Modern Health Systems Research Articles

Users\u2019 involvement in mental health services: programme logic model of an innovative initiative in integrated care

BackgroundCollaboration and partnership are key issues for modern health systems seeking to implement quality integrated care that meets the needs of the population. The Carrefour Communautaire-Institutionnel-Usagers (Connecting Community organisations-Institutions-Users, CCIU), involving community- and institution-based mental health workers, carers and users, is an innovative normative integrated care group (group for shared values, culture and vision) established by the Canadian Mental Health Association-Montreal Branch. A programme evaluation approach was used to conduct a logic analysis of the CCIU in order to understand the relationships between its resources, activities and outcomes, build a common understanding and, allow for its replication.MethodsFive steps were involved in the creation of a programme logic model. A non-exhaustive literature search for similar initiatives, a review of documents related to the CCIU process and direct observations led to the development of a first model. Then, following a participatory and reflexive process, this model was validated with CCIU participants.ResultsA comprehensive model and a simplified model were created. Participants’ experiential knowledge and scientific knowledge helped to identify the essential components of the successful operation of the CCIU.ConclusionsThe CCIU, with its eight essential components, including relations based on equality and mutual respect, corresponds to an essential step in normative integration and integrated care that lead to improved quality services.

Community Awareness about and Response towards Hygiene and Sanitation Services by IRSP

Hygiene and sanitation is one of the core issue discussed in modern health system. Hygiene and sanitation is significantly correlated with health conditions. This study aims to find out community awareness about and response towards hygiene and sanitation services in village Dheri Zardad, District Charsadda. This study is quantitative and cross-sectional in nature. Purposive sampling technique has been adopted and the information has been collected through structured interview schedule designed in relevance to the current study. The collected information has been analyzed in shape of tabular form including frequencies and percentages. Findings shows that there are various components of hygiene and sanitation, for example, cleaning water tank, spreading pipe lines out of sewage water ways, cleaning sewage ways to avoid standing water and provision of latrine in homes. To some extent public was aware of sanitation and hygiene and sanitation in the study area. Further, IRSP is doing various efforts to bring betterment in hygiene and sanitation, and public had a positive perception and attitude towards the work of IRSP.

E-Zdravlje, kako graditi savremeni zdravstveni sistem

E-Zdravlje, kako graditi savremeni zdravstveni sistem

A person centred model for people with complex care needs

It is well known in the literature how the modern health and care systems are being oriented to launch and develop national strategies to construct and build a more comprehensive system for the people with health and social care Most of Chronic Care programs have been introduced proactive care management for this vulnerable population who are causing high utilization of high cost services. However a new Integrated health and social care have been introduced in some countries and regions and there is a need of identifying these populations at risk with new and well accepted criteria and new care approaches in the field. This workshop will combine both the and implementation in related to proactive management of people with complex care needs from a joint health and social care perspective. 2 or 3 countries will be invited to explain main strategies and real implementation examples which could be easily escalated. An additional overview of Walter Wodchis as international expert and reviewer of different international national or regional best practices will be incorporated. We will introduce different issues related to - Earlier work of complex chronic health needs during implementation of Chronic Care programs. Some part of this work has started some time ago and experience of some yers could be - Evolution from the “complex health needs” toward a “complex health and social care needs” approach. New approaches to identify criteria related to complex social care needs will be explored especially related to the social care area. ·International overview of the most recognized innovative experience related to care for people with complex health and social care needs - Terminology required to talk properly about complexity: complexity, complex care needs, multimorbidity, complex health and social care needs,...? - Complex care in practice explaining which strategy is being developed to take care of people with complex health and social care needs from an “individual, team and territorial (county)” perspective - ICT developments to support work with different organizations and professionals who work collaboratively to manage people under a person centred model: introduction of Key Information Summary or Individual Intervention Plans to be shared by all organizations and professionals under a 24/7 scheme and other strategies - Evaluation of complex care strategy It would be introduced 2 or maybe 3 experiences and an additional international overview: - Catalonia and Scotland will talk about both policy and implementation in practice models which have priorised care approach - Walter Wodchis from Intitit oof Healt Policy, Management and Evaluation at University of Toronto speak about the most promising and innovative world experiences related to complex care (Walter Wodchis is co-author of the June issue of IJIC publishing 7 study cases related to complexity), showing lessons about these experiences and reccommendations for countries and regions developing and implementing Integrated Care for people with complex health and social care needs. This workshop will offer a combination of policy and implementation in practice issues and additionally an overview of the best practices in the world related to complex care

Jurisprudential Analysis on the Implementation of and Compliance with European Safety Standards on Patient Mobility in the Romanian Health System

Since the Directive on cross-border healthcare regulates the provision of pan-European medical services, but without taking into account of the organization, provision and financing of such services, this article examines the need to reform national legislation in order to eliminate any restrictions to the fundamental freedoms of European citizens. This article aims to analyse, by presenting the jurisprudence of the Court of Justice of the European Union, the degree of harmonization of national policies in view of reforming the Romanian health system, in order to create a modern health system. In order for a modern health system to be created, it needs to be centred on patient needs, to have dynamic and integrated structures, adaptable to the various and changing healthcare needs of society in general and of individuals in particular and which, not least, must recognize the active role of the patient as partner in healthcare policies.

Jurisprudential Analysis on the Implementation of and Compliance with European Safety Standards on Patient Mobility in the Romanian Health System

Since the Directive on cross-border healthcare regulates the provision of pan-European medical services, but without taking into account of the organization, provision and financing of such services, this article examines the need to reform national legislation in order to eliminate any restrictions to the fundamental freedoms of European citizens. This article aims to analyse, by presenting the jurisprudence of the Court of Justice of the European Union, the degree of harmonization of national policies in view of reforming the Romanian health system, in order to create a modern health system. In order for a modern health system to be created, it needs to be centred on patient needs, to have dynamic and integrated structures, adaptable to the various and changing healthcare needs of society in general and of individuals in particular and which, not least, must recognize the active role of the patient as partner in healthcare policies.

Triple Aim in Canada: developing capacity to lead to better health, care and cost.

Quality problemMany modern health systems strive for ‘Triple Aim’ (TA)—better health for populations, improved experience of care for patients and lower costs of the system, but note challenges in implementation. Outcomes of applying TA as a quality improvement framework (QI) have started to be realized with early lessons as to why some systems make progress while others do not.Initial assessmentLimited evidence is available as to how organizations create the capacity and infrastructure required to design, implement, evaluate and sustain TA systems.Choice of solutionTo support embedding TA across Canada, the Canadian Foundation for Healthcare Improvement supported enrolment of nine Canadian teams to participate in the Institute for Healthcare Improvement's TA Improvement Community.ImplementationStructured support for TA design, implementation, evaluation and sustainability was addressed in a collaborative programme of webinars and action periods. Teams were coached to undertake and test small-scale improvements before attempting to scale.EvaluationA summative evaluation of the Canadian cohort was undertaken to assess site progress in building TA infrastructure across various healthcare settings. The evaluation explored the process of change, experiences and challenges and strategies for continuous QI.Lessons learnedDelivering TA requires a sustained and coordinated effort supported by strong leadership and governance, continuous QI, engaged interdisciplinary teams and partnering within and beyond the healthcare sector.

Prescrição off-label, direito à informação, consentimento informado e processo clinico eletrónico no direito português

A prescrição off-label de medicamentos é não só uma prática comum e amplamente aceite, como também incontornável nos sistemas de saúde modernos. Perante a ausência de terapia eficaz, o médico não pode ficar sujeito ao tempo necessário para que todo o processo de aprovação de um determinado uso para um determinado medicamento se desenvolva. No entanto, apesar de se mostrar urgente, ainda não existe uma regulamentação desse tipo de receita médica em Portugal (ou mesmo na Europa). Como uma prerrogativa do médico, a liberdade terapêutica deve garantir o respeito pelo paciente, razão pela qual deve ser plenamente informado. É imperativo que o paciente conheça aquela terapia particular, os seus potenciais riscos e benefícios e as razões que levaram o médico a prescrever off-label. Todas as informações devem, por isso, ser claramente anotadas nos registos clínicos do paciente de modo garantir uma efetiva proteção tanto para o paciente como para o médico. Embora não exista, ainda, consenso quanto à prescrição off-label, em 2014 a Direção Geral de Saúde portuguesa emitiu uma norma que recomenda a obtenção do consentimento informado, sob a forma escrita, para os casos de uso off-label de medicamentos. O problema reside na seguinte questão: como ajustar essa recomendação com a crescente informatização dos registros clínicos e com mecanismos como a Plataforma de Dados de Saúde Português? Na verdade, este é um problema comum. Recentemente, a FDA (Food and Drug Administration, EUA) publicou um projeto que fornece, precisamente, recomendações sobre procedimentos utilizando um consentimento informado eletrónico.

The rehabilitation research matrix: producing knowledge at micro, meso, and macro levels

Purpose: EU policy documents and health scholars point out that in order to understand the complexity of modern health systems, as well as to devise appropriate policy responses, considering micro, meso, and macro levels is indispensable. This article aims to develop an analytical framework for how rehabilitation as an interdisciplinary field can be framed in such a three-level framework.Methods: This is a conceptual paper based on recent contributions to the development of a theory of rehabilitation. The paper applies sociological theory to build an analytical framework for a holistic understanding of rehabilitation.Results: Three groups of agents in the field of rehabilitation are identified: individuals with disabilities, professionals, and governmental authorities. The paper systematizes how these agents are positioned and act at micro, meso, and macro levels. In the intersection between the three levels of society and the three groups of actors, a nine-cell table emerges. In the cells of the table, key examples of important social processes to study in the field of disability and rehabilitation are identified. At the micro level, individuals experience a daily life relevant to rehabilitation, professionals ask what works in therapy, and policy authorities promote a strong work ethic. At the meso level, individuals with disabilities act as service user groups, professionals develop organizational designs and the policy authorities ask for cost-effective services. At the macro level, organizations representing people with disabilities lobby, professionals negotiate authorization issues, and the policymaking authorities must identify what can count as just distribution of services. The nine cells of the table are elaborated on by presenting relevant current studies exemplifying each cell.Conclusion: To systematize societal levels and agents involved is to enhance the understanding of rehabilitation as an interdisciplinary field of research.Implications for rehabilitationRehabilitation practice and research must relate to different levels of society and identify different social agents.Service users are not only individuals receiving therapy, but also organized agents influencing the organization of rehabilitation services as well as priorities made at the level of policy development.Both the results produced by health professionals doing a clinical trial and political scientists studying rehabilitation policy disputes will improve when placed in a wide frame of knowledge production.

Health Economics at the Crossroads of Centuries - From the Past to the Future.

Health economics, as an interdisciplinary science, has experienced exceptionally bold evolution through the past eight decades. Generations of committed scholars have built up huge body of knowledge and developed a set of methodological tools to assist health-care authorities with resource allocation process. Following its conception at the US National Bureau of Economic Research and Ivy League US Universities, this science has spread across the Globe. It has adapted to a myriad of local conditions and needs of the national health systems with diverse historical legacies, medical services provision, and financing patterns. Challenge of financial sustainability facing modern day health systems remains primarily attributable to population aging, prosperity diseases, large scale migrations, rapid urbanization, and technological innovation in medicine. Despite promising developments in developing countries with emerging BRICS markets on the lead, rising out-of-pocket health spending continues to threaten affordability of medical care. Universal health coverage extension will likely remain serious challenge even for some of the most advanced OECD nations. These complex circumstances create strong drivers for inevitable further development of health economics. We believe that this interdisciplinary health science shall leave long-lasting blue print to be visible for decades to come.

Ethical challenges in designing and conducting medicine quality surveys

ObjectivesIn this paper we discuss the main ethical challenges related to the conduct of medicine quality surveys and make suggestions on how to address them.MethodMost evidence‐based information regarding medicine quality derives from surveys. However, existing research ethical guidelines do not provide specific guidance for medicine quality surveys. Hence, those conducting surveys are often left wondering how to judge what counts as best practice. A list of the main ethical challenges in the design and conduct of surveys is presented.Results and conclusionsIt is vital that the design and conduct of medicine quality surveys uphold moral and ethical obligations and analyse the ethical implications and consequences of such work. These aspects include the impact on the local availability of and access to medicines; the confidentiality and privacy of the surveyors and the surveyed; questions as to whether outlet staff personnel should be told they are part of a survey; the need of ethical and regulatory approvals; and how the findings should be disseminated. Medicine quality surveys should ideally be conducted in partnership with the relevant national Medicine Regulatory Authorities. An international, but contextually sensitive, model of good ethical practice for such surveys is needed.

Editorial introductions

Current Opinion in Anesthesiology was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of anesthesiology is divided into 15 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Gernot MarxFigureDr Gernot Marx, MD, FRCA is full Professor of Anesthesiology and Critical Care Medicine and Chair at the University RWTH Aachen, Germany. He is Head of the Department of Intensive Care Medicine and Intermediate Care at the University Hospital RWTH Aachen. He is full board member of the German Society of Anaesthesia and Intensive Care and full board member of the interdisciplinary German Society of Intensive Care and Emergency Medicine. He graduated and took his residency at the Medizinische Hochschule Hannover in Germany. He was Senior Lecturer in Anaesthesia and Intensive Care Medicine at the University of Liverpool, UK and full Professor for Anaesthesiology, Intensive Care and Emergency Medicine at the Friedrich-Schiller-Universität Jena, Germany. He received the Fellowship by election of the Royal College of Anaesthetists. His research interest is focused on sepsis, fluid therapy and telemedicine. He is Editor of two books, Checklist Intensive Care Medicine and The Intensive Care Medicine. He is Editor of AINS (Anaesthesiologie Intensivmedizin Notfallmedizin Schmerztherapie) and Associate Editor of British Journal of Anaesthesia. Hartmut BürkleFigureHartmut Bürkle, MD, PhD is full Professor of Anesthesiology and Critical Care Medicine, and Chair of the Department of Anesthesiology and Intensive Care Medicine at the University Medical Center Freiburg, Germany. After his residency in Anesthesiology in Hamburg and a postdoctoral fellowship at the UCSD, San Diego (Prof T. L. Yaksh) he joined Prof Hugo Van Aken[Combining Acute Accent]s anesthesia and intensive care medicine group in Muenster, Germany. His research interests are centered on regional anesthesia techniques, perioperative pain therapy and perioperative rehabilitation, highlighting patient's outcome. During the last decade, he has also focused on the development of safe anesthesia strategies, the economical and ethical issues of modern health systems related to anesthesia and intensive care medicine, as well as on implementing peer reviewed quality care in anesthesiology and intensive care medicine. He has published more than 120 studies and acted as reviewer for most of the national and international journals of anesthesiology and intensive care medicine. Kai ZacharowskiFigureProfessor Kai Zacharowski holds the position of the Ordinarius and is the Director of the Department of Anesthesia, Intensive Care Medicine and Pain Therapy at the University Hospital Frankfurt. His research, teaching, and consulting interests are in both clinical and basic aspects of patient safety, transfusion and clotting, innate immunity, cardiovascular and critical care medicine. Professor Zacharowski received his MD from the German University of Mainz and his PhD from Queen Mary, University of London (where he was working with the Nobel laureate Prof Sir John Vane → discovered how aspirin works). His scientific contributions are published in peer-reviewed journals such as Nature Medicine, Lancet, NEJM and Proceedings of the National Academy of Science and were awarded with numerous awards for Innovative Clinical Research. He is serving as Editor-in-Chief for the Journal of Anesthesia & Intensive Care Medicine as well as an Editorial Board member of numerous journals in Critical Care Medicine, Emergency Medicine and Anesthesia. He obtained 2 clinical specializations (Anesthesia/Intensive Care Medicine and Clinical Pharmacology) and is practicing Anesthesia and Critical Care Medicine in Frankfurt.

Maternal and Child Healthcare Practices among the Tribes of Mysore District, Karnataka

The perception of maternal and child health-care practice in tribal areas remained largely unsuccessful due to their prevailing beliefs and practices towards the modern health system. The paper investigates maternal and child healthcare during pregnancy, antenatal checkups, antenatal advices, reasons for not receiving antenatal checkups, place of delivery and assistance during delivery and also the post-natal healthcare of the mother as well as the baby of Hakkipikki and Iruliga tribal mothers.

African Traditional Medicine Based Immune Boosters and Infectious Diseases: A Short Commentary

Introduction: Developed from centuries of oral knowledge passed from generation to generation, African traditional medicines (ATM) are at a crossroads. In order for these ATMs to evolve with time similarly to modern medical sciences, there is an urgent need to scientifically evaluate their mechanism of action, safety and efficacy. Case report: In this short commentary we report on the progress we have made in scientifically evaluating traditional herbal immune boosters at a period where the African continent finds itself ravaged by a plethora of infectious diseases. Discussion: While the South African government has gone a long way in building an effective modern health system, many people still use ATMs such as immune boosters for a variety of infectious diseases and general wellbeing. The high prevalence of HIV infections is one of the reasons that have led to an increase in the use of ATMs which purport to have immune boosting capabilities. In our laboratory we have developed various models and carried out extensive in vitro and in vivo biochemical and molecular experiments on the immunomodulatory effects of these immune boosters and have shown that these products can modulate the expression and secretion of both cytokines and chemokines. Therefore the potential uses of immune boosters in clinical medicine does not only apply in treating immunodeficiency caused by HIV but can be useful in managing tuberculosis (TB), various forms of cancer and various other diseases that can be managed by modulating the immune response. Such research studies are very promising and present opportunities for further clinical studies to develop unique ATMs. Conclusion: As medicines meant to stimulate the body’s immune system to defend itself, immune boosters can be useful alone or as immune adjuvants along with pharmaceutical drugs. Therefore further studies on the effectiveness of these immune boosters are justified along with those that will ensure that there are no drug interactions with other pharmaceutical products.

Healthcare systems, the State, and innovation in the pharmaceutical industry

Abstract: This article discusses the relations between healthcare systems and the pharmaceutical industry, focusing on state support for pharmaceutical innovation. The study highlights the experiences of the United States, United Kingdom, and Germany, developed countries and paradigms of modern health systems (liberal, universal, and corporatist), in addition to Japan, a case of successful catching up. The study also emphasizes the experiences of China, India, and Brazil, large developing countries that have tried different catching up strategies, with diverse histories and profiles in their healthcare systems and pharmaceutical industries. Finally, with a focus on state forms of support for health research, the article addresses the mechanisms for linkage between health systems and the pharmaceutical industry, evaluating the possibilities of Brazil strengthening a virtuous interaction, favoring the expansion and consolidation of the Brazilian health system - universal but segmented ‒ and the affirmation of the innovative national pharmaceutical industry.

The FADOI (Federation of Associations of Hospital Doctors on Internal Medicine) position paper on cardiovascular prevention in the higher risk complex patients

Prevention is a very topical issue that any modern health system cannot ignore. The discussion about the concept of cardiovascular (CV) prevention is very wide and has been lasting for a long time. In this context, the research has never been stopped. A schematic classification of different types of prevention, as well as raised by the literature, implies some limitations, not always suitable to our complex patients. According to evidence-based medicine we should refer to the best available guidelines. Unfortunately the quality of <em>evidence-based</em> guidelines is far from optimal. The Federation of Associations of Hospital Doctors on Internal Medicine (FADOI) faced the problem of CV prevention in the higher risk complex patients with its experts in ischemic heart disease, heart failure, stroke, chronic kidney disease, peripheral arterial disease and diabetes mellitus, by asking the following questions: i) which are the methods of risk assessment and prognostic stratification (also with respect to the existing comorbidities)?; ii) which are the tailored actions to implement for the <em>individual patient</em>? For the purposes of a CV risk evaluation in complex patient we cannot be satisfied with a single <em>high baseline risk strategy</em>: we should resize our assessment parameters to the real world, implementing a <em>high multidimensional CV complexity risk assessment strategy</em>, in respect of an anthropological approach to the complexity of our patients. Essentially, hospital internists are called to exercise a proactive role of <em>experts for each single complex patient</em>, also in CV prevention.

The challenge for healthcare systems in the XXI century: how to incorporate the focus of social determinants in healthcare?

During the 20th century, a series of reflections on the role of biomedicine and social factors in the concept of health and disease processes served as a necessary prelude to the conceptual and empirical development of what later became known as the social determinants of health. In relation to this perspective, the question arises: What is the role of modern health systems from the perspective of the social determinants of health? This article presents an alternative view of the role of health systems from the focus of the social determinants of health, raising its importance and influence on the structural level, while addressing its implications as an intermediary determinant of health inequalities.

A Comparison of Integration Models for Professionals With Different Skills in Healthcare

Integration between hospital and territory has to be faced as a critical aspect in modern health systems. The evolving of health care demand in Western countries leads the debate on health care system to focus on how to meet the needs of chronic diseases. Creating gatekeeper models for admission to health care facilities presumes a high level of integration between a wide variety of professions that interact in patients’ therapy processes. This paper analyzes two models of integration of professionals with different skills: Clinical commissioning groups (CCGs) in United Kingdom health care system and Case della Salute (CdS) in Italian regional health care system of Emilia Romagna. The analysis of the two models highlights critical situations, strong points, and success critical factors in the two models. In particular, the analysis will highlight how the two systems faced the necessity to integrate the different category of professionals that, during the care process of a chronic patient, have to integrate in order to guarantee the continuity of the care process and the most effective response for the patient. This study highlights the methodologies used to share competences and knowledge on which the building of a system with high professional integration is based.

Redefining clinical leadership for team-course development

Objective: Value choices are rooted in the philosophical deliberations of Aristotle, Levinas and Gadamer. Balancing the needs of “the other” with societal and institutional needs to meet the objectives of “the cause” is core to the modern health systems priority setting debate. These value conflicts present themselves bed-side in the day-to-day decision-making processes. A clinical leadership (CL) framework should present solutions to this challenge.Methods: The definition of CL is redefined to include four key values involved in this value conflict. These are 1) trust, 2) quality, 3) responsiveness and 4) efficiency. A CL in Teams course curriculum and design was developed to link these values to tools and to context in the hospital.Results: A new definition of CL has provided a common formative framework useful in clinical settings for priority setting, evaluation and professional development. By the end of 2015 a total of 82 participants will have completed the course. It has been evaluated to be timely, feasible, flexible, relevant and sustainable.Conclusions: Values influence how clinical leaders operate and have an important impact on their leadership abilities and how they respond to challenges. For clinical leaders and teams to work effectively it is crucial to develop common basic values. Developing a set of tools and reflective practice to understand the inter-relationship between values and how they can conflict or reinforce each other, contributes to improved quality of service, patient-centred care and workforce satisfaction.

Telepsychiatry: Now and Here!

Telepsikiyatri, gunumuzun hizla degisen saglik sisteminin ortaya cikardigi, hem hastaya hem de klinisyene yararlari olan bir uygulamadir. Son yillarda tasinabilir bilgisayarlarin yayginlasmasi ve guvenilir iletisim sistemlerinin gelistirilmesi, telepsikiyatrinin dilenen yer ve zamanda sunumunun onunu acmistir. Uygun teknolojinin gelistirilmesi, yasal duzenlemelerin yapilmasi, psikiyatristlerin, hastalarin ve ucuncu kuruluslarin memnuniyetlerinin saglanmasi oraninda telepsikiyatrinin ivmesi artacaktir. Bugune kadar elde edilen deneyimler, degisen ekonomik ve sosyal parametreler ile buyuyen saglik sisteminin beklentileri goz onunde tutuldugunda; klinisyenlerin yakin bir gelecekte telepsikiyatriye uyum saglayacak bir platforma hazirlikli olmasi onerilebilir.