healthcare services delivery and controlled patient expenditures. Vertical integration has improved healthcare system performance in East China from 2009 to 2015.

Healthcare staff experiences on the impact of COVID-19 on emergency departments: a qualitative study

BackgroundThe COVID-19 pandemic has had a major impact on the access and delivery of healthcare services, posing unprecedented challenges to healthcare staff worldwide. Frontline healthcare staff faced unique stressors and challenges that impact their well-being and patient care. This qualitative study aimed to explore the experiences and perspectives of frontline ED healthcare staff on emergency care services during the COVID-19 pandemic, providing valuable insights into the challenges, adaptations, and lessons learned in delivering emergency care.MethodsThis study utilized a qualitative approach. In-depth semi-structured interviews were conducted with 30 ED healthcare staff from three different hospitals located in Turkey between 15/03/2022 and 30/04/2022. Convenience sampling was used to recruit participants. The duration of the interviews ranged from 28 to 37 min. Data saturation was reached as no new information was gathered. The data were analyzed using the thematic analysis method. NVivo software was used to manage the data analysis process. Member check was carried out to ensure that the generated themes conformed to the participants’ views.Results15 sub-themes under three themes emerged: (1) the impact of COVID-19 on emergency care services, including sub-themes of “introducing a COVID-19 unit in the ED”, “changes in the routine functioning of EDs”, “changes in the number of ED visits”, “quality of care”, “resources”, and “increased workload”; (2) the psychological effects of COVID-19 on ED healthcare staff, including sub-themes of “staying away from family”, “fear”, “society’s perspective on healthcare professionals”, “morale-staff burnout”, “psychological and emotional effects”, and “unable to receive sufficient support”; and (3) the difficulties faced by ED healthcare staff, including sub-themes of “difficult working conditions”, “community-based effects difficulties”, and “COVID-19 is an unknown situation”.ConclusionStaff burnout threatens the quality of patient care and staff retention, and therefore this should be addressed by ED directors and leaders. This study could inform appropriate stakeholders regarding lessons learned from COVID-19 to better manage future pandemics. Learning from such lived experiences and developing appropriate interventions to minimize the difficulties faced during COVID-19 would allow better management of future pandemics. This study calls for a reform to address the challenges faced by healthcare staff, improve the overall response to public health crises, and enhance the resilience of healthcare systems for future crises.

Patient-resident physician communication – a qualitative study to assess the current state, challenges and possible solutions

BackgroundPatients perceive effective patient-doctor communication as an important metric when evaluating their satisfaction with health systems. Hence, optimal patient-physician communication is fundamental for quality healthcare. High-income countries (HICs) have extensively studied patient-resident communication. However, there is a dearth of similar studies in low- and middle-income countries (LMICs). Therefore, we aimed to explore the current state of and barriers to practicing good patient-resident communication and explore possible solutions to mitigate these challenges at one of the largest Academic Medical Centers in an LMIC.MethodsThis study employed an exploratory qualitative study design and was conducted at the Aga Khan University Hospital in Pakistan. Through purposive maximum variation sampling, 60 healthcare workers from diverse cohorts, including attendings, fellows, residents, and medical students, participated in eight focus group discussions.ResultsWe identified three key themes from the data: Status-quo of residents’ communication skills and learning (Poor verbal and non-verbal communication, inadequate training programs, and variable sources of learning), Barriers to effective communication (Institutional barriers such as lack of designated counselling spaces, lack of resident insight regarding effective communication and deficits in intra-team communication), and the need for developing a communication skills curriculum (Design, implementation and scaling to other cohorts of healthcare workers).ConclusionsFindings from this study show that multifaceted factors are responsible for inadequate patient resident-physician communication, highlighting the need for and importance of developing a formal communication skills training curriculum for residents. These insights can be used to create standardized training for equipping residents with adequate skills for effectively communicating with patients which can improve healthcare service delivery and patient outcomes.

Development and implementation of a digital health intervention (DHI) electronic patient-reported outcome measure (ePROM) platform to monitor patients with cancer.

163 Background: Cancer is heterogeneous diseases associated with a significant burden of symptoms and treatment-related adverse events. Digital Health Interventions (DHIs) emerge as promising tools for active/continuous monitoring of patients (pts). Evidence suggests that DHIs may enhance healthcare delivery and improve clinical outcomes by facilitating symptom detection and enabling more effective real-time informed decisions. We aim to develop and implement an electronic Patient-reported Outcome Measure (ePROM) platform to monitor pts undergoing cancer treatment. Methods: We developed ThummiOnco, a DHI ePROM platform designed for monitoring of pts during cancer treatment. It allows pts to report their symptoms (reported and graded according to the CTCAE), quality-of-life (QoL) (EORTC EQ-5D questionnaire), emotional state, treatment adherence (Morisky-Green questionnaire), Emergency Room (ER) visits and hospitalizations through a mobile application. Upon registration, pts consent to share their data with their medical team and provide essential demographic information such as age, sex, cancer type, and treatment regimen. A medical algorithm analyzes the collected data to generate instant personalized recommendations and guidance, including indicating the need of seeking emergency care in the case of serious high-grade or worrisome complaints. Patients also have the option to engage in real-time conversations with the medical team through an online chat feature. Treating physicians and the medical team can continuously access pts data real-time, through an online dashboard, enabling them to visualize information and statistics, address symptom alerts, and make informed management decisions. ThummiOnco is available at no cost to pts at htt ps://thummi.global . Results: Between August 2021 and March 2024, ThummiOnco monitored 925 pts across 7 institutions in Brazil, encompassing both private and public health systems. The majority of pts (72%) were female, with 28% being male. The most frequently monitored cancer types were Breast Cancer (39%), Lung Cancer (7%) and Colon Cancer (6%). During this period, a total of 71.373 interactions were recorded, including 36.175 (51%) chat messages, 21.644 (30%) symptom reports, 10.597 (15%) emotional state reflections, 2.819 (4%) QoL assessments, and 138 (0.2%) ER registries. A total of 23 different symptoms were reported, with the most frequent being: fatigue (16%), joint pain (8%), and nausea (7%). 13.187 (61%) grade 1, 6.545 (30%) grade 2, and 1.912 (9%) grade 3 symptoms were registered. In total, the medical algorithm generated 1.921 recommendations for seeking emergency care. Conclusions: ThummiOnco's capacity to detect a wide range of symptoms and enable real-time informed decisions underscores its potential to enhance patient outcomes and healthcare service delivery.

Stakeholder Engagement and Quality Health Care Service Delivery in Government Hospitals. A Case of Lyantonde Hospital

Stakeholder Engagement and Quality Health Care Service Delivery in Government Hospitals. A Case of Lyantonde Hospital

Somebody who understands the culture and their needs that can cater for them in their retirement time: a peer research study exploring the challenges faced by British Muslims with palliative care needs during the COVID-19 pandemic

BackgroundInequities in palliative and end-of-life care access exist, with evidence of lower uptake of these services among people from the British Muslim community. Little research exists exploring the experiences of...

EVALUATING RESOURCE ALLOCATION MANAGEMENT TO HOSPITALS IN BAUCHI STATE: A CASE STUDY OF FEDERAL MEDICAL CENTRE AZARE AND PRIMARY HEALTHCARE CENTRE AZARE

Background: This study evaluates resource allocation management in hospitals in Bauchi State, focusing on Federal Medical Centre (FMC) Azare and Primary Healthcare Centre (PHC) Azare. The research addresses significant disparities in resource allocation that affect healthcare service delivery and patient outcomes. Methods: Using a mixed-method approach, the study combines quantitative data analysis of financial records, resource allocation reports, and healthcare service delivery metrics with qualitative insights from interviews and focus group discussions. Data Envelopment Analysis (DEA) was utilized to measure the relative efficiency of the hospitals in converting inputs such as financial resources, staff, and infrastructure into healthcare services and outputs. Additionally, descriptive analysis was conducted using IBM SPSS version 27 to analyze 100 questionnaire responses and demographic data. Results: The findings reveal significant disparities between FMC Azare and PHC Azare, with FMC Azare benefiting from more adequate financial resources, human resources, medical supplies, and infrastructure. These disparities lead to differences in patient satisfaction, service delivery efficiency, patient outcomes, and waiting times. Conclusions: The study underscores the need for more equitable resource allocation to improve healthcare delivery and patient outcomes at under-resourced centers like PHC Azare. Recommendations for policy interventions include addressing resource allocation inequities, staffing solutions, supply chain improvements, and infrastructure development. These recommendations aim to enhance resource allocation management, thereby improving healthcare services in Bauchi State and providing insights applicable to similar contexts in Nigeria, Africa, and globally. KEYWORDS: Resource Allocation Management, Healthcare Delivery, Data Envelopment Analysis (DEA), Federal Medical Centre, Primary Healthcare Centre.

Factors critical for the successful delivery of telehealth to rural populations: a descriptive qualitative study

BackgroundThe use of telehealth has proliferated to the point of being a common and accepted method of healthcare service delivery. Due to the rapidity of telehealth implementation, the evidence underpinning this approach to healthcare delivery is lagging, particularly when considering the uniqueness of some service users, such as those in rural areas. This research aimed to address the current gap in knowledge related to the factors critical for the successful delivery of telehealth to rural populations.MethodsThis research used a qualitative descriptive design to explore telehealth service provision in rural areas from the perspective of clinicians and describe factors critical to the effective delivery of telehealth in rural contexts. Semi-structured interviews were conducted with clinicians from allied health and nursing backgrounds working in child and family nursing, allied health services, and mental health services. A manifest content analysis was undertaken using the Framework approach.ResultsSixteen health professionals from nursing, clinical psychology, and social work were interviewed. Participants mostly identified as female (88%) and ranged in age from 26 to 65 years with a mean age of 47 years. Three overarching themes were identified: (1) Navigating the role of telehealth to support rural healthcare; (2) Preparing clinicians to engage in telehealth service delivery; and (3) Appreciating the complexities of telehealth implementation across services and environments.ConclusionsThis research suggests that successful delivery of telehealth to rural populations requires consideration of the context in which telehealth services are being delivered, particularly in rural and remote communities where there are challenges with resourcing and training to support health professionals. Rural populations, like all communities, need choice in healthcare service delivery and models to increase accessibility. Preparation and specific, intentional training for health professionals on how to transition to and maintain telehealth services is a critical factor for delivery of telehealth to rural populations. Future research should further investigate the training and supports required for telehealth service provision, including who, when and what training will equip health professionals with the appropriate skill set to deliver rural telehealth services.

Brain-Drain in Health Sector: Towards Sustainable Healthcare Development in Nigeria: A Study of Selected State Hospitals in Ogun State.

Abstract: This study investigates the impact of brain drain in the health sector on sustainable healthcare development in Ogun State, Nigeria, focusing specifically on selected state hospitals. The research was conducted across several state hospitals with the entire medical staff forming the target population. Utilizing a random sampling strategy, data were collected from a sample of 278 healthcare professionals, determined through Taro Yamane sampling techniques from a population of 912. Data collection was facilitated through a systematically designed containing 26-item questionnaire employing a four-point Likert scale. The reliability instrument was confirmed with a Cronbach alpha statistic, while its validity was assessed using component factor analysis. Descriptive statistics summarized the data, and inferential statistics were derived using simple linear regression analysis. The findings reveal a significant brain drain phenomenon, driven by factors such as inadequate remuneration, subpar working conditions, and limited professional growth opportunities. This has resulted in a critical shortage of healthcare providers, negatively impacting the quality and accessibility of healthcare services in Ogun state. The regression analysis further illustrates a strong correlation between brain drain and the deterioration of healthcare service delivery, which in turn hampers the region's progress towards sustainable healthcare development. The study recommends that the level of poverty must be reduce in the country; high pay incentives must be adequately provided by the government; initiatives that support youth in realizing their full potential must be developed; and a sound macroeconomic plan must be Implemented.

Revolutionizing primary health care in Tanzania: unravelling the contextual factors on electronic health record systems implementation for effective decision support

Purpose This qualitative case study aims to identify and analyse the factors influencing the implementation and effectiveness of electronic health record systems (EHRS) in primary health-care (PHC) facilities in Tanzania. This study aims to explore ways to optimize the use of EHRS for better health-care service delivery. Design/methodology/approach The study uses a qualitative case study design. Data were collected through interviews and focus groups conducted with health-care workers and information and communication technology officers at the PHC facilities in Tanzania. Purposive sampling and data source triangulation were used to address potential biases and limitations associated with the study’s small sample size. Findings This study identifies several key findings related to the implementation and effectiveness of EHRS in Tanzanian PHC facilities. The primary obstacles include inadequate technical infrastructure, poor internet connectivity and insufficient financial resources. The study suggests a comprehensive strategy for improving EHRS, emphasizing patient and health-care professional involvement in system design, investments in technical infrastructure and connectivity, data quality and accuracy and ongoing technical support and training. Originality/value This research contributes to the existing body of knowledge by offering a nuanced understanding of the Tanzanian health-care context. It emphasizes the need for tailored solutions and strategies specific to the region’s challenges and opportunities. The study’s originality lies in its focus on EHRS in the Tanzanian context, providing valuable insights for future initiatives. A key policy implication underscores the importance of a supportive regulatory framework, dedicated resources and consistent stakeholder communication for successful EHRS implementation.

Global lessons on delivery of primary healthcare services for people with non-communicable diseases: convergent mixed methods

ObjectiveTo extract key lessons on primary healthcare (PHC) service delivery strategies for non-communicable diseases (NCD) from the work of researchers funded by the Global Alliance for Chronic Diseases (GACD).DesignA convergent...

Clients’ satisfaction with cervical cancer screening services and influencing factors at public health facilities in Debre Markos town, Northwest Ethiopia, 2022/23: a convergent parallel mixed method

BackgroundSatisfaction is defined as the perceived fulfillment of patient or client needs and desires through the delivery of healthcare services. In developed countries, more than 60% of women have been screened for cervical cancer. However, only 12% of women in sub-Saharan Africa have been screened for precancerous cervical lesions. There is limited evidence on client satisfaction with cervical cancer screening services (CSCCSS) in Ethiopia, particularly, there is no study conducted by mixed method in the Amhara region.ObjectiveThe study aimed to assess clients’ satisfaction with cervical cancer screening services and influencing factors among women screened in Debre Markos town public health facilities in Northwest Ethiopia, 2022/23.MethodsA convergent parallel mixed methods design was conducted in Debre Markos town’s public health facilities from October 10th, 2022 to January 10th, 2023. For the quantitative wing, a total of 401 cervical cancer screening service users were selected using a systematic random sampling technique. Data were collected using an interviewer-administered structured questionnaire. Clients were interviewed on exit in a private area far from the screening unit and the data were entered into Epi-data version 4.6.0.2, then exported to STATA version 14 for analysis. A binary logistic regression model was fitted to identify factors associated with client satisfaction with cervical cancer screening services. The qualitative data were collected through in-depth and key informant interviews using a semi-structured topic guide. The data were analyzed using a thematic analysis approach with Open code software (version 4.0.2.3).ResultThe quantitative wing revealed that overall, 65% (95% CI: 60–69) of respondents were satisfied with the cervical cancer screening services they received. Gender of the provider (AOR: 6.11, 95% CI: 3.23–11.55, p-value = 0.000), waiting time (AOR: 4.77, 95% CI: 1.32–17.31, p-value = 0.017), clients’ knowledge (AOR: 0.26, 95% CI: 0.12–0.59, p-value = 0.001), and clients’ attitude (AOR: 6.43, 95% CI: 3.43–12.03, p-value = 0.000) were significantly associated with CSCCSS.Qualitative resultThe thematic analysis revealed three themes. Theme 1: facility-related barriers (shortage of skilled manpower, shortage of infrastructure, providers’ skill gap, unavailability of full service, leadership problem, long waiting time). Theme 2: client-related barriers (poor knowledge and attitude, gender preference). Theme 3: facility-related facilitators (free service, presence of supportive partners).ConclusionAccording to the findings of this study, two-thirds of clients were satisfied with cervical cancer screening services, which was lower than the national target of 80%. Long waiting time, male gender of the service provider, unfavorable attitude, and good knowledge of clients were identified as significant factors negatively affecting client satisfaction with cervical cancer screening.

The justification and practice of the patient rights charter from the perspective of patients admitted to surgical wards during COVID-19 pandemic: evidence from Southern Iran

BackgroundHospitals, as one of the core elements of healthcare service delivery, should pave the way for more efficient compliance with the Patient Rights Charter (PRC). The COVID-19 pandemic affected the interactions between healthcare providers and patients. The present study aimed to investigate the importance and practice of PRC from the perspective of hospitalized patients in surgical wards during the COVID-19 pandemic.MethodsThe participants in this cross-sectional study were 355 patients who underwent surgery at Imam Khomeini Hospital in southern Kerman, Iran, in 2021. Data was collected by convenience sampling. The data in this study were collected using Justification and Practice of Patient Rights (JPPR). Data analysis was performed with SPSS-16 software using the Kruskal-Wallis, Wilcoxon, and Spearman correlation tests.ResultsThe total mean score for the justification of patient rights (PR) was 69.12 ± 58.44, which was significantly higher than the total mean score of PR practice (61.02 ± 1.32) (p < 0.001). In addition, the mean scores for all PR justification dimensions were significantly higher than the mean scores for PR practice (p < 0.05). A comparison of the dimensions of the PR justification showed service facilitation had the highest score and handling patient complaints had the lowest score. Furthermore, an analysis of the dimensions of PR practice indicated that handling patient complaints had the lowest score and other dimensions had the same score.ConclusionThe results of this study showed that despite the great importance of PR from the patients’ perspective, PR is not still practiced optimally. The findings from this study can have some clinical implications and help hospital managers to take measures to better adapt to the PRC with staff training and developing a strong policy to comply with the PRC, especially by paving the way for handling patient complaints.

Client-reported challenges and opportunities for improved antiretroviral therapy services uptake at a secondary health facility in Ghana

Antiretroviral therapy (ART) regimens in African countries, including Ghana, are often faced with the challenge of treatment default. To maximize ART utilization and efficiency among people living with HIV (PLHIV), it is pertinent to ensure that ART-related challenges that clients encounter are identified and addressed holistically. A phenomenological qualitative study of thirty participants recruited through the purposive sampling technique was conducted using in-depth interviews from June to July 2021. Independent coding was done using Atlas ti. Sub-themes were developed from the codes, using the most expressive phrases, and grouped under two broad themes, challenges, and opportunities to maximise ART uptake. Ten different challenges, grouped into the health system and individual constraints were reported. Health system constraints included stigmatisation and discrimination by healthcare workers, queuing outside while waiting to be served, long waiting periods, non-communication of laboratory test results to clients, lack of proper education on side effects associated with ART, and language barrier. Individual constraints included financial constraints, perceived non-improvement in health outcomes, food insecurity, and forgetfulness. Opportunities identified for improved ART uptake were assuring ART clients of improved health outcomes, leveraging the good rapport between ART clients and healthcare providers, leveraging the better counselling services offered to PLHIV at the ART clinic, provision of varied ART treatment regimens to clients, routine communication of laboratory test results to clients, and leveraging clients’ satisfaction with ART services at ART clinic. We recommend health system reforms targeting healthcare service delivery to PLHIV to encourage linkage, continuity, and retention in care and augmenting ART regimes with financial and nutritional support while encouraging status disclosure to a trusted family member.

Evaluating the feasibility of a tele-diagnostic auditory brainstem response service in a rural context.

There is a noticeable gap in access to audiology services in South Africa, and the gap is intensified in rural areas. Often, primary healthcare (PHC) facilities have an unequal ratio of audiologists to patients in need. Telehealth can expand the range of hearing healthcare services. This study aimed to determine whether, for infants, tele-diagnostic Auditory Brainstem Response (ABR) assessment results conducted within a mobile clinic van are comparable to face-to-face diagnostic ABR results in rural Winterveldt, Pretoria North, South Africa. The study utilised a quantitative, prospective cross-sectional comparative within-subject design. Each participant received both face-to-face and mobile tele-diagnostic ABR tests, which were then compared to evaluate the feasibility of mobile tele-diagnostic ABR testing. The Student's t-test was used to determine whether there was a difference between face-to-face and tele-diagnostic tests, and Bland -Altman plots were used to assess the level of agreement between the ABR testing results. There was a strong correlation (p 0.001) between face-to-face and mobile tele-diagnostic ABR test results for both neurological and audiological ABR tests. The study found that there was no statistical significance between face-to-face and tele-diagnostic ABR measures; additionally, the results were within clinically acceptable and normative measures. Tele-diagnostic ABR offered within a mobile clinic van is feasible as it produces similar and clinically acceptable results when compared to the traditional assessment method.Contribution:This feasibility study is a positive indicator that tele-diagnostic ABR testing through a mobile clinic van may be considered to accelerate the delivery of hearing healthcare services to the infant population in rural communities.

Changes in the incidence and prevalence of systemic lupus erythematosus between 1990 and 2020: an observational study using the Clinical Practice Research Datalink (CPRD)

ObjectiveTo obtain updated estimates on the incidence and prevalence of systemic lupus erythematosus (SLE) in the UK, over the period 1990–2020, using the Clinical Practice Research Datalink (CPRD).MethodsThis was a...