Improve Health Services Research Articles

The use of locum doctors in the NHS: understanding and improving the quality and safety of care.

The use of locum doctors in the National Health Service is widely believed to have increased, and there have been widespread and sustained concerns among policy-makers, healthcare providers, professional associations and professional regulators about the quality/safety, cost and effective use of locum doctors. To provide evidence on the extent, quality and safety of medical locum practice and the implications of medical locum working for health service organisation and delivery in primary and secondary care in the English National Health Service, to support policy and practice. Four interlinked work packages involving surveys of National Health Service trusts and of general practices in England; semistructured interviews and focus groups across 11 healthcare organisations in England; analysis of existing routine data sets on the medical workforce in primary care and in National Health Service trusts in England from National Health Service Digital and National Health Service Improvement; and analysis of data from the Clinical Practice Research Datalink in primary care and of electronic patient record data from two National Health Service hospitals in secondary care. In primary care, about 6% of general practice medical consultations were undertaken by locums in 2010 and this had risen slightly to about 7.1% in 2021. In National Health Service trusts (mostly secondary care and mental health), about 4.4% of medical staff full-time equivalent was provided by locum doctors. But those overall national rates of locum use hide a great deal of variation. In primary care, we found the National Health Service Digital workforce returns showed the rate of locum use by Clinical Commissioning Group varied from 1% to almost 31%. Among National Health Service trusts, the reported rate of locum use varied from < 1% to almost 16%. We found that there was poor awareness of and adherence to national guidance on locum working arrangements produced by National Health Service England. Our research showed that locum working can have adverse consequences for the quality and safety of care, but that such consequences were probably more likely to result from the organisational setting and the working arrangements than they were from the locum doctors themselves and their competence, clinical practice or behaviours. Our research was hampered in some respects by the COVID pandemic which both resulted in some delays and other challenges. Our efforts to use electronic patient record data in secondary care to explore locum doctor working were stymied by the problems of data access and quality. Locum doctors are a key component of the medical workforce in the National Health Service, and provide necessary flexibility and additional capacity for healthcare organisations and services. We found that the extent of reliance on locum doctors varied considerably, but that an over-reliance on locums for service provision was undesirable. Some differences in practice and performance between locum and permanent doctors were found, but these seemed often to arise from organisational characteristics. We found that patients were more concerned with the clinical expertise and skills of the doctor they saw than whether they were a locum or not. Organisational arrangements for locum working could be improved in many respects. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128349) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 37. See the NIHR Funding and Awards website for further award information.

Analysis of Educational Technology Approaches in Supporting Health Services at College Clinics

Educational technology is a growing area of interest, including healthcare management in higher education. This study aims to evaluate the role of educational technology in improving health service management in college clinics, with a focus on the Universitas Negeri Manado Clinic. The research method used was a qualitative approach with data collection techniques including in-depth interviews, direct observation, and documentation. Data were analyzed using the triangulation method to identify key themes and in-depth interpretation of the influence of educational technology on health services. The results showed that the implementation of educational technology in college clinics can improve the efficiency and effectiveness of health services. Information technologies such as electronic medical record management systems and e-learning platforms have helped to improve the process of planning, implementing and evaluating health services. However, there are challenges in terms of system integration and additional training needs for staff. This study found that while educational technology provides significant benefits, its successful implementation is highly dependent on infrastructure readiness and user skills. Suggestions for improvement include increasing technology training for staff, updating hardware and software, and strengthening evaluation procedures to ensure that technology can be optimally used to improve the quality of health services.

Adherence to treatment in pulmonary tuberculosis: Rodgers' evolutionary concept analysis.

Adherence to treatment is essential for the management of pulmonary tuberculosis. Nurses and healthcare professionals play a significant role in promoting adherence behavior among this population. Nevertheless, defining adherence to treatment within this particular population remains complex. This study aimed to explore and clarify the concept of adherence to treatment among individuals with pulmonary tuberculosis. Rodgers' evolutionary concept analysis was employed in this study. A literature search was conducted in the PubMed and Scopus databases to identify relevant studies published between July 2013 and July 2023. The attributes of adherence to treatment in pulmonary tuberculosis consist of multiple components: biological, individual, social, health service, and policy-making processes. Antecedents include various patient-related factors as well as factors associated with clinical conditions and patient-health professional engagement. Three consequences of the concept have emerged: enhanced treatment efficacy, increased commitment to tuberculosis treatment adherence, and improved health service quality. This study provides a comprehensive operational definition of adherence to tuberculosis treatment, including its attributes, antecedents, and consequences. This framework will assist nurses in evaluating adherence more effectively. However, further research into the experiences of individuals adhering to tuberculosis treatment is needed to confirm and enhance these strategies.

Building a digital supportive supervision system for improving health service delivery in Low- and Middle-Income countries through the collaborative requirements development methodology (CRDM): Experience from Tanzania

Background Supportive supervision is pivotal for both health service providers and managers to improve the quality of services and health outcomes. Tanzania's digital supportive supervision system is called Afya Supportive Supervision System (AfyaSS ®). The latter was designed and developed using a human-centered approach called Collaborative Requirements Development Methodology (CRDM). This paper describes the experiences of building the digital supportive supervision system through CRDM in Tanzania, a transition from the paper-based supportive supervision system. Methods In 2018, with the support of PATH, the government of Tanzania adopted a participatory human-centered design by carrying out desk reviews of existing guidelines and tools, field visits, stakeholder workshops, and user advisory groups to gather information for developing a digital supportive supervision system. The gathered information was analyzed with the lens of identifying the common challenges and system requirements. Results AfyaSS was successfully developed using CRDM and deployed in all regions across the country. It has consolidated multiple checklists for distinct health domains, and dashboard functionalities to track progress toward health system indicators, objectives, and action plans. As part of the deployment, several resources were developed to aid in the deployment process, such as a comprehensive user manual, facilitator's guide, training slides, and video tutorials. Health workers and managers can be empowered and motivated to implement comprehensive and coherent supportive supervision by using the lessons learned from this digitalization process to transform the current supervision processes to improve the quality of care by offering instruments that promote evidence-based actions. Conclusion A human-centered approach has been shown to be useful in developing digital tools for use in Tanzania’s health system. Tanzania's lessons can be applied in other low- and middle- income countries (LMICs) with similar contexts when considering implementing digital health interventions. While using the human-centered approach, it is crucial to establish a system development roadmap, conduct appropriate training, provide sustained information and communication technology, and management support for unforeseen issues, and ensure ongoing maintenance.

Prevalence of infection and reinfection among health care workers in a hospital of Northern China between BA.5/BF.7 and XBB.1.5 wave

BackgroundTo analyze the epidemiological characteristics of the SARS-CoV-2 infection and reinfection associated with the emergence of Omicron variant in Healthcare workers (HCWs). MethodsWe enrolled 760 HCWs who received 2-4 vaccination doses of COVID-19 and followed by BA.5/BF.7 and/or XBB.1.5 breakthrough infections between December 2022 and July 2023. Serum sample from each individual were collected approximately 1,3 and 6 months after last exposure. IgM, IgG and Total antibodies against SARS-CoV-2 were measured by chemiluminescent immunoassay. Meanwhile, we created an Enterprise WeChat link for HCWs to self-report SARS-CoV-2 infections, symptoms and post COVID-19 conditions. ResultsOur study revealed that the reinfection rate among HCWs reached 26.1%. The main symptoms were fever (91.2% vs 60.1%), cough (78.8% vs 58.0%), and sore throat (75.4% vs 59.6%) during infection and reinfection in Omicron BA.5/BF.7 and XBB.1.5 wave, and the interval for reinfection ranged from 91 to 210 days (median 152). Fatigue (23.6%), memory loss (18.8%) and coughing (18.6%) were the most prevalent long COVID symptoms, with a higher prevalence among female HCWs. ConclusionsHCWs reinfection with SARS-CoV-2 causes milder symptoms, but high reinfection rate and short intervals. Strengthen infection prevention and control is crucial to mitigating infection risk and improving health services.

Protocol for a discrete choice experiment: understanding preferences for seeking health services for survivors of sexual violence in Uganda

IntroductionSexual violence is a significant public health concern with severe physical, social and psychological consequences, which can be mitigated by health service utilisation. However, in Uganda and much of sub-Saharan...

Classification of Big Data Stunting Using Support Vector Regression Method at Stella Maris Medan Maternity Hospital

This study aims to classify big data related to stunting using the Support Vector Regression (SVR) method at Stella Maris Maternity Hospital, Medan. Stunting, a condition of impaired growth in children due to chronic malnutrition and repeated infections, affects physical and cognitive development. With increasing health data, big data processing methods are essential for accurate information. SVR was chosen for handling high-dimensional and non-linear data, providing precise results. The study uses medical information, nutritional history, and socio-economic factors collected from hospital patients. The research process includes data collection, pre-processing to address missing values and outliers, normalization, and SVR application. Final results use SVR with Voting Classifier combining Support Vector Classifier (SVC), Random Forest (RF), and Gradient Boosting (GB), achieving an accuracy of 91.67%. This approach effectively identifies main stunting factors, aiding clinical decision-making and intervention programs. The study showcases big data and machine learning's potential in healthcare, serving as a model for improving health services and monitoring children's health conditions.

Bridging the divide: addressing discrepancies between clinical guidelines, policy guidelines, and biomarker utilization.

This paper aims to identify and address gaps in cancer treatment and diagnosis within European health services, focusing specifically on discrepancies between clinical guidelines and policy guidelines. It seeks to highlight how the underutilization of advanced diagnostic techniques recommended by medical societies contributes to missed opportunities for improving patient outcomes. A comprehensive analysis was conducted across multiple European countries to assess the compliance and integration of clinical guidelines with the availability of advanced diagnostic technologies. Secondary data related to clinical and policy guidelines in cancer care were collected and analyzed. Key indicators of adoption and utilization of next-generation sequencing and liquid biopsy were examined to evaluate their impact on health service efficiency and patient care. The analysis revealed significant discrepancies between the recommendations of medical societies regarding advanced diagnostic techniques and their adoption in health policy decisions across Europe. Country-specific assessments indicated varying levels of alignment between clinical guidelines and the availability of advanced diagnostics. These findings underscored missed opportunities for optimizing patient care and health service efficiency through better alignment and integration of clinical guidelines with policy decisions. This study concludes that there is a critical need for health policy decision-makers to prioritize the adoption of clinical guidelines in resource allocation and health service organization. Greater attention to the recommendations of medical societies regarding advanced diagnostic techniques could significantly enhance diagnostic accuracy, treatment efficacy, and overall patient outcomes in cancer care. The paper advocates for policy reforms that acknowledge and leverage the potential benefits of advanced diagnostics in improving health service performance and patient-centered care across Europe.

Health Service Improvement for People with Parkinson’s Disease: A Scoping Review

Health Service Improvement for People with Parkinson’s Disease: A Scoping Review

ANALYSIS OF HEALTHCARE QUALITY IN THE ERA OF DIGITALIZATION: CHALLENGES AND OPPORTUNITIES

Digitalization offers numerous opportunities to improve the quality of health services. This study aims to analyze the impact of digitalization on the health services, identify the challenges faced in the implementation of digital technology, and explore the opportunities offered by digitalization in improving the health service quality. A qualitative approach is used to understand the perspectives and experiences of patients and medical personnel towards digitalization. Quantitative analysis is carried out using descriptive and inferential statistics to identify trends and patterns in the data. Thematic analysis techniques are used to identify the main themes and categories that emerged from the interview and observation data. Digitalization has a significant impact on the quality services, both positive and negative. To maximize the benefits of the digitalization, efforts are needed to address existing challenges, including increasing access to digital technology and strengthening data security and privacy, and providing training and support for medical personnel. Further research is needed to explore how digital technology can be used to improve health services and provide recommendations to overcome existing challenges.

Codesigning culturally safe oral health care with First Nations Kidney Warriors experiencing kidney disease in South Australia

BackgroundThis paper describes how First Nations Kidney Warriors (Aboriginal and Torres Strait Islander people living with kidney disease), dental hygienists, kidney health care professionals, an Aboriginal hostel accommodation manager and researchers co-designed an approach to improve oral health in South Australia. Kidney Warriors have strong connection to Country, Community and family that underpins health, wellbeing and approaches to research. However, significant colonisation, racism and marginalisation have impacted Kidney Warriors’ social, cultural and financial determinants of health, leading to increased chronic conditions including kidney disease. Access to culturally safe, affordable and responsive oral health care is vital but challenging for First Nations Peoples undergoing dialysis and kidney transplantation; Australian oral health care is generally provided privately, in metropolitan centres, by professionals who may hold unconscious bias about First Nations Peoples and incorrect assumptions regarding equal access to care.MethodsThe AKction – Aboriginal Kidney Care Together Improving Outcomes Now kidney care oral health working group codesigned strategies to address disparities and gaps in care, and co-create more accessible, responsive, culturally safe and sustainable models of care. A decolonising and collaborative participatory action research was informed by Dadirri Deep Listening and Ganma Knowledge Sharing with repeated cycles of Look and Listen, Think and Discuss, Take Action Together. A small pilot evaluation survey of clinical placement in an Aboriginal setting was undertaken.ResultsFour phases of collaboration were undertaken. Community and health professional consultations identified key gaps and priorities. Clinical yarning and cultural safety training and an interprofessional skills day was co-facilitated. Dental hygienist student clinical placement at Kanggawodli Aboriginal Hostel was initiated and evaluated. First Nations Kidney Warriors were positioned as educators and experts of their own lives and health care needs. A new framework for kidney health—oral health cultural safety and clinical education was developed.ConclusionThis codesigned approach involving inter-professional collaboration and joint decision making with community members has significantly informed improvements in oral health care information, services and referral with and for First Nations Peoples with kidney disease. This project provides a working example of how to decolonise health service and education programs from the ground up.Trial registrationNHMRC PAR 2004389.

Application of Tat Twam Asi educational values to improve health services for deaf people.

Application of Tat Twam Asi educational values to improve health services for deaf people.

Use of an electronic wellness instrument in the integrated health and social care of older adults: a group concept mapping study

BackgroundHealth system fragmentation directly contributes to poor health and social outcomes for older adults with multiple chronic conditions and their care partners. Older adults often require support from primary care, multiple specialists, home care, community support services, and other health-care sectors and communication between these providers is unstructured and not standardized. Integrated and interprofessional team-based models of care are a recommended strategy to improve health service delivery to older adults with complex needs. Standardized assessment instruments deployed on digital platforms are considered a necessary component of integrated care. The aim of this study was to develop strategies to leverage an electronic wellness instrument, interRAI Check Up Self Report, to support integrated health and social care for older adults and their care partners in a community in Southern Ontario, Canada.MethodsGroup concept mapping, a participatory mixed-methods approach, was conducted. Participants included older adults, care partners, and representatives from: home care, community support services, specialized geriatric services, primary care, and health informatics. In a series of virtual meetings, participants generated ideas to implement the interRAI Check Up and rated the relative importance of these ideas. Hierarchical cluster analysis was used to map the ideas into clusters of similar statements. Participants reviewed the map to co-create an action plan.ResultsForty-one participants contributed to a cluster map of ten action areas (e.g., engagement of older adults and care partners, instrument’s ease of use, accessibility of the assessment process, person-centred process, training and education for providers, provider coordination, health information integration, health system decision support and quality improvement, and privacy and confidentiality). The health system decision support cluster was rated as the lowest relative importance and the health information integration was cluster rated as the highest relative importance.ConclusionsMany person-, provider-, and system-level factors need to be considered when implementing and using an electronic wellness instrument across health- and social-care providers. These factors are highly relevant to the integration of other standardized instruments into interprofessional team care to ensure a compassionate care approach as technology is introduced.

Interventions to improve system-level coproduction in the Cystic Fibrosis Learning Network

BackgroundCoproduction is defined as patients and clinicians collaborating equally and reciprocally in healthcare and is a crucial concept for quality improvement (QI) of health services. Learning Health Networks (LHNs) provide...

Utilising an Allied Health Practitioner Capability Audit and Confidence Survey to Identify Implications for Telehealth Safety and Risk-A Chronicle of a Health Service Improvement Activity.

Whilst the benefits of telehealth were identified during the COVID-19 pandemic, we noted barriers to its use at a vital time. Through a health service improvement approach, we sought to increase allied health professional capability in telehealth, but we also sought to understand if there were risks associated with its use. We designed and implemented tools to evaluate allied health professional competence and confidence in using telehealth with private and public patients in a metropolitan teaching hospital setting. With an emphasis on technology capability, we undertook audits over three consecutive years (2020 to 2022) of allied health professional telehealth occasions of service reporting on compliance with the audit criteria and investigating staff confidence in undertaking telehealth sessions using a co-designed survey. The audit tool and confidence survey results were used to identify risk factors to telehealth service delivery using a Modified Health Failure Modes, Effects Analysis. Although confidence levels were relatively high among staff, confidence in managing safety factors and technology risks associated with telehealth were not initially verified by the audit findings. Remedial efforts resulted in service improvements in many identified risk factors, yet technology performance and its troubleshooting remained a primary variable in the ability of staff to comply with the requirements of the real-time audits. Health workers using telehealth should have training to engage safely and effectively in telehealth care and the technology.

Age Differences in Electronic Mental Health Literacy: Qualitative Study.

Electronic mental health literacy (eMHL) is critical for accessing and effectively using digital mental health resources. However, there is a paucity of research on how eMHL varies across age groups. This study aimed to investigate differences in eMHL among young, middle-aged, and older adults; provide insights into the needs, behaviors, and attitudes of different age groups in relation to digital mental health resources; and ultimately, inform the improvement of mental health services. A qualitative investigation was conducted to examine the differences in eMHL across different age demographics in the Chinese population in 2023. The study sample comprised 3 distinct age groups: 18-34 years, 35-64 years, and 65 years and older. Participants were recruited through purposive sampling to ensure a diverse representation of the population. Data were collected through semistructured one-on-one interviews, which allowed for in-depth exploration of individual experiences and perceptions. The gathered data were subsequently subjected to rigorous thematic analysis to enable the identification and interpretation of recurring patterns and themes. The principal outcomes derived from these interviews were synthesized into 5 distinct dimensions: emotional needs, use of digital mental health resources, assessment of digital mental health information, engagement with social media to regulate emotions, and coping strategies. These dimensions were uniformly observed across the 3 age groups. We identified differences in knowledge, skills, and attitudes regarding the use of web-based information for managing mental health problems between the 3 age groups. The findings highlight the importance of age-specific strategies for improving eMHL.

Determinan Kejadian Penyakit Infeksi Saluran Pernapasan Akut pada Balita di Wilayah Kerja Puskesmas 7 Ulu Palembang

Currently, ISPA disease in Palembang City is still one of the highest causes of death among children under five. Risk factors associated with the incidence of ARI are extrinsic and intrinsic factors. The aim of this research was to determine the relationship between exclusive breastfeeding, maternal knowledge, smoking habits, nutritional status and the incidence of ISPA in toddlers in the working area of the 7 Ulu Palembang Community Health Center. This research is analytical with a cross sectional design. The population in this study were mothers with toddlers aged 24 - 59 months with a sample size of 66 people. The sampling technique in this research is purposive sampling. The results of the research show that there is a relationship between exclusive breastfeeding, maternal knowledge, smoking habits, nutritional status and the incidence of ARI in toddlers in the working area of the 7 Ulu Palembang Community Health Center. It is hoped that the end of this research will be an illustration for the community health center to be able to further improve health services and be more active in providing counseling and education regarding ISPA in toddlers.

The implementation and impacts of the Comprehensive Care Standard in Australian acute care hospitals: a survey study

BackgroundComprehensive care (CC) is becoming a widely acknowledged standard for modern healthcare as it has the potential to improve health service delivery impacting both patient-centred care and clinical outcomes. In 2019, the Australian Commission on Safety and Quality in Health Care mandated the implementation of the Comprehensive Care Standard (CCS). However, little is known about the implementation and impacts of the CCS in acute care hospitals. Our study aimed to explore care professionals’ self-reported knowledge, experiences, and perceptions about the implementation and impacts of the CCS in Australian acute care hospitals.MethodsAn online survey using a cross-sectional design that included Australian doctors, nurses, and allied health professionals in acute care hospitals was distributed through our research team and organisation, healthcare organisations, and clinical networks using various methods, including websites, newsletters, emails, and social media platforms. The survey items covered self-reported knowledge of the CCS and confidence in performing CC, experiences in consumer involvement and CC plans, and perceptions of organisational support and impacts of CCS on patient care and health outcomes. Quantitative data were analysed using Rstudio, and qualitative data were analysed thematically using Nvivo.Results864 responses were received and 649 were deemed valid responses. On average, care professionals self-reported a moderate level of knowledge of the CCS (median = 3/5) and a high level of confidence in performing CC (median = 4/5), but they self-reported receiving only a moderate level of organisational support (median = 3/5). Only 4% (n = 17) of respondents believed that all patients in their unit had CCS-compliant care plans, which was attributed to lack of knowledge, motivation, teamwork, and resources, documentation issues, system and process limitations, and environment-specific challenges. Most participants believed the CCS introduction improved many aspects of patient care and health outcomes, but also raised healthcare costs.ConclusionCare professionals are confident in performing CC but need more organisational support. Further education and training, resources, multidisciplinary collaboration, and systems and processes that support CC are needed to improve the implementation of the CCS. Perceived increased costs may hinder the sustainability of the CCS. Future research is needed to examine the cost-effectiveness of the implementation of the CCS.

Evaluation of the effectiveness of online research groups in increasing research capacity among young African Family Physicians

ABSTRACT Introduction Low research output is hindering efforts to improve health services in Sub-Saharan Africa (SSA). AfriWon Research Group of WONCA Africa has established an online collaborative research mentorship and training programme to boost research capacity among Family Physicians in SSA. This study aims to assess the effectiveness of the programme in achieving this goal. Methodology A mixed-method descriptive cross-sectional study was used to interview the 54 members of the 2022 SOGER cohort. Structured questionnaires and key informant interviews of 12 members were used to collect data. Quantitative analysis was done using Epi Info version 7.2.5. Descriptive statistics were used to present data using frequencies and percentages. Qualitative analysis was then done by using Nvivo®. Results The 54 participants practised in 10 SSA countries and were mostly males 28 (51.9%) with a mean age of 41.56 ± 2.04 years. The majority of them 33 (61.1%) have had some form of research experience prior to joining SOGER. Members identified key benefits of the programme as fostering collaboration, mentorship and continuing education 46 (85.2%); and improvement of research skills 33 (61.1%). Barriers identified were poor collaboration and participation among members 37 (68.5%); irregular meeting schedules as a result of the different time zones 18 (33.3%); and poor internet facilities 19 (35.2%). Conclusion The SOGER programme was rated as very effective in increasing the research capacity of young FPs and helping participants engage with other researchers and develop research skills. Identified areas of improvement were difficulty meeting set group targets, irregular meetings and conflicting work schedules.

Leveraging on the fourth industrial revolution by African accountants in the sustenance of SDGs and AU Agenda 2063

AbstractThe research sought to assess the use of 4IR technologies by the accountancy profession in Africa in the sustenance of SDGs and AU Agenda 2063. The investigation adopted a pragmatic approach, associated with mixed‐methodological approach. The target population for the study was 114,800 Professional Accountancy Organisations (PAOs) members from all 44 countries in Africa who were members of the Pan African Federation of Accountants (PAFA). Online questionnaires and telephone interviews were administered to gather data. A total of 267 responses were received out of 114,800 members representing 0.23% of the population. Forty‐eight accountants were interviewed by telephone using the snowball sampling technique. Quantitative data gathered from online questionnaires was analysed using the IBM Statistical Package for Social Sciences (SPSS) version 26 and ATLAS.ti 9 was used to analyse responses from interviews. The study showed that accountants in Africa had heard about 4IR technologies, with the Internet of Things (IoT) mostly used and known by accountants. The study established that 4IR technologies improved the standard of living, reduced social marginalisation, eased manual work, improved agricultural productivity, reduced environmental pollution, improved health services, financial inclusion and knowledge sharing. These benefits are critical for achieving SDGs and the African Agenda 2063. Accountants are recommended to continuously train and retrain on new and trending technologies like computerised audits, big data analytics, machine learning, artificial intelligence, robotics, bitcoin and its risks in the monetary systems, cyber security in the 4IR era, cloud computing and information management systems to sustain SDGs and AU Agenda 2063.