Health Care Services For Individuals Research Articles

Out of pocket health-care services in Germany during pregnancy under consideration of migration and acculturation.

More than a quarter of the German population has a migration background (MB). As various studies in the healthcare sector have already shown, ethnic background and migration status can have an influence on individual patient care. The aim of our study was to evaluate whether there are differences in utilization of out of pocket health-care services and the consultation situation in the context of prenatal care, taking into account migration status, acculturation and socio-demographic aspects. In the period from 01.03.21-01.03.22, a total of 511 women in childbed at the University Women's Hospital Ulm were interviewed in a retrospective survey using a standardized questionnaire translated into 9 languages and asked about their prenatal care. Due to the COVID pandemic, the study had to be terminated after one year. Women with MB-particularly 1st generation migrant women-used significantly fewer out of pocket prenatal care services (p < 0.001) and felt less informed and counselled regarding costs and benefits of possible prenatal care examinations (p < 0.001) compared to women without MB. Consistent with these results, there were associations between the assimilation index (AI) of patients with MB and both utilization and perception of individual healthcare services. Our study indicates that even today there are still differences in the treatment and perception of various health services in the context of prenatal care between women with and those without MB.

The use of healthcare services and disabling chronic pain: results from the cross-sectional population-based Andalusian Health Survey.

Several factors seem to be related to the use of healthcare services, and chronic pain (CP) is among these characteristics. The objective is to describe the number of visits to a doctor's surgery or emergency rooms, and the periods of hospitalization; to identify characteristics associated with frequent healthcare use, including disabling chronic pain (DCP) and non-disabling chronic pain (n-DCP). Representative population-based cross-sectional study of 6569 people older than 16 years from southern Spain was collected. The frequency of visits to a doctor's surgery or emergency rooms and periods of hospitalization were defined as at or above the 90th percentile. Binary logistic regression analyses were conducted separately on women and men to identify characteristics associated with being frequent visitors. People with DCP are more frequent visitors to a doctor's surgery and emergency rooms and endure longer periods of hospitalization compared to people with n-DCP and without pain. In logistic regression models, people with DCP are twice as likely to over-visit a doctor's surgery; to endure longer periods of hospitalization and more visits to an emergency room service. No relationship was found in n-DCP. Disability seems to modulate a greater use of health services among the population with CP, doubling it when compared to n-DCP and n-CP, both in women and men. Understanding the role of disability in the use of healthcare services for individuals with CP allows for the identification of needs and strategies to optimize resources.

Processes and the Electronic Health Record: Challenges and Difficulties Faced when Creating an OB Quality Dashboard.

Healthcare quality as defined by the National Academy of Medicine is "the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes [1]". While building QI dashboard data quality to improve the maternal health of our patient population issues were discovered that hindered that the progress of the project. This paper will discuss the challenges and difficulties faced while creating an OB quality dashboard at a regional perinatal.

Demographic, Clinical, and Antiretroviral Regiment Treatment Characteristics of HIV/AIDS Patients at the Regional General Hospital of Central Papua

The incidence of HIV infections in Papua is currently on the rise, primarily due to restricted access to antiretroviral treatment and insufficient support and care. Additionally, there is a lack of awareness among residents in rural or mountainous areas about HIV/AIDS infection, as provided by healthcare professionals. Until now, research data have been scarce on the demographic characteristics, clinical features, and treatment approaches for HIV/AIDS patients in the interior regions of Papua. This data is crucial for devising strategies aimed at enhancing healthcare services for individuals affected by HIV/AIDS.Consequently, this study endeavors to gain insights into the demographic characteristics, clinical features, and treatment modalities for HIV/AIDS patients at the Regional General Hospital of the Central Papua Region. It employs an observational descriptive approach, utilizing medical records of HIV/AIDS patients who visited the Central Papua Regional Government Hospital in June 2023. The findings indicate that, based on demographic data, the majority of patients were, on average, ≤25 years old (60.8%), male (52.5%), married (56.7%), and the highest number of HIV/AIDS cases were among secondary education graduates (40.8%). The majority were employed (67.5%) with incomes below the minimum wage threshold (69.2%). All heterosexual patients exhibited behavioral risk factors, and 4.2% had comorbidities such as hypertension. Tuberculosis was the most common opportunistic infection (17.5%). The highest proportion of individuals with HIV/AIDS were in stage II (66.7%). The predominant antiretroviral treatment regimen was a fixed-dose combination (FDC) containing Tenofovir 300mg, Lamivudine 300mg, and Efavirenz 600mg. The duration of use of ARV therapy in people with HIV / AIDS is at most 1 month.

TELEDENTISTRY IN A JURIDICAL PERSPECTIVE: CRIMINAL, CIVIL AND ADMINISTRATIVE ASPECTS

Introduction: To address the limitations resulting from the implementation of health protocols in providing healthcare services to patients, a solution was found in the utilization of information and communication technology to support healthcare services for patients in the form of telehealth, often known as telemedicine. Review: According to Article 1, Paragraph 21 of Law Number 17 of 2023 regarding Health, telemedicine is defined as the provision and facilitation of healthcare services, including public health, health information services, and self-care services, through telecommunications and digital communication technology. One of the aspects of telemedicine in the field of dentistry is teledentistry, which can be a solution for optimizing dental and oral healthcare services for individuals and the community. However, there are various issues in its implementation, especially related to legal issues such as licensing, patient electronic medical record privacy and confidentiality, clinical guidelines, and others that are highly vulnerable to data discrepancies, falsification, or digital patient data leakage. Conclusion: These issues can potentially lead to medical disputes that may enter the legal realm. On the other hand, teledentistry services also play a crucial role in improving public health, especially in dental and oral health in Indonesia, particularly during the COVID-19 pandemic. Therefore, the development of teledentistry services needs to be continuously improved, both in terms of systems and regulations, to provide security and legal certainty for the Indonesian population.

Digital healthcare framework for patients with disabilities based on deep federated learning schemes

Utilizing digital healthcare services for patients who use wheelchairs is a vital and effective means to enhance their healthcare. Digital healthcare integrates various healthcare facilities, including local laboratories and centralized hospitals, to provide healthcare services for individuals in wheelchairs. In digital healthcare, the Internet of Medical Things (IoMT) allows local wheelchairs to connect with remote digital healthcare services and generate sensors from wheelchairs to monitor and process healthcare. Recently, it has been observed that wheelchair patients, when older than thirty, suffer from high blood pressure, heart disease, body glucose, and others due to less activity because of their disabilities. However, existing wheelchair IoMT applications are straightforward and do not consider the healthcare of wheelchair patients with their diseases during their disabilities. This paper presents a novel digital healthcare framework for patients with disabilities based on deep-federated learning schemes. In the proposed framework, we offer the federated learning deep convolutional neural network schemes (FL-DCNNS) that consist of different sub-schemes. The offloading scheme collects the sensors from integrated wheelchair bio-sensors as smartwatches such as blood pressure, heartbeat, body glucose, and oxygen. The smartwatches worked with wearable devices for disabled patients in our framework. We present the federated learning-enabled laboratories for data training and share the updated weights with the data security to the centralized node for decision and prediction. We present the decision forest for centralized healthcare nodes to decide on aggregation with the different constraints: cost, energy, time, and accuracy. We implemented a deep CNN scheme in each laboratory to train and validate the model locally on the node with the consideration of resources. Simulation results show that FL-DCNNS obtained the optimal results on the sensor data and minimized the energy by 25%, time 19%, cost 28%, and improved the accuracy of disease prediction by 99% as compared to existing digital healthcare schemes for wheelchair patients.

Policy implications of heterogeneous demand reactions to changes in cost-sharing: Patient-level evidence from Austria

Cost-sharing is a prominent tool in many healthcare systems, both for raising revenue and steering patient behaviour. Although the effect of cost-sharing on demand for healthcare services has been heavily studied in the literature, researchers often apply a macro-perspective to these issues, opening the door for policy makers to the fallacy of assuming uniform demand reactions across a spectrum of different forms of treatments and diagnostic procedures. We use a simple classification system to categorize 11 such healthcare services along the dimensions of urgency and price to estimate patients’ (anticipatory) demand reactions to a reduction in the co-insurance rate by a sickness fund in the Austrian social health insurance system. We use a two-stage study design combining matching and two-way fixed effects difference-in-differences estimation. Our results highlight how an overall joint estimate of an average increase in healthcare service utilization (0.8%) across all healthcare services can be driven by healthcare services that are deferrable (+1%), comparatively costly (+1.4%) or both (+1.6%) and for which patients also postponed their consumption until after the cost-sharing reduction. In contrast, we do not find a clear demand reaction for inexpensive or urgent services. The detailed analysis of the demand reaction for each individual healthcare service further illustrates their heterogeneity. We show that even comparatively minor changes to the costs borne by patients may already evoke tangible (anticipatory) demand reactions. Our findings help policy makers better understand the implications of heterogeneous demand reactions across healthcare services for using cost-sharing as a policy tool.

Help-seeking patterns and level of care for individuals with bipolar disorder in Rwanda.

Most descriptive data on individuals with bipolar disorder originate from high-resource settings. Very little is known about the accessibility and service provision of intensive mental health care to persons living with bipolar disorder in low-resource settings. This information is needed to inform health systems and guide practitioners to improve standard treatment options and access to treatment. This cross-sectional study explored the level of care for outpatients with bipolar disorder and their help-seeking patterns at the two national referral hospitals in Rwanda. The study found that the majority, 93%, of outpatients with bipolar disorder in Rwanda were on prophylactic psychopharmacological treatment, but mainly first-generation antipsychotics and just 3% received lithium treatment. Furthermore, there was a lack of psychosocial intervention; consequently, 44% were not aware that they had bipolar disorder. Moreover, 1 in 5 participants utilized or had previously used traditional medicine. Awareness of own diagnostic status was not associated with educational level or use of traditional medicine. The study's sample size of 154 patients is relatively small, and the cross-sectional design does not provide causal inferences. The results demonstrate a considerable unmet need for improved mental health care services for individuals with bipolar disorder in Rwanda, including access to optimal medication and psychosocial interventions. Psychoeducation could be a possible starting point for improving the standard of care, informing the individual on their diagnosis and medication while empowering them to engage in their treatment plan. Trial registration: ClinicalTrials.gov NCT04671225. Registered on November 2020.

PENYULUHAN NILAI GUNA REKAM MEDIS DI RUMAH SAKIT UMUM DELI MEDAN

A hospital is a healthcare institution offering comprehensive individual healthcare services, encompassing inpatient, outpatient, and emergency care. These healthcare facilities maintain medical records that consist of documentation and files comprising patient identification, examination results, administered treatments, as well as other procedures and services delivered to patients. The primary purposes of medical records are to facilitate healthcare and treatment, serve as legal evidence when necessary, establish the foundation for healthcare service financing, and contribute to health-related statistical analyses. The objective of this awareness campaign is to enhance healthcare professionals' comprehension of the significance of thorough medical records and to aid healthcare workers in accurately completing medical record documents at Deli Medan General Hospital.

Outcomes of Implementing a Webinar-Based Strategy to Improve Spinal Cord Injury Knowledge and Community Building: Convergent Mixed Methods Study.

COVID-19 disrupted services received by persons with spinal cord injury (SCI) worldwide. The International Disability Alliance declared the need for a disability-inclusive response to the COVID-19 crisis, as decreased access to health care services for individuals living with varying levels of function was unacceptable. As a result, an SCI community in Canada created a novel webinar-based strategy aimed at improving access to self-management information for people living with SCI and other stakeholders. However, although telehealth practices have previously been used effectively in SCI management and rehabilitation, little to no scholarship has investigated the outcomes of implementing a webinar-based telehealth strategy in this population. This study aims to understand the outcomes of implementing the webinar series. Specifically, the authors aimed to determine the reach of the series; understand its impact on social connectedness, perceptions of disability, and overall quality of interactions among persons with SCI, their families, service providers, and the public at large; and explore the long-term sustainability of the initiative. The authors implemented a community-based participatory strategy to define a convergent mixed methods design to triangulate qualitative and quantitative data collected simultaneously. Quantitative methods included pop-up questions administered during the live webinars, surveys administered following webinars, and an analysis of YouTube analytics. Qualitative methods included semistructured interviews with persons with SCI and health care providers who attended at least one webinar. The results were integrated, following methods adapted from Creswell and Clark. A total of 234 individuals attended at least 1 of the 6 webinars that took place during the 6-month study period. In total, 13.2% (31/234) of the participants completed the postwebinar survey, and 23% (7/31) participated in the semistructured interviews. The reach of the webinar series was mainly to persons with SCI, followed by health professionals, with most of them living in urban areas. The topics sexuality and research were the most viewed on YouTube. The knowledge disseminated during the webinars was mainly perceived as valid and useful, related to the fact that the presentation format involved people with lived experience and clinical experts. The webinars did not necessarily help build a new extended community of people involved in SCI but helped strengthen the existing community of people with SCI in Alberta. The webinar positively influenced the perceptions of normality and disability regarding people with SCI. The webinar format was perceived as highly usable and accessible. The webinar series was associated with improved participant knowledge of what is possible to achieve after an SCI and their perceptions of disability. The long-term implementation of this initiative is feasible, but further considerations to increase its reach to rural areas and ensure the integration of diverse individuals should be taken.

The Challenges of Establishing Healthcare Services in Low- and Middle-Income Countries: The Case of Autism Spectrum Disorders (ASD) in the Kurdistan Region of Iraq-Report from the Field.

The present report from the field tries to present challenges associated with establishing healthcare services for individuals with autism spectrum disorders (ASD) in a low- and middle-income area. The given case that has been highlighted is establishing daycare services focusing on rehabilitation and training services for individuals with ASD, and their caregivers and family members, in the Kurdistan Region of Iraq (KRI). Based on my experience, the associated challenges are divided into three primary levels: personal, professional, and organizational. The report highlights the importance of understanding the challenges associated with establishing healthcare services with the desire to put them under control. Plus, understanding the cultural aspects of the healthcare services for individuals with ASD experiences to address the issues at each level shared. It is concluded in the final part of the report that the key to establishing healthcare quality is to understand attitudes toward healthcare at the personal, professional, and organizational levels. This attitude determines the expectation from the services and defines assistance-seeking behaviors. Results offer insight for stakeholders in the healthcare field, allowing for a better understanding and improvement of availability and access to quality-driven healthcare services. A pre- and in-service training approach is practiced to address the associated challenges of establishing healthcare services at the personal level in KRI. A similar policy might be applicable in other LMICs, where there is a lack of professional and skillful healthcare service providers.

The Potential Dangers of Quality Assurance, Physician Credentialing and Solutions for Their Improvement

The Institute of Medicine defines health care quality as "the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”. However, defining which are the desired outcomes and current professional knowledge can be controversial. In this review article the effectiveness of quality assurance is reviewed along with pointing out some of the dangers to physicians. Since deficient quality assurance can affect credentialing, solutions for the problem are offered including an independent medical staff and election rather than appointment of the chief of staff. Solutions to expedite and ensure accuracy in credentialing are offered including use of the Interstate Medical Licensure Compact (IMLC). These solutions should lead to improved and fairer quality assurance, reduced administrative expenses, decreased fraud, and modernization of physician licensing and credentialing.

Missing Care: the Initial Impact of the COVID-19 Pandemic on CKD Care Delivery

BackgroundChronic kidney disease (CKD) is a common condition with adverse health outcomes addressable by early disease management. The impact of the COVID-19 pandemic on care utilization for the CKD population is unknown.ObjectiveTo examine pandemic CKD care and identify factors associated with a high care deficit.DesignRetrospective observational studyParticipants248,898 insured individuals (95% Medicare Advantage, 5% commercial) with stage G3–G4 CKD in 2018Main MeasuresPredicted (based on the pre-pandemic period of January 1, 2019–February 28, 2020) to observed per-member monthly face-to-face and telehealth encounters, laboratory testing, and proportion of days covered (PDC) for medications, evaluated during the early (March 1, 2020–June 30, 2020), pre-vaccine (July 1, 2020–December 31, 2020), and late (January 2021–August 2021) periods and overall.Key ResultsIn-person encounters fell by 24.1% during the pandemic overall; this was mitigated by a 14.2% increase in telehealth encounters, resulting in a cumulative observed utilization deficit of 10% relative to predicted. These reductions were greatest in the early pandemic period, with a 19.8% cumulative deficit. PDC progressively decreased during the pandemic (range 9–20% overall reduction), with the greatest reductions in hypertension and diabetes medicines. CKD laboratory monitoring was also reduced (range 11.8–43.3%). Individuals of younger age (OR 1.63, 95% CI 1.16, 2.28), with commercial insurance (1.43, 95% CI 1.25, 1.63), residing in the Southern US (OR 1.17, 95% CI 1.14, 1.21), and with stage G4 CKD (OR 1.21, 95% CI 1.17, 1.26) had greater odds of a higher care deficit overall.ConclusionsThe early COVID-19 pandemic resulted in a marked decline of healthcare services for individuals with CKD, with an incomplete recovery during the later pandemic. Increased telehealth use partially compensated for this deficit. The downstream impact of CKD care reduction on health outcomes requires further study, as does evaluation of effective care delivery models for this population.

Are medical students in Palestine adequately trained to care for individuals with autism spectrum disorders? A multicenter cross-sectional study of their familiarity, knowledge, confidence, and willingness to learn

BackgroundMedical students are the future workforce of physicians in primary, secondary, tertiary, and highly specialized care centers. The present study was undertaken to assess familiarity, knowledge, confidence, of medical students with regard to autism spectrum disorders (ASDs).MethodsThis multicenter study was conducted in a cross-sectional design among medical students in the 3 main universities in Palestine. In addition to the sociodemographic and academic details, the questionnaire measured familiarity (8-items), knowledge (12-items), confidence and willingness to learn (5-items) with regard to ASDs.ResultsThe questionnaire was completed by309 medical students (response rate = 77.3 %). The median familiarity, knowledge, and confidence scores were 50 % (42.5 %, 57.5 %), 50 % (41.7 %, 66.7 %), and 60.0 % (54.0 %, 68.0 %), respectively. There was a positive moderate correlation between familiarity and knowledge scores (Spearman’s rho = 0.29, p-value < 0.001) and familiarity and confidence scores (Spearman’s rho = 0.34, p-value < 0.001). Medical students who have received a course on autism were 3.08-fold (95 % C.I. of 1.78–5.31) more likely to score ≥ 50 % on the familiarity items compared to those who did not receive a course. The medical students who were in their clinical academic stage, who received a course on ASDs, and those who interacted with individuals with ASDs were 2.36-fold (95 % C.I. of 1.34–4.18), 2.66-fold (95 % C.I. of 1.52–4.65), and 2.59-fold (95 % C.I. of 1.44–4.63) more likely to score ≥ 50 % on the knowledge items. Medical students who reported high satisfaction with their social life were 2.84-fold (95 % C.I. of 1.15-7.00) more likely to score ≥ 50 % on the confidence items.ConclusionsThe present study identified considerable awareness and knowledge gaps among medical students with regard to ASDs. Medical students in this study reported low confidence in their ability to provide healthcare services to individuals with ASDs. Appropriately designed educational interventions might improve familiarity, knowledge, and confidence of medical students. More studies are still needed to investigate if such interventions can improve healthcare services for individuals with ASDs.

Access to oral health care services for individuals with rare genetic diseases affecting skeletal development.

To identify factors associated with oral health care services for individuals with and without rare genetic diseases. A cross-sectional study was undertaken, with 140 individuals paired by sex and age (70 with rare genetic diseases and 70 without), aged between 3 and 27 years, and their parents. The sample was selected from two reference hospitals for patients with rare genetic diseases in southeastern Brazil. The parents completed a questionnaire on individual aspects and their child's medical/dental history. Participants who did and did not suffer from rare genetic diseases were examined for dental caries, malocclusion, dental anomalies, and oral hygiene. The theoretical model Directed Acyclic Graphs (DAG) was used to identify possible confounding variables in the association between rare diseases and access to dental care. Descriptive analyses and non-matched and matched logistic regression models (p<0.05) were carried out. The chance of individuals without rare genetic disease having access to oral health care service was 5.32 times higher (95% CI 2.35-12.01) than those with such conditions. Individuals who had not suffered upper respiratory tract infections had a 3.16 times greater chance of being in the group with access to oral health care service (95% CI 1.45-6.90). Individuals with no rare genetic diseases and no history of upper respiratory tract infections had a greater chance of belonging to the group of individuals with access to a dental service. Individuals with rare genetic diseases have less access to oral health care.

Prevalence and correlates of physical health conditions in Jamaica and Guyana

The increasing prevalence of non-communicable diseases remains an important source of concern in the Caribbean and Latin American regions. This study examines rates and the associated socio-demographic correlates of physical health indicators in Jamaica and Guyana. Area probability cross-sectional data were collected on 1,218 Jamaicans and 2,068 Guyanese participants in 2005. Physician- diagnosed hypertension, diabetes mellitus, arthritis, and self-rated oral and general physical health were assessed using descriptive statistics, chi-square, and hierarchical logistic regression analytic procedures. Jamaicans generally reported poorer physical health, including diabetes mellitus, arthritis, and overall perceived oral and physical health compared to Guyanese; Guyanese reported higher rates of hypertension. Generally, lower social and economic standing was associated with poorer health conditions but made different contributions across countries. The study highlights the need for greater awareness and access to health care services for individuals who are especially vulnerable to poorer health. The results of this study suggest the need for additional studies on factors associated with physical health conditions, including a better understanding of the role of race/ethnicity in the Caribbean. Key words: prevalence, physical health, Guyana, Jamaica.

Introducing the ICF in the care of individuals with id under consideration of the situation of health care services in poland for individuals with id and mental health problems

The introduction of the ICF scale in Poland started a few years ago. One of the institutions, which started trainings and implementation of the scale is the Polish Association for Persons with Intellectual Disability (PSONI). The use of the ICF scale turned out to be very important because the diagnosis itself still tells us little about the life and personality of a person. The disorder itself does not determine functioning in society. The application of this scale helps to capture the dynamics between concepts such as health, human body functions, ability to participate in different activities, environmental factors and personality. It allows, for example, to clearly define whether the problems are caused by the health of a given person or by external limitations, even of an architectural nature. It is expected to implement ICF in different centers run by the Association like e.g. Vocational Activity Centers or the Center for Vocational Counseling and Support for People with Intellectual Disabilities (DZWONI). The scale is also being implemented in Health Care Services for Individuals with ID and Mental Health Problems in Poland because it remains an integrative model and not only medical and social one.DisclosureNo significant relationships.

Personalisation of treatment pathways – analysis of chances and barriers by the implementation of digital technologies under the conditions of the German Health System

Background: The potential of digital technologies is far from being exhausted for patients. The regulatory framework becomes a brake on innovation due to digitalisation, but also due to the trend towards individualisation. Strategies, corporate culture and processes, which are necessary for the design of high-quality and cost-effective healthcare services, are still lacking in many healthcare providing organisations. Health Services 4.0 and patient integration as leverage: With Health Services 4.0 it is possible to improve the outcome of the individual healthcare service and meet the regulatory requirements. This requires the capabilities of the provider to dynamically balance exploitation and exploration. The challenges are to develop innovations in a continuously changing working environment and/or to adapt (medical) technical innovations into their own service processes. Conclusion: This article is focused on hypotheses of cause-and-effect analyses formulated as scenarios, related to the implementation of digital technologies in order to improve efficiency and effectiveness for a high medical expertise as well as for a higher level of service quality. The output is a more detailed analysis of key value drivers, success factors as well as internal and external value generators for the design of Health Services 4.0. Up to now many issues regarding the use of digital technologies are still only partly analysed and not yet proved for a more efficient care on high-quality level. The company's capacity for ambidexterity is becoming an important dynamic capability, with on one hand flexibility for new developments and on the other hand stability for hard factors in physical value chains and soft factors in value-oriented attitudes and behaviour based on empathy. This article was previously published in German in "Monitor Versorgungsforschung" under the original title " Personalisierung von Behandlungspfaden – Das Potenzial digitaler Technologien". This translated version faithfully reflects the authors, data, and interpretations of the original.

Personalisation of treatment pathways - analysis of chances and barriers by the implementation of digital technologies under the conditions of the German Health System.

Background: The potential of digital technologies is far from being exhausted for patients. The regulatory framework becomes a brake on innovation due to digitalisation, but also due to the trend towards individualisation. Strategies, corporate culture and processes, which are necessary for the design of high-quality and cost-effective healthcare services, are still lacking in many healthcare providing organisations. Health Services 4.0 and patient integration as leverage: With Health Services 4.0 it is possible to improve the outcome of the individual healthcare service and meet the regulatory requirements. This requires the capabilities of the provider to dynamically balance exploitation and exploration. The challenges are to develop innovations in a continuously changing working environment and/or to adapt (medical) technical innovations into their own service processes. Conclusion: This article is focused on hypotheses of cause-and-effect analyses formulated as scenarios, related to the implementation of digital technologies in order to improve efficiency and effectiveness for a high medical expertise as well as for a higher level of service quality. The output is a more detailed analysis of key value drivers, success factors as well as internal and external value generators for the design of Health Services 4.0. Up to now many issues regarding the use of digital technologies are still only partly analysed and not yet proved for a more efficient care on high-quality level. The company's capacity for ambidexterity is becoming an important dynamic capability, with on one hand flexibility for new developments and on the other hand stability for hard factors in physical value chains and soft factors in value-oriented attitudes and behaviour based on empathy. This article was previously published in German in "Monitor Versorgungsforschung" under the original title " Personalisierung von Behandlungspfaden - Das Potenzial digitaler Technologien". This translated version faithfully reflects the authors, data, and interpretations of the original.

Prevalence of Anxiety, Depression, Stress, and Insomnia among Healthcare Workers during Covid-19: A Systematic Review and Meta-Analysis

Covid-19 pandemic had a deleterious impact on the healthcare system and interrupted the healthcare services for individuals, families, and communities. This review aimed to ascertain the prevalence of anxiety, depression, insomnia, and stress among nurses and doctors during Covid-19 pandemic based on Cochrane collaboration guidelines and reported using Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement. The online literature search was conducted from 1 January 2021 to 31 April 2021; two authors independently searched and appraised the quality of studies. The quality of studies was assessed using modi'Agrave; ed Newcastle-Ottawa scale. Pooled data was analysed using random-effect model and heterogeneity was assessed by I2 test. A total of 13 studies comprising 9060 participants were selected for meta-analysis. The prevalence of anxiety and depression among nurses was ES (95% CI) [0.42(0.33,0.50), I2 I =97.42, p'lt;0.001], and 0.42 (0.32, 0.52), I2 I =97.60, p'lt;0.001] respectively. Anxiety and depression among doctors was ES (95%CI) [0.34(0.26,0.42)], I2 I =95.26, p'lt;0.001 and 0.34 (0.23,0.45), I2 I =97.61, p'lt;0.001 respectively. The overall pooled prevalence of insomnia among nurses was 0.44 (0.35, 0.53), I2 I =90.97, p'lt;0.001 and doctors was 0.35 (0.26, 0.43), I2 I =90.79, p'lt;0.001. The total pooled prevalence rate of stress among nurses was 0.37 (0.08, 0.66), I2 I =99.56, p'lt;0.001 and doctors was 0.37 (0.06, 0.68), I2 I =99.07, p'lt;0.001. The overall subgroup pooled prevalence rate of anxiety, depression, insomnia, and stress due to Covid-19 pandemic among nurses and doctors was 0.42 (0.33, 0.50) I2= 99.96, p'lt;0.001, 0.34 (0.29, 0.40), I2 I =96.93, p'lt;0.001, respectively. Anxiety and depression were the most common problems exhibited by the doctors and nurses during Covid-19 pandemic. These 'Agrave;ndings emphasise the urgency for an early identi'Agrave;cation and interventional strategies to mitigate the mental health crisis among frontline healthcare providers.