Health Care Research Articles

The perceptions and experiences of facility managers in the implementation of safer conception services in public health care facilities

ABSTRACT Safer Conception Services (SCS) refers to the provision of a package of care for individuals of reproductive age who are affected with HIV to have safe and healthy pregnancies. South Africa has one of the highest HIV burdens in the world, yet limited availability of SCS. Therefore, this study investigated healthcare managers’ response to an implementation project piloting SCS integration into primary healthcare services in Johannesburg. As part of the implementation study, data was collected from six facility healthcare managers using In-Depth interviews between November 2017 - September 2018. Data were analyzed using thematic analysis. The following four (4) themes emerged: positive response to the implementation of SCS, capacity building, the impact of SCS, and the need to scale up SCS. The results suggested that providers engaged saw value in the implementation of SCS. The results further suggest that there was an openness, willingness, cheerful outlook, and support to make SCS more widely available; however, streamlined processes are important to ensure feasibility. Continuous training is necessary to routinize implementation and ensure adequate coverage of services. Available guidelines should be translated into training programs and more initiative-taking policies to support the scale-up of this essential service.

Political Determinants of Health: Health Care Privatization and Population Health in Europe.

The extent to which health care reforms affect health remains understudied. Health care reforms result in policy outputs that determine provision of medical services, which have consequences for the health of the population. The authors scrutinize this relationship between health policy outputs and population health by focusing on legislative changes implying privatization of health care delivery and finance. They ask the following question: What is the relationship between reforms that privatize health care provision and population health in terms of health outcomes and inequalities? They answer this question by relying on fixed-effects time-series cross-section models. The authors use an original dataset of health care reforms passed in 36 European countries from 1989 to 2019. Health outcomes are operationalized with measures of subjective health status, unmet health needs, and resulting health inequalities. Their results show that privatization of health care is associated with higher rates of bad subjective health and unmet health needs several years after the passing of reforms. These effects are stronger for individuals in the lower tiers of income and education, resulting in greater socioeconomic inequalities. The article contributes to conceptualization of the political determinants of health as health policy outputs and a better understanding of the relationship between policy outputs and population health outcomes.

No Country for Sick Men: The Political Determinants of Health Policy in Poland.

The objective of this article is to explain the political factors determining the relatively weak performance of the Polish health care (HC) sector. This can be treated as a critical case for several reasons. First, the Poles are among the most unsatisfied patients in the European Union, with one of the lowest life expectancy levels. Second, Poland spends one of the lowest shares of gross domestic product on HC-related expenditures among OECD countries. Third, the country is facing medical personnel shortages. The analysis is based on the mixed-methods approach. The authors rely on quantitative data outsourced from a survey, which is supplemented by the semistructured, in-depth interviews with selected key HC stakeholders representing patients' advocacy groups, medical personnel organizations, and high-level decision-makers. The Polish HC system remains weak due to the postcommunist legacy in terms of organization, a short-term approach by politicians, and weak decision-making processes. The HC policy inertia in Poland is determined by a group of interrelated political factors that effectively block the development of any positive reform.

Impact of Guideline-Directed Statin Prescriptions on Cardiovascular Outcomes by Race in a Real-World Primary Prevention Cohort

BackgroundData on real-world statin prescription in large, private health care networks and impacts on primary prevention of atherosclerotic cardiovascular disease (ASCVD) outcomes across race are scarce. ObjectivesThe purpose of this study was to investigate the impact of statin prescription on ASCVD outcomes within and across race in a large, nongovernmental health care system. MethodsStatin prescription in Black and White patients without ASCVD was evaluated (2013-2019). Guideline-directed statin intensity was defined as at least “moderate” for intermediate and high-risk patients. Statin prescription at index and ASCVD outcomes at follow-up (myocardial infarction/revascularization, stroke, mortality) were assessed via electronic health care records using International Classification of Diseases-9 and 10 codes. Cox regression models, adjusted for CVD risk factors, were used to calculate HRs for association between statin prescription and incident ASCVD events across race. ResultsAmong 270,079 patients, 7.6% (n = 20,477) and 92.4% (n = 249,602) identified as Black and White, respectively. Significantly fewer Black patients were prescribed statin therapy than White patients (13.6% vs 19.0%; P < 0.001). At a mean follow-up of 6 years, patients with “no statin” prescription vs guideline-directed statin intensity showed increased ASCVD in Black patients (HR: 1.40 [95% CI: 1.05-1.86]), and White patients (HR: 1.32 [95% CI: 1.21-1.45]; P < 0.05) and all-cause mortality. Intermediate and high-risk Black patients faced a 17% higher risk of mortality compared to White patients. However, the interaction between race and statin prescription was not a significant predictor of incident ASCVD events. ConclusionsStatins remain underprescribed. Although Black patients received proportionally less statin prescription than White patients, this was not associated with higher risk of mortality in Black patients.

A Novel Content and Usability Analysis of UK Professional Regulator Information About Raising a Concern by Members of the Public.

Health and social care regulators ensure that professionals have the correct qualifications and experience to practice in their profession. Globally, there are over 130 regulators of nursing alone and 13 health and social care statutory regulators in the United Kingdom. The public are the largest source of concerns to regulators about the registrants' fitness to practise (FtP). This study aimed to examine the amount, type and content of the information available from UK regulators and evaluate the usability of the process for members of the public considering raising a concern with a regulator about a registrant's fitness to practise (FtP) and the experience of those who had recently raised a concern. The websites of the UK's 13 statutory health and social care regulators were searched between November 2021 and February 2022 for information about the process of raising a concern. Webpages and public-facing documentation were downloaded, and qualitative content analysis was conducted. The usability of regulator websites and the concerns referral form were assessed by 11 people using an adapted 'system usability scale'. Seven interviews, a focus group (n = 5) and a survey (n = 62) of people who had raised a concern were used to explore their experiences to validate our findings and recommendations. Themes were identified related to format and layout, the process and support to raise a concern, with wide variation found between regulators. Focus groups, interviews and surveys validated these findings. Information and the ease of finding this information are fundamental in promoting public confidence and trust in regulator purpose and process. When raising a concern, it is important that information is honest, clear and accurate and available in a range of different formats so that it suits the diverse needs of members of the public. Improvements in these processes could support regulators to better achieve their primary purpose of protecting the public. The public were consulted on our findings using two focus groups, seven interviews and 62 survey respondents. Our project advisory group of people with lived experience of involvement in FtP discussed the findings and contributed to the recommendations. N/A.

Evaluating ExpandED: Evaluating the effectiveness of a serious game expansion pack in teaching health professional students about interprofessional care.

The emergency department (ED) is a challenging fast-paced environment with high-acuity, undifferentiated patients who often require extensive interdisciplinary care. This paper introduces ExpandED, an expansion pack to the serious board game GridlockED, designed to enhance players' understanding of interprofessional collaboration in the ED and the diverse scope of practice of different ED professionals including physicians, residents, registered nurses, registered practical nurses, social workers, occupational therapists, and physiotherapists. This investigation evaluates the effectiveness of ExpandED as a teaching tool for medical and allied health professions students about interprofessional collaboration in the ED. A program evaluation harnessing a playtest framework was employed. Participants completed pre- and postgame surveys including quantitative measures (e.g., Likert scales) and qualitative free-text feedback that focused on participant familiarity with ED functioning, valuation of interprofessional collaboration before and after playing, and feedback on game usability and effectiveness. Recruitment was open to students in all health care and allied health professional programs at the institution. Forty-five participants were recruited from medical doctor, nursing, physiotherapy, and speech language pathology programs. ExpandED enhances participants' understanding of ED workflow (p < 0.001) and provides an enjoyable playing experience. However, participants' valuation of interdisciplinary teamwork did not change significantly before and after game play (p = 0.17). Participants expressed satisfaction with the game's accuracy in simulating the ED environment and appreciated the opportunity to collaborate with peers from different disciplines. Challenges reported included some tension among players, potential biases, and limitations of fidelity to a real-life ED. While this study has limitations regarding participant sampling and duration of gameplay sessions, it highlights the potential of ExpandED for teaching interprofessional collaboration in the ED. These findings will guide further development to optimize the expansion pack's effectiveness and its implementation into health care curricula.

Patient needs in women of childbearing age with psoriasis: retrospective analysis from the German PsoBest registry.

Women of childbearing age (WoCBA) with psoriasis face additional burden related to contraindications of systemic treatments during pregnancy/lactation and to the physical and psychosocial impact of psoriasis on their intimate/sexual relationships. Within a people-centered health care model, this study aimed to identify specific patient needs and their correlates in WoCBA (18-45 years), in comparison to same-age men and women above 45 years. Baseline data from the German PsoBest registry, including patients with moderate/severe plaque-type psoriasis with the indication for systemic therapy, were retrospectively analyzed. Psoriasis severity was assessed with the Psoriasis Area and Severity Index and patient-reported outcomes included EuroQoL Visual Analogue Scale, Dermatology Life Quality Index (DLQI), and Patient Needs Questionnaire. The participants were 2308 WoCBA, 3634 men between 18 and 45 years of age, and 3401 women older than 45 years. In comparison to both control groups, WoCBA reported more DLQI impairments and higher needs to reduce social impairments (eg, "to be able to lead a normal working life"; "to be less burdened in your partnership"; "to be able to have a normal sex life"). These patient needs were associated with having psoriasis arthritis, previous systemic therapy, worse general health, and more DLQI impairments. Retrospective analysis of an established dataset limited the examination of specific developmental, sexual, and reproductive variables. The specific needs of WoCBA with psoriasis were particularly related to the work context/financial stability and intimate relationships, which are crucial aspects in family planning. These results claim for a sex/age-sensitive approach in the psoriasis health care, by considering these needs as qualifiers in the clinical decision for systemic treatment.

Protocol for a personalized (N-of-1) trial for testing the effects of a mind–body intervention on sleep duration in middle-aged women working in health care

Protocol for a personalized (N-of-1) trial for testing the effects of a mind–body intervention on sleep duration in middle-aged women working in health care

Neurologic Care for Transgender and Gender-Diverse People: A Review of Current Evidence and Clinical Implications.

To summarize the literature on neurologic care for transgender and gender-diverse (TGD) people and provide implications for clinical practice. There are limited data on the frequency and management of neurologic conditions among TGD people. TGD people have a higher prevalence of various neurologic conditions compared with cisgender or general population cohorts, including migraine, subjective cognitive decline, sleep disturbances, functional disorders, and cerebrovascular disease. Gender-affirming hormone therapy interacts with commonly prescribed neurologic medications and increases stroke risk among transfeminine people. Sex hormones and sex chromosomes may play a role in neurodegeneration and disability progression in neuroimmunologic diseases. Clitoral reduction surgeries on intersex children can cause neurologic disability and sexual dysfunction in adulthood. Socioeconomic disparities among TGD people contribute to health care barriers. Neurologists should consider the unique experiences and health care needs of TGD people in their clinical practice and research protocols.

Integrating Simulation in Pediatric Health Care: Collaboration of Primary and Acute Care Pediatric Nurse Practitioners Across Settings

Pediatric nurse practitioner (PNP) education continues to evolve. Clinical placement availability significantly impacts student’s exposure to complex pediatric patients. The intricacy of pediatric health care demands innovative educational approaches, especially in managing high-risk, low-frequency emergencies. Simulation-based education is a vital tool to bridge learning gaps and enhance core competencies, particularly in diagnosing and managing pediatric patients across diverse health care settings. Here we explore a collaborative formative simulation experience for primary care PNPs and acute care PNPs, focusing on a single patient transitioning through primary care, emergency, and acute care settings. Results demonstrate enhanced student satisfaction and self-confidence, underscoring the efficacy of such simulations in preparing future pediatric health care providers. Opportunities for improvement and future directions are discussed, highlighting the significance of interprofessional collaboration and continuous innovation in PNP education.

Health care under the military government (1964-1985) and its legacy for the SUS: the public-private hybrid Unified Health System

This article analyzes the health care policy developed during the military government in Brazil (1964-1985), with a core focus on the relationship between the public and private sectors in the provision of health services, in the different modalities in which this occurred, and its repercussions. The objective, from an institutionalist and historical perspective, which considers the mechanisms by means of which prior policies affect the subsequent decision-making process and impose limits on the possibilities for change, is to identify the effects of this policy on the configuration of health policy reform, implemented in the democratization process, which led to the creation of a universal and comprehensive health system. Among these, the political effects on the configuration of the health area stand out; cognitive effects related to the perception of health policy, and effects on the government's capacity to provide and regulate services. The result was the continuation of a duality in the health system, resulting in the coexistence of a vigorous private sector with an allegedly universal public system which posed/poses difficulties for the SUS, but did not prevent its implementation and institutionalization. The article is taken from a previously published book.

The EU as Active and Passive Political Determinant of Forced Migrants' Health: Insights from the Case of Germany.

This article examines the EU's function as a political determinant of health (PDoH) in national-level regulation of forced migrants' access to health(care), with a focus on Germany. It sheds light on the role the EU has come to play-and has been assigned-in national policy making under the impact of different crises. By applying the concepts of claims and frames/framing, the article examines in a document analysis how and to what end(s) the EU as a polity and specific EU legislation were invoked in German draft legislation. Increasing Europeanization in the areas of health and migration has not only forced national legislators to adapt legislation to abide by EU rules and standards, it has also prompted governmental actors to shift responsibility for policy reforms to the EU-even in cases where not all of these reforms were legally required. The EU's role as a PDoH must be considered from two angles: the EU's active potential to determine public health through its policies and laws, and its passive-to some extent involuntary-potential to do so through the strategic invoking of EU norms, rules, and (in)competences by actors across the EU multilevel governance system.

Identifying Service, Research and Policy priorities for preventing the impacts of family adversity on children’s mental health: An Australian national resource allocation study with professional and lived experience experts

ObjectivesThe objective of this study was to develop Service, Research and Policy priorities to prevent the impact of family adversity on child mental health and determine comparative priorities of diverse stakeholders to those with lived experience of adversity. MethodsValue-weighting approach conducted in a staged process: (i) professionals and experts with lived experience from health, education, justice and social care sectors attended a national symposium to identify priorities for family adversity and mental health and (ii) a subsequent resource allocation survey gathered views from participants and external experts on symposium priorities. ResultsConsensus was reached on priorities. Service priorities included establishing intersectoral hubs for children and families and early childhood nurse home-visiting programs. Research priorities included scaling up evidence-based interventions and evaluating cross-sector, flexible funding models for services addressing childhood adversity. Policy priorities included developing evidence-based policies with evaluation and implementation plans and flexible funding models to support integrated care. ConclusionsOur results provide detailed and actionable clarity on next steps to address family adversities. Implications for Public HealthThe priorities call for a focus on cross-sectoral approaches to preventing or mitigating the effects of family adversity. The current Australian policy environment provides a timely opportunity to action the proposed interventions.

Deprescribing Proton Pump Inhibitors: Updated Clinical Guidelines

The diagnosis of gastroesophageal reflux disease (GERD) in adults has been steadily increasing over the years. GERD is often treated with proton pump inhibitors (PPIs). Studies have found upwards of 82% of PPIs are not being used following evidenced-based guidelines. The American College of Gastroenterology and American Gastroenterology Association released updated guidelines in 2022 for the treatment of GERD and deprescribing of PPIs. It is imperative for health care providers to review the updated guidelines. This report will review the guidelines and suggest a comprehensive deprescribing PPI protocol.

Factors Affecting Quality of Health Care Services in Government Facilities in Kakindo Health Centre IV in Kakumiro District

This study aimed to examine the factors that affect quality of health services in Kakindo Health Center IV in Kakumiro District. The study used a cross-sectional design using a quantitative approach on the population which was under study. Data was collected using questionnaires, processed in excel, and word using SSP software for correlation purposes. The study found a high significant relationship between health-related factors, health worker related factors and quality of health service delivery. Patient related factors had a low significance. The study concluded that the quality of health services depends on the level to which the management of the facility provides the employees with a conducive work environment. appropriate knowledge and skills, and positive attitude of health workers towards patients was emphasized. health workers were argued to carry out daily patient education in order to change their traditional beliefs. Grading the facility to a level of Hospital this would help to build more infrastructure for both patients and staffs, for security of both patients and staff, the facility needs tapped water so that staff can access clean water inwards, especially the paediatric ward, theatre, general ward, outpatient department, A R T Clinic Cold chain unit and a few staff quarters. A proper fence must be put constructed at the facility. Keywords: Health service, Health workers, Patients, Delivery, Staff

Multidisciplinary perspectives in Demodex blepharitis: A new view of treatment from clinical, payer, and patient perspectives.

Demodex infestation is the cause of more than two-thirds of all cases of blepharitis in the United States. Although symptoms may include crustiness, redness, or itching of the eyelids, diagnosis can be accomplished through a simple examination of the eyelashes. The presence of a waste product of the Demodex mite, known as collarettes, on the base of the eyelashes is a pathognomonic sign of Demodex blepharitis. Demodex infestation that results in blepharitis may cause blockage and ultimately atrophy of the meibomian glands, worsening dry eye disease. Until recently, management of Demodex blepharitis has been limited by a lack of approved therapy options. Lotilaner ophthalmic solution 0.25%, the first approved therapy for treatment of Demodex blepharitis, has not only been shown to eradicate Demodex mites in one-half to two-thirds of patients following short-term treatment but also demonstrated continued benefits through 1 year of follow-up. In addition to managing Demodex blepharitis, treatment with lotilaner ophthalmic solution 0.25% may aid in the management of dry eye disease and other forms of ocular surface disease caused by complications of Demodex infestation. As a result, it is possible that successful management of Demodex blepharitis may reduce chronic use of health care resources dedicated to managing other chronic ocular conditions. As eye care professionals recognize Demodex infestation as a key mediator of ocular surface disease, increasing diagnostic awareness and addressing this underlying cause of Demodex blepharitis may reduce the need for specialist follow-up care, decrease the need for chronic therapy, and improve patient outcomes. Through routine screening for Demodex infestation and Demodex blepharitis, eye care professionals can now address an underlying factor in ocular surface disease to improve use of health care resources in the community.

Embedding Multimodal Rehabilitation Within Routine Cancer Care in Sheffield-The Active Together Service Evaluation Protocol.

Approximately 3 million people in the United Kingdom are currently living with or beyond cancer. People undergoing treatment for cancer are at risk of complications following treatment. Increasing evidence supports the role of rehabilitation (including prehabilitation) in enhancing psychological and physical well-being in patients with cancer and improving outcomes. Active Together is an evidence-based, multimodal rehabilitation service for patients with cancer, providing support to help patients prepare for and recover from treatment. This paper presents the evaluation protocol for the Active Together service, aiming to determine its impact on patient-reported outcomes and clinical endpoints, as well as understand processes and mechanisms that influence its delivery and outcomes. This evaluation comprises an outcome and process evaluation, with service implementation data integrated into the analysis of outcome measures. The outcome evaluation will assess changes in outcomes of patients that attend the serviceand compare health care resource use against historical data. The process evaluation will use performance indicators, semistructured interviews, and focus groups to explore mechanisms of action and contextual factors influencing delivery and outcomes. Integrating psychological change mechanisms with outcome data might help to clarify complex causal pathways within the service. Evidence to support the role of multimodal rehabilitation before, during, and after cancer treatment is increasing. The translation of that evidence into practice is less advanced. Findings from this evaluation will contribute to our understanding of the real-world impact of cancer rehabilitation and strengthen the case for widespread adoption of rehabilitation into routine care for people with cancer.

Professional Doctorate in Primary Care (DPAPS): a legacy for the Rio de Janeiro SUS.

Since 2009, the Municipal Health Secretariat of Rio de Janeiro (SMS-RJ) has encouraged the creation of a Master's degree in primary health care at the National Health School/Fiocruz (ENSP/Fiocruz). In the following decade, this proposal became one of the main lines of the institution's professional stricto sensu postgraduate program, which culminated in CAPES approving the first professional doctorate class in the history of Fiocruz-RJ offered in 2024. The class comprises primary health care (PHC) students from Rio's SUS and Fiocruz employees in science, technology and innovation. Regarding the profile of the PHC students, the highlights were women (61.5%), a degree in medicine (53.8%), a mean of 15 years since graduating, 10 years working in PHC, graduates of a medical or multiprofessional residency course (69.2%) and a Master's degree in primary care from ENSP/Fiocruz or UFRJ (84.6%). The SMS-RJ thus leaves a legacy for Brazilian Public Health as a leader in the promotion of Fiocruz-RJ stricto sensu professional training programs, innovating in the end-of-course work, reviving the presence of doctors in the classes and bringing the contributions of the Portuguese SNS, a source of inspiration for the PHC reform undertaken in Rio de Janeiro, to the Rio de Janeiro SUS debate.

Empowering Health Care Providers: A Collaborative Approach to Enhance Financial Performance and Productivity in Clinical Practice.

The combination of inadequate financial training, limited benchmarks, and mindset contribute to many physicians prioritizing revenue below quality, outcomes, and safety. This creates a challenge as hospital administrators aim to motivate clinicians to improve RVU generation and increase revenue. Creating physician/administrator teams that defines and explores the gap between observed and expected financial performance in parallel with appreciating the physician's practice preferences can create new opportunities for billing. The proposed 3 phase approach emphasizes nonjudgmental communication, education and partnership. The most common and effective opportunities for improvement include billing optimization, scheduling and system infrastructure modifications. As reimbursement decrease, balancing revenue generation with physician satisfaction has become paramount. Promoting data drive bidirectional communication can lead to identifying previously unrecognized billing opportunities where change is driven by providers rather than by 1-dimensional institutional goals.

Characterizing the Compressive Force at L5/S1 During Patient Transfer From Bed to Wheelchair.

The peak compressive forces at L5/S1 during patient transfers have been estimated. However, no study has considered the actual patient body weight that caregivers had to handle during transfers. We developed a simple kinematic model of lifting to address this limitation. Fifteen prospective health care providers transferred a 70-kg individual who mimicked a patient ("patient") from bed to wheelchair. Trials were acquired with the patient donning (weighted) and doffing (unweighted) a 5-kg weight belt. Trials were also acquired with and without knee assistance and a mechanical lift. During trials, kinematics and kinetics of transfers were recorded to estimate the peak compressive force at L5/S1 using static equilibrium equations. The peak compressive force was associated with the transfer method (P < .0005), and the compressive force was 68% lower in lift-assisted than manual transfer (2230 [SD = 433]N vs 6875 [SD = 2307]N). However, the peak compressive force was not associated with knee assistance, nor with a change in the patient body weight. Our results inform that mechanical loading exceeding the National Institute for Occupational Safety and Health safety criterion occurs during patient transfers, confirming a high risk of lower back injuries in caregivers. However, the risk can be mitigated with the use of a mechanical lift.