Optimal Health Care System Research Articles

Burnout level and associated factors in a sub-Saharan African medical setting: prospective cross-sectional survey

BackgroundBurnout in the hospital environment is a problem that affects care and training. Often explored in the high-income medical context, burnout is poorly studied in low and middle-income countries characterized by a precarious hospital situation and a high stake linked to the Millennium Development Goals. The aim of our study was to determine in medical practitioners, in a sub-Saharan African country’s medical context, the burnout level and associated factors.MethodsA prospective cross-sectional study by using a self-administered Likert-scale questionnaire addressed to doctors and doctoral medical students in Gabon. Maslach Burnout Inventory scale has been used. Burnout symptoms were defined by high level in at least one of the 3 dimensions. Severe burnout defined by high level in all dimensions. Explored factors: socio-demographic and psychometric. Multiple logistic regression has been performed.ResultsAmong 104 participants, severe burnout prevailed at 1.9% (95% CI: 0.2–6.8%) and burnout symptoms at 34.6% (95% CI: 25, 6–44.6%). The associated factors with burnout symptoms: age (OR = 0.86, p = 0.004), clinical activity in a university hospital center (OR = 5.19, p = 0.006), the easy access to the hospital (OR = 0.59, p = 0.012), number of elderly dependents living with the practitioner (OR = 0.54, p = 0.012), place of residence (same borough where the hospital is located: OR = 4.09, p = 0.039) and to be favorable to traditional medicine (OR = 1.82, p = 0.087). Nagelkerke’s R-squared:53.1%.ConclusionIn Gabon, middle-income country, almost one practitioner in two has burnout symptoms. The young age, the university hospital center, the difficulty to access to hospital and to live in the borough where the hospital is located increase the probability of burnout symptoms. These results must put question to relevant authorities regarding health and medical education, to set up: a public transport for practitioners, an optimal primary health care system, a regulation of medical tasks in hospitals, a training in clinical supervision.

Fostering Collegial Collaboration Between Labor Nurses and Doulas

Nurses and doulas do not always have positive views of each other. When labor nurses face challenges in their ability to provide continuous labor support, one might believe that a doula would be welcomed, yet this is not always true. Conflicts can arise between nurses and doulas, often because of overlapping roles. However, an optimal health care system is one for which there is an integrated system that fosters collegial interprofessional collaboration. This commentary explores the role of doulas and the care they provide and describes strategies to promote collegial relationships between nurses and doulas.

Why some patients who do not need hospitalization cannot leave: A case study of reviews in 6 Canadian hospitals.

In an optimal healthcare system, patients receive care in the most appropriate, least expensive setting. In Canada, too many patients remain in hospital well after they no longer require hospital-based care. This study examines the observations on this problem by a team with a home and community lens in six cases. The underlying issues across the six are the insufficiency of home and community supports before hospitalization, the routine underestimation of these patients’ potential for independence, the deconditioning of patients while in hospital, and hospital staff’s lack of understanding of home care. Addressing these issues would help many of these patients transition from hospital to less costly, more fitting settings.

Appropriateness of emergency department use in pediatric inflammatory bowel disease: a quality improvement opportunity.

We sought to characterize emergency department (ED) encounters for pediatric inflammatory bowel disease (IBD) to identify areas for prevention. Retrospective chart review of 5 consecutive ED encounters at 7 centers was performed. Of 35 unique encounters by 32 patients, 3 main factors contributed to ED utilization: disease severity or course, day or time of care, and physician instruction. Of the ED encounters, approximately one-fifth were judged medically unnecessary, and one-half avoidable in a more optimal health care system. ED visits by pediatric patients with IBD may be reduced in a more optimal health care system.

Users’ Perception towards the “Safe Medication through Pharmacovigilance and Compliance Monitoring (Pharmacov)” Service

A feasibility study was conducted to evaluate the acceptability and effectiveness of the “Safe medication through pharmacovigilance and compliance monitoring (PharmacoV)” service, an Internet-based interactive information tool that assists physicians in identifying potential Adverse Drug Events (ADEs) or contraindications when they are prescribing medicinal products to patients. The users’ perception was assessed by the means of a structured questionnaire containing Likert type responses ranging from 1 to 5. Five hundred eighty nine (n=589) healthcare professionals were enrolled during an eight (8) month trial of the service in London, UK during 2007. The vast majority of the healthcare professionals who participated in the study was very enthusiastic about the PharmacoV concept and perceived clear benefits in terms of accessing drug information. The authors’ results suggest that a well-designed intervention study is possible. This will allow the evaluation of the feasibility, acceptability and effectiveness of the intervention in the context of the different European healthcare systems, and may gradually shape an optimal health care system. Their study is limited to the specific extend that the pilot trial of the service could not be implemented as part of the routine clinical practice of the participating physicians mainly because of the need to continuously update the service functionality during the execution of the study.

Present problems and controversies concerning pregnant adolescents

Pregnancy during adolescence is a very vulnerable aspect of human reproduction. Multiple studies from around the world show the increased burden of pregnancy on adolescent females compared to their adult counterparts, with adverse outcomes for both mother and child including anemia, preterm delivery and low birth weight. Adverse obstetrical outcomes have been related to socio-economic status, physical immaturity and ongoing maternal growth, and nutritional status. Negative aspects related to pregnancy may be mitigated with an optimal health care system targeting certain areas within this specific population, such as socio-economic and family support, treatment of infections, adequate nutrition, appropriate management of labor and the implementation of intervention programs (both before and after birth). Preventing subsequent pregnancies in adolescent mothers should be a major medical and social goal. This manuscript will review updated information regarding the risks related to adolescent pregnancies.

Ex PostWelfare under Alternative Health Care Systems

AbstractThe implications of a societal aversion to inequality for the optimal structure of the health care system are studied. The agents are assumed to be ex ante identical, but to differ ex post in the state of their health. Inequality aversion is introduced by postulating a strictly concave ex post social welfare function. It is shown that the optimal public health care system allocates health care differently than would private health insurance; specifically, people who are relatively unhealthy with and without treatment receive more health care, and people who are relatively healthy with and without treatment receive less health care. The aggregate quantity of health care under the optimal public health care system can be either greater or smaller than under private health care insurance. If the public health care system is optimally designed, allowing agents to purchase supplementary private health care insurance cannot raise social welfare and is likely to decrease it.

Implementing economic principles in medicine while maintaining medical professionalism

IntroductionVarious forms of the managed-care concept have been conceived to reconcile the medical professionalism with necessary cost-cutting measures in health-care provision. A plethora of bureaucratic regulations and required paperwork result in increasing resignation among physicians and withdrawal from patient care.OptionsAn appropriate option would be to focus not on structures and processes, but primarily on patient-related outcomes. We describe suitable options, their possible consequences, possible developments, and conclusions that can be derived.PrognosesNeglecting a trustful doctor-patient relationship risks forfeiting fundamental parts of essential health-care provision. Patients’ preferences have to be respected, while unnecessary risks and expenses have to be avoided.Further developmentAt least 12 dimensions influence the balance between medical professionalism and economics. The success of our health-care systems will depend on the best possible mix.ConclusionAn optimal health-care system is characterized neither by the structures nor processes of health-care delivery, but by the quality of patient outcomes. Our patients must be involved in the description of the goals they want to achieve so that physicians can select the best possible ways to attain these goals.

Is a Paradigm Shift in US Healthcare Reimbursement Inevitable?

The fundamental goal of health care is to increase longevity and optimize physical, psychological, and social well-being at the individual, community, and society levels. An optimal healthcare system should fulfill these goals in an efficient and cost-effective manner. Although we believe that our healthcare system in the United States is going in the right direction, there is certainly room for improvement.1 In the present article, we review some of the shortcomings of the present system and offer an alternative philosophy that might facilitate a more viable and efficient approach to healthcare expenditure. In the present environment, health care is generally viewed as an expense, and, because “costs” are managed by budgets, this translates into a fiscal mindset in managing health care. Naturally, this attitude generates a pattern of fragmented thinking. That is, the individual components of healthcare cost, such as pharmacy and hospital inpatient admissions, are considered independently, whereas total healthcare value and other important patient outcomes are overlooked. This fiscal mindset also does little to encourage the provision of quality care because reimbursement is based more on quantity. The natural consequence of this is exemplified by the results of a recent study in which patients received only 55% of the recommended care.2 The failure of the current system to promote quality care is also apparent in the infrequent use of incentives for preventive care or proactive disease management. Indeed, such services are often not reimbursed. In short, the focus is on episodic care rather than on encouraging proactive health management. This contributes to the current environment in which 50% of Medicare dollars are being spent on 5% of the Medicare population.3 Finally, a cost-based system fails to consider broader societal benefits of improving health, such as increased productivity and improved quality of life. Our criticism of …

Professional autonomy in the health care system.

Professional autonomy interferes at a structural level with the various aspects of the health care system. The health care systems that can be distinguished all feature a specific design of professional autonomy, but experience their own governance problems. Empirical health care systems in the West are a nationally coloured blend of ideal type health care systems. From a normative perspective, the optimal health care system should consist of elements of all the ideal types. A workable optimum taking national values into account could be attained by governance structures that also introduce elements from other ideal type systems. Thus a normative approach to medical practice guaranteeing an essential degree of professional autonomy for a relationship of trust between the patient and the physician, could be combined with an efficient and equitable allocation of health care resources.

A Proposed Optimal Health Care System Based on a Comparative Study Conducted Between Canada and Japan

Every country wants a good health care system for all citizens with minimum expenditure. By comparing health care systems in Canada and Japan, both of which have a universal health care system for all citizens in its own country, an attempt was made to visualize or search for an optimal health care system. Data and information obtained were tabulated and compared from the standpoint of the effectiveness of the health insurance system and the feasibility of its application so as to propose an optimal health care system. Some of the suggestions and proposals made for an optimal health care system for all citizens include implementation and/or establishment of minimal user fees, centralized rational decision-making processes, private delivery system of health care, centralized computer-aided patient record system, insurance monitoring system, patient education, and physician guidelines.

Practitioner or provider: Are they mutually exclusive?

Practitioner or provider: Are they mutually exclusive?

In search of an optimal health care system.

In search of an optimal health care system.