Healthcare Services Policy Research Articles

Exploring the Lived Experience of Aging among Chronically Homeless Older Adults

Introduction/background summary: Twenty-four percent of Canada’s homeless shelter users are over the age of 50 years, a number that is predicted to rise [1]. Homeless older adults experience chronic health issues. They encounter barriers to accessing and utilizing healthcare and social services, such as stigma and misalignment between their needs and available services.
 Why did you do it? Designing healthcare and social services to address the needs of older adults aging with homelessness first requires evidence of their experiences. This study explores the conceptualization of older chronically homeless adults’ lived experiences related to aging.
 Who is it for? The research is for healthcare and social service providers and policymakers, populations that are homeless, researchers, and advocates interested in issues of homelessness.
 Who did you involve and engage with?Collaboration will occur with staff members and research participants in the study setting. Staff offer insights into participants’ recruitment, engagement and retention. Participants provide feedback on the interview questions, their transcribed interview notes, and written descriptions of their stories. Knowledge translation products and actionable items to improve service delivery will be co-created with the study settings.
 What did you do? The phenomenological research explores the aging experiences of older adults living with chronic homelessness. Participants will be recruited from four social service organizations and screened using the eligibility screening survey. Twenty eligible participants will be selected from the screening for data collection. The interview questions will be piloted with participants. Qualitative data collection occurs through face-to-face interviews and unstructured observations of participants in the study settings. Quantitative descriptive data will be gathered using the demographic survey and the SF-12 Short Form Health Assessment Survey. The NVivo software will be utilized to analyze the qualitative data. Quantitative data analysis will be completed with the SPSS statistical software.
 What results did you get? What impact did you have? Expected results include evidence of participants’ early physiological and psychosocial changes related to aging, healthcare and social service unmet needs and service utilization, and strategies utilized to manage developmental tasks related to aging. This study contributes new knowledge on the aging experiences of older adults living with chronic homelessness. It helps to inform healthcare and social service policy and emerging practices, including person-centred care and integrated healthcare.
 What is the learning for the international audience?The results will be transferable or interesting to international audiences that are involved in areas of research, policy, practice and advocacy related to homelessness.
 What are the next steps? The next steps involve knowledge translation at conferences, symposiums, presentations and publications. Researchers will collaborate with the study settings to translate the research findings into actionable policy, service design, and delivery mechanisms.
 References
 1.Gaetz S., Dej E., Richter T., & Redman M. (2016). The State of Homelessness in Canada 2016. Toronto: Canadian Observatory on Homelessness Press.
 

Research on Older Adults’ Willingness to Enroll in Health Care Services based on Andersen Behavioral Model

Ageing has increasingly become a severe social problem nowadays, resulting in burden for both whole society and each family unit. Jiangsu is a typical aging province in China with dramatically increasing aging population. This paper analyzed Andersen behavioral model theoretically and empirically, and made an overview about older adults’ healthcare services utilization behavior from three aspects, namely, predisposing characteristics, enabling resources, and need factors. This paper revealed that it is significant to apply Andersen behavioral model in older adults’ healthcare services utilization in Jiangsu to understand older adults’ healthcare enrollment behavior, and provide evidence for healthcare services providers and policy makers to better manage and allocate social resources to improve services quality thus relieve family pressure brought by aging society.

Increasing the accuracy of the asthma diagnosis using an operational definition for asthma and a machine learning method

IntroductionAnalysis of the National Health Insurance data has been actively carried out for the purpose of academic research and establishing scientific evidences for health care service policy in asthma. However, there has been a limitation for the accuracy of the data extracted through conventional operational definition. In this study, we verified the accuracy of conventional operational definition of asthma, by applying it to a real hospital setting. And by using a machine learning technique, we established an appropriate operational definition that predicts asthma more accurately.MethodsWe extracted asthma patients using the conventional operational definition of asthma at Seoul St. Mary’s hospital and St. Paul’s hospital at the Catholic University of Korea between January 2017 and January 2018. Among these extracted patients of asthma, 10% of patients were randomly sampled. We verified the accuracy of the conventional operational definition for asthma by matching actual diagnosis through medical chart review. And then we operated machine learning approaches to predict asthma more accurately.ResultsA total of 4,235 patients with asthma were identified using a conventional asthma definition during the study period. Of these, 353 patients were collected. The patients of asthma were 56% of study population, 44% of patients were not asthma. The use of machine learning techniques improved the overall accuracy. The XGBoost prediction model for asthma diagnosis showed an accuracy of 87.1%, an AUC of 93.0%, sensitivity of 82.5%, and specificity of 97.9%. Major explanatory variable were ICS/LABA,LAMA and LTRA for proper diagnosis of asthma.ConclusionsThe conventional operational definition of asthma has limitation to extract true asthma patients in real world. Therefore, it is necessary to establish an accurate standardized operational definition of asthma. In this study, machine learning approach could be a good option for building a relevant operational definition in research using claims data.

COVID-19 pandemic and transgender migrant women in India: Socio-economic vulnerability and vaccine hesitancy

In India, transgender women, often referred to as hijra or kinnar, remain a marginalized group and encounter interpersonal and structural barriers that subject them to social exclusion, discrimination, lack of access to education and health care, and fewer job opportunities compared with the general population. During the COVID-19 pandemic these disparities were heightened and the livelihood of transgender migrant women were severely hit and disrupted, causing further financial and physical hardship. The present study aims to explore the socio-economic vulnerability faced by these women during the pandemic and the factors that contribute to vaccine hesitancy in order to assist government officials and policy makers in the formulation of more inclusive policies for transgender people. Results indicate that the pandemic has adversely impacted their livelihood as most of them depend on sex work and begging. In order to fulfil their daily needs during the lockdown, they have borrowed loans from multiple sources with a higher interest rates and remain in debt. On vaccination status, only seven out of 43 transgender migrant women have taken one vaccine dose, and the rest are not willing to visit vaccine centres because of societal stigma and discrimination including from healthcare personnel. The study reported that these migrant women suffered intensified social stigma, verbal hostility and transphobia attitudes from healthcare professionals whihc caused panic, fear, anxiety and depression among them, and thus they evade these spaces for further consultation or to obtain any other services. Many of them have decided not to take the COVID-19 vaccine in order to stay away from hostility. Further, the lack of trust in medical professionals is also one of the principal concerns leading to vaccine hesitancy among transgender migrant women. Thus a systemic inclusive healthcare services policy is required to address the factors that may influence the vaccine acceptance among transgender women in India.

Barriers to healthcare for Venezuelan migrants: physicians' perspective

PurposeIncreased migration to small island developing states poses major challenges on receiving countries' healthcare systems. Due to public health policy on treating migrants in Trinidad and Tobago, Venezuelan migrants are experiencing less than optimal care. This paper examines the retrospective accounts of physicians treating Venezuelan migrants with limited access to healthcare.Design/methodology/approachTen in depth, semi-structured interviews were conducted with physicians working in primary healthcare and emergency departments about their clinical decision-making process in providing care for Venezuelan migrants. A narrative approach was used to highlight the personal experiences of participants. Participants were recruited by their response to an online advertisement on social media (i.e. Facebook and Instagram) and via email invitations. Interviews were transcribed verbatim and coded using NVIVO-12 software.FindingsFindings revealed language barriers between Venezuelan migrants and Trinidad and Tobago-based physicians hindered providing optimal care coordination. Physicians indicated the use of a translator app to bridge the service gap but questioned their ethics. Participants noted tensions between junior and senior physicians regarding referrals of Venezuelan migrants to outpatient care. The data suggests physicians' felt constrained providing additional services such as primary care due to the Provision of Public Healthcare Services Policy which forbids primary care services to migrants.Originality/valueSparse research on the barriers to accessing healthcare for Venezuelan migrants residing in the small island states.

Abuse of Power on Managing the Health Care Services Policy for the Indonesian National Army Forces and its Implication on Marginalized Soldier’s Health

This research aims to understand the abuse of power on managing the health service policy and its implication that is very significant in reducing marginalized soldiers’ health due at the ontological level and sociological level. The problem is very interesting to be analyzed by conducting a qualitative research method based on public policy theory, abuse of power theory, and health services theory. Data were collected through in-depth interviews, observation, and documentation related to managing the health service policy cases in Indonesia. Data were analyzed by using interactive models are data reduction, data display, data verification, and supported by triangulation. The results were based on ontological level and sociological level using public policy perspective and power perspective for improving health service policy and practice for The Indonesian Army Forces. Vision and mission of public policy on managing health service policy are needed for providing information to stakeholders related, regarding the regulations and sanctions in health service policy. This result provides inputs for making better regulation on health service policy in Indonesia for state agencies as public officials and practitioners.

Key factors of the willingness of rural populations settling in cities (RPSC) from a Lacanian psychoanalysis theory perspective.

The migration of populations from rural to urban areas is a typical phenomenon of urbanization in developing countries. Based on Lacanian psychoanalysis theory, this study analyzes the decision-making mechanism of the willingness of rural populations settling in cities (RPSC), and analyzes the key factors that affect the willingness of RPSC by using the binary Logit regression method based on survey data in Changyi, China. The results show that the willingness of RPSC is a realistic choice under the joint action of the ‘mirrored’ incarnation and the ‘non-mirrored’ order. Among the factors, ‘age’, ‘ethnic groups’, ‘educational attainment’, and ‘social intercourse’, representing the ‘mirrored’ incarnation, and ‘communities’ safety gap’, ‘healthcare services policy’, ‘public housing policy’ and ‘employment insurance gap’, representing the ‘non-mirrored’ order, are significant in affecting the willingness of RPSC. These findings validate the adaptability of psychoanalysis to analyze the willingness of RPSC, and increases the understanding of individual willingness and behavioral choice in the context of a specific social background, which can provide decision-making reference for urban and rural planning and public policy makers.

Improving patients loyalty: A guide for healthcare service providers and policy makers

ABSTRACT Objectives: This study aims to identify the factors affecting hospital choice decisions of patients, to categorize the decision-makers involved in the selection of hospitals, and to predict patients’ repurchase intention model based on identified factors for tertiary-level healthcare services. Methodology: Data were collected from in-patients of multispecialty hospitals located in northern India. Factor analysis and linear discriminant analysis techniques have been used to analyze the data. Findings: Study has revealed that factors that affect hospital choice decisions are basic amenities, fame and quality, building and infrastructure, ease and affordability, personal substances, responsiveness of services, recommendations and suggestions, clinical support, privacy and information sharing, and range of services. It has been found that family member and doctors individually or jointly, friends/relatives, and patients themselves take decisions to choose the hospitals. Study has also resulted in a model consisting of linear discriminant equation to predict patients’ repurchase intentions for the services of same hospitals.

Prevalence of Mental Disorders and Suicidality in Canadian Provinces.

There is limited information to guide health-care service providers and policy makers on the burden of mental disorders and addictions across the Canadian provinces. This study compares interprovincial prevalence of major depressive disorder (MDD), bipolar disorder, generalized anxiety disorder (GAD), alcohol use disorder, substance use disorders, and suicidality. Data were extracted from the 2012 Canadian Community Health Survey-Mental Health (n = 25,113), a representative sample of Canadians over the age of 15 years across all provinces. Cross tabulations and logistic regression were used to determine the prevalence and odds of the above disorders for each province. Adjustments for provincial sociodemographic factors were performed. The past-year prevalence of all measured mental disorders and suicidality, excluding GAD, demonstrated significant interprovincial differences. Manitoba exhibited the highest prevalence of any mental disorder (13.6%), reflecting high prevalence of MDD and alcohol use disorder compared to the other provinces (7.0% and 3.8%, respectively). Nova Scotia exhibited the highest prevalence of substance use disorders (2.9%). Quebec and Prince Edward Island exhibited the lowest prevalence of any mental disorder (8.5% and 7.7%, respectively). Manitoba also exhibited the highest prevalence of suicidal ideation (5.1%); however, British Columbia and Ontario exhibited the highest prevalence of suicidal planning (1.4% and 1.3%, respectively), and Ontario alone exhibited the highest prevalence of suicide attempts (0.7%). Significant interprovincial differences were found in the past-year prevalence of mental disorders and suicidality in Canada. More research is necessary to explore these differences and how they impact the need for mental health services.

Evaluation of the Roles of Physicians and the Functionality of the Healthcare System in Nigeria

Background: A comprehensive medical care system is required for effective healthcare delivery to people who need it. Even though exact configuration of healthcare services varies from country to country, a sturdy mechanism comprising of a robust financing, a well-trained and adequately paid workforce; research, policy recommendation and implementation is needed for a well-maintained system to deliver effective healthcare services.
 Methods: This is a descriptive study conducted on 100 Nigerian trained physicians with at least 1-year practice experience. The online questionnaire was administered to participants through social media platforms such as WhatsApp, Facebook and twitter using purposive sampling method. Data analysis was done using Microsoft excel 2010 version.
 Results: The response rate was 100%. Ninety six percent (96%) and 99% of surveyed physicians think their monthly salary and the amount of money budgeted to the health sector is grossly inadequate. It was also noted that poor enumeration and/or low income 82/330 (25%) and poor medical facilities 70/330 (21%) are the commonest reasons they believe physicians emigrate from Nigeria while problem identification (20.2%), provision of leadership, healthcare service delivery (13.5%), policy making and implementation (12.9%) and research and development (10.4%) are the commonest roles for physicians identified by study participants.
 Conclusion: The Nigerian physician is poorly enumerated, and the healthcare budget is poor. This accounts to large part why leave Nigeria. There is need for better funding of the healthcare system in Nigeria and more involvement of physicians in leadership, research and policy development.

Cultural barriers in access to healthcare services for people with disability in Iran: A qualitative study.

Background: People with disability experience various problems to access to healthcare services. This study aimed to identify cultural barriers in access to healthcare services for people with disability in Iran. Methods: We conducted a qualitative study using content analysis to identify the cultural barriers. We used semi-structured interviews to collect data. Participants were selected through purposeful sampling with maximum variation. 50 individual interviews were conducted with three groups of people with disability, healthcare services providers and policy makers, September to May 2015, at different locations in Tehran, Iran. Results: We identified a number of different cultural barriers in access to health services for people with disability in Iran. These related to health service providers, namely reluctance to provide health services and disrespect; related to People with disability, namely denial of disability, disproportionate expectation, shame and insufficient sociocultural supports; and related to policy makers, namely lack of concern, little attention to the culture of disability and discrimination. We categorized misconception as a barrier that was observed at all levels of the society. Conclusion: Disability is a reality that some human being may experience and live with it. The negative attitude towards people with disability has a close relationship with the cultural norms of a society. The culture of disability in different dimensions should be a priority for all policy makers. Removing cultural barriers in access to healthcare for people with a disability needs collective efforts and collaborations among all stakeholders.

Men at Risk: Men's Health, Illness and the (Un)Healthy Construction of Gender Identity

While men in South Africa are succumbing to the societal pressures and notions of manhood and masculinity, they are faced with health-related risks that have contributed to an increase in the mortality rate of young men. The need to be perceived and accepted as masculine further compromises men’s voluntary use of the available healthcare and social services. This is the rationale for seeking to understand men’s health needs and their realities and how these factors inform healthcare and social service provision and policy development initiatives that should be directed at men. Generating new ideologies around masculinities and men’s health creates possibilities where men can actively contribute to the production or the reframing of masculinity, and towards the healthy construction of gender identity and gender equality.

The Responsiveness of Bureaucracy in Implementing Free Health Care Service in Sidenreng Rappang Regency, Indonesia

The aim of this research is to find out and analyze the implementation of bureaucracy responsiveness principle in implementing free health care service policy in Sidenreng Rappang regency based on: bureaucracy`s attitude in responding complaints, service in providing health care, and response in involving and empowering service user in health care service system. The result of this research concludes that the implementation of bureaucracy responsiveness principle in implementing free health care service in Sidenreng Rappang Regency is not fully optimal. It is proven by: (1) Health Official Bureaucrat shows friendly and committed attitude toward the cleanliness, togetherness, and disciplines in providing health care service and in accordance to the implementation of bureaucracy responsiveness principle in providing health service; (2) Properly respond user`s complaints related to the planning program, but the response to complaints related to program implementation, monitoring and evaluation of the program is not maximally administered or less responsive; (3) Empowerment/service user involvement, including participative program from all the stakeholder component gives positive impact and implication toward the bureaucrat`s working performance in executing free health care service. DOI: 10.5901/mjss.2015.v6n6s1p567

Healthcare service providers’ and facility administrators’ perspectives of the free maternal healthcare services policy in Malindi District, Kenya: a qualitative study

BackgroundGlobally, there are increasing efforts to improve maternal health outcomes including the reduction in maternal mortality rates. Improved access to skilled care utilisation during pregnancy and delivery has been one of the strategies employed to improve maternal health outcomes. In Kenya, more than half of the women deliver without the assistance of a skilled attendant and this has contributed to high maternal mortality rates. The free maternal healthcare services policy in all public facilities was initiated as a strategy to improve access to skilled care and reduce poor maternal health outcomes. This study aimed to explore the perspectives of the service providers and facility administrators of the free maternal health care service policy that was introduced in Kenya in 2013.MethodsA qualitative inquiry using semi-structured one-on-one interviews was conducted in Malindi District, Kenya. The participants included maternal health service providers and facility administrators recruited from five different healthcare facilities. Data were analysed using a thematic framework analysis.ResultsFree maternal healthcare service provision was perceived to boost skilled care utilisation during pregnancy and delivery. However, challenges including; delays in the reimbursement of funds by the government to the facilities, stock outs of essential commodities in the facilities to facilitate service provision, increased workload amidst staff shortage and lack of consultation and sensitisation of key stakeholders were perceived as barriers to effective implementation of this policy.ConclusionFree maternal healthcare services can be one of the strategies to improve a range of maternal health outcomes. However, the implementation of this policy would be more effective if; the healthcare facilities were upgraded, equipped with adequate supplies, funds and staff; the community are continually sensitized on the importance of seeking skilled care during pregnancy and delivery; and inclusivity and collaboration with other key stakeholders be fostered in addressing poor maternal health outcomes in the country.

Managing risks in EU health services policy: Spot markets, legal certainty and bureaucratic resistance

European Union (EU) healthcare services policy has been largely driven by the European Court of Justice (ECJ) applying the law of the internal market to the previously separate area of healthcare systems. We argue that it opened up two major risks: that health service planning would be disrupted by cross-border flows of patients and professionals, including ostensibly interchangeable professionals or procedures that actually vary in quality; and that health systems would be disrupted by the application of liberalizing EU regulatory frameworks. The threats have largely been managed by four developments. Cross-border flows have largely appeared as spot markets rather than broad competition. States, meanwhile, have managed both regulatory and planning risks by debating and then legislating, which increases legal certainty, and the ECJ has taken the hint and become more cautious in its rulings. Meanwhile, states and health systems alike have implemented a strategy of ‘bureaucratic resistance’ upon discovering how easy it is to comply in only the narrowest ways, thereby limiting affects on systems and regulations alike. The experience testifies to the difficulty of creating and sustaining health markets, but also to the risks of international trade in health services and the amount of effort it takes to manage such risks.

Being Spain in Brussels: Policy bureaucracy, agenda setting and negotiation in the EU policy process

Spanish bureaucracy is often said to be marked by poor coordination, poor information and inability to shape political agendas - but analyses of Spanish EU policy regularly present a list of its achievements. We focus on the 'policy bureaucracy' that monitors and acts on dossiers regardless of their political priority, using one EU policy area: health care services policy. For almost the entire EU health care debate, Spain was uncoordinated and invested little in formulating its interests or shaping agendas. Spain's policy bureaucracy fits a country that wins amendments at late stages, but does not engage early to shape policy outside its key priorities.

Distribution of Abo and Rhesus D blood groups among the Bini ethnic group of Southern Nigeria

Background : ABO and Rhesus (Rh) blood group antigens are hereditary characters and are useful in population genetic studies, in resolving medico-legal issues and more important in planning blood utilization by health care service providers and policy markers. In Nigeria, the prevalence of ABO and Rhesus D blood groups in some tribes appear similar. However, the distribution and frequencies of different blood groups in several communities especially the rural populations of the country have not been determined. Aims : The study is aimed at determining the distribution of ABO and Rhesus D blood groups among a rural Bini ethnic group of Evboesi village in Orhionmwon Local Government Area (LGA) of Edo State, Nigeria. Materials and Methods : Cross-sectional studies of six hundred (600) apparently healthy residents of the community aged 18 - 60 years volunteered to participate and were recruited. Venous blood was collected from the subjects and tile agglutination method was performed on each sample for ABO and Rhesus D groupings. Standard commercially produced anti-A, anti-B monoclonal grouping reagents and anti- D sera were used for the tests and performed at room temperature. Results : Data obtained was analyzed using frequency tables. Blood group O was the commonest constituting 56.5% followed by blood group A (26.3%) and B (15%) while blood group AB was the least with distribution of 2.2%. Rhesus D positive and negative blood antigens were 95.7% and 4.3% respectively. The highest distribution of Rhesus D negative was found in blood group O while none was found in AB blood group. Conclusion : The pattern of ABO group and Rhesus D blood antigens among rural Bini ethnic group sampled was similar to some other ethnic groups earlier reported in Nigeria with slight variation in frequency.

Challenges and possible solutions for long-term follow-up of patients surviving critical illness

Surviving critical illness can be life-changing and present new healthcare challenges for patients after discharge from hospital. Optimisation of recovery, rather than mere survival, is an important goal of intensive care. Observational studies have identified decreased quality of life and increased healthcare needs for survivors but loss to follow-up can be high with possible selection bias. Patients in need of support may therefore not be included in study results or allocated appropriate follow up support. To examine the frequency and reasons patients admitted to general ICUs who survive critical illness are excluded from study participation or lost to follow-up and consider the possible implications and solutions. The literature review included searches of the MEDLINE, EMBASE, and CINAHL databases. Studies (2006-2010) were included if they described follow-up of survivors from general ICUs. Ten studies were reviewed. Of the 3269 eligible patients, 14% died after hospital discharge, 27% declined, and 22% were lost to follow-up. Reasons for loss to follow-up included no response, inability to contact the patient, too ill or admitted to another facility. The most appropriate method of care follow-up has yet to be established but is likely to involve an eclectic model that tailors service provision to support individual patient needs. Identifying methods to minimise loss to follow-up may enhance interpretation of patients' recovery, lead to improvements in clinical practice and inform healthcare service decisions and policy.

The weakness of strong policies and the strength of weak policies: Law, experimentalist governance, and supporting coalitions in European Union health care policy

AbstractThe experience of European Union (EU) health care services policy shows the importance of supporting coalitions in any effort to effect policy change and the extent to which the presence or absence of such coalitions can qualify generalizations about policymaking. EU health care services law is substantively liberalizing and procedurally driven by the courts, with little legislative input. But the European Court of Justice (ECJ) has been much better at establishing an EU competency in law than in causing policy development in the EU or member states. Literature on courts helps to explain why: courts are most effective when they enjoy supporting coalitions and the ECJ does not have a significant supporting coalition for its liberalizing health care services policy. Based on interview data, this article argues that the hard law of health care services deregulation and the newer forms of health care governance, such as the Open Method of Coordination and the networks on rare diseases, depend on supporting coalitions in member states that are willing to litigate, lobby, budget, decide cases, and otherwise implement EU law and policy. Given the resistance that the Court has met in health care sectors, its overarching deregulatory approach might produce smaller effects than expected, and forms of experimentalist governance that are easy to deride might turn out to have supporting coalitions that make them unexpectedly effective.

Changing geographies of care: employing the concept of therapeutic landscapes as a framework in examining home space

Changes in health care service delivery have resulted in the transfer of care from formal spaces such as hospitals and institutions towards informal settings such as home. Due to the degree of this transfer, it is increasingly important for geographers to explore the experience and meaning of these changing geographies of care in order to reveal and understand the impact and effect on particular individuals and places. Recognizing that the home environment not only designates a dwelling but also represents a multitude of meanings (such as personal identity, security and privacy) that likely vary according to class, ethnicity and family size (among other socio-demographic variables), it presents a complex site for study. This paper suggests research directions to further understand the role of caregiving in contributing to the experience and meaning of the home environment by informal caregivers, the majority of which are women. Using a political economy approach, this paper first reviews the reorganization of health care services and discusses how this is reshaping the experience of informal caregivers at home. A review of the place identity literature contextualizes the specific discussion of the literature on the meaning of home, both of which are then critically examined. Next, the concept of therapeutic landscapes is discussed as an idealized framework to explore the health-promoting properties of home on informal caregivers. Questions for research are outlined before conclusions highlight how research on home space can allow a better understanding of the impact and effect of caregiving on family caregivers and the places where they live. Such research can inform the changes and trends in health care service policy.