Inappropriate Health Services Research Articles

Healthcare social network research and the ECHO model™: Exploring a community of practice to support cultural brokers and transfer cultural knowledge

BackgroundProject ECHO® networks at Children’s Health Queensland Hospital and Health Service (CHQHHS) are communities of practice designed to mitigate services and systems fragmentation by building collaborative partnerships addressing priority child and youth health needs. Aboriginal and Torres Strait Islander people experience the negative impacts of fragmentation in addition to historical challenges of absent or culturally inappropriate health services. Access to culturally safe and responsive services can be improved by engaging Aboriginal and Torres Strait Islander Health Workers and similar roles in an online community of practice, supporting the integration of cultural and clinical knowledge and self-determination of Aboriginal and Torres Strait Islander consumers in decisions affecting their health.Analysing professional support networks and knowledge sharing patterns helps identify enablers and barriers to partnerships. Using social network research, the multilevel network inclusive of ECHO network members and their colleagues was studied to identify interdisciplinary and cross-sector advice exchange patterns, explore the position of cultural brokers and identify common relational tendencies.MethodsSocial network theories and methods informed the collection of network data and analysis of advice-seeking relationships among ECHO network members and their nominees. Registered members from two ECHO networks were invited to complete the Qualtrics survey. Networks analysed comprised 398 professionals from mainstream health, Aboriginal and Torres Strait Islander Community Controlled Health Organisation, education, disability and child safety service settings.ResultsBrokers were well represented, both those who hold knowledge brokerage positions as well as cultural brokers who incorporate clinical and cultural knowledge enabling holistic care for Aboriginal and Torres Strait Islander patients (38 individuals, 17% of network). Professionals who occupy brokerage positions outside the ECHO network tend to be more connected with co-members within the network.ConclusionsThis study is the first application of contemporary social network theories and methods to investigate an ECHO network. The findings highlight the connectivity afforded by brokers, enabling the coordination and collaboration necessary for effective care integration. Inclusion of cultural brokers in an ECHO network provides sustained peer group support while also cultivating relationships that facilitate the integration of cultural and clinical knowledge.

Legal Consequences Of Doctor's Negligence in Making Visum et Repertum and Corpse Autopsis

The purpose of this study is to examine the actions of forensic doctors that tend to cause medical negligence. This research is a prescriptive research. The results of this study regarding forensic doctors can be qualified as crimes due to negligence, if they provide inappropriate health services to patients. This can be seen through the Standard Operating Procedures or what are called SPOs that doctors use to work. In addition, forensic doctors can be burdened with legal responsibilities, i. e. administrative, civil and criminal from medical law with license revocation, compensation for patient losses due to liability due to default or unlawful acts. And criminal dispute resolution in the local district court with criminal sanctions.

Australian health policies related to diagnostic imaging: too much of a good thing?

Diagnostic imaging is increasingly being used in Australia to aid clinician diagnostic and therapeutic decision-making. There is concern that this increased use represents an overconsumption of inappropriate health services, which wastes finite resources and may cause direct or indirect harm to the patient. Australian health policies have primarily focused on increasing patient access to diagnostic imaging. While these policies address inequitable access and may lead to timely diagnosis and improved health outcomes, these benefits have not been weighed against the unintended harms. This perspective article will explore the unintended consequences of increasing access to diagnostic imaging as well as provide potential solutions to improve the effectiveness of policies in this area.

A "Behind-the-Scenes" Look at Interprofessional Care Coordination: How Person-Centered Care in Safety-Net Health System Complex Care Clinics Produce Better Outcomes.

Introduction:While the effectiveness of team-based care and wrap-around services for high utilizers is clear, how complex care clinics deliver effective, person-centered care to these vulnerable populations is not well understood. This paper describes how interactions among interprofessional team members enabled individualized, rapid responses to the complex needs of vulnerable patients at the Virginia Commonwealth University Health System’s Complex Care Clinic.Methods:Researchers attended twenty weekly care coordination meetings, audio-recorded the proceedings, and wrote brief observational field notes. Researchers also qualitatively interviewed ten clinic team members. Emergent coding based on grounded theory and a consensus process were used to identify and describe key themes.Results:Analysis resulted in three themes that evidence the structures, processes, and interactions which contributed to the ability to provide person-centred care: team-based communication strategies, interprofessional problem-solving, and personalized patient engagement efforts.Conclusion:Our study suggests that in care coordination meetings team members were able to strategize, brainstorm, and reflect on how to better care for patients. Specifically, flexible team leadership opened an inter-disciplinary communicative space to foster conversations, which revealed connections between the physical, and socio-emotional components of patients’ lives and hidden factors undermining progress, while proactive strategies prevented patient’s rapid deterioration and unnecessary use of inappropriate health services.

Big Data-Driven Approach for Health Inequalities in Foreign Patients with Injuries Visiting Emergency Rooms.

ObjectivesForeign patients are more likely to receive inappropriate health service in the emergency room. This study aimed to investigate whether there is health inequality between foreigners and natives who visited emergency rooms with injuries and to examine its causes. MethodsWe analyzed clinical data from the National Emergency Department Information System database associated with patients of all age groups visiting the emergency room from 2013 to 2015. We analyzed data regarding mortality, intensive care unit admission, emergency operation, severity, area, and transfer ratio.ResultsA total of 4,464,603 cases of injured patients were included, of whom 67,683 were foreign. Injury cases per 100,000 population per year were 2,960.5 for native patients and 1,659.8 for foreign patients. Foreigners were more likely to have no insurance (3.1% vs. 32.0%, p < 0.001). Serious outcomes (intensive care unit admission, emergency operation, or death) were more frequent among foreigners. In rural areas, the difference between serious outcomes for foreigners compared to natives was greater (3.7% for natives vs. 5.0% for foreigners, p < 0.001). The adjusted odds ratio for serious outcomes for foreign nationals was 1.412 (95% confidence interval [CI], 1.336–1.492), and that for lack of insurance was 1.354 (95% CI, 1.314–1.394).ConclusionsInjured foreigners might more frequently suffer serious outcomes, and health inequality was greater in rural areas than in urban areas. Foreign nationality itself and lack of insurance could adversely affect medical outcomes.

Food Security in Rural Bangladesh: Examining the Role of Women’s Earnings and Food Budget Control

Household food security is vital to measure of a country’s advancement and well-being. Three mostly usage determinants to measure household food security are per capita daily calorie availability, dietary diversity, and individuals body mass index (BMI) scores. Food security condition in rural Bangladesh is vulnerable due to poverty, unavailability and high prices of food. Almost every year food price is increasing in Bangladesh due to the low level of production, improper market management and fraud business syndicate from some top traders. In Bangladesh, food production is affected by natural calamities such as the flood in monsoon period. Rice is considering as the leading food and dominating 70% of total calorie intake in rural Bangladesh. Rural inhabitants are consuming protein and micronutrient-rich food very infrequent. The main barriers to decrease the malnutrition rate are a lack of access to protein and micronutrient rich foods and inappropriate health services. Women and children are the primary targets of ensuring nutrition security in developing worlds. However, in rural Bangladesh, in practice, both women and children are getting fewer privileges regarding food consumption and health facilitates. The main objective of this paper is to examine the role of women’s earnings and food budget control. Very authentic, recognized and useful datasets are needed to get the precise insights and information about food security condition and the role of women in food security in the rural Bangladesh. Bangladesh Integrated Household Survey 2011-12 datasets are used for this study. Regression method is used to analyze the research objectives. This paper found that women control over food budget has positive roles to ensure food availability in the house and more dietary diversity. However, the BMI scores indicate that rural people are heavily under-weight and under-nutrition.

Iraqi primary care system in Kurdistan region: providers' perspectives on problems and opportunities for improvement.

BackgroundAs part of a comprehensive study on the primary health care system in Iraq, we sought to explore primary care providers’ perspectives about the main problems influencing the provision of primary care services and opportunities to improve the system.MethodsA qualitative study based on four focus groups involving 40 primary care providers from 12 primary health care centres was conducted in Erbil governorate in the Iraqi Kurdistan region between July and October 2010. A topic guide was used to lead discussions and covered questions on positive aspects of and current problems with the primary care system in addition to the priority needs for its improvement. The discussions were fully transcribed and the qualitative data was analyzed by content analysis, followed by a thematic analysis.ResultsProblems facing the primary care system included inappropriate health service delivery (irrational use of health services, irrational treatment, poor referral system, poor infrastructure and poor hygiene), health workforce challenges (high number of specialists, uneven distribution of the health workforce, rapid turnover, lack of training and educational opportunities and discrepancies in the salary system), shortage in resources (shortage and low quality of medical supplies and shortage in financing), poor information technology and poor leadership/governance. The greatest emphasis was placed on poor organization of health services delivery, particularly the irrational use of health services and the related overcrowding and overload on primary care providers and health facilities. Suggestions for improving the system included application of a family medicine approach and ensuring effective planning and monitoring.ConclusionsThis study has provided a comprehensive understanding of the factors that negatively affect the primary care system in Iraq’s Kurdistan region from the perspective of primary care providers. From their experience, primary care providers have a role in informing the community and policy makers about the main problems affecting this system, though improvements to the health care system must be taken up at the national level and involve other key stakeholders.

Judging a patient's decision to seek emergency healthcare: clues for managing increasing patient demand

In recent years, the concept of an 'inappropriate' emergency department or ambulance user has arisen. This discussion paper explores definition and measurement of inappropriate emergency healthcare utilisation, and the effect on demand. A comprehensive literature review of published articles was conducted. Exploration of the definitions of 'inappropriate' emergency healthcare utilisation identified two patient cohorts; emergency healthcare utilisation by those who are not experiencing a health emergency, and those who do not seek emergency healthcare who should. Several position papers from Australian and international sources emphasised the patient's right to access emergency healthcare when they feel the need, and the responsibility of emergency healthcare workers to provide treatment to all patients. Differences between medical classifications of urgency based on physiological measures are contrasted with patient-based determination of urgency, which is defined by psychosocial factors. This literature review raises questions about patients' understanding of the role of emergency healthcare services in an emergency. This has implications for determining the patient's point of access to the health system in an acute health event, and offers an opportunity to selectively educate patients and carers to change help-seeking behaviours to suit the health system resources and moderate patient demand.

Indigenous cultural training for health workers in Australia.

Culturally inappropriate health services contribute to persistent health inequalities. This article reviews approaches to indigenous cultural training for health workers and assesses how effectively they have been translated into training programmes within Australia. CINAHL PLUS, MEDLINE, Wiley InterScience, ATSIHealth and ProQuest. The review focuses on the conceptual and empirical literature on indigenous cultural training for health workers within selected settler-colonial countries, together with published evaluations of such training programmes in Australia. Data extraction Information on conceptual models underpinning training was extracted descriptively. Details of authors, year, area of investigation, participant group, evaluation method and relevant findings were extracted from published evaluations. Six models relevant to cultural training were located and organized into a conceptual schema ('cultural competence, transcultural care, cultural safety, cultural awareness, cultural security and cultural respect'). Indigenous cultural training in Australia is most commonly based on a 'cultural awareness' model. Nine published evaluations of Australian indigenous cultural training programmes for health workers were located. Of the three studies that assessed change at multiple points in time, two found positive changes. However, the only study to include a control group found no effect. This review shows that the evidence for the effectiveness of indigenous cultural training programmes in Australia is poor. Critiques of cultural training from indigenous and non-indigenous scholars suggest that a 'cultural safety' model may offer the most potential to improve the effectiveness of health services for indigenous Australians.

Treating people you never see: internet-based treatment of the internalising mental disorders

In the acute care model (people get sick, see doctor, get remedy, get well) it is always presumed that people 'see' a clinician, even if the clinician is only connected by a video link. Medicare is based on this model. This piece is about treating people you never see, specifically about the web-based treatment of common internalising menta] disorders, e.g. major depression, generalised anxiety disorder, panic disorder and social phobia.The traditional model is to see people, listen to the history of symptoms and then examine the person for the signs associated with illness. Telephone counselling for anxiety and depression by trained professionals ' or by trained lay people2 has been shown to produce benefits commensurate with face-to-face treatment, so one doesn't always have to see the person.The internet is the greatest collection of freely available medical information that has ever been constructed. There is no doubt that it can inforni - but sometimes it misinforms and some clinicians are wary of the patient with an internet print out. Surely sensible information does help people with chronic disorders understand and manage themselves. Patient education on a face-to-face basis has been shown to improve outcome and reduce inappropriate health service utilisation.3'4 We are unaware of internet education having been shown to do this, but it seems likely that it would be effective.The larger question is whether the internet can deliver treatment, i.e. an intervention in the course of an illness that is (a) superior to the value of good information on disease management and (b) equivalent in benefit to good face-to-face treatment. Clearly the supply of prescription medication to someone you have never seen is not practical, as is surgery and physical manipulations, but psychotherapy does seem to be a possibility. Marks et air reviewed a large number of systems to provide computer aided psychotherapy largely, but not always, supervised by a clinician. Moodgym6 was an early example of a web-based intervention that was effective in reducing depression in the population with a standardised mean difference (or effect size) to the control group of 0.35; although it was eventually found not to be superior to good information about effective treatments for depression. Nevertheless, the health gain from open use of this free program is likely to have been considerable.Four internalising disorders (major depression, generalised anxiety disorder, panic disorder and social phobia) together contribute 6% (150000 disability-adjusted life years lost (DALYs) in Australia) to the burden of human disease.7'8 Although these disorders present differently they share similar vulnerability or risk factors and are probably aspects of the same underlying disorder. The nature of these disorders is well established. Twin data show that the genetic risk associated with major depression is substantially shared with generalised anxiety disorder,10 and to a lesser extent with the phobias. Neuroticism, a personality trait sometimes termed negative affectivity, also explains some of the common genetic risk of the internalising disorders.'12 High scores for neuroticism precede the development of these disorders.'3'4 What does this genetic liability produce? Mineka el a/.15 conclude that anxiety and depressive disorders are associated with automatic attentional biases for emotion-relevant material, and with negative judgmental or interpretive biases. Indeed the anxiety and depress i ve di sorders appear to be risk factors for each other.16Cognitive behaviour therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) separately or together can be effective treatments in all the internalising disorders. However, treatment with SSRIs can be disappointing; effect sizes in research studies are only moderate and improvement stops when the medication is stopped. In practice, patient adherence is poor. Treatment with CBT is better; effect sizes are marginally larger than with drugs and the improvement lasts after treatment ends. …

Características dos nascidos vivos, das mães e mortalidade neonatal precoce na Região Metropolitana de São Paulo, Brasil

The objective was to describe maternal and neonatal characteristics and early neonatal mortality rate according to place of delivery in Greater Metropolitan São Paulo, Brazil. The study linked the databases on live births and early neonatal deaths with the national hospital registry. Place of delivery was identified through certificates of live birth. There were a total of 154,676 live births: 98.7% in-hospital; 0.3% home deliveries, and 1% in other health services. Deliveries in birthing centers and small hospital units were associated with low obstetric risk and a low proportion of preterm and low birth weight infants, and as a result these services showed the lowest early neonatal mortality rate. Compared to hospital maternity ward deliveries, the early neonatal mortality rate was 4.7 times higher for home deliveries and 9.6 higher for emergency room deliveries. There is a high rate of hospital delivery care in São Paulo, but there is still a small portion of accidental home births and deliveries occurring in inappropriate health services, probably as a result of obstetric emergencies and difficulties in accessing hospital services.

Physicians' perception of the effects of internet health information on the doctor–patient relationship

The objective of the study was to determine physician's perception of the effects of health information on the internet on doctor–patient relationship. Online questionnaire with 25 items were sent to the Korean physicians' e-mail, and 493 replied. Eight-nine percent of the Korean physicians reported they had experiences of patients discussing the Internet health information. They perceived that Internet health information may enhance the patients' knowledge about their health. However, they perceived that Internet health information may have variety of negative effects such as; heightening the cost of health care by adopting the inappropriate health service utilisation (56.2%); making the patients over-concerned about their health (74.5%); damaging the time efficiency of the visit (60.9%). The physicians deemed that those informations were not relevant to the patients' health condition (42.7%), and even were not correct (39.0%). Physicians' perception of the Internet health information is both positive and negative, and they perceive the overall effects on doctor–patient relationship as neutral. More physicians think the discussion could be the hindrance on the efficient time management during their visits. However, more physicians have positive perception of the effects on the quality of care and patient outcomes which is promising.

Substance use treatment barriers for patients with frequent hospital admissions

Substance use (SU) disorders adversely impact health status and contribute to inappropriate health services use. This qualitative study sought to determine SU-related factors contributing to repeated hospitalizations and to identify opportunities for preventive interventions. Fifty Medicaid-insured inpatients identified by a validated statistical algorithm as being at high-risk for frequent hospitalizations were interviewed at an urban public hospital. Patient drug/alcohol history, experiences with medical, psychiatric and addiction treatment, and social factors contributing to readmission were evaluated. Three themes related to SU and frequent hospitalizations emerged: (a) barriers during hospitalization to planning long-term treatment and follow-up, (b) use of the hospital as a temporary solution to housing/family problems, and (c) unsuccessful SU aftercare following discharge. These data indicate that homelessness, brief lengths of stay complicating discharge planning, patient ambivalence regarding long-term treatment, and inadequate detox-to-rehab transfer resources compromise substance-using patients' likelihood of avoiding repeat hospitalization. Intervention targets included supportive housing, detox-to-rehab transportation, and postdischarge patient support.

The Infant Food Industry and International Child Health

Declining breast-feeding, with accompanying increased marasmus and diarrhea, has occurred in developing countries because of many factors, including inappropriate health services, new urban life styles, and so forth. The infant food industry must bear a considerable burden of blame as a result of "unethical" advertising. Responses have most recently included various journalistic and legal actions. There is a need for revised roles for the infant food industry, and for mechanisms to monitor intrinsically harmful practices.