Integration Of Health Care Services Research Articles

Perinatal care: Integrative healthcare services

Background: Healthcare (HC) deliberations are under huge pressure during the perinatal period. Like other healthcare sub-sectors, maternal HC delivery has encountered substantial moderations over the years, similar to the commutive streak that swept across the healthcare field over twenty-five years. Aim: Our literature aims to examine scientific research on commutive professional care (PC) to inform procedural decisions. Results: By evaluating the effectiveness of various clinical practices and intervention programs, researchers interested in integrated perinatal care have focused primarily on continuity of care and clinical and professional integration.

Inisiasi Pendirian Posyandu Lansia Jomboran, Sleman Melalui Pelatihan dan Pendampingan Kader Kesehatan

The Elderly Posyandu (integrated healthcare services post) has not yet been established in Jomboran, Donokerto, Turi, Sleman, Yogyakarta. The health cadres have never received training on organizing elderly Posyandu. Furthermore, some elderly people are unable to visit the Posyandu due to illness. This community service project aimed to establish an elderly Posyandu and train health cadres for the Posyandu to operate continuously. This community service used an action research cycle to identify priority problems and their solutions by involving and empowering partners. Our partners were hamlet and health cadres, with 21 cadres trainees and 54 elderly as the targets. This community service resulted in a considerable increase in health cadres' knowledge following the training (p=0.000). Furthermore, other indicators of community service effectiveness include increasing cadres' skills to conduct health checks and elderly Posyandu management, the enthusiasm of participants (elderly) in Posyandu activities, and establishment of an elderly posyandu were achieved. In conclusion, community service activities effectively increase the capacity of cadres and help form the Elderly Posyandu. The Elderly Posyandu that has been formed needs to be continued by increasing cross-sectoral support and cadres' capacity on an ongoing basis.

Challenges to Systems of Long-Term Care: Mapping of the Central Concepts from an Umbrella Review.

The ageing of the population poses urgent challenges to the health and social protection sectors, including the need for greater adequacy and integration of health care services provided to older people. It is considered necessary and urgent to understand the state-of-the-art of community-based models of care for older people in institutional care and at home. This study aims to map the concepts that politicians and providers need to address through an umbrella review as a review method. Articles describing the structuring aspects of care models appropriate to the needs in long-term care and systematic reviews or meta-analyses targeting people aged 65 years or more were considered. A total of 350 studies met the inclusion criteria and were included in the review. The results identified the need to contribute to effective and more efficient integration and articulation of all the stakeholders, based essentially on professional care at the patient's homes, focused on their needs using the available technologies, empowering patients and families. Eight categories emerged that addressed factors and variables involved in care models for the long-term care needs of institutionalised and home-based older people as a guarantee of accessibility to healthcare and to enhance the well-being and quality of life of patients and family caregivers.

Ontological Model for Cohesive Smart Health Services Management

Health care has become an essential social-economic concern for all stakeholders (e.g., patients, doctors, hospitals etc.), health needs, private care and the elderly class of society. The massive increase in the usage of health care Internet of things (IoT) applications has great technological evolvement in human life. There are various smart health care services like remote patient monitoring, diagnostic, disease-specific remote treatments and telemedicine. These applications are available in a split fashion and provide solutions for variant diseases, medical resources and remote service management. The main objective of this research is to provide a management platform where all these services work as a single unit to facilitate the users. The ontological model of integrated healthcare services is proposed by getting requirements from various existing healthcare services. There were 26 smart health care services and 26 smart health care services to classify the knowledge-based ontological model. The proposed ontological model is derived from different classes, relationships, and constraints to integrate health care services. This model is developed using Protégé based on each interrelated/correlated health care service having different values. Semantic querying SPARQL protocol and RDF query language (SPARQL) were used for knowledge acquisition. The Pellet Reasoner is used to check the validity and relations coherency of the proposed ontology model. Comparative to other smart health care services integration systems, the proposed ontological model provides more cohesiveness.

Acceptability and feasibility of tuberculosis and diabetes mellitus bidirectional screening and joint treatment services in Malawi: a cross-sectional study and a policy document review

ObjectivesA cross-sectional and a policy document review study was performed to investigate perceived acceptability and feasibility to implementing different integration measures for tuberculosis (TB) and diabetes mellitus (DM) healthcare among...

Willingness to pay for integrative healthcare services to treat sleep disturbances: Evidence from a nationwide survey

IntroductionWillingness to pay (WTP) is an expression of product value in the choices available to medical consumers. This study examined Korean medical consumers’ WTP for sleep disturbance treatment through integrative healthcare services. MethodsA random sample of subjects was acquired from 17 Korean regions by proportion of the population by region, sex, and age. This sample set was divided into three equally sized groups of 1,300 for each of the first three price bids proposed in the WTP questionnaire. An online survey was then conducted November 10–26, 2021, and anonymized data were obtained. The contingent valuation method was employed to estimate WTP for integrative healthcare services using the double-bounded dichotomous choice and open-ended question formats. ResultsA total of 3,900 valid completed questionnaires were analyzed, and the following results were obtained: (1) 69.26% of the respondents were willing to pay the amount proposed in the first or second bid; (2) the mean WTP for integrative healthcare services for sleep disturbances was KRW 15,535.46 (USD 12.95) per consultation; and (3) the factors positively influencing WTP for integrative healthcare services were private health insurance coverage, household income, and health-related quality of life, while the sole negatively influencing factor was age. ConclusionsThe preferences and estimated WTP for sleep disturbance therapy via integrative healthcare services could support the legitimacy of this approach for people with this condition and the implementation of these healthcare policy decisions.

Conducting Co-Design with Older People in a Digital Setting: Methodological Reflections and Recommendations.

Co-design has been identified as a participatory method to create person-centred integrated healthcare services that align with older people's values and lived experiences. Existing guidelines on conducting co-design primarily focus on in-person methods with limited guidance on using digital methods to collect data. This gap in knowledge is particularly pertinent when co-designing with older people who can experience challenges with digital literacy and accessibility. This article uses the exemplar of a pilot site within a European co-design research project, aiming to create digital health technology to support integrated care, to describe the steps and considerations required when collaborating with older people in an online environment. Focus groups and one-to-one interviews were conducted utilising digital mediums of teleconferencing and telephone calls to engage and collaborate with older people. Several preparatory steps are required to effectively bridge the digital divide and conduct co-design with older people including engaging gatekeepers, relationship and trust-building, assessing digital literacy levels, education and providing technological support. This article highlights the steps and considerations that researchers should be aware of when embarking on co-designing with older people in a digital setting. The authors describe their methods that promotes inclusivity and the empowerment of older people as equal collaborators in the research process. The co-design approach and recommendations can be applied to various research settings and wider areas of integrated care with this population.

Attitudes toward harm reduction and low-threshold healthcare during the COVID-19 pandemic: qualitative interviews with people who use drugs in rural southern Illinois

BackgroundChronic health conditions associated with long-term drug use may pose additional risks to people who use drugs (PWUD) when coupled with COVID-19 infection. Despite this, PWUD, especially those living in rural areas, may be less likely to seek out health services. Previous research has highlighted the increased disease burden of COVID-19 among PWUD. Our manuscript supplements this literature by exploring unique attitudes of PWUD living in rural areas toward the pandemic, COVID-19 vaccination, and the role of harm reduction (HR) organizations in raising health awareness among PWUD.MethodsSemi-structured interviews were conducted with 20 PWUD living in rural southern Illinois. Audio recordings were professionally transcribed. A preliminary codebook was created based on interview domains. Two trained coders conducted iterative coding of the transcripts, and new codes were added through line-by-line coding and thematic grouping.ResultsTwenty participants (45% female, mean age of 38) completed interviews between June and November 2021. Participants reported negative impacts of the pandemic on mental health, financial wellbeing, and drug quality. However, the health impacts of COVID-19 were often described as less concerning than its impacts on these other aspects of life. Many expressed doubt in the severity of COVID-19 infection. Among the 16 unvaccinated participants who reported receiving most of their information from the internet or word of mouth, uncertainty about vaccine contents and distrust of healthcare and government institutions engendered wariness of the vaccination. Distrust of healthcare providers was related to past stigmatization and judgement, but did not extend to the local HR organization, which was unanimously endorsed as a positive institution. Among participants who did not access services directly from the HR organization, secondary distribution of HR supplies by other PWUD was a universally cited form of health maintenance. Participants expressed interest in low-threshold healthcare, including COVID-19 vaccination, should it be offered in the local HR organization’s office and mobile units.ConclusionCOVID-19 and related public health measures have affected this community in numerous ways. Integrating healthcare services into harm reduction infrastructures and mobilizing secondary distributors of supplies may promote greater engagement with vaccination programs and other healthcare services.Trial numberNCT04427202.

Potential cost and benefits of integrating health care services for managing multiple chronic conditions in sub-Saharan Africa: A critical short review and commentary

Sub-Saharan Africa is currently having a dual burden of HIV and Non-communicable diseases. HIV is regarded as a chronic condition regardless of HIV being infectious, due to the absence of a cure. However, these patients have achieved a substantial increase in survival after receiving Antiretroviral Therapy (ART). An increase in survival puts HIV patients at risk of developing Non-Communicable Diseases (NCD). Integration of health services for chronic diseases has been one of the suggested measures to be considered and recently, a scientist has invested to conduct research in this area to see if it can help to improve the quality of health care services particularly in resource-limited countries. Most of the published work has found that; the integration of health services for chronic diseases into a single clinic is potentially cost-effective and has benefits. This approach could be used to minimize cost and help improve the quality of life and increase life expectancy among HIV-infected individuals. However, these findings need further evidence because some of the published data were obtained from weak study designs, and those regarded as strong were designed as pilots.

Models of Care for People Re-Entering the Community After Incarceration


 Twenty relevant references were identified regarding the models of care have been used to support integrated health care service delivery for incarcerated adults transitioning back into the community setting.
 The majority of the studies identified were conducted in the US with additional studies conducted in Canada, Ireland, the UK, and New Zealand.

Evolutionary game model of health care and social care collaborative services for the elderly population in China

IntroductionThe synergy of health care and elderly social care organizations has become the focus of the research on integrated health care and social care. This study aims to propose a collaborative strategy among health care and elderly social care service providers.MethodsAn evolutionary game model is applied for performance analysis and optimization of the cooperation between health care and elderly social care organizations. The behavioural strategies and the impact of key parameters on promoting the cooperation of the players are presented in detail.ResultsSimulation experiments and sensitivity analysis results indicate that (1) the behavioural evolution of health care organizations and elderly social care organizations forms three types of integrated health care and social care services, namely, the bilateral cooperation type, health care organization-led type and elderly social care organization-led type. (2) Increasing the additional benefits for cooperation and reducing the additional costs for cooperation can promote the willingness to synergize to provide integrated health care and elderly social care services. At the early stage of evolution, increasing the costs that elderly social care organizations pay to purchase health care services or pay for negotiation in the bilateral cooperation type can provide incentives for health care organizations to cooperate while reducing the cooperation preferences of elderly social care organizations. However, the long-term impact of the costs on the behavioural strategies for cooperation of the two players cannot be determined.ConclusionThe behavioural decisions on cooperation between health care and elderly social care organizations influence each other; commitment to integration and effective collaboration can be achieved by increasing the additional benefits and reducing the marginal costs. The findings suggest that the political-economic context and government policies have a greater influence on promoting cooperation, thus yielding positive or negative results for integrated care practice.

종양전문간호사의 노인 암환자 케어 코디네이션 경험에 관한 내용분석

Objectives This study aimed to analyze the experiences of oncology advanced practice nurses who provided care coordination services to elderly cancer patients. Methods This study was a descriptive study using content analysis method. Six oncology advanced practice nurses recruited from a University hospital were interviewed in-depth about their experiences of providing care coordination for elderly cancer patients. Data collection was conducted from September 18, 2017 to February 2, 2018. The data were analyzed using Krippendorf’s qualitative content analysis method. Results As a result, 30 themes, 14 themes clusters, and 5 categories were identified from the in-depth interviews. The 5 categories were ‘considering the characteristics of elderly cancer patients’, ‘advanced practice nurse as a partner for overall cancer treatment process’, ‘pride in the role of the advanced practice nurse’, ‘tasks for improvement of advanced practice nurse service’, ‘strategies for the improvement of nursing care for elderly cancer patients’. Conclusions Based on the results of this study, it is concluded that the benefits of care coordination service by advanced practice nurses should be recognized to provide more integrated healthcare services for elderly cancer patients. Consistent support and multidisciplinary collaboration should also be emphasized to increase the competency of advanced practice nurses in the field of oncology nursing.

The acceptability of integrated healthcare services for HIV and non-communicable diseases: experiences from patients and healthcare workers in Tanzania

BackgroundIn sub-Saharan Africa, the prevalence of non-communicable diseases (NCDs) has risen sharply amidst a high burden of communicable diseases. An integrated approach to HIV and NCD care offers the potential of strengthening disease control programmes. We used qualitative methods to explore patients’ and care-providers’ experiences and perspectives on the acceptability of integrated care for HIV-infection, diabetes mellitus (DM), and hypertension (HT) in Tanzania.MethodsA qualitative study was conducted in selected health facilities in Dar es Salaam and Coastal regions, which had started to provide integrated care and management for HIV, DM, and HT using a single research clinic for patients with one or more of these conditions. In-depth interviews were held with patients and healthcare providers at three time points: At enrolment (prior to the patient receiving integrated care, at the mid-line and at the study end). A minimum of 16 patients and 12 healthcare providers were sampled for each time point. Observation was also carried out in the respective clinics during pre- and mid-line phases. The Theoretical Framework of Acceptability (TFA) underpinned the structure and interpretation of the combined qualitative and observational data sets.ResultsPatients and healthcare providers revealed a positive attitude towards the integrated care delivery model at the mid-line and at study end-time points. High acceptability was related to increased exposure to service integration in terms of satisfaction with the clinic setup, seating arrangements and the provision of medical care services. Satisfaction also centred on the patients’ freedom to move from one service point to another, and to discuss the services and their own health status amongst themselves. Adherence to medication and scheduling of clinic appointments appeared central to the patient-provider relationship as an aspect in the provision of quality services. Multi-condition health education, patient time and cost-saving, and detection of undiagnosed disease conditions emerged as benefits. On the other hand, a few challenges included long waiting times and limited privacy in lower and periphery health facilities due to infrastructural limitations.ConclusionThe study reveals a continued high level of acceptability of the integrated care model among study participants in Tanzania. This calls for evaluation in a larger and a comparative study. Nevertheless, much more concerted efforts are necessary to address structural challenges and maximise privacy and confidentiality.

ZAMBIA’S MENTAL HEALTH PATIENTS: VICTIMS OF UNSPEAKABLE INFRASTRUCTURE CHALLENGE IN ZAMBIA’S HEALTH SYSTEM

Purpose: This article attempts to examine the critical role that physical health infrastructure and associated facilities play in the delivery of effective integrated primary health care services for mental patients in Zambia. The working definition for ‘physical infrastructure’ in the paper relates to wider capacities in form of hospital buildings, bed spaces, medical equipment, and professional healthcare personnel, among other elements that facilitate effective operations of a health facility.
 Methodology: This study has used both quantitative and qualitative data from various sources to map the debate on the impact of inadequate infrastructure on mental health patients in Zambia’s health system. 
 Findings: Inadequate health infrastructure has had a negative impact on the well-being of mental health patients and other sectors of the Zambian society. The entire country has only one ill-resourced main hospital, offering mental health services and has been overwhelmed by a combination of insufficient infrastructure and effects of COVID-19 pandemic.
 Unique contributions to theory, practice, and policy: For the health reforms to be effective, it is recommended that the conceptual integrated health system in Zambia be anchored on universal allocation of adequate resources and operationalization of mental health policies that genuinely connect with social determinants of mental health issues within communities. The involvement of non-governmental organizations providing an interface between communities and governments should be supported by organizational and multi-institution capacity and coordination. A systems theory informed this study and has been elaboratively discussed in the second chapter of this paper

Integrated healthcare services for HIV, diabetes mellitus and hypertension in selected health facilities in Kampala and Wakiso districts, Uganda: A qualitative methods study.

Health policies in Africa are shifting towards integrated care services for chronic conditions, but in parts of Africa robust evidence on effectiveness is limited. We assessed the integration of vertical health services for HIV, diabetes and hypertension provided in a feasibility study within five health facilities in Uganda. From November 2018 to January 2020, we conducted a series of three in-depth interviews with 31, 29 and 24 service users attending the integrated clinics within Kampala and Wakiso districts. Ten healthcare workers were interviewed twice during the same period. Interviews were conducted in Luganda, translated into English, and analysed thematically using the concepts of availability, affordability and acceptability. All participants reported shortages of diabetes and hypertension drugs and diagnostic equipment prior to the establishment of the integrated clinics. These shortages were mostly addressed in the integrated clinics through a drugs buffer. Integration did not affect the already good provision of anti-retroviral therapy. The cost of transport reduced because of fewer clinic visits after integration. Healthcare workers reported that the main cause of non-adherence among users with diabetes and hypertension was poverty. Participants with diabetes and hypertension reported they could not afford private clinical investigations or purchase drugs prior to the establishment of the integrated clinics. The strengthening of drug supply for non-communicable conditions in the integrated clinics was welcomed. Most participants observed that the integrated clinic reduced feelings of stigma for those living with HIV. Sharing the clinic afforded privacy about an individual's condition, and users were comfortable with the waiting room sitting arrangement. We found that integrating non-communicable disease and HIV care had benefits for all users. Integrated care could be an effective model of care if service users have access to a reliable supply of basic medicines for both HIV and non-communicable disease conditions.

Healthcare musicians and musico-emotional work: An in-depth case study within the context of end-of-life care

The purpose of this in-depth case study is to explore the work of musicians in end-of-life care. In this study, a healthcare musician is considered to be a professional who has both an academic degree in music and in-service training in music and healthcare settings. In addition to working with healthcare personnel, they often collaborate with music therapists to provide integrated healthcare services for the best patient care. In the study, six musicians who had experience in end-of-life care settings were interviewed. Their reflections on their socially engaged work were analysed through the emerging theoretical lens of emotional work. This resulted in the identification of three themes beyond that of pure performativity in music professionalism, relating to the emotional work in end-of-life care. Furthermore, the emotional processes that were encountered, which were deeply social in nature, were conceptualised as musico-emotional work. This other-centred work aligns with music therapy research, and is an essential part of music therapists’ end-of-life work. In conclusion, the similarities between music therapists and musicians, as well as the interprofessional potential of their cooperation, are reflected upon.

Competition, Quality and Integrated Health Care

Integration of health care services has been promoted in several countries to improve the quality and coordination of care. We investigate the effects of such integration in a model where providers compete on quality to attract patients under regulated prices. We identify circumstances under which integration either increases or reduces the quality of services provided. In the absence of synergies related to costs or benefits, integration generally leads to increases in quality for some services and reductions for others. The corresponding effect on health benefits depends largely on whether integration leads to quality dispersion or convergence across services.

Integrating Healthcare Services Using Blockchain-Based Telehealth Framework

Blockchain technology (BT) has a wide range of built-in features, such as decentralization, transparency, data provenance, security, immutability, and has moved beyond the hype to practical applications in the healthcare industry. Telehealth turns out to be the most efficient and effective way of dispensing healthcare services even in remote areas. Though telehealth has the proven potential to improve the quality of healthcare, its implementation and adoption remain far from ideal. There is a need for a telehealth system that not only ensures the privacy and security of the users but also provides authentic services that enhance the trust to the highest level. Existing applications are leveraging BT and providing limited telehealth services. These applications are focused on a few services; hence do not cover all aspects of healthcare. To unveil the true potential of telehealth, this paper aims to develop an effective telehealth framework-BlockHeal which integrates all essential healthcare services under one platform and ensures a full-fledged trusted environment. The methodology employed includes survey of existing telehealth system, identifying their weaknesses and critical reasons behind their lack of widespread adoption. The proposed framework addresses the limitations and includes all stakeholders of the healthcare system instigating a consolidated platform to ensure authentic, safe, and timely healthcare facilities. Additionally, as the proposed framework is based on BT, it ensures the provision of secure, fault-tolerant, transparent, and tamper-proof data. Moreover, it offers decentralized storage via hyperledger fabric and a collection of decentralized applications (DApps). Finally, the effectiveness of the BlockHeal framework is validated by demonstrating several use-cases.

Postacute-Stroke Management Problems in Home Care Service: A Qualitative Single-Centered Study in Yogyakarta, Indonesia.

Objective This study explores the postacute-stroke management problems, particularly for patients with total dependency (Barthel Index <20), in home care service of Dr. Sardjito Hospital (SH) from the hospital personnel's and caregiver's points of view. Materials and Methods In-depth interviews with a semi-structured interview guide were conducted with hospital personnel and patients' caregivers based on the purposeful sampling. There were 10 hospital personnel that were interviewed: the director of medical service, head of home care unit, neurologists, general practitioners, nurses, and physiotherapist. There were eight caregivers who participated in the study. Statistical Analysis Data from the interviews were analyzed using systematic text condensation using Nvivo 12 plus. Results Our findings showed that all health personnel in SH agreed that home care service is a part of an integrated health care service for continuation of care. However, the preparedness by the hospital management is still lacking in infrastructures, such as standardized operational procedure, quality control, and financial system, as well as in terms of competent human resources and their welfare. In addition, the patient's family and caregiver are lacking in knowledge and independency to take care of the patients with the need of home care services' monitoring to deliver the expected home care for postacute-stroke's patient regularly. Conclusion Home care service is an act of implementing hospital obligation to fulfill the patients' rights. An established hospital policy to ensure a comprehensive home care service delivery is necessary. The capability and welfare of the health care personnel should be put into account for the standardized human resources.

Integrating healthcare services for people experiencing homelessness in Australia: key issues and research principles

In 2016, the Australian Census found approximately 116 000 people to be experiencing homelessness.[1][1] People experiencing homelessness have higher morbidity and mortality than the general population,[2][2] and so require meaningful...