Organization Of Health Care Services Research Articles

Transitional care: the evolution of an ever-green service to make integrated care happen

The coordination of care across the health care continuum represents the most critical organisational knot to meet the actual implementation, management, and outcome evaluation of a patient’s care plan. In fact, poor coordination of services, fragmentation of treatments, lack of discharge planning and ineffective handoff of information between care providers can lead to poor transitions and, in turn, can cause overlaps with treatment plans, duplicative testing, discrepancies in medications, missed physician follow-up, patient dissatisfaction and, consequently, burgeoning of health care costs. Transitional Care TC models are gaining increasing value and a wide spread out, at the international level, to improve the quality and efficiency of health services’ delivery and have been piloted and tested in different Countries as well as within different healthcare service delivery models and organisations. TC models have a long-lasting presence in the literature if we consider discharge management and planning services, however, analysis of the emergence of new TC models, especially exploiting the health service management perspective and the interest to generalise models of care to support health managers and policy makers are very limited. In this line, there is a widespread recognition across experts that more research is needed on services organisations. In this broad scenario, we aim to provide a comparative analysis of TC patterns across Europe by cross-tabulating independent and dependent variables featuring the institutional and organisational context of development. We therefore aim to explore what are the main characteristics of the health service delivery model; what are the opportunities, threats and levers of improvement across different organisational configurations; and to what extent organizational arrangements of TC models may impact their capacity to influence the health service delivery model, the strategic planning and indeed the capacity to meet patients’ needs. We employed mixed methods in order to exploit a multiple case-study analysis. These included a literature review of theoretical frameworks and TC experiences developed at an international level and an in-depth analysis of several TC experiences analysing local documents and interviewing key managers of the services. Whereas the new models of TC retain the original objectives of discharge management and planning services, their role and organisation is changing dramatically within the renewed model of delivery designed by managed care models and the search for integration across the overall care system from community to acute to end of life care. Of interest, in most cases, either due to the complexity of the new TC models, which require not only discharge management but the overall management of patient and of transitions across care settings, or due to the fragmentation of services, TC services have been externalised to new agencies or services outside the delivery system i.e. the service centre. The latter organisational choice allows TC models to serve the organisations as well as the patients and families. On the contrary, where TC models have been established within healthcare organisation, they are located as a strategy service unit belonging to the strategic board of managers, but these patterns serve only the organisation and not the patients.

AidAdom: Supporting Inter-Organizational Coordination for Home Help and Healthcare Services Through a Web Platform

PurposeFrom temporary need of help for household chores after a short stay at the hospital to complex healthcare due to chronic conditions, an important number of professional caregivers belonging to different organizations are involved in providing help and healthcare services at home. Despite the well-defined role of each professional, these organizations are complaining of a lack of coordination and visibility of each other work, especially in case of incident. Coordination between organizations appears here as essential but is at the same time the responsibility of all and of no one of the involved professionals. In this context, our research aims at supporting coordination for home care work through the design and implementation of a web platform. MethodsIn order to ground the design of an inter-organizational coordination platform (AidAdom), we first studied the work practices and coordination issues of two help services providers through interviews and observation with different stakeholders (n=11). Then we have conducted a pilot study at three homes (involving from 6 to 17 caregivers) during one month to evaluate the system use in the field as well as to address implementation issues at both technical and social levels. ResultsWe provide an account of inter-organizational coordination in home care and identify issues in terms of limited resources for articulation work and basic coordination information sharing requirements. This analysis supports the features of the AidAdom web platform that enable caregivers to easily register data and messages related to their interventions. The pilot study allowed us to identify deployment issues at regional scale. ConclusionThe AidAdom platform provides a lightweight system which enables organizations to share a minimal set of coordination information. Our future work is oriented toward opening the system to new help and healthcare service professionals and organizations.

Implementation of Integrated Care in Singapore: A Complex Adaptive System Perspective.

Background:Integrated care that focuses on organising healthcare services around people and their communities rather than their diseases is promoted as the strategy to overcome the challenges associated with growing complexity in healthcare needs, demand for healthcare services and inadequate supply of services due to fragmentation in the provision of services. While conceptually appears to be simple, integrated care is made up of multicomponent delivery strategies targeting various levels of the healthcare system while engaging various stakeholders in their execution.Methods:We applied the complex adaptive system (CAS) perspective to two different initiatives that exemplify approaches towards integrating care in Singapore: the Regional Health System (RHS) model, implemented across healthcare institutions at the national level, and CARITAS Integrated Dementia Care implemented in the northern region of Singapore. We adopted an inductive approach in our analysis in which we studied the RHS and CARITAS Integrated Dementia Care according to the components of the CAS. We applied the typical characteristics of CAS: (i) diverse, interdependent and semi-autonomous actors (ii) self-organizing capacity and simple rules (iii) relationship with the bigger system, emergent behaviour and non-linearity in our analysis of key drivers behind the implementation of both the RHS and CARITAS integrated dementia care.Results:By considering the RHS and CARITAS as whole networks each comprising of interacting and adaptive components instead of separate entities within a bigger system, the CAS provided a new mind-set in surfacing issues associated to the implementation of these integrated care networks. In addition to important actors, systems, it informed understanding of relationships and dependencies between different parts of the network – revealing the lack of homogeneity, conformity and difficulties in designing any optimal system in advance given the many moving parts.Conclusions:Drawing on the two examples of integrated care networks, this paper highlights the significance of effective collaboration built on a common focus, responsiveness to emergent behaviours, simple rules, the ability to self-organize and adapt in response to unexpected situations in further development of integrated care in the Singapore context and beyond.

An intelligent algorithm for assessing patient safety culture and adverse events voluntary reporting using PCA and ANFIS.

Patient safety culture (PSC) as a main component of the organizational culture plays a key role in providing safe, effective and economic cares and services in healthcare organizations. PSC provides a way to assist hospitals in order to improve patient safety and prevent medical errors. The present study aimed to measure PSC and healthcare professionals' attitude towards voluntary reporting of adverse events in two hospitals in Iran and to develop a hybrid intelligent approach for modeling PSC grades. The Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire and a two-part questionnaire were used for examining the PSC and healthcare professionals' attitude towards voluntary reporting of adverse events, respectively. Principal component analysis (PCA) was applied to extract of the main components in the HSOPSC questionnaire and to construct 12 dimensions of patient safety culture. The overall grade of patient safety culture was modeled using adaptive neuro-fuzzy inference systems (ANFIS) as a classification problem. Almost half of the participants have experienced a medical error and adverse events. The PSC grade was acceptable from the point of view of 55.5% and 50% of participants in hospital No.1 and hospital No.2, respectively. The overall accuracy of ANFIS in modeling overall grades of patient safety culture in both study hospitals was 0.84. Of those individuals gave an acceptable grade on patient safety culture in both study hospitals, more than 50% believed that all medical errors and near misses should be reported. The ANFIS algorithm was proposed for modeling and predicting of PSC for healthcare organizations. The results confirm the capability of the proposed model to predict patient safety grades in healthcare settings.

Impact of the Regional Network for AMI in the Management of STEMI on Care Processes, Outcomes and Health Inequities in the Veneto Region, Italy.

Cardiovascular diseases are a leading cause of death in Europe. Outcomes in terms of mortality and health equity in the management of patients with ST-Elevation Myocardial Infarction (STEMI) are influenced by health care service organization. The main aim of the present study was to examine the impact of the new organizational model of the Veneto Region’s network for Acute Myocardial Infarction (AMI) to facilitate primary percutaneous coronary intervention (PCI) on STEMI, and its efficacy in reducing health inequities. A retrospective cohort study was conducted on HDRs in the Veneto Region for the period 2007–2016, analyzing 65,261 hospitalizations for AMI. The proportion of patients with STEMI treated with PCI within 24 h increased significantly for men and women, and was statistically much higher for patients over 75 years of age (APC, 75–84: 9.8; >85: 12.5) than for younger patients (APC, <45: 3.3; 45–64: 4.9), with no difference relating to citizenship. The reduction in in-hospital, STEMI-related mortality was only statistically significant for patients aged 75–84 (APC: −3.0 [−4.5;−1.6]), and for Italians (APC: −1.9 [−3.2;−0.6]). Multivariate analyses confirmed a reduction in the disparities between socio-demographic categories. Although the new network improved the care process and reduced health care disparities in all subgroups, these efforts did not result in the expected survival benefit in all patient subgroups.

Rethinking the Meaning of Cloud Computing for Health Care: A Taxonomic Perspective and Future Research Directions.

BackgroundCloud computing is an innovative paradigm that provides users with on-demand access to a shared pool of configurable computing resources such as servers, storage, and applications. Researchers claim that information technology (IT) services delivered via the cloud computing paradigm (ie, cloud computing services) provide major benefits for health care. However, due to a mismatch between our conceptual understanding of cloud computing for health care and the actual phenomenon in practice, the meaningful use of it for the health care industry cannot always be ensured. Although some studies have tried to conceptualize cloud computing or interpret this phenomenon for health care settings, they have mainly relied on its interpretation in a common context or have been heavily based on a general understanding of traditional health IT artifacts, leading to an insufficient or unspecific conceptual understanding of cloud computing for health care.ObjectiveWe aim to generate insights into the concept of cloud computing for health IT research. We propose a taxonomy that can serve as a fundamental mechanism for organizing knowledge about cloud computing services in health care organizations to gain a deepened, specific understanding of cloud computing in health care. With the taxonomy, we focus on conceptualizing the relevant properties of cloud computing for service delivery to health care organizations and highlighting their specific meanings for health care.MethodsWe employed a 2-stage approach in developing a taxonomy of cloud computing services for health care organizations. We conducted a structured literature review and 24 semistructured expert interviews in stage 1, drawing on data from theory and practice. In stage 2, we applied a systematic approach and relied on data from stage 1 to develop and evaluate the taxonomy using 14 iterations.ResultsOur taxonomy is composed of 8 dimensions and 28 characteristics that are relevant for cloud computing services in health care organizations. By applying the taxonomy to classify existing cloud computing services identified from the literature and expert interviews, which also serves as a part of the taxonomy, we identified 7 specificities of cloud computing in health care. These specificities challenge what we have learned about cloud computing in general contexts or in traditional health IT from the previous literature. The summarized specificities suggest research opportunities and exemplary research questions for future health IT research on cloud computing.ConclusionsBy relying on perspectives from a taxonomy for cloud computing services for health care organizations, this study provides a solid conceptual cornerstone for cloud computing in health care. Moreover, the identified specificities of cloud computing and the related future research opportunities will serve as a valuable roadmap to facilitate more research into cloud computing in health care.

P2‐128: Viral hepatitis: healthcare services organization, access and integrality

P2‐128: Viral hepatitis: healthcare services organization, access and integrality

The delay to the first psychiatry consult in two acute inpatients clinics in Romania

Around 25% of adults experience a mental illness in each year and approximately 60% received no mental health care. There are still long delays between the onset of symptoms and the first psychiatric consult and treatment. Objective: To understand the pathway to care and to determine the delay in seeking help for mental health problems, considering sociodemographic variables in patients admitted in two Romanian acute psychiatric inpatients settings. Methods: Between May-August 2015, WHO's Pathway Encounter Form was applied to 200 individuals, at their first admission, consecutively hospitalized in acute psychiatry clinics from Targu Mures and Craiova, Romania. Results: The profile of the participants in this study was: woman in the sixth decade of life, having an average economic status and without psychiatric history, searching help for depressive symptoms (by themselves or at the advice of the family), mainly to a psychiatrist or a General Practitioner. The average delay from the onset of symptoms to the first psychiatry consult was 16 weeks. Only previous positive personal history for MH problems and current diagnosis had a high statistically significant influence on the moment when subjects of our study decided to access the MH services. Conclusions: A better knowledge and understanding on the factors that influence people to seek help in mental health problems would be useful for improving the future organization of healthcare services and programs.

Applying the benefits of biophilic theory to hospital design

IntroductionIn 1839, the Lexicon Medicum mentioned the “healing powers of nature”, arguing that many illnesses could be cured without the help of medicines, simply by paying attention to air, food, rest, physical activity, and state of mind. Therefore, already then, the environment was considered therapeutic and capable of affecting the health of individuals and helping their recovery (Hickman in Therapeutic landscape. A history of English hospital gardens since 1800, 2013). This awareness has remained valid since then, although the approach has changed and evolved over time.Case descriptionIn the 20th century, these assumptions have been supported, among others, by the research carried out by Ulrich on the ability of surgical patients to recover when they were exposed to the sight of nature. Indeed, there is a growing body of research which confirms the benefits of interacting with nature in hospital settings. The results of such studies have helped to better define a new approach to design that benefits the psychophysical well-being of individuals and improves their health (i.e. biophilic design).Discussion and evaluationThe aim of this article is to highlight the growing importance of a cultural change in the design of spaces aimed at reconnecting individuals with the patterns and processes of nature, both in the urban context and, in particular, in healthcare spaces. This study intends to contribute to the ongoing debate concerning a new architectural language for hospitals and to shed light on the key features of health-inducing buildings.ConclusionsThe global health challenges of the 21st century require a new way of thinking and a change in the organisation of healthcare services through an approach that considers human needs in their entirety, and not in a strictly therapeutic sense. According to several studies, the humanisation of healthcare spaces and contact with nature can empower the patient and have a positive impact by reducing stress and pain and improving emotional wellbeing. However, further studies are required not just in order to deepen our understanding of the human-nature relationship and its impact on health, but also to change our approach regarding patients’ health by considering a new vision of medicine, healthcare and healing environment.

Links between social environment and health care utilization and costs

ABSTRACTThe social environment influences health outcomes for older adults and could be an important target for interventions to reduce costly medical care. We sought to understand which elements of the social environment distinguish communities that achieve lower health care utilization and costs from communities that experience higher health care utilization and costs for older adults with complex needs. We used a sequential explanatory mixed methods approach. We classified community performance based on three outcomes: rate of hospitalizations for ambulatory care sensitive conditions, all-cause risk-standardized hospital readmission rates, and Medicare spending per beneficiary. We conducted in-depth interviews with key informants (N = 245) from organizations providing health or social services. Higher performing communities were distinguished by several aspects of social environment, and these features were lacking in lower performing communities: 1) strong informal support networks; 2) partnerships between faith-based organizations and health care and social service organizations; and 3) grassroots organizing and advocacy efforts. Higher performing communities share similar social environmental features that complement the work of health care and social service organizations. Many of the supportive features and programs identified in the higher performing communities were developed locally and with limited governmental funding, providing opportunities for improvement.

Kompetenzanforderungen an Führungskräfte in Organisationen des Gesundheits- und Sozialwesens: Ergebnisse einer Delphi-Studie

BackgroundLeadership in social services and healthcare organizations is marked by high levels of complexity and contradiction, which cannot be fully explained by politically, economically, and socially induced changes. Rather, it is the particularities of service provision in healthcare and social services that confront executives with specific demands. ObjectiveThis study aimed to capture and prioritize required leadership competencies in healthcare and social services organizations. MethodsA three-step Delphi study was conducted with executives and managerial staff, who are job holders and thus experts on their occupation. For the first step, an explorative qualitative approach was chosen to record general opinion without prior assumptions. The following two steps weighted and selected the competency requirements in step one using rating- and ranking procedures. ResultsResults of the Delphi inquiry imply high relevance of social and personal competencies. Approximately 66 % of the competencies assessed in round three were social and personal competencies. 12 out of the 15 highest rated competencies in Delphi step three can be assigned to these two competency categories. In contrast, the importance of professional as well as methodical competencies was rated as less important. Only two methodical competencies and one professional competency were rated as very important by the panel. Nevertheless, the importance of executive professional and methodical competencies in healthcare and social services organizations is emphasized by high ratings of the competencies “Sector-specific expertise” and “Analytical skills”. The methodical competency “Analytical skills” was identified by the Delphi respondents as the most important competency requirement. ConclusionSocial and personal requirements are of primary importance for leadership in healthcare and social services organizations. These results mostly correspond to leadership requirements posited in the literature on leadership skills. Emphasis should be on the specific relevance of professionalism, which can be traced back to the high proportion of professional activities in everyday working practices, the self-conception of executive staff based on professional qualifications and profession as well as the organizational form as expert organization. Healthcare and social services organizations are expert organizations with a strong emphasis on professional expertise. Professional knowledge is the most important means of production of expert organizations and imperative to leadership in healthcare and social services organization, given the high integration of executives into the professional system. Despite the dominance of social and personal competency requirements, the most important competency requirement is “Analytical skills”, which can be described as the basis of every action.

Between exercising of public powers and economic activity. The latest findings on the notion of entrepreneur made in the process of judicial review of the decision of the President of the Office of Competition and Consumer Protection

Aim: There is no doubt that public authorities may be directly or indirectly involved in economic activity. A traditional way of distinguish state activity which is not subject to the rules of the market is to decide when the state acts as public authority. In case of state activity two category of situations should be distinguished: these where the state is engaged in an economic activity (sphere of dominium) and these when the state acts by exercising of public powers (sphere of imperium). In the opinion of the author of the article, the distinction between imperium and dominium is still relevant. According to the Competition and Consumer Protection Act of February 16, 2007, an entrepreneur is inter alia natural and legal person, as well as an organisational unit without a legal status to which legislation grants legal capacity, organising or providing public utility services which do not constitute economic activity in the meaning of the provisions on freedom of economic activity. The President of the Office of Competition and Consumer Protection found that public authorities exercising their administrative powers (sphere of imperium) may be classified as entrepreneurs. In the recent decisions which were subject of judicial review the President of UOKiK decided that the National Health Fund – a state authority responsible for organization and management of health care services in Poland – is an entrepreneur in the meaning of the Polish law (act on competition and consumer protection). The aim of this article is to answer the question whether competition rules should be applied to the state activity in the imperium sphere. This article will focus on the notion of an entrepreneur (undertaking) in polish and EU law in the context of the activity of the state. Design / Research methods: The objective of the article is achieved through doctrinal analysis of the relevant rules of the Polish and EU law and analysis of the recent decisions issued by the President of UOKiK, as well as judgments of the EU Courts, concerning the possibility of qualification of the widely understood state as an undertaking (entrepreneur).Conclusions / findings: From the analysis of the same concept applied in polish and EU law clearly follows that public entities acting ‘by exercising public power’ or ‘in their capacity as public authorities’ (imperium sphere) should not be classified as entrepreneurs (undertakings) in the meaning of competition law. The main scientific value added of the article are the conclusions that the provisions on the protection of competition should be applicable only to the activity of the state in the dominium sphere and that the definition of an entrepreneur and business (economic) activity should be connected to the existence of a market. Originality / value of the article: Paper should be interesting for public authorities, as well as for lawyers, dealing with problems concerning of qualification of public entities in the context of the competition law. The results of the research may be applied for example in the decisions that would be taken by the President of UOKiK. The consequences of application of the findings of the research to practice may be a change of approach to qualification of public entities in the context of the provision of competition law.

Impact of network size and demand on cost performance for high- and low-quality healthcare service organizations

PurposeHealthcare networks are becoming ubiquitous, yet it is unclear how hospitals with varying quality capabilities would fare by being affiliated with large healthcare networks. The purpose of this paper is to first consider the deductive configuration perspective and distinguish high and low quality hospitals by using clinical and experiential quality as two dimensions of quality capability. Next, it examines the impact of healthcare network size on operating costs of hospitals. Additionally, the paper investigates the interaction effect of hospital demand and healthcare network size on operating costs.Design/methodology/approachThe paper uses a dataset that was created by combining five separate sources. Cluster analysis technique is used to classify hospitals into four groups – holistic quality leaders (high clinical and experiential quality capability), experiential quality focusers (low clinical quality capability and high experiential quality capability), clinical quality focusers (high clinical capability and low experiential quality capability), and quality laggards (low clinical and experiential quality capability). The authors test the research hypotheses by means of regression analyses after controlling for several contextual characteristics.FindingsThe results show that affiliation with large healthcare networks reduces operating costs for quality laggards, but increases these costs for experiential quality focusers and clinical quality focusers. The hypothesized positive relationship between healthcare network size and costs is not supported for holistic quality leaders. The authors find that clinical quality focusers and holistic quality leaders can complement higher utilization levels in their operations due to increased demand and healthcare network size to reduce their operating costs per day.Originality/valueThere has been increasing evidence suggesting that hospitals must carefully manage both clinical and experiential quality. By focusing on both clinical and experiential quality, unlike experiential quality focusers and clinical quality focusers, holistic quality leaders are not adversely affected by the size of their network. The results suggest that experiential quality focusers and clinical quality focusers should either embrace holistic quality management or restrict the size of their networks to maintain their quality level and to reduce coordination costs.

One Hundred Fifty Years of Organized Health Care Services in Bosnia and Herzegovina.

Introduction:Austro-Hungarian monarchy had great impact on healthcare system in Bosnia and Herzegovina (B&H), and consequences of that exist today.Aim:To launch of the section „The Most Influential Physicians in the Development of Health Care in Bosnia and Herzegovina“, in which, within next issues of the Medical Archives will be presented the prominent physicians, dentists and pharmacists who gave contribution to development of healthcare system in B&H.Results:This paper provides a full overview from the literature about health care circumstances during 150 years in Bosnia and Herzegovina and important of the role health care institutions and of all the doctors working in B&H during the Austro-Hungarian administration. To some of them is devoted more attention in the texts about their life and work and their contribution to the development of the health service in B&H. Also, author gave description of the others, except for the medical activities who have contributed to our homeland, such as Dr. Jozef Kecet, Dr. Julije Makanec, Dr. Teodora Krajewska, Dr. Josef von Preindlsberger, Dr. Hamdija Karamehmedovic and others, but there are many more that we should know about and mention them. Conclusion:The fact is Austro-Hungarian model of healthcare system in that time was functional for that period and great improvement in comparison to past and the fact is that that system represents a basis even for modern medicine in territory of B&H.

The use of primary health care services after transformation in health and related factors in a province example&lt;p&gt;Bir il örneğinde sağlıkta dönüşüm sonrası I. basamak sağlık hizmetleri kullanımı ve ilişkili faktörler

Introduction: Health reforms that have been put into practice in our country within the scope of the Transformation in Health process have brought about with them significant changes in the organization, human labor and financing structures of healthcare services. Community healthcare centers have been replaced by family practice system at the primary level. The results of this change should be evaluated by monitoring the health indicators of the public as well as their use of healthcare services.Purpose: The objective of this study was to determine the factors affecting the access to family practice (FP) service at the Mersin provincial center along with the factors affecting the use of this service. Method: Data of this cross-sectional study were acquired via face-to-face interviews carried out with 394 adult individuals at the Mersin city center during the dates of 14.02.2017– 30.07.2017. The structural characteristics of the healthcare services along with service satisfaction for primary healthcare services were evaluated in the study using the developed question form. The acquired data were analyzed via SPSS 21 package software with complementary statistics and independent T test, Chi-square test and ANOVA. Results: The age average of the participants was 42.08±1.30 years, 5.3% had not received formal education, there was a child under the age of five in 34.0% of the households and a chronic disease in 36.8%; those who used the primary healthcare services had mostly done so for treatment purposes. Of the participants, 63.5% evaluated family practice service as very good/good and the secondary or tertiary healthcare services were the first points of contact for 51.1% in case of health related issues. The most frequently observed problems for family practice were determined as failure to reach family practice when the family practice is closed, lack of house visits and the inability to operate the transfer services. Whereas age, education, regular income job, pregnancy/birth in the household did not result in any statistically significant difference with regard to the fundamental structural characteristics for the primary services (p&gt;0.05), there were differences with regard to the region of residence, gender, marital status, existence of a small child in the household and the existence of a chronic disease (p&lt;0.05).Conclusion: Even though adults are mostly registered in the family practice system and majority have rated the family practice services as “very good/good”, FP services need to be developed for access to services, comprehensive service provision and coordination with secondary/tertiary services.Suggestion: Studies for developing the culture of using primary healthcare services among the public via household visits are suggested in addition to activities for strengthening family practice services qualitatively and quantitatively.Extended English abstract is in the end of Full Text PDF (TURKISH) file.ÖzetGiriş: Ülkemizde Sağlıkta Dönüşüm süreci ile uygulamaya geçirilmiş olan sağlık reformları sağlık hizmetlerinin örgüt, insan gücü ve finansman yapısında önemli değişimleri beraberinde getirmiştir. Birinci basamakta sağlık ocaklarının yerini aile hekimliği sistemi almıştır. Bu değişimin sonuçları sağlık göstergelerinin izlenmesi kadar halkın sağlık hizmetlerini kullanımı ile de değerlendirilmelidir.Amaç: Yapılan bu çalışma ile bir il merkezinde halkın aile hekimliği hizmetlerini kullanımı ve ilişkili faktörlerin değerlendirilmesi amaçlandı.Yöntem: Kesitsel nitelikteki bu çalışmanın verileri 14.02.2017- 30.07.2017 tarihleri arasında Mersin merkezde 394 yetişkin bireyle yüz yüze görüşülerek toplandı. Çalışmada araştırmacılarca oluşturulan soru formu ile I. basamak sağlık hizmetlerinin yapısal özellikleri ve hizmet memnuniyeti değerlendirildi. Elde edilen veriler SPSS 21 paket programı kullanılarak tanımlayıcı istatistikler ile independent T test, Ki Kare testi ve ANOVA kullanılarak çözümlendi. Bulgular: Araştırmaya katılanların yaş ortalaması 42.08±1.30 yıldı, %5.3’ü örgün eğitim almamıştı, hanelerin %34.0’ında beş yaş altı çocuk, %36.8’inde kronik hastalık vardı, birinci basamak hizmeti kullananlar sıklıkla tedavi amaçlı hizmet almıştı. Katılımcıların %63.5’i aile hekimliği hizmetini çok iyi/iyi olarak değerlendirmişti, %51.1’inin sağlıkla ilgili sorunu olduğunda ilk başvurduğu yer II. veya III. basamak hizmetlerdi. Aile hekimliğinde en fazla sorun alanlarının aile hekimliği kapalı iken aile hekimliğine ulaşamama, ev ziyaretleri yapılmaması ve sevk sisteminin işletilememesi ile ilgili olduğu tespit edildi. Yaş, eğitim, düzenli gelir getiren iş varlığı, ailede gebelik/doğumun olması I. basamağa ilişkin temel yapısal özelliklere ait puan ortalamaları yönüyle fark yaratmazken (p&gt;0.05), ikamet edilen bölgeye, cinsiyete, evli olma durumuna, ailede küçük çocuk varlığına ve kronik hastalık varlığına göre fark vardı (p&lt;0.05).Sonuç: Yetişkinlerin büyük ölçüde aile hekimliği sistemine kayıtlı olması ve çoğunluğun aile hekimliği hizmetlerini “çok iyi /iyi” olarak değerlendirmesine rağmen hizmetlere ulaşım, kapsamlı hizmet sunumu ile II/ III. basamak hizmetlerle eşgüdümü sağlama yönünden AH hizmetlerinin geliştirilmesi gerekmektedir.Öneriler: Nicelik ve nitelik olarak aile hekimliği hizmetlerinin güçlendirilmesi yanında düzenli ev ziyaretleri ile halk arasında birinci basamak sağlık hizmetlerinin kullanım kültürünü geliştirmeye dönük çalışmaların yapılması önerilir.

Experiences and shared meaning of teamwork and interprofessional collaboration among health care professionals in primary health care settings: a systematic review.

During the last decade, teamwork has been addressed under the rationale of interprofessional practice or collaboration, highlighted by the attributes of this practice such as: interdependence of professional actions, focus on user needs, negotiation between professionals, shared decision making, mutual respect and trust among professionals, and acknowledgment of the role and work of the different professional groups. Teamwork and interprofessional collaboration have been pointed out as astrategy for effective organization of health care services as the complexity of healthcare requires integration of knowledge and practices from differente professional groups. This integration has a qualitative dimension that can be identified through the experiences of health professionals and to the meaning they give to teamwork. The objective of this systematic review was to synthesize the best available evidence on the experiences of health professionals regarding teamwork and interprofessional collaboration in primary health care settings. The populations included were all officially regulated health professionals that work in primary health settings: dentistry, medicine, midwifery, nursing, nutrition, occupational therapy, pharmacy, physical education, physiotherapy, psychology, social work and speech therapy. In addition to these professionals, community health workers, nursing assistants, licensed practical nurses and other allied health workers were also included. The phenomena of interest were experiences of health professionals regarding teamwork and interprofessional collaboration in primary health care settings. The context was primary health care settings that included health care centers, health maintenance organizations, integrative medicine practices, integrative health care, family practices, primary care organizations and family medical clinics. National health surgery as a setting was excluded. The qualitative component of the review considered studies that focused on qualitative data including designs such as phenomenology, grounded theory, ethnography, action research and feminist research. A three-step search strategy was utilized. Ten databases were searched for papers published from 1980 to June 2015. Studies published in English, Portuguese and Spanish were considered. Methodological quality was assessed using the Qualitative Assessment and Review Instrument developed by the Joanna Briggs Institute. All included studies received a score of at least 70% the questions in the instrument, 11 studies did not address the influence of the researcher on the research or vice-versa, and six studies did not present a statement locating the researcher culturally or theoretically. Qualitative findings were extracted using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Qualitative research findings were pooled using a pragmatic meta-aggregative approach and the Joanna Briggs Institute Qualitative Assessment and Review Instrument software. This review included 21 research studies, representing various countries and healthcare settings. There were 223 findings, which were aggregated into 15 categories, and three synthesized findings: CONCLUSIONS: This review shows that health professionals experience teamwork and interprofessional collaboration as a process in primary health care settings; its conditions, consequences (benefits and barriers), and finally shows its determinants. Health providers face enormous ideological, organizational, structural and relational challenges while promoting teamwork and interprofessional collaboration in primary health care settings. This review has identified possible actions that could improve implementation of teamwork and interprofessional collaboration in primary health care.

Effect of socio-demographic factors on the association between multimorbidity and healthcare costs: a population-based, retrospective cohort study

ObjectivesTo estimate the attributable costs of multimorbidity and assess whether the association between the level of multimorbidity and health system costs varies by socio-demographic factors in young (<65 years) and...

Nursing supervision for care comprehensiveness.

To reflect on nursing supervision as a management tool for care comprehensiveness by nurses, considering its potential and limits in the current scenario. A reflective study based on discourse about nursing supervision, presenting theoretical and practical concepts and approaches. Limits on the exercise of supervision are related to the organization of healthcare services based on the functional and clinical model of care, in addition to possible gaps in the nurse training process and work overload. Regarding the potential, researchers emphasize that supervision is a tool for coordinating care and management actions, which may favor care comprehensiveness, and stimulate positive attitudes toward cooperation and contribution within teams, co-responsibility, and educational development at work. Nursing supervision may help enhance care comprehensiveness by implying continuous reflection on including the dynamics of the healthcare work process and user needs in care networks. refletir a supervisão de enfermagem como instrumento gerencial do enfermeiro para integralidade do cuidado, considerando suas potencialidades e limitações no cenário atual. estudo reflexivo baseado na formulação discursiva sobre a supervisão de enfermagem, apresentando conceitos e enfoques teóricos e/ou práticos. limitações no exercício da supervisão estão relacionadas à organização dos serviços de saúde embasada no modelo funcional e clínico de atenção, assim como possíveis lacunas no processo de formação do enfermeiro e sobrecarga de trabalho. Quanto às potencialidades, destaca-se a supervisão como instrumento de articulação de ações assistenciais e gerenciais, que pode favorecer integralidade da atenção, estimular atitudes de cooperação e colaboração em equipe, além da corresponsabilização e promoção da educação no trabalho. supervisão de enfermagem pode contribuir para fortalecimento da integralidade do cuidado, pressupondo reflexão contínua, para contemplar a dinamicidade do processo de trabalho em saúde e necessidades dos usuários nas redes de atenção.

Improving the care of veterans: The role of nurse practitioners in team-based population health management.

Improving healthcare delivery for U.S. veterans is a national priority. The Veterans Health Administration (VHA) employs a variety of team-based, population health strategies to address critical issues in veterans' health including the effective management of chronic disease. Nurse practitioners (NPs) are integral members of the VHA patient care team with a substantial role to play in the organization and delivery of healthcare services for veterans. This report explores the contributions of NPs in team-based, population health strategies within the VHA. This review of the literature examines peer-reviewed articles published between 2006 and 2017 to explore the contributions of NPs in team-based, population health strategies within the VHA. Search words include veterans, VHA, NPs, population health, panel management, and chronic disease. NPs are vital members of the VHA primary care team; however, there is a dearth of available evidence reflecting the unique contribution of NPs within VHA team-based, population health management strategies. The VHA adoption of full practice authority for NP practice provides NPs with an expanded capacity to lead improvements in veterans' health. Future research is needed to fully understand the unique role of the NP in the delivery of population health management strategies for veterans.

Prescribing indicators in primary health care in Belo Horizonte, Brazil: associated factors.

Background The prescription is one of the factors that influences rational use of medicines. The evaluation of prescribing indicators should contribute to organization of primary health care services. Objective The aim of this study was to evaluate prescribing indicators and associated factors in primary health care in the northeast health district, Belo Horizonte, Brazil. Setting Twenty primary health care units in the Northeast Health District, Belo Horizonte, Brazil. Method The study was cross sectional. Indicators proposed by World Health Organization were used to evaluate rational use of medicines. Main outcome measure Indicators evaluated were average number of medicines per prescription, proportion of medicines with antibiotic, injectable, medicines prescribed by generic name and medicines present in the essential medicines list. Results Three hundred and ninety-nine patients were interviewed. The average number of medicines per prescription was 3.5 (SD 2.2). The proportion of medicines with antibiotic, injectable, medicines prescribed by generic name and medicines present in the essential medicines list was 17.8, 9.8, 94.9, 91.4%, respectively. Patient age ≥60years was positively associated with number of medicines per prescription (P=0.00). Conclusion In the northeast health district of Belo Horizonte, the proportion of prescriptions of antibiotics and injections, the adoption of prescribing by generic name and the prescribing of essential medicines were satisfactory in this study considering reference values for these indicators and international scientific literature. However, the mean number of prescribed medicines requires a more in-depth evaluation.