Need For Health Care Services Research Articles

Crucial aspects promoting meaning and purpose in life: perceptions of nursing home residents

BackgroundMeaning and purpose in life are fundamental to human beings. In changing times, with an aging population and increased life expectancy, the need for health care services and long-term care is likely to grow. More deeply understanding how older long-term care residents perceive meaning and purpose in life is critical for improving the quality of care and the residents’ quality of life. The purpose of this study was to explore crucial aspects promoting nursing home residents’ experience of meaning and purpose in everyday life.MethodAn exploratory hermeneutical design with qualitative interviews for collecting data.ResultsFour key experiences were found to promote meaning and purpose in life: 1) physical and mental well-being, 2) belonging and recognition, 3) personally treasured activities and 4) spiritual closeness and connectedness.ConclusionIn supporting meaning and purpose in life of nursing home residents, the residents’ everyday well-being should be a central focus of care and facilitate personally treasured activities. Focused attention should also be given to the meaning-making power of experiencing belonging, recognition and spiritual connectedness.

The Prevalence and Determinants of Catastrophic Health Expenditures in Iran: A Systematic Review and Meta-Analysis

Objective: In this systematic review, we aimed at estimating the pooled prevalence of catastrophic health expenditures (CHE) in Iran and identifying and summarizing the determinants of CHE among Iranian households. Methods: We comprehensively searched the literature on November 2016 in PubMed, Scopus, Web of Science, the Cochrane Library, and 3 Persian databases. We also obtained the literature through colleague communications. Two review authors independently selected studies, extracted data, and evaluated them. We performed meta-analysis of prevalence of CHE and subgroup meta-analyses to assess the influence of data source and scope of research. Moreover, we categorized the determinants of CHE in Ian. Results: In this review, 16 studies met the inclusion criteria, and of them, 2 presented the results of multiple surveys. Results of 27 cross-sectional studies were used to estimate the pooled prevalence of CHE in Iran during 1995 and 2015, which was found to be 3.91% (95% confidence interval, CI: -3.26- 11.07). Subgroup meta-analyses based on data source revealed that the highest prevalence estimate of facing CHE was associated with author-made questionnaires, and the lowest to the statistical Centre of Iran (SCI) questionnaire. Also, meta-regression showed that the difference in sample size and year of study did not have any significant effect on the prevalence of CHE. Some of the variables such as use of inpatient, outpatient, and dentistry services, education, place of residence, and household income, which were considered as determinants of CHE in Iran, increased the possibility of facing CHE. Conclusions: Decrease in CHE to less than 1%, which was the objective of the 2 of Iran’s five-year development plans in 2007 and 2015, was not met. This percentage may need to be reconsidered according to the pooled estimate of CHE. Also, the factors revealed to be the determinants of an increase in the probability of facing CHE could indicate the need for health care services and socioeconomic variables that lower one’s capacity to pay for health services.

Health Atlas Ireland - Resource Profiler

Introduction: The Resource Profiler informs decisions about meeting local health needs. The available local health resource (such as staff numbers) can be flexibly compared to the local patient case-mix, taking into consideration the makeup of that population group. Background: The national resource/case-mix proportion is used as the gold standard against which each local resource/case-mix proportion is compared. Variance from the national average is expressed in simple graphical, numeric, percentage, and map formats. In the primary/community care context, the demographic profile (i.e. age and deprivation) of the local population form the basis of the patient case-mix as these factors are the dominant drivers of health need. The Resource Profiler allows for the flexible adjustment (weighting) of age and deprivation in terms of their known impact on health and service provision as indicated by available evidence and/or local knowledge. The steps: The resource of interest is first selected, such as the whole time equivalent (WTE) staff type by health administrative area. Secondly, the health service area of interest (such as community health organisation, health and social care network or primary care team) is selected. The granularity of the analysis is dependent on the degree to which the resource is geo-referenced. Thirdly, the appropriate census of population, age range and gender is selected. Projected population per health service area may also be selected to inform longer term health planning projects. Fourthly, the population can be adjusted to take account of the impact of age and deprivation within each area. The age adjustment reflects the often dramatic differences in relative health need by age, as health care utilisation tends to be higher per capita in young children and to rapidly rise in the older age groups. The purpose of the deprivation adjustment is to reflect the poorer health status (and so greater need for healthcare services) that is associated with deprivation. Levels of deprivation is measured for each small area using the Haase & Pratschke (HP b) subtract existing resources from service areas; c) redistribute existing resources between service areas. The change may be applied to all areas, or to areas currently categorised as low, average, and/or high. Display: The Resource Profiler displays the relative distribution of resources against the inferred need by each service area in simple plot and table formats. The impact of population weighting and differences from average are clearly signalled and colour coded. Selecting the map options displays the relative resource/population result in a thematic format for the area type selected. Key services can be displayed on the map to help orientate the user. Health service boundaries and key service locations such as hospitals, health centres and general practice locations can be show in the context of the relative provision of local resources.

Remote Assessment of Older People in a Care Home Setting (REACHES): Qualitative Study

Background: Older adults, particularly those with physical and cognitive impairments, are typically under-recruited in clinical trials, despite the fact that they experience the greatest need for healthcare services. Reasons for underrepresentation are disparate but may relate to comorbidities, communication difficulties (e.g. hearing and vision impairments) and physical immobility that constrains transportation to a research site. Remote trials supported by mobile and wearable health technologies have the potential to make clinical research participation more accessible for these groups. In order to determine the feasibility of this model, it is essential to understand the burden remote data collection places on the participants involved.

Motivating factors in hospital environmental management programs: a multiple case study in four private Brazilian hospitals

Abstract Environmental responsibility has been a widespread and relatively recent research theme in the healthcare sector. Considering that the greater life expectancy increases the need for healthcare services and that these services produce negative environmental externalities on human health, it is important to understand the relationship between environmental responsibility and the healthcare sector. This article aims to investigate what motivates hospital managers to adopt environmental responsibility programs and to identify the actions implemented by them. A multiple case study was conducted involving four Brazilian hospitals based in Rio de Janeiro and São Paulo. The results indicate that the main drivers are competitive, ethical and regulatory and that the competitive and regulatory motivators have the potential to establish a baseline for environmental performance that varies across ownership type (public or private). The results also indicate that the comprehensiveness of environmental actions is related to organizational resilience and to the motivators that drive hospitals to adopt those actions. Two conceptual models are proposed to illustrate these findings and offer bases for further research.

Canadian healthcare readiness for public health emergencies

Following the 2003 SARS (Severe Acute Respiratory Syndrome) outbreak in Toronto, there remains a concern that Canada’s healthcare systems are inadequately equipped to respond to a future public health emergency. Public health emergencies, defined as an emergency need for health care services to respond to a disaster, significant or catastrophic event, are economically costly. Effective prevention and responses to future emergencies would prevent economic costs like those from the 2003 SARS outbreak. An analysis from Hawryluck et al. of the SARS response identified major gaps: incomplete infection control, lack of system-wide communications, and no system-wide coordination leading to isolated, inefficient responses. More than a decade later, improvements have been made but there are areas in the infection control protocol that still require changes. More training is required for Emergency Medical Services (EMS) personnel to effectively handle emergency scenes and to improve multiple agency coordination. Local hospitals need to improve their surge capacity, administrative emergency preparedness infrastructure, and personnel training. The creation of the Public Health Agency of Canada (PHAC) in 2004 responded to concerns about the capacity of Canada’s healthcare system to respond effectively to public health threats. At the provincial level, the Emergency Management Branch (EMB) works effectively similar to and in coordination with PHAC. The needs for improvement should question if Canada will be able to handle the next public health emergency that rolls through its door.

A Simulation Exercise to Raise Learners' Awareness of the Physical and Cognitive Changes in Older Adults.

The growing number of older adults with cognitive impairment is increasing the need for healthcare services. However, there is a great shortage of geriatric trained primary care providers and psychiatrists. A positive attitude towards people with cognitive impairment is associated with better quality of life among residents of long-term care settings. This led us to develop a simulation exercise to raise learners' awareness of, and attentiveness to, physical and cognitive changes experienced by the aging population. Fifty-one learners rotating through Psychiatry at the Michael E. DeBakey VA Medical Center received the 10-min training over 1year. The Approaches to Dementia Questionnaire was used to measure attitudes towards older persons with cognitive impairment. Pre- and postsimulation data subscores for the Hope, Person-centered, and total score were calculated, and a paired sample t test was conducted. Results of the questionnaire showed statistically significant improvement in the Approaches to Dementia Questionnaire scores among participants after they completed the simulation exercise, indicating an increase in positive attitudes. The mean difference in the total score of the Approaches to Dementia Questionnaire was 3.22, with a 95% CI of 1.67 to 4.74, t=4.20, df (47), p<.000, r=.64, and a medium effect size of d=.61. On the basis of these findings, the simulation exercise can be used for improving learners' attitudes towards those with cognitive impairment.

Introducing the Adults with Chronic Healthcare Needs (ACHCN) definition and screening instrument: Rationale, supporting evidence and testing

BackgroundAmong working age adults in the United States, there is a large, heterogeneous population that requires ongoing and elevated levels of healthcare and related services. At present, there are conflicting approaches to the definition and measurement of this population in health services research. ObjectiveAn expert panel was convened by the National Institutes of Health with the objective of developing a population-level definition of Adults with Chronic Healthcare Needs (ACHCN). In addition, the panel developed a screening instrument and methods for its use in health surveys to identify and stratify the population consistently. MethodsThe panel employed multiple methods over the course of the project, including scoping literature reviews, quantitative analyses from national data sources and cognitive testing. ResultsThe panel defined the ACHCN population as “Adults (age 18–65) with [1] ongoing physical, cognitive, or mental health conditions or difficulties functioning who [2] need health or related support services of a type or amount beyond that needed by adults of the same sex and similar age.” The screener collects information on chronic health conditions, functional difficulties, and elevated use of or unmet need for healthcare services. ConclusionsAdapted from the Maternal and Child Health Bureau definition that identifies Children with Special Healthcare Needs, aligned with the ACS-6 disability measure, and consistent with the HHS Multiple Chronic Condition Framework, this definition and screener provide the research community with a common denominator for the identification of ACHCN.

Recontacting in clinical practice: the views and expectations of patients in the United Kingdom

This paper explores the views and expectations of patients concerning recontacting in clinical practice. It is based on 41 semi-structured interviews conducted in the United Kingdom. The sample comprised patients or parents of patients: without a diagnosis; recently offered a test for a condition or carrier risk; with a rare condition; with a variant of unknown significance – some of whom had been recontacted. Participants were recruited both via the National Health Service (NHS) and through online, condition-specific support groups. Most respondents viewed recontacting as desirable, however there were different opinions and expectations about what type of new information should trigger recontacting. An awareness of the potential psychological impact of receiving new information led some to suggest that recontacting should be planned, and tailored to the nature of the new information and the specific situation of patients and families. The lack of clarity about lines of responsibility for recontacting and perceptions of resource constraints in the NHS tended to mitigate respondents’ favourable positions towards recontacting and their preferences. Some respondents argued that recontacting could have a preventative value and reduce the cost of healthcare. Others challenged the idea that resources should be used to implement formalised recontacting systems – via arguments that there are ‘more pressing’ public health priorities, and for the need for healthcare services to offer care to new patients.

Characteristics of communication with older people in home care: A qualitative analysis of audio recordings of home care visits.

To describe the characteristics of communication practice in home care visits between older people (over 65years old) and nurse assistants and to discuss the findings from a person-centered perspective. The older population is increasing worldwide, along with the need for healthcare services in the person's home. To achieve a high-quality care, person-centered communication is crucial. A descriptive design with a qualitative inductive approach was used. Fifteen audio recordings of naturally occurring conversations between 12 nurse assistants and 13 older people in Norway were analysed by qualitative content analysis. Four categories were revealed through analysis: (i) supporting older people's connection to everyday life; (ii) supporting older people's involvement in their own care; (iii) attention to older people's bodily and existential needs; and (iv) the impact of continuity and predictability on older people's well-being. The communication between the older people and the nurse assistants during home care visits was mainly task-oriented, but also related to the person. The older people were involved in the tasks to be carried out and humour was part of the communication. Greater attention was paid to bodily than existential needs. The communication was connected with the older people's everyday life in several ways. Time frames and interruptions concern the older people; hearing and speech impairments were a challenge to communication. To enhance person-centred communication, further studies are needed, especially intervention studies for healthcare professionals and students. Being responsive to older people's subjective experiences is important in meeting their needs in home care. Communication that addresses the need for trust and predictability is important for older people. Responding to existential needs require more attention. The home care setting has an impact on communication.

Hospital admissions by the oldest old: Past trends in one of the most ageing countries in the world.

To examine discharges of octogenarians, nonagenarians and centenarians from Portuguese public hospitals, namely admission type, principal diagnoses, comorbidities and length of stay. The present study used administrative data from public acute care hospitals in the Portuguese National Health Service. All discharges of persons aged ≥80 years between 2000 and 2014 were analyzed. HCUP Clinical Classifications Software was considered to aggregate principal diagnosis, and comorbidities were assessed using the Charlson Comorbidity Index computed using International Classification of Diseases 9th Revision Clinical Modification codes. A total of 2 494 924 discharges of persons aged 80 years or older were registered. Most (73.7%) referred to inpatient episodes, of which 73% were unplanned and medical (non-surgical). Pneumonia (12.2%), acute cerebrovascular disease (7.1%) and non-hypertensive cardiac heart failure (5.3%) were the most common principal diagnoses among inpatient episodes. Congestive heart failure and diabetes without chronic complications were the two most frequent comorbidities (16.6%), and discharge diagnoses with higher median length of stay were tuberculosis, burns, and infective arthritis and osteomyelitis. The number of hospitalizations of the oldest old has suffered a significant increase in the past few years, reinforcing the need for healthcare services being prepared to the specificities of the oldest old population. Geriatr Gerontol Int 2017; 17: 2255-2265.

Unmet need for healthcare services in adolescents and young adults with cancer and their parent carers.

Cancer in adolescents in and young adults (AYA) has the potential to disrupt health, well-being and developmental trajectories. This study aimed to describe the healthcare support service needs of AYAs with cancer and parent carers and to explore the association of unmet need and emotional distress. As part of a national Australian survey of 15-25year olds with cancer and a nominated parent carer, 196 AYAs reported total and unmet need for 10 clinical services and 204 parents reported on their child's and their own healthcare service needs. Proportions of total and unmet need for specific clinical services are reported. The association of unmet service needs and distress (measured using the Posttraumatic Stress Disorder Checklist) was also examined. AYAs and parent carers expressed high total need for clinical services during treatment. Leading AYA unmet needs were for an exercise therapist (37%), genetic counsellor (30%), dietitian (26%), peer support group (26%) and educational and vocational advisor (24%). After treatment, AYAs and parents had fewer total needs. However, 60% of AYA and 38% of parents had two or more unmet needs, similar to during treatment. Female gender and receiving treatment in an adult setting were significantly associated with unmet need for clinical services. After treatment, higher distress levels in AYAs and parents were associated with two or more unmet service needs. AYAs and parents had high levels of total and unmet service need, which were associated with greater emotional distress. These results highlight opportunities to re-orientate services to better meet AYA and parent needs.

Unmet healthcare needs in Ireland: Analysis using the EU-SILC survey

The analysis used the 2013 Survey of Income and Living Conditions to examine the extent and causes of unmet need for healthcare services in Ireland. The analysis found that almost four per cent of participants reported an unmet need for medical care. Overall, lower income groups, those with poorer health status and those without free primary care and/or private insurance were more likely to report an unmet healthcare need. The impact of income on the likelihood of reporting an unmet need was particularly strong for those without free primary care and/or private insurance, suggesting a role for the health system in eradicating income based inequalities in unmet need. Factors associated with the healthcare system – cost and waiting lists – accounted for the majority of unmet needs. Those with largely free public healthcare entitlement were more likely than all other eligibility categories to report that their unmet need was due to waiting lists (rather than cost). While not possible to explicitly examine in this analysis, it is probable that unmet need due to cost is picking up on the relatively high out-of-pocket payments for primary care for those who must pay for GP visits; while unmet need due to waiting is identifying the relatively long waiting times within the acute hospital sector for those within the public system.

The Syrian public health and humanitarian crisis: A ‘displacement’ in global governance?

ABSTRACTOngoing failure by the international community to resolve the Syrian conflict has led to destruction of critical infrastructure. This includes the collapse of the Syrian health system, leaving millions of internally displaced persons (IDPs) in urgent need of healthcare services. As the conflict intensifies, IDP populations are suffering from infectious and non-communicable disease risks, poor maternal and child health outcomes, trauma, and mental health issues, while healthcare workers continually exit the country. Healthcare workers who remain face significant challenges, including systematic attacks on healthcare facilities and conditions that severely inhibit healthcare delivery and assistance. Within this conflict-driven public health crisis, the most susceptible population is arguably the IDP. Though the fundamental ‘right to health’ is a recognised international legal principle, its application is inadequate due to limited recognition by the UN Security Council and stymied global governance by the broader international community. These factors have also negatively impacted other vulnerable groups other than IDPs, such as refugees and ethnic minorities, who may or may not be displaced. Hence, this article reviews the current Syrian conflict, assesses challenges with local and global governance for IDPs, and explores potential governance solutions needed to address this health and humanitarian crisis.

Spatial clusters of AIDS in Indonesia

ObjectiveThis study seeks to determine whether distinctive clusters of case rates, number of new cases, treatment types, and other socio-demographic characteristics exist among provinces in Indonesia. Hierarchical Agglomerative and k-means clustering techniques are used to empirically derive the patterns of AIDS among Indonesian provinces by forming clusters of provinces with similar characteristics. MethodsCluster analysis is used to segment the Indonesian provinces in terms of how their rates of medical care and number of new cases of AIDS vary with respect to the socio-economic characteristics and sustainable health system of the province. Data from the 2011 Statistik Indonesia (2014–2015) and the 2006 Governance and Decentralization Survey were used. ResultsCluster analysis yielded three distinct clusters: the high incidence rates and moderately high case rates cluster, the low case and incidence rates cluster, and the high case and incidence rates cluster. ConclusionAddressing the socioeconomic, demographic, and health inequalities that exist among the provinces should be a priority. Preventive interventions should consider provincial poverty and illiteracy rates, the population and its density, the type of self-treatment sought, the unmet need for healthcare services, the density of medical professionals, as well as the number of opportunistic infections.

Alcohol consumption and use of health care services in people with severe mental illness and stressful childhood experiences

ABSTRACTPeople who suffer from severe mental illness often present with histories of abuse during childhood. Alcohol use disorders is a common co-morbidity of survivors of childhood abuse and neglect. This study analyzes the effects of stressful childhood experiences, a proxy for trauma, on the frequency of alcohol consumption and the utilization of health care services in a population of people with severe mental illness. There were 111 men (mean age: 35 years) and 72 women (mean age: 40.0 years) with severe mental illness that were recruited from psychiatric outpatient clinics in New York City. The analysis focused on lifetime prevalence of stressful childhood experiences, alcohol consumption, and utilization of health care services over time. The longitudinal data were analyzed over 12 months with a level-2 model (multilevel modeling). Out of the participants, 41.5% reported a history of more than four types of abusive experiences. There were 33.3% that had a DSM-IV diagnosis of alcohol abuse and 27.3% qualified for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of alcohol dependence throughout their lives. Stressful childhood experiences predicted an increased frequency of alcohol consumption over time. People with histories of childhood abuse had more often been to outpatient clinics and 12-step programs, but at the same time showed lower frequency rates of psychiatrist visits and visits to outpatient clinics. Childhood abuse is prevalent in people with severe mental illness and is related to an increased alcohol consumption. Despite an increased need of health care services, affected persons might encounter more barriers to access them.

Health Care Engagement Among LGBT Older Adults: The Role of Depression Diagnosis and Symptomatology.

Optimal engagement in health care plays a critical role in the success of disease prevention and treatment, particularly for older adults who are often in greater need of health care services. However, to date, there is still limited knowledge about the relationship between depression and health care engagement among lesbian, gay, bisexual, and transgender (LGBT) older adults. This study utilized data from Aging with Pride: National Health, Aging, Sexuality/Gender Study, from the 2014 survey with 2,450 LGBT adults 50 years old and older. Multiple-variable regression was utilized to evaluate relationships between three indicators of health care engagement and four depression groups after controlling for background characteristics and discrimination in health care. Health care engagement indicators were "not using preventive care," "not seeking care when needed," and "difficulty in adhering to treatments." Depression groups were defined by depression diagnosis and symptomatology, including Diagnosed-Symptomatic group (Diag-Sympt), Diagnosed-Nonsymptomatic group (Diag-NoSympt), Nondiagnosed-Symptomatic group (NoDiag-Sympt), and Nondiagnosed-Nonsymptomatic group (NoDiag-NoSympt). Depression groups displayed different patterns and levels of health care engagement. The Diag-Sympt group displayed the highest "difficulty in adhering to treatments." Diag-NoSympt group displayed the lowest "not using preventive care." The NoDiag-Sympt group reported the highest "not using preventive care" and "not seeking care when needed." The NoDiag-NoSympt group had the lowest "not seeking care when needed" and "difficulty in adhering to treatments." Depression diagnosis and symptomatology are jointly associated with health care engagement among LGBT older adults. Interventions aiming to promote health care engagement among this population should simultaneously consider both depression diagnosis and symptomatology.

Analysis of the Inequalities in Healthcare Service Usage Considering Healthcare Service Needs

Analysis of the Inequalities in Healthcare Service Usage Considering Healthcare Service Needs

Comparison of pharmaceutical pricing and reimbursement systems in Turkey and certain EU countries.

Recently, the need for health care services has increased gradually and the limitations in sources allocated for this area have been recognized. Moving from this fact, it has gained a supreme importance to determine what health programs or technologies will be given priority. According to Danzon (Reference pricing: theory and evidence, reference pricing and pharmaceutical policy: perspectives on economics and innovation, springer, New York, pp 86–126, 2001), arrangements towards controlling the expenses through price and profit controls, reimbursement methods and incentives have recently gained wide currency. This present study examines; along with the current situation in Turkey, pharmaceutical pricing methods, reimbursement methods and basic health indicators, within the scope of changing pharmaceutical policies, in Turkey, the EU countries which Turkey takes as reference and the United Kingdom, the implementations of which are of utmost importance for other countries. Upon the research conducted, it was detected that the pharmaceutical pricing in Turkey has been performed on the basis of the reference pricing system that takes Italy, Portugal, Spain, Greece and France as reference. The regulations regarding the reimbursement process are determined by SSI. For Turkey’s case; pricing and reimbursement system has been changed numerous times and the discount rates has incrementally risen. In pricing, on the other hand, during this period companies faced with difficulties in economic terms because of the fact that price discount of high rates are implemented over the reference price and that the European currency of Euro is determined as 70% of previous year average Euro sales rate which is 2,1166 for the year 2016. Each country has specific regulations and pricing and reimbursement policies of medicines based on economic situation, reimbursement methods and market size. The aim of pricing and reimbursement systems are reaching more efficient and sustainable healthcare systems.

Balancing the use of language to enable care: a qualitative study of oral and written language used in assessments and allocations of community healthcare services for persons with dementia.

BackgroundAlthough a large number of people are diagnosed with dementia each year, the syndrome is still perceived as a sensitive and tabooed topic. Communication about dementia to those living with the syndrome and their relatives is often experienced as challenging by health professionals.Failure to communicate clearly may threaten assessment and allocation of appropriate, effective healthcare services. Accordingly, the aim of this study was to explore how purchasers, assessing and allocating healthcare services to home-dwelling older people with dementia, described challenges in communicating about dementia with those with the syndrome and their relatives. Furthermore, the study aimed to explore the purchasers’ justifications for their choice of words.MethodsA qualitative study was conducted to investigate two data sources: focus group interviews with purchasers assessing need for healthcare services, and a review of administrative decisions written by those allocating services. Focus group data were explored using an interpretive approach and qualitative content analysis was carried out with the administrative decisions.ResultsThe purchasers found it challenging to talk and write about dementia to those with the syndrome and their relatives when assessing and allocating services. The purchasers were flexible in their communication and aimed to be open when talking and writing about dementia. However, euphemisms and omission were used extensively. Four justifications for the chosen verbal and written language were identified: avoiding disclosure; protecting the person with dementia; protecting the relatives/avoiding conflict; and last, taboo and stigma.ConclusionsDespite purchasers experiencing difficulties in communicating about dementia to those with the syndrome and their relatives, they did manage to communicate in a conscious and flexible way. The purchasers had several justifications for their language choice. However, extensive use of euphemisms and omission might threaten appropriate identification of needs and provision of high quality healthcare services. The challenges experienced by the purchasers demonstrate the need to focus on appropriate and flexible strategies for individually-tailored communication about dementia with people living with the syndrome.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1659-0) contains supplementary material, which is available to authorized users.