Providing Quality Health Care Research Articles

St Thomas Kilakala Health Facility: The Cost of Providing Quality Healthcare, For Free, at a Fee or to Flee? (B)

St Thomas Kilakala Health Facility: The Cost of Providing Quality Healthcare, For Free, at a Fee or to Flee? (B)

St Thomas Kilakala Health Facility: The Cost of Providing Quality Healthcare, For Free, at a Fee or to Flee? (C)

St Thomas Kilakala Health Facility: The Cost of Providing Quality Healthcare, For Free, at a Fee or to Flee? (C)

St Thomas Kilakala Health Facility: The Cost of Providing Quality Healthcare, For Free, at a Fee or to Flee? (A, B & C)

St Thomas Kilakala Health Facility: The Cost of Providing Quality Healthcare, For Free, at a Fee or to Flee? (A, B & C)

Medication Adherence and Practices in Pediatric Patients

Background: Improper medication practices and non-adherence are the biggest challenges faced by pediatricians in outpatient practice. Hence this study was aimed at determining the medication practices and factors affecting adherence. Methods: A cross sectional descriptive study was conducted at a tertiary care hospital in Southern India over a period of 3 months (January to March 2023), to study medication adherence and parental medication practices in pediatric patients. A pre structured questionnaire was administered to parents of 320 children. Results: Majority of the parents (55%) had children aged 1-5 years of age. It was noted that most of the families (89%) were above poverty line (APL). About 34% parents were educated till graduate level and 17% were educated beyond post graduate level. Frequency of medication adherence in our study was found to be 78%. It was noted that parents with education of graduate level and above, those belonging to APL families and the ones with no fear of adverse drug reactions showed higher medication adherence as compared to other parents and this association was found to be statistically significant (p <0.001). Majority of the parents (80%) reported that their children preferred liquid formulations, of which 57% preferred fruit flavoured ones. Around 51% parents preferred twice daily dosing of medications. While 47% parents used previous prescriptions, 39% bought over the counter medicines, especially paracetamol. Conclusion: Knowledge about medication practices and factors affecting adherence is important in order to provide quality health care. Actively involving children and parents while prescribing medications with health education goes a long way in improving adherence.

Chemical Poisoning: Prevalence, Knowledge, and Management of Commonly Encountered Types among Selected Adult Population

Chemical poisoning is a threat to the health of both children and adults in the Niger Delta region. Nevertheless, the study of the prevalence of poisoning has been undermined in Bayelsa state. Chemical poisoning remains an important health concern in Nigeria, especially in the south-south Niger Delta states which are rich in natural fuel. Information on the prevalence in the Niger Delta region is quite scarce, especially in Bayelsa state. The study investigated the risk factors, awareness, and perception of chemical poisoning, and the prevalence among residents of Amassoma and Yenagoa. A descriptive research employed systematic random sampling of 400 residents from Amassoma and Yenagoa from ages 15 years and above, by administering questionnaires and, collecting data. Data were analyzed using SPSS software utilizing ANOVA. The percentage of awareness of chemical poisoning is 28.4% and the majority of the respondents are educated at the tertiary level with a percentage of 51.5%. The female gender was more with a percentage of 51.0%. Among the signs and symptoms of chemical poisoning, nausea or stomach upset has a percentage of 74.6% being the highest percentage, and stomach cramps have a percentage of 72.9% while having a percentage of 56.7%. About 95.5% of respondents concurred to contacting qualified healthcare providers when poisoning is suspected and 93.8% agreed to keep all chemicals out of reach of children as a preventive measure. It can be concluded that the overall prevalence of chemical poisoning is quite low though used intentionally in young adults for suicide. It can also be said that there is proper awareness of the preventive measures for unintentional poisoning.

Public–Private Partnership Model in Delivering Quality Health Care and Medical Education - An Enduring Success Story for the Past Seven Decades

Public–private partnerships (PPPs) are integral to the National Health Mission (NHM). Kasturba Medical College (KMC), Mangalore, was the first private institution in India to embrace the PPP model way back in 1953. The then Government of Madras permitted KMC Mangalore to partner with the 2 district hospitals – the Government Wenlock and the Lady Goschen Hospitals. For almost seven decades, KMC Mangalore has been using the clinical facilities at District Wenlock and Lady Goschen hospitals to provide quality health care and also train the Undergraduate and Postgraduate students of KMC. The Manipal experiment is a shining example of public–private collaboration to provide quality accessible health care to everyone, which is in line with the Sustainable Development Goal (SDG) 3 and its targets.

Exploring cultural competence barriers in the primary care sexual and reproductive health centres in Catalonia, Spain: perspectives from immigrant women and healthcare providers

BackgroundImmigrant populations, especially women, continue facing challenges in accessing quality healthcare, particularly sexual and reproductive health services (SRH). Poor cultural competent health systems contribute to communication challenges between immigrant women and healthcare providers perpetuating health disparities. This exploratory study describes these communication barriers from the perspective of Moroccan and Pakistani immigrant women and healthcare providers within the Catalan health system and its implications to ensure an equitable provision of SRH services.MethodsAn exploratory-descriptive qualitative study was conducted in various municipalities of Barcelona with high concentration of immigrants. Eight focus groups (N = 51) and semi-structured interviews (N = 22) with Moroccan and Pakistani immigrant women were combined with key informant interviews (N = 13) with healthcare professionals. Thematic analysis and data triangulation were performed primarily using an inductive approach.ResultsLanguage barriers and cultural differences in health needs, expectations, care-seeking behaviours and understanding of quality healthcare provision hindered the ability of immigrant women and providers to interact effectively. Limited availability of intercultural mediators and inadequate cultural competence training opportunities for health staff were also identified. Findings suggest a lack of minority representation in the Catalan health workforce and leadership roles.ConclusionThis study reinforces the evidence of persistent inequities in accessing healthcare among immigrant populations by focusing on the cultural competence barriers of the Catalan health system in the provision and access to SRH services. The regularization of adequately trained intercultural mediators, quality training in cultural competence for health staff and a commitment to increase workforce diversity would contribute to improve intercultural communication between immigrant patients and providers. An urgent call to action in this direction is needed to ensure an equitable access to SRH services among immigrant women.

Digital Education on Hospital Nutrition Diets: What Do Patients Want to Know?

Therapeutic nutrition plays an imperative role during a patient's hospital course. There is a tremendous body of literature that emphasizes the systematic delivery of information regarding hospital nutrition diets. A major component of delivering healthcare information is the principle of providing quality healthcare information, but this has not yet been investigated on hospital nutrition diets. This study aimed to evaluate the comprehension and readability of patient education materials regarding therapeutic hospital diets. The methodology employed the use of publicly available questions regarding hospital nutrition diets and categorized them per Rothwell's Classification of Questions. Additionally, the questions were extracted online and have an associated digital article linked to the question. These articles underwent analysis for readability scores. This study's findings reveal that most hospital diets do not meet the recommended grade-reading levels. This underscores the need for healthcare providers to enhance patient education regarding hospital diets. The prevalence of "Fact" questions showcases the importance of clearly explaining diets and dietary restrictions to patients.

Healthcare sectors in EU countries: Their impact on employment and infrastructure development

This scientific study aims to thoroughly assess the current status and evaluate key indicators influencing healthcare and the workforce in selected European Union (EU) member states. Building upon this ambitious research agenda, we focused on a comprehensive descriptive analysis of selected indicators within the healthcare sector, including healthcare financing schemes, overall employment in healthcare and social care, the number of graduates in healthcare (including physicians and general practitioners), as well as migration patterns within the healthcare sector. The data forming the basis of this analysis were systematically gathered from Organization for Economic Co-operation and Development (OECD) and Eurostat databases. Subsequently, we conducted a robust correlation analysis to explore the intricate relationships among these indicators. Our research endeavour aimed to identify and quantify the impact of these indicators on each other, with a focus on their implications for overall healthcare and the workforce in the respective countries. Based on the findings obtained, we derived several significant conclusions and recommendations. For instance, we identified that increasing employment in the healthcare sector may be associated with the overall quality of healthcare provision in a given country. These findings have important implications for policymaking and decision-making at the EU level. Therefore, we recommend that policymakers in these countries consider implementing measures to further develop the healthcare sector while also helping to retain and attract qualified professionals in the healthcare industry. Such recommendations could include improving healthcare infrastructure, incentivizing professional education and further training in the healthcare sector, and implementing policies to support healthcare provision more broadly.

The effect of health facility ownership on perceived healthcare quality: evidence from Ghana.

Whether private healthcare providers should be encouraged over public providers remains unclear. On the one hand, because private providers are profit-driven, they are more motivated to compete for demand by enhancing quality if demand is elastic. However, because they are more motivated to maximize revenue, they may sacrifice quality to maximize profit. A crucial factor in determining whether private providers should be encouraged is the extent to which their quality exceeds or falls short of that of the public provider. This study, therefore, investigates whether the public and private differ in providing quality healthcare services using the 2014 Ghana Demographic and Health Survey. Our measure of healthcare quality is based on patient satisfaction level with nine healthcare services (cleanliness, waiting time, comfort and safety, consultation time, privacy, listening, explanation, treatment advice and confidentiality) provided by public and private healthcare facilities. We applied an instrumental variable approach to account for endogeneity issues related to the patient's choice of healthcare provider. We find that private facility users have a higher probability of being very satisfied with "waiting time", "consultation time", "listening", "cleanliness", "comfort and safety", "confidentiality", and "privacy" than public users, thus suggesting that private facilities provide better service than public. We thus recommend encouraging the private sector to enter the healthcare market. We also find that failing to account for endogeneity in provider choice when estimating the effect of healthcare facility ownership on healthcare service quality underestimates the effects.

Impact of COVID-19 lockdown on sleep patterns and the related problems among nursing students.

To evaluate the impact of the COVID-19 lockdown on sleep patterns and quality among nursing students in our college. A cross-sectional study was carried out. A total of 302 nursing students aged 18-25 years, representing both genders and various academic levels, participated in this study. A pre-validated, self-administered questionnaire was used to assess sleep quality during COVID-19 and it was distributed through various social media platforms for data collection. Female students comprised the majority (92.1%) of participants. Of 332 nursing students, 302 completed the questionnaire, yielding a 91% response rate. Statistically significant differences were observed before and during the COVID-19 lockdown regarding the need to sleep after waking, feeling refreshed upon waking, satisfaction with individual sleep patterns and experiencing restless and troubled sleep (p = 0.001). Additionally, approximately one-third of nursing students (32.9%) reported poor sleep quality during the COVID-19 pandemic, with minimal impact on the total sleep hours among the studied cohorts. The COVID-19 pandemic has statistically significant impacted nursing students' sleep quality and levels. Acknowledging these challenges and planning for providing supporting measurements is essential to ensuring that nursing students can maintain their physical and mental health, which is critical for their ability to provide quality healthcare.

High Responsibility, limited authority, and endless expectations: a policy critique of the Community Health Officer’s role in the government healthcare delivery systems in India

BackgroundThe shortage of qualified healthcare providers in rural areas of India has led to a emergence informal and unqualified practitioners and poses significant risks to population health. Community Health Officers (CHOs) were introduced as mid-level health providers (MLHP) at Sub-health Centres (SHC) to bridge the healthcare resource gap and serve as the primary point of contact for rural communities.MethodsThis qualitative cross-sectional study aimed to explore the CHOs experiences and performance at sub-health centre Health and Wellness Centres (SHC-HWCs) in India. CHOs and Medical Officers (MOs) from randomly selected SHC-HWCs and Primary Health Centre-Health and Wellness Centres (PHC-HWCs) across different geographic zones were interviewed. Semi-structured interviews were conducted with CHOs, MOs, and State Nodal Officers (SNOs) to gather information on drug provisioning, prescription practices, and perspectives on the roles and capacities of CHOs. The study is based on 40 in-depth interviews of health providers sampled at different levels of healthcare system in India.ResultsThe study revealed barriers and challenges faced by CHOs in meeting the expectations outlined in the Comprehensive Primary Health Care (CPHC) guidelines. These included a lack of agency, difficulties in team dynamics with existing healthcare professionals, and inadequate availability of medicines at sub-health centres. Due to the existing contradictions and prescription restrictions, CHOs found themselves failing to meet community expectations and foster trust.ConclusionCHOs encounter significant challenges in fulfilling their roles as mid-level health providers. Addressing these challenges is crucial for optimizing their effectiveness and strengthening the delivery of primary healthcare in rural areas. Clear protocols, supportive policies, and capacity-building initiatives are necessary to enhance the role and impact of CHOs in the healthcare system.

Doctors' understanding of their learning and learning needs in Kwazulu-Natal district hospitals.

Medicine is a self-regulating profession. Doctors must learn how to self-regulate to keep up-to-date with evolving health care needs. This is challenging for those working at District Hospitals (DHs) in rural settings, where limited resources and understaffing may compound a poor approach and understanding of how to become a self-directed learner. To explore perspectives of doctors working in rural DHs, regarding their understanding of learning and learning needs. This study was conducted in Bethesda and Mseleni DHs, in rural KwaZulu-Natal. This was a qualitative study. Data was collected through 16 semi-structured interviews and non-participatory observations. Four major themes emerged: "Why I learn," "What I need to learn," "How I learn," and our learning environment." This paper focussed on the first three themes. Doctors' learning is influenced by various factors, including their engagement with clinical practice, personal motivation, and their learning process. Deliberate practice and engagement in reflective practice as key principles for workplace learning became evident. In rural DHs, doctors need to take a proactive self-regulated approach to their learning due to difficulties they encounter. They must build competence, autonomy, a sense of connection in their learning process, thus recognizing the need for continuous learning, motivating themselves, and understanding where they lack knowledge, all essential for achieving success.Contribution:This article contributes towards strengthening medical education in African rural context, by empowering medical educators and facility managers to meet the learning needs of doctors, thus contributing to the provision of quality health care.

The transition of patient care: Exploring the outcomes of prehospital to hospital patient handover practices and healthcare provider education

IntroductionInadequate patient handover is linked to numerous medical errors and lapses in communication between hospital healthcare providers and prehospital healthcare providers. Undergraduate healthcare curricula may limit programme-specific education on patient handover and shift learning to informal learning opportunities. This study aimed to investigate the outcomes of qualified healthcare provider (HCPs) educational programmes to determine the adequacy of handover practices, the source of their training, and their interprofessional acceptance of these practices. MethodsA multi-method study design was used – a document analysis of HCP programme outcomes and a two-section questionnaire. The questionnaire was sent to HCPs to determine the impact of patient handover practices on current healthcare systems and their opinion on whether the training on handovers is sufficient. ResultsHCPs indicated little educational interaction regarding patient handover. Most participants felt handover education relied predominantly on informal training. With their existing knowledge, many HCPs revealed that they were comfortable in handing over a patient. Little interprofessional confidence regarding patient handover information indicates minimal interprofessional collaboration toward standardised approaches for patient handover. ConclusionThis study indicates a lack of standardised handover procedures, which leads to HCP self-interpretations. There is low trust between HCPs regarding information received. The study highlights the need for standardised handover training in healthcare curricula to improve patient safety and interprofessional collaboration.

Intercultural competence development: A qualitative case study

AimThe aim of this study was to explore Bachelor of Science in Nursing (BSN) students' perceptions of the effectiveness of a unique teaching-learning strategy using their results from the Intercultural Development Inventory (IDI), an instrument for the assessment of intercultural competence, with their customized Intercultural Development Plan (IDP) in enhancing their cultural competence development in a nursing senior practicum. The study also examined student insights about how having a plan to develop their intercultural competence will have an impact on their future nursing practice. BackgroundIntercultural competence is vital for providing quality healthcare, yet there is a gap in understanding how educational interventions are designed and implemented to enhance cultural competence among nursing students. This paper describes a strategy for developing intercultural competence. The IDI was administered to Bachelor of Science in Nursing (BSN) students in the fourth semester of a five-semester BSN program. Based on their IDI results, each student received a customized IDP that suggested specific activities and encouraged guided self-reflection to enhance intercultural competence development. In the fifth-semester senior practicum course, the students developed personal intercultural competence development goals based on their IDP. They also kept weekly journals on their intercultural competence development during their practicum. DesignThis study used a Qualitative Case Study design. MethodsThis study was conducted from January to July 2021 with 47 senior practicum students in a large BSN program in the Southeastern United States. Data consisted of student written responses to prompts on how the IDI/IDP influenced their intercultural development and its potential effect on their future practice. The data were analyzed through inductive content analysis. ResultsThree key themes emerged: self-awareness, recognition of cultural influences and growth goals. Student reflections suggested that they desired to develop intercultural competence so they could provide the best possible nursing care for their patients. Still, most students did not have a plan for how to grow in this area. Many students reported that their IDI/IDP heightened cultural awareness throughout their practicum, guiding their development of intercultural competence and leading to a deeper and broader understanding of culture. Students suggested that this enhanced cultural understanding, along with their IDP, will facilitate their continued development of intercultural competence in their future professional practice. ConclusionThis study contributes to existing knowledge about intercultural competence development and effective teaching methods by providing empirical evidence of the positive impact of the IDI/IDP on nursing students' perceived intercultural development. These findings can inform the development and implementation of pedagogical strategies to enhance intercultural competence, which will ultimately improve patient care outcomes in all healthcare settings.

Risk management of radioiodine treatment in differentiated thyroid cancer

IntroductionPatient safety is paramount in providing quality healthcare and constitutes a global concern for healthcare systems. Radioiodine treatment to patients with well-differentiated thyroid cancer is not without risks. The aim of this study is to identify, evaluate and mitigate the risks associated with this procedure. Materials and methodsA single-centre descriptive study was conducted in which risk management was carried out by establishing a risk map using FMEA methodology. ResultsBased on the process map 6 sub-processes and 23 failure modes in the three phases of the treatment process were analysed. According to risk priority number (RPN), the sub-process with the highest risk was administrative management (RPN 82), followed by treatment per se and post-treatment imaging (both with RPN 70). An overall process RPN of 300 (156 pre-treatment, 74 treatment and 70 post-treatment) was obtained. Failures directly related to the patient pose a high risk. The implementation of verification systems, performing tasks earlier and providing quality medical information are the most relevant preventive measures to be implemented. ConclusionsThe application of the FMEA methodology in the risk management for radioiodine treatment is a valuable tool for improving the quality and safety of this process. The risk map has been able to identify failures at different stages, assess their causes and effects, prioritise the risks identified and implement preventive and corrective measures that can be monitored, ensuring the effectiveness of the actions taken.

Transgender and Gender Diverse Health Care in the US Military: What Dermatologists Need to Know.

The US Military has made considerable strides in providing quality health care to transgender and gender diverse service members (TSMs). Current policies ensure continued military readiness and allow TSMs to receive gender-affirming care while continuing to serve. Dermatologists play an important role in the multidisciplinary medical team required for medical gender transition; however, there is considerable discord between medically necessary procedures for dermatologic gender-affirming care and insurance-covered benefits. Within the scope of dermatology, many of the available procedures currently are not covered by insurance. This article seeks to discuss how military and civilian dermatologists can contribute to gender-affirming care. We also review existing disparities in health care and identify potential areas of improvement.

Inclusive innovations in services: leveraging digital technologies for inclusive innovations in healthcare services

PurposeThis paper aims to provide insights into the potential of digital technologies-based innovations for more inclusive healthcare by alleviating the affordability, accessibility and availability barriers to utilization of healthcare services. Also, it aims to provide insights into the potential of digital technologies-based innovations for more inclusive services, broadly.Design/methodology/approachA conceptual framework is inductively developed by analyzing real-world examples of digital technologies-based innovations for more inclusive healthcare through the lenses of economics of information in digital form and certain characteristics of services.FindingsConcurrent implementation of digital technologies-based healthcare innovations with innovations and/or modifications in service processes can enable greater inclusivity by alleviating the affordability, accessibility and availability barriers to utilization of healthcare services.Research limitations/implicationsIssues relating to inequities in healthcare, as a social problem, are the focus of research at multiple levels (e.g. global, national, regional and local) in several academic disciplines. In relation to the scope of the problems and challenges pertaining to providing quality healthcare to the unserved and underserved segments of society, worldwide, the contribution of the proposed framework to practice is modest. However, by highlighting the promise and potential of digital technologies-based innovations as solutions for alleviating barriers to affordability, accessibility and availability of healthcare services during various stages (prevention, detection, diagnosis, treatment and post-treatment follow-up) with illustrative vignettes and developing a framework, the article offers insights for future research. For instance, in reference to mission-driven social enterprises that operate in the product-market space for inclusive innovations under resource constraints, a resourcefulness-based view of the social enterprise constitutes a potential avenue for theory development and research.Practical implicationsGiven the conceptual nature of the article, the implications for practice are limited to cognitive implications. Action implications (instrumental implications or implications for practice) are outside of the scope of the article.Social implicationsInnovations that are economically viable, environmentally sustainable and socially impactful is one of the important issues of our times.Originality/valueThe proposed framework provides insights into the potential of digital technologies-based innovations for more inclusive healthcare by alleviating the affordability, accessibility and availability barriers in the context of emerging and less developed country markets and base of the pyramid segments of society in these markets.

Utilisation of postnatal care services among maternal in Maeen District – Sana’a City, Yemen

BackgroundOne of the most effective ways to reduce maternal and neonatal mortality is to improve mother and newborn health via the provision of appropriate postnatal care services by qualified healthcare providers. However, there is limited information on the use of postnatal care services in Yemen. This study aimed to determine the utilisation of postnatal care services among mothers in Yemen.MethodologyA descriptive cross-sectional study was conducted in the Maeen District of Sana’a City, Yemen from December 2022 to January 2023. Convenience sampling was employed to recruit 321 participants. Semi-structured questionnaires were applied as the study tool in the face-to-face survey.ResultLess than half (45.2%) of the study participants utilised postnatal care services in this study. The mode of delivery, place of delivery, and receiving information about postnatal care during antenatal visits were significantly associated with postnatal care service utilisation.ConclusionLess than half of the study participants were informed about postnatal care services, contributing to their low utilisation. Thus, it is vital to strengthen the provision of information, education, and communication with regard to postnatal care services among pregnant mothers visiting antenatal clinics.

Examining How the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model Improves Health Equity for Underserved Communities and Safety Net Hospitals in New York State.

Safety net hospitals (SNHs) are essential to our healthcare ecosystem, providing quality healthcare to underserved communities. These institutions offer specialized services and acute medical care to populations facing structural or systemic healthcare barriers. However, for decades, the NYS Medicaid program reimbursed hospitals less than the cost of care, resulting in several independent SNHs becoming financially distressed, with many facing closure. Recently, the Center for Medicaid and Medicare Service Innovation Center (CMSI) introduced the State All-Payer Health Equity Approaches and Development (AHEAD) Model, which aims to support the financial needs of providers while also addressing the complex medical and social circumstances of underserved communities. This article will explore how the AHEAD model can be utilized as an alternative payment method for SNHs in New York State (NYS) to improve healthcare for underserved communities.