Health Care Priorities Research Articles

Changes in the Utilization of Korean Medicine Clinical Services on Clinic Level Before and After COVID-19

Objectives: The coronavirus disease 2019(COVID-19) impacted the utilization of medical services in Republic of Korea, leading to decreased utilization due to social distancing and diverted healthcare priorities. Post-pandemic, anxiety about infection remained high, further affecting medical service utilization, however, there was no study between infection disease and the utilization of Korean Medicine clinical services. Therefore, this aimed to find the changes in the utilization of Korean Medicine clinical services on the level of clinics by reflecting the environmental factors of the COVID-19.Methods: This study examined data from 2016 to 2022, focusing on clinic-level statistics derived from census, national health insurance(NHI), and the data of medical care assistance. It described changes in the number of clinics and doctors, patient’s visits, and medical expense and compared pre- and post-COVID-19 especially.Results: In the utilization of Korean Medicine clinical services before and after COVID-19, the number of Korean Medicine clinics and doctors per 10,000 people nationwide increased, but in Gwangju, Jeonnam, and Chungnam, both decreased. The number of visits in Korean Medicine clinics for NHI and medical care assistance decreased, but that of visits in Western Medicine clinics recovered. The medical expense increased in both Western Medicine clinics and Korean Medicine clinics, and the rate of increase in Western Medicine clinics was higher than that of Korean Medicine clinics.Conclusion: These changes were the result of COVID-19 affecting medical services including Korean Medicine, and further research is needed on Korean Medicine clinical services due to external effects including infectious diseases.

Advancing the Quintuple Aim Through Public Health and Health Care Collaboration: Perspectives from Washington State

The Covid-19 pandemic resulted in remarkable collaboration between public health and health care institutions. But without intentional efforts, the end of the U.S. Public Health Emergency could lead to a return to an era when these institutions’ relationships were more limited and their population health improvement efforts less integrated. This is concerning, given that collaboration between public health and health care will be needed to overcome the multiple health crises facing the United States today. The Washington State Department of Health (WA-DOH), the state public health agency, identified health systems and workforce transformation as one of its five strategic priorities. To further define and operationalize its vision for health systems and workforce transformation, WA-DOH conducted an environmental scan that led to the identification of six priorities for public health and health care to align on systems strengthening, as follows: enhancing robust whole-person care; the primary care and rural health safety net; health workforce intelligence and development; population health intelligence; innovation and learning; and health system resilience. WA-DOH is using this six-priority framework to execute its vision for health in Washington, in line with the Quintuple Aim for health care improvement and the fundamental public health goal of ensuring an effective system that enables equitable access to the services and the care people need to be healthy. Public health agencies at the state or local level, looking to partner to improve health care delivery in their jurisdictions, can take advantage of the six-priority framework expounded in this paper.

An evaluation of a mentoring program in Emergency Medicine: A qualitative assessment using semi-structured interviews

Background Mentorship plays a crucial role in professional development, particularly in fields like emergency medicine. However, the dynamics of mentor-mentee relationships in this context remain underexplored. Understanding these dynamics is essential for optimizing mentorship programs and enhancing healthcare outcomes. This research investigates the factors influencing mentorship relationships in emergency medicine within the United Arab Emirates (UAE) context. It seeks to uncover the characteristics and dynamics of these relationships through qualitative analysis, providing insights into facilitators and barriers to success. Methods The study adopts a qualitative approach, conducting interviews with both mentors and mentees. Thematic analysis is employed to identify recurring themes in mentor-mentee interactions. The analysis delves into the supportive, communicative, approachable, knowledgeable, and empathetic traits of effective mentors. It also explores hindrances such as time constraints, resource limitations, random mentor allocation, and gender and cultural differences. Results The research findings underscore the pivotal role of mentors in fostering successful mentorship relationships. Effective mentors exhibit traits such as supportiveness, communication skills, approachability, knowledge, and empathy. Conversely, barriers to these relationships include mentees' behavior, time and resource constraints, random mentor allocation, and gender and cultural disparities. Conclusions While highlighting the importance of mentorship in emergency medicine, the study identifies the need for tailored mentorship approaches. It emphasizes the significance of selecting, training, and supporting mentors and optimizing mentorship programs. The research also suggests developing guidelines, aligning mentorship goals with healthcare priorities, fostering diversity, and integrating mentorship into professional development and quality assurance mechanisms. Ultimately, this study sheds light on the complexities of mentor-mentee relationships in emergency medicine, offering valuable insights for academic research, practice, and policy development in the UAE healthcare context.

Global and Regional Economic Burden of Eating Disorders: A Systematic Review and Critique of Methods.

This systematic review aims to comprehensively examine up-to-date evidence on the economic burden of eating disorders (EDs), both globally and by region. A comprehensive search within five electronic databases, MEDLINE, Embase, CINAHL, PsycINFO, and EconLit, retrieved studies published from August 1, 2013, to June 30, 2024. Cost of illness (COI) studies, burden of disease, and other cost studies that reported costs in monetary values were included, and cost-effectiveness analysis studies were excluded. The quality of COI studies was assessed using Schnitzler's checklist. All cost estimates were converted into 2024 USD purchasing power parity (PPP). The PROSPERO registration number is CRD42022358136. Twenty-six studies were identified for inclusion in this review, with 11 COI studies. The nationwide annual financial cost of EDs is estimated at PPP-USD 70.5 billion. Indirect costs contributed 70%-93% of total financial costs in the reviewed studies. Intangible costs (burden of disease) were estimated to be PPP-USD 355.6 billion. About half of the COI studies met 60% of the elements of Schnitzler's checklist, either completely or partly. The number of COI studies has more than doubled in the last 10 years. Findings can inform healthcare administrators/policymakers to understand the magnitude of this burden when setting healthcare priorities and allocating resources to maximize social welfare. However, there are variations in the methods (thus quality) and perspectives used to assess this economic burden. Findings suggest that there is potential for enhancing the methodological rigor of future research.

The antimicrobial potential of traditional remedies of Indigenous peoples from Canada against MRSA planktonic and biofilm bacteria in wound infection mimetic conditions.

Methicillin-resistant Staphylococcus aureus (MRSA) is the leading cause of wound infections, often progressing into serious invasive bloodstream infections. MRSA disproportionately affects Indigenous peoples in Canada with higher rates of skin and wound infections, an example of persistent gaps in health outcomes between Indigenous and non-Indigenous peoples precipitated by the legacy of colonialism. Conversely, Indigenous peoples have long used natural remedies for infections and other diseases; however, their knowledge was rarely considered for modern medicine. The stagnant antibiotic discovery pipeline and alarming rise of resistance to current antibiotics prompted us to turn to Indigenous medicine as an untapped source of antimicrobials. As such, we collected and prepared 85 extracts of medicinal plants of value to Indigenous peoples spanning the Canadian Prairies. We explored the antimicrobial potential of these extracts against MRSA under wound infection-mimetic conditions compared with culture media typically used to study bacterial antibiotic responses and biofilms but not adequately representative of infection sites. We identified extracts with MRSA growth inhibitory [e.g., bergamot, dock, gaillardia, and dandelion extracts] and biofilm prevention and eradication [e.g., gumweed extracts] activities. Extracts, including those of chokecherry, hoary puccoon, and Northern bedstraw, were only active under wound infection-mimetic conditions, highlighting the benefit of antibiotic discovery under host-relevant conditions. Testing growth inhibitory extracts against an S. aureus cross-resistance platform suggested that they act through mechanisms likely distinct from known antibiotic classes. Together, through an interdisciplinary partnership leveraging Western approaches and traditional Indigenous knowledge, we identified plant extracts with promising antimicrobial potential for drug-resistant MRSA wound infections.IMPORTANCEWe explored the antimicrobial potential of traditional Indigenous remedies against MRSA under wound infection-mimetic conditions. We chose to tackle MRSA wound infections because they constitute an Indigenous health priority, ensuring mutual benefits and reciprocity, which are important principles in partnerships between Indigenous and non-Indigenous researchers. Our partnerships strive to serve as steps towards reconciliation with Indigenous peoples in Canada and a roadmap inspiring similar interdisciplinary collaborations to tackle other healthcare priorities. We identified extracts with promising antibacterial growth inhibitory, biofilm prevention, and eradication activities against MRSA. The antimicrobial potential of some extracts was only observed under wound infection-mimetic conditions, a proof-of-concept that screening under infection-mimetic conditions reveals novel activity undetected under standard conditions. The natural product antimicrobial extracts discovered herein warrant further investigation into their mode of action and chemical composition; they may address the dire need for new antimicrobial and anti-biofilm activity to counter the AMR crisis.

The Role of Nursing in Managing Chronic Illness: A Review of Patient Outcomes and Quality of Life

The management of chronic illness is a growing priority in healthcare, with nursing playing a critical role in improving patient outcomes and quality of life. This review explores the various nursing interventions that support chronic illness management, including patient education, symptom monitoring, and emotional support. By providing personalized care and fostering self-management skills, nurses contribute to reduced hospital readmissions, improved medication adherence, and enhanced physical and mental health outcomes. Additionally, nursing care significantly influences patients' quality of life, offering emotional support that positively impacts their mental well-being and overall satisfaction. Despite the benefits, challenges such as limited resources, time constraints, and nursing burnout remain barriers to effective care. This review emphasizes the need for continued support for nursing roles in chronic illness management, policy adjustments to address resource limitations, and integration of technology to enhance care delivery. Overall, a strengthened nursing role in chronic illness management not only benefits patient outcomes but also enhances patients' quality of life, underscoring the importance of investment in nursing care to meet the demands of chronic illness in healthcare.

The climate crisis - actions to prioritize for anaesthesiologists.

Climate change is the biggest threat to human health and survival in the twenty-first century. Emissions associated with healthcare contribute to climate change and there are many personal and professional actions that can reduce carbon emissions. This review highlights why action is necessary and what anaesthetists and healthcare workers can do. Encouraging continuing research regarding sustainable anaesthesia and expanding education at all levels to include climate action is key. Professionally, actions include limiting use of single-use equipment, reducing reliance on volatile gas inhalational anaesthesia, and adopting low fresh gas flow techniques. Personal actions such as climate-conscious travelling, spending, and eating are important, especially when shared to create climate positive movements. This article shows that, while patient safety and quality of care must remain healthcare's top priority, considering the climate implications of care is part of that duty. Many actions that reduce the carbon impact of care simultaneously improve the quality of care and reduce financial cost. More research into sustainable healthcare is needed. Departments and hospitals and must create environments in which climate conversations are welcomed and can result in positive advancements.

Global Disparities of Cancer and Its Projected Burden in 2050

Cancer prevention and care efforts have been challenged by the COVID-19 pandemic and armed conflicts, resulting in a decline in the global Human Development Index (HDI), particularly in low- and middle-income countries. These challenges and subsequent shifts in health care priorities underscore the need to continuously monitor cancer outcome disparities and statistics globally to ensure delivery of equitable and optimal cancer prevention and care in uncertain times. To measure the global burden of 36 cancers in 2022 by sex, age, and geographic location and to project future trends by 2050. This cross-sectional study used population-based data from 2022 in 185 countries and territories were obtained from the Global Cancer Observatory database. Data extraction and analysis were carried out in April 2024. Counts, rates, prevalence, mortality to incidence ratios (MIRs), and demography-based projections were used to characterize current and future cancer burden. This population-based study included 36 cancer types from 185 countries and territories. By 2050, 35.3 million cancer cases worldwide are expected, a 76.6% increase from the 2022 estimate of 20 million. Similarly, 18.5 million cancer deaths are projected by 2050, an 89.7% increase from the 2022 estimate of 9.7 million. Cancer cases and deaths are projected to nearly triple in low-HDI countries by 2050, compared to a moderate increase in very high-HDI countries (142.1% vs 41.7% for cancer cases and 146.1% vs 56.8% for cancer deaths). Males had a higher incidence and greater number of deaths in 2022 than females, with this disparity projected to widen by up to 16.0% in 2050. In 2022, the MIR for all cancers was 46.6%, with higher MIRs observed for pancreatic cancer (89.4%), among males (51.7%), among those aged 75 years or older (64.3%), in low-HDI countries (69.9%), and in the African region (67.2%). In this cross-sectional study based on data from 2022, cancer disparities were evident across HDI, geographic regions, age, and sex, with further widening projected by 2050. These findings suggest that strengthening access to and quality of health care, including universal health insurance coverage, is key to providing evidence-based cancer prevention, diagnostics, and care.

State Pharmacopoeia of the Russian Federation Edition XV: Development Priorities

INTRODUCTION. Regular reviews of the current portfolio of general chapters and monographs are essential to ensure the well-balanced development of the State Pharmacopoeia of the Russian Federation (Ph. Rus.) in line with the priorities of the national healthcare system.AIM. This study aimed to identify the most promising areas for further Ph. Rus. development through an analysis of recent legislative changes in Russia and the current compendial portfolio.DISCUSSION. This article compares Ph. Rus. editions XIV and XV, analyses the key features and structure of edition XV, and reviews amendments to the regulations governing the Ph. Rus. publication. The current compendial portfolio is dominated by monographs on chemical active substances; it also includes a substantial number of monographs on herbal drugs and herbal drug preparations. Noteworthy, edition XV is the first Ph. Rus. edition to include a separate section dedicated to monographs on excipients necessary for the development of pharmacy compounding. Moreover, this article analyses the coverage of active substances that are used for the production of listed vital and essential medicines.CONCLUSIONS. The authors outlined the priority areas for the development of quality standardisation. The Ph. Rus. should continue developing monographs on active substances that are used for the manufacturing and compounding of listed vital and essential medicines. In addition, the coverage of herbal drugs should be expanded. The Ph. Rus. should develop monographs on excipients that are used for the manufacturing and compounding of medicinal products. Finally, the Ph. Rus. should complete the development of requirements for biological medicinal products and relevant test methods.

How do homeless service users view their own health and healthcare? An ethnographic study

BackgroundThe provision of healthcare to those in homelessness often fails to consider what is important to those receiving care. Using an ethnographic approach grounded in a social constructivist research paradigm, this study aimed to explore the perspectives of homeless service users in Dublin, Ireland on their priority health and healthcare needs. MethodsActive participant observations and informal interviews were conducted with 74 adult clients attending a low-threshold primary care and addiction service between October, 2022 and April, 2023. Participants were selected using purposive, critical case sampling; clinic medical or operations staff identified adult homeless clients of sound mental capacity with whom they had an established rapport. Field note data were collected, anonymised, and analysed using inductive thematic analysis in accordance with the Declaration of Helsinki and the researchers’ institutional Research Ethics Committee. All participants gave informed verbal consent. FindingsClients’ priority concerns relate to their mental health and personal safety, strengthening ties with children and families, finding a sense of purpose, and alleviating physical pain. These challenges are acute both prior to and during experiences of homelessness, coupled with disproportionately high levels of grief, fear, isolation, and fatigue. In terms health services, clients value accessing primary care and harm reduction in a social environment where positive exchanges with friends and providers take place. Conversely, barriers to accessing mental health and addiction services persist including the internalised belief that one is beyond help, lack of access to information on available services and their entry requirements, and lingering stigma within a health system that treats addiction as separate to health. InterpretationHealth initiatives recommended by homeless service users to improve their lives and conditions include the provision of more/more acceptable single occupancy housing, refuge spaces, mental health and parenting supports, residential addiction treatment, and meaningful social activities. Study limitations include the obtention of data from a single site and from only English speakers. FundingThe authors received no specific funding for this work.

Economic effects of priority setting in healthcare: a scoping review of current evidence

ObjectivesStudy objective was to map the current literature on the economic effects of priority setting at the system level in healthcare.DesignThe study was conducted as a scoping review.Data sourcesScopus electronic database was searched in June 2023.Eligibility criteriaWe included peer-reviewed articles published 1 January 2020–1 January 2023. All study designs that contained empirical evidence on the financial effects or opportunity costs of healthcare priority setting were included excluding disease, condition, treatment, or patient group-specific studies.Data extraction and synthesisTwo independent researchers screened the articles, and two additional researchers reviewed the full texts and extracted data. We used Joanna Briggs Institute checklists to assess the quality of qualitative, quasi-experimental and economic evaluations and the mixed methods appraisal tool for the mixed method studies. Synthesis was done qualitatively and through descriptive statistics.Results8869 articles were screened and 15 fulfilled the inclusion criteria. The most common study focus was health technology assessment (7/15). Other contexts were opportunity costs, effects of programme budgeting and marginal analysis, and disinvestment initiatives. Priority setting activities analysed in the studies did not achieve cost savings or cost containment (4/15) or have mixed findings at best (8/15). Only five studies found some indication of cost savings, cost containment or increased efficiency. Also, many of the studies consider costs only indirectly or qualitatively.ConclusionsAll in all, there is very little research addressing the pressing question of whether explicit priority setting and priority-setting methods can support cost containment on a health service system level (regional or national). There is limited evidence of the economic effects of priority setting.

Embedding voices of under-served communities in Health Research Priority Setting in Thailand

Health research is needed to develop new treatments, diagnostic methods and prevention strategies for many diseases, but resources are limited particularly in low-and middle-income countries (LMICs). Our proposed project involves in-depth engagement with community advisory boards and existing community groups in healthcare research priority setting in Thailand. We will use Wellcome’s “Responsive Dialogues” engagement approach, focusing on “underserved” groups, as their voices are seldom heard in healthcare research priority setting. We estimate that we will engage with 6–8 community groups involving 48–80 participants. Our objectives are firstly, to contribute to the health research agenda setting in Thailand for government, non-governmental actors, academia, and others who conduct health research in the next 5 to 10 years. Secondly, we aim to identify ethical and practical issues related to healthcare research priority setting, specifically in relation to involving under-served communities.

6.G. Scientific session: The importance of using country-specific severity distributions in burden of disease indicators

Abstract One of the most commonly used health gap summary measures in the field of public health is the Disability-adjusted life year (DALY). It has become the key metric for quantifying the burden of disease (BoD) and is used as an information source for setting priorities for health care and health service planning. The DALY metric quantifies gaps between a theoretical population in perfect health and the current health status related to both morbidity and mortality. It is the sum of the number of healthy life years lost due to disability (YLD) and death (YLL). The YLD summarises the loss of healthy life time using the frequency of diseases differentiated by severities or related health states (including sequelae). Depending on each health state, it converts the time spent with diseases into YLD by weighting each year with health limitation with so-called disability weights. This allows the two indicators YLL and YLD to be added to the DALY. Consequently, severity distributions are a means of describing the range of health loss along specific health states, which enables an accurate mapping with disability weights. For most of the diseases, these distributions are usually categorised as mild, moderate, severe, or no health loss (asymptomatic). Conditions with higher severity levels contribute more to the YLD and thus, to the overall disease specific BoD. The severity distributions are highly dependent on utilization at the individual level, but also on available health care services at the society level, which indicates that differences by settings are to be expected. Changes over time in the share of severe cases, for instance, may reflect the effectiveness of health interventions and policies. This underlines the importance of severity distributions, as they also reflect information about the quality of healthcare for those affected. The Global Burden of Disease (GBD) study applies for a significant proportion of their considered diseases uniform severity distributions across countries and broader regions. They acknowledge concerns over applying estimates of severity distributions based on limited data, noting that it is the only available information that they were able to use. As the YLD estimates are often utilized to develop and prioritize health policy interventions, there is a necessity for country-specific estimates that are evidence based and less susceptible to model assumptions. In most cases, the estimation of severity distributions involves complex methodology as data for such assessments are very limited or hardly reliable. In the following workshop, general concepts and country cases from Germany, Scotland, and Belgium will be presented covering a variety of diseases. The examples underline the importance of estimating national and even regional severity distributions when identifying the importance of diseases or comparing the health conditions of populations across time. Key messages • As the Burden of disease indicators are predominantly used to prioritize health interventions and allocate resources, it is crucial to use accurate information in the severity levels of disease. • Severity distributions reflect the health care services and vary across different settings. Utilising country-specific severity distributions when estimating Burden of Disease indicators is essential.

Severity and Temporality in Healthcare Priority Setting - A Case for A Condition-specific Affectable Time-neutral Approach.

Priority setting of scarce resources in healthcare is high on the agenda of most healthcare systems implying a need to develop robust foundations for making fair allocation decisions. One central factor for such decisions in needs-based systems, following both empirical studies and theoretical analyses, is severity. However, it has been noted that severity is an under-theorized concept. One such aspect is how severity should relate to temporality. There is a rich discussion on temporality and distributive justice, however, this discussion needs to be adapted to the practical and ethical requirements of healthcare priority setting principles at mid-level. In this article, we analyze how temporal aspects should be taken into account when assessing severity as a modifier for cost-effectiveness. We argue that when assessing the severity of a condition, we have reason to look at complete conditions from a time-neutral perspective, meaning that we take the full affectable stretch of the condition into account without modifying severity as patients move through the temporal stretch and without discounting the future. We do not find support for taking the 'shape' of a condition into account per se, e.g. whether the severity has a declining or inclining curve, or that severity is intermittent rather than continuous. In order to take severity seriously, we argue that we have reason to apply a quantified approach where every difference in severity should impact on priority setting. In conclusion, we find that this approach is practically useful in actual priority setting.

Building patient safety culture by using interprofessional simulation with nursing, paramedic and emergency telecommunication students: A mixed-methods research study

AimThe aim of this study was to investigate student attitudes toward interprofessional education and collaborative practice and their perceptions of simulation design elements after participating in an interprofessional simulation educational activity. BackgroundPatient safety continues to be an international healthcare priority. However, critical incidents to patients continue to persist due to poor communication between professionals and poor teamwork. DesignA mixed methods design. MethodThe study sample consisted of Bachelor of Nursing (n=81), Paramedic (n=38) and Emergency Telecommunication (n=11) students randomized into interprofessional groups. Following the interprofessional learning experience, students completed two standardized self-reporting instruments, Students Perceptions of Interprofessional Clinical Education, National League for Nursing Simulation Design Scale and open-ended questions of their perceptions on teamwork and collaboration, communication skills, transfer of care and patient safety. ResultsStudents in each program reported high scores for attitudes toward the importance of teamwork and collaborative practice. There were significant differences in scores between programs for the ranking factors ‘Teamwork and Team-Based Practice’ (BN=4.74 SD 0.72, PM=4.66 SD 0.81, ET=4.95 SD 0.15 *; p = 0.00005) and ‘Roles & Responsibilities’ (BN=3.78 SD 1.12, PM=3.55 SD 0.92, ET=4.67 SD 0.85*; p= 0.012). Themes included: communication and collaboration in teamwork; roles, responsibilities and leadership; patient-centred care and safety; and emotional dynamics and professional growth. ConclusionAn interprofessional simulation is an effective strategy to practice teamwork and collaboration and communication skills during transfer of care. Ensuring earlier education of roles and responsibilities during transfer of care needs review as do strategies for structured handover communication tools.

A global snapshot on health systems capacity for detection, monitoring, and management of acute kidney injury: A multinational study from the ISN-GKHA.

Acute kidney injury (AKI) is a significant cause of morbidity and mortality, especially in low and lower-middle income countries. Data from the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) were used to evaluate the organization of structures and services for the provision of AKI care in world countries and ISN regions. An international survey of key stakeholders (clinicians, policymakers, and patient advocates) from countries affiliated with the ISN was conducted from July to September 2022 to assess structures and services for AKI care across countries. Main findings of the study show that overall, 167 countries or jurisdictions participated in the survey, representing 97.4% of the world's population. Only 4% of countries had an AKI detection program based on national policy or guideline, and 50% of these countries used a reactive approach for AKI identification (i.e., cases managed as identified through clinical practice). Only 19% of national governments recognized AKI as a healthcare priority. Almost all countries (98% of the countries surveyed) reported capacity to provide acute hemodialysis (HD) for AKI, but in 31% of countries, peritoneal dialysis (PD) was unavailable for AKI. About half of all countries (44% of countries surveyed) provided acute dialysis (HD or PD) via public funding, but funding availability varied across ISN regions, including less than a quarter of countries in Oceania and South East Asia (17%) and Africa (24%) and highest availability in Western Europe (91%). Availability increased with the increasing country income level. Initiatives have been developed to propose and promote optimal care for AKI (including the ISN 0-by-25 initiative), but capacity for optimal AKI care remains low, particularly in low- and lower-middle-income countries. Concerted efforts by the global community are required to close these gaps, to improve AKI outcomes across the world.

The future of AVS, dizziness, and vertigo in emergency departments Part IV: Priorities for universal healthcare after COVID

The future of AVS, dizziness, and vertigo in emergency departments Part IV: Priorities for universal healthcare after COVID In the fourth article of this five-part series, Dr Millie Nakatsuka discusses how reform must be integrated into the broader context of the public health landscape. 2024 marks the 46th anniversary of the Alma-Ata Declaration, which identified primary healthcare as the key method of achieving ‘Health for All’. OECD analysis, however, continues to show that substantial chronic underinvestment in preventive healthcare and chronic disease management persists, reflecting a global failure to adopt coherent coordinated health policies, and to rationally plan cost-effective healthcare aligned with population health priorities. Instead, governments regularly misallocate and waste resources on ad hoc politically motivated projects, all too often catering to the lobbying power of vested interest groups.

Transforming healthcare with integrated inter-professional education in a research-driven medical school

Singapore, located strategically at the meeting point of the Malacca Strait and the South China Sea, has established itself as a global financial and economic hub. Despite its small geographical size, Singapore is home to over 5 million people from diverse cultural backgrounds. The city-state’s medical education landscape has evolved significantly over the past century. Originally, Singapore had only one undergraduate medical school, the NUS Yong Loo Lin School of Medicine, established in 1905. Over time, this institution has grown into Singapore’s largest and oldest medical school. NUS Medicine’s vision centres on developing highly competent, values-driven, and inspired healthcare professionals to transform the practice of medicine and improve health worldwide. A curriculum overhaul in 2020 introduced new educational components to prepare future healthcare professionals for the challenges of Singapore’s resilient healthcare system. This includes proficiency in integrated care, collaboration across disciplines, and leveraging AI and data science in clinical decision-making. The introduction of a common curriculum in August 2023 for Medicine, Nursing, Dentistry, and Pharmacy undergraduates further aligns with Singapore’s 'Healthier SG' vision, ensuring that graduates are well-equipped to meet the evolving needs of the healthcare landscape. The common curriculum aims to address professional hierarchies and foster interprofessional collaboration among students from diverse academic backgrounds. By promoting frequent interaction and a team-oriented mindset, the curriculum seeks to instil a collective approach to healthcare, emphasising the importance of interprofessional practice in achieving the broader goals of healthcare delivery. This paper describes the reforms that took place and how the challenges were mitigated in a research-intensive top-ranked academic medical institution. This strategic alignment of medical education with national healthcare priorities underscores NUS Medicine’s commitment to transforming medical practice and improving health outcomes in Singapore and beyond.

A-188 Modal Failure and Effects Analysis, FMEA methodology, as a strategy to increase patient safety

Abstract Background Patient safety during the clinical care process is considered a priority in healthcare. Failure Mode and Effects Analysis (FMEA) is a proactive and systematic method of process evaluation and is used to identifying where and how each phase of the analytical process could fail allowing the detection of the causes and the effects they produce on the quality of the results that are issued. A regular use of this tool makes possible to identify the most critical steps, propose improvement strategies and evaluate their impact. The aim of the study is to evaluate applicability of the FMEA tool to identify errors in the pre analytical, analytical, and post analytical phase of a clinical laboratory as well as the main causes and effects, to reduce them by proposing improvement strategies Methods For each phase into which the laboratory activity is divided, the frequency and type of errors that are made and their final consequences on the patient are evaluated. A risk index (NPR=OxDxS) is calculated for each error considering the frequency with which it occurs (O), the ease with which it is detected (D) and the severity of the consequences on the patient (S). Values goes from 1 (rarely) to 10 (often). Improvement actions are proposed for all errors with a risk index greater than 100 and this index is re-evaluated after the implementation of that improvement measures. This same analysis is performed for three times over the last 10 years (in 2014, 2019 and 2023). Results In FMEA analysis carried out in 2014, a total of 40 errors were identified in the pre-analytical phase (63.5% of the total), 12 in the analytical phase and 11 in the post-analytical phase. 50% of the total errors detected required improvement strategies because they had an NPR≥100 value. In the 2023 evaluation, a total of 27 errors were identified in the pre-analytical phase, 10 in the analytical phase, and 5 in the post-analytical phase but only 6 required improvement strategies, which represents an 80% reduction in the most critical errors for patient safety. However, the pre-analytical phase continues to be the most critical, as it continues to account for 64% of the total errors identified, including the lack of identification of the patient or sample and the inadequate prior preparation of the patient. In analytical and post-analytical phases, the NPR values obtained in 2023 decrease significantly over analysis carried out in 2014 and its not needed to apply improvement strategies. Automation and the IT tools significantly reduce the number of errors with high NPR values, but it is undoubtedly the involvement of service professionals that makes the difference over the years. Conclusions The use of the FMEA methodological tool allows the design of appropriate indicators to detect and reduce errors in the clinical laboratory. Its application as part of a good quality control allows a continuous improvement in the laboratory process and consequently a guarantee of quality for the patient

Barriers to mobile personal health assistant in patients living with diabetes.

Continued use of a digital health assistant that helps patients living with diabetes to self-manage and deal with complex problems in order to enhance their health status is a healthcare priority. The objective was to explore the barriers related to the use of a mobile personal health assistant for patients with type 2 diabetes. Eighty-one participants were offered a personal health assistant through a smartphone application. They completed a questionnaire after initial training (T0) and after 1month's experience (T1). Most had a positive behavioral intention before using it, but the opposite was found after 1month. There were positive correlations between behavioral intention and the eight related factors. The strongest correlations were with satisfaction and perceived usefulness at T0 and T1, respectively. The factors' mean values decreased after 1month. The best predictors of behavioral intention were satisfaction and performance expectancy at T0 and T1, respectively, which predicted the status of 88.4% and 82.7% of the sample. Our findings will help health experts to build better tools that satisfy patients and meet their expectations.