Provision Of Health Care Services Research Articles

AI‐CARING: National AI Institute for Collaborative Assistance and Responsive Interaction for Networked Groups

AbstractOver 13 million Americans aged 65 and older are currently living with a diagnosis of mild cognitive impairment (MCI), a common precursor to dementia. These individuals largely rely on a network of informal caregivers—family, friends, and community members—who work together with professional healthcare and social service providers to provide care and support in home settings. The AI‐CARING Institute contributes foundational AI research focused on developing personalized collaborative AI systems that improve the quality of life and independence of aging adults living at home.

Mental Disorders Among Healthcare Workers During the Coronavirus Pandemic.

Coronavirus disease 2019 (COVID-19) is a disease that has become a regular part of care by health services. In the beginning, health services faced immense pressure due to new disease exposure, irregular schedules, and high work stress for healthcare workers. Unfortunately, their mental health was not adequately safeguarded, and there are few healthcare units that screen staff for depression and anxiety. The objective of this study is to describe the prevalence and factors associated with anxiety and depression diagnoses among healthcare workers during the coronavirus pandemic. Across-sectional study was conducted in which depression (Beck questionnaire) and anxiety (Hamilton questionnaire) were investigated in health staff, after providing informed consent. This study was carried out during November and December 2022. All workers in all areas of a first-level unit were invited to participate in this research, so no sample calculation or sampling technique was required. Statistical analysis was performed using X2 and Student's t-test. Among the 232 workers surveyed, the prevalence of mild anxiety, severe anxiety, and certain levels of depression was 42.1%, 33.5%, and 18.9%, respectively. The study revealed that smoking is associated with a higher risk of anxiety diagnosis (OR=4; CI95%=1.3-12.7). A higherscore on the Hamilton Anxiety Scale (OR=1.07; CI95%=1.04-1.11) as well as not being permanent staff (OR=3.34;CI95%=1.2-9.3) was found associated with depression diagnosis. The SARS-CoV-2 pandemic increased the stress and pressure on healthcare workers. Thus, early detection, timely treatment, and effective prevention measures are necessary for safeguarding health status and the provision of healthcare services.

Implementasi Data Mining dengan K-Means Clustering untuk Memprediksi Pengadaan Obat

Community Health Center is one of the institutions that provides healthcare services. To ensure the provision of quality healthcare services, the Community Health Center management must be able to effectively manage medicine inventory to avoid the risks of shortages or excess stock. Therefore, the purpose of this research is to observe and perform clustering of medicine demands at Puskesmas Mandala using the K-Means Clustering technique. The data used includes medicine demand data from January to December 2023 at the health center. In its implementation, the RapidMiner application or software is utilized to perform clustering using the K-Means Clustering algorithm. The available medicine data will be grouped into 3 clusters: cluster 0 for high medicine demands, cluster 1 for moderate medicine demands, and cluster 2 for low medicine demands. Out of the 28 test data used, the results show the first cluster consisting of 24 items, the second cluster consisting of 3 items, and the third cluster consisting of 1 item with a Davies Bouldin Index value of 0.276. From this research, the Puskesmas can continue to procure medicine for the types classified under high-demand clusters to ensure that the medicine needs are consistently met.

Implementation issues and barriers for assessing oral health in dependent patients after stroke: A qualitative study

ObjectivesTo explore implementation issues and potential barriers for assessing oral health in dependent post-stroke patients. MethodsSemi-structured interviews were conducted with a purposively identified sample of healthcare service providers who work in two National Health Service (NHS) Trusts in the north of England. Interviews were conducted until data saturation was achieved (n = 30). Data were analysed using the constant comparative method. ResultsSix themes were drawn out in this study, which described potential barriers to assessing oral health in post-stroke patients, aspects of oral health that need assessment, streamlining the oral health assessment, input methods for oral health assessment, characteristics of assessors, and how oral care should be planned. ConclusionsAssessment of oral health for post-stroke patients has been viewed as a complex task because of several identified barriers. Several suggestions have been proposed to overcome these barriers, aiming to enable more feasible and effective oral health assessments for post-stroke patients. Clinical SignificanceThe findings from this study have the potential to contribute to developing oral health measurement instruments that might be more successfully implemented and guide oral care planning for dependent patients after stroke.

The Shape of Mobile Health: A Systematic Review of Health Visualization on Mobile Devices

mHealth apps and tracking technology are becoming popular because they help people adopt a healthier lifestyle and form healthy habits. One way mHealth apps can help users is by presenting visuals to help them better understand their health data. Commendable efforts have been carried out to personalize health-promoting interventions to help users become more aware of their own health, and health practitioners for providing healthcare services. For example, digital self-tracking apps nowadays can be used to monitor physical activity, nutrition and sleep patterns. This systematic review aims to investigate the current trends, challenges, gaps, and opportunities in health visualizations on mobile devices. Peer-reviewed papers in English collected using online databases (ACM Digital Library, PubMed, and Web of Science) from 2012 to 2022 were considered, and 56 studies were selected out of 1,168 studies. Results showed that among 11 different health domains, general health and physical health were the most heavily studied. Relatedly, results also showed that physical fitness data is the most frequently collected data type automatically from sensors/trackers. Furthermore, bar and line charts are the most popular type of visualizations used for presenting a variety of health data, and while most apps present static visualizations, interactive visualizations, as well as a combination of both static and interactive visualizations, are becoming more common. Based on our results, we offer recommendations for future research as designers and researchers continue to improve the presentation of data visualizations in mHealth apps.

A COMPREHENSIVE REVIEW OF TELEMEDICINE TECHNOLOGIES: PAST, PRESENT, AND FUTURE PROSPECTS

This comprehensive review explores telemedicine technologies' past, present, and future. Telemedicine has evolved significantly, providing healthcare services and exchanging medical information remotely. The historical overview traces its roots from early experiments to its current state, marked by advanced technology, diverse applications, and increased adoption, especially during the COVID-19 pandemic. Emerging technologies like AI, VR, IoT, and blockchain promise to revolutionize telemedicine, enhancing diagnostics, patient monitoring, and personalized treatment. Potential applications range from chronic disease management to tele-ICUs and global health initiatives. To maximize telemedicine's benefits, healthcare providers, technology developers, policymakers, and researchers are offered recommendations. Telemedicine's potential to transform healthcare delivery is profound, fostering accessibility, efficiency, and improved patient outcomes. While challenges exist, addressing them will help create a future where telemedicine is central to delivering equitable and patient-centred healthcare.
 Keywords: Telemedicine, Healthcare Technology, Remote Healthcare, Emerging Technologies, Healthcare Access, Telehealth Trends.

Medical deserts in Spain-Insights from an international project.

Medical deserts are a growing phenomenon across many European countries. They are usually defined as (i) rural areas, (ii) underserved areas or (iii) by applying a measure of distance/time to a facility or a combination of the three characteristics. The objective was to define medical deserts in Spain as well as map their driving factors and approaches to mitigate them. A mixed methods approach was applied following the project "A Roadmap out of medical deserts into supportive health workforce initiatives and policies" work plan. It included the following elements: (i) a scoping literature review; (ii) a questionnaire survey; (iii) national stakeholders' workshop; (iv) a descriptive case study on medical deserts in Spain. Medical deserts in Spain exist in the form of mostly rural areas with limited access to health care. The main challenge in their identification and monitoring is local data availability. Diversity of both factors contributing to medical deserts and solutions applied to eliminate or mitigate them can be identified in Spain. They can be related to demand for or supply of health care services. More national data, analyses and/or initiatives seem to be focused on the health care supply dimension. Addressing medical deserts in Spain requires a comprehensive and multidimensional approach. Effective policies are needed to address both the medical staff education and planning system, working conditions, as well as more intersectoral approach to the population health management.

HIV-related knowledge and risk behaviors among transgender individuals in Dhaka, Bangladesh: A cross-sectional study

The prevalence of human immunodeficiency virus (HIV) among transgender individuals in Bangladesh stands at 1%, with a slightly lower rate of 0.9% observed specifically in Dhaka city. Given their status as a minority group, the limited understanding of HIV among transgender individuals poses a significant public health concern. Consequently, the study aims to investigate the HIV-related knowledge and risk behaviors prevalent among transgender individuals in Dhaka city. This cross-sectional study included 135 transgender individuals sourced from a drop-in-center (DIC) and three selected Hijra Pollis in Dhaka. Data collection employed a semi-structured questionnaire featuring a Likert scale designed to collect data on HIV-related knowledge. The majority of participants identified as professional sex workers, with 54.10% reporting irregular sexual clients, and 48.90% involved in sex work for more than 10 years. Despite more than half (57%) exhibiting robust HIV-related knowledge, only one-third (37.30%) reported sporadic use of barrier methods, and slightly more than half (58%) demonstrated awareness of HIV symptoms. A notable discrepancy in HIV-related knowledge was discerned between transgender individuals from the DIC and their counterparts from the Hijra Pollis (t [95% confidence interval] = 0.168 [0.1001 – 0.236], p < 0.001). In conclusion, despite the provision of healthcare services at the DIC, there persists a pressing need to address current risk behaviors and enhance sex education related to HIV awareness to mitigate associated hazards.

Building digital patient pathways for the management and treatment of multiple sclerosis.

Recent advances in the field of artificial intelligence (AI) could yield new insights into the potential causes of multiple sclerosis (MS) and factors influencing its course as the use of AI opens new possibilities regarding the interpretation and use of big data from not only a cross-sectional, but also a longitudinal perspective. For each patient with MS, there is a vast amount of multimodal data being accumulated over time. But for the application of AI and related technologies, these data need to be available in a machine-readable format and need to be collected in a standardized and structured manner. Through the use of mobile electronic devices and the internet it has also become possible to provide healthcare services from remote and collect information on a patient's state of health outside of regular check-ups on site. Against this background, we argue that the concept of pathways in healthcare now could be applied to structure the collection of information across multiple devices and stakeholders in the virtual sphere, enabling us to exploit the full potential of AI technology by e.g., building digital twins. By going digital and using pathways, we can virtually link patients and their caregivers. Stakeholders then could rely on digital pathways for evidence-based guidance in the sequence of procedures and selection of therapy options based on advanced analytics supported by AI as well as for communication and education purposes. As far as we aware of, however, pathway modelling with respect to MS management and treatment has not been thoroughly investigated yet and still needs to be discussed. In this paper, we thus present our ideas for a modular-integrative framework for the development of digital patient pathways for MS treatment.

Impact of COVID-19 Pandemic on Utilization of Healthcare Services and Spending Patterns in Dubai, United Arab Emirates: A Cross-Sectional Study.

The COVID-19 pandemic affected the utilization of healthcare services in many parts of the world. The response to the healthcare burden imposed by the COVID-19 pandemic was associated with ensuring the provision of optimum healthcare services. This study aimed to estimate the effect of the COVID-19 pandemic on health services utilization and spending patterns in Dubai, the UAE. This cross-sectional study used secondary data on healthcare utilization and spending to compare between 2019 and 2020. The data was extracted from the health insurance claims on the eClaimLink platform. Descriptive and inferential statistics were used to calculate the percent change of service utilization and spending and percentages of total claims by each encounter type across major diagnostic categories (MDCs). In 2020, there was an overall reduction in outpatient visits and inpatient admissions of 27% and 21%, respectively, compared to 2019. Outpatient visits and prescriptions decreased across all the MDCs except mental and behavioral disorders, which showed an increase of 8% in outpatient visits and 29% in prescriptions. The admissions to the healthcare facilities were also reduced significantly across various MDCs, ranging from 10% to 44%. Similarly, a downward trend was seen in diagnostics for different MDCs. An increase in expenditure on diagnostics and drugs for neoplasm was reported, despite a corresponding decrease in outpatient and inpatient admissions for the same. A significant decrease in overall healthcare utilization and corresponding healthcare spending, resulting from a decline in outpatient and inpatient volume in healthcare facilities at all the levels (hospitals, clinics, speciality centres), was reported during the pandemic. The impact of the pandemic on mental health was reported by this study, as it showed an upward trend in utilization and spending. For the neoplasms, although the utilization declined, the expenditure on diagnostics and drugs during each encounter increased significantly.

It’s the state, indeed! How state capacity facilitates social equality in authoritarian regimes

ABSTRACT Empirical evidence suggests that contemporary authoritarian regimes face several incentives to redistribute social policy concessions to their citizens. Yet autocracies differ extensively in their capacity to implement policy decisions. In this article, we identify three distinct but interrelated mechanisms through which state capacity determines a more equal provision of social benefits and services in healthcare and education sectors. Administrative capacity allows the regime to manage the implementation of social policy, extractive capacity ties in with more resources and information to be used for the provision of social benefits and services, and coercive capacity permits the state to effectively enforce policies. Using static and dynamic regression models for over 120 countries from 1960 to 2016, our findings show that state capacity enhances social equality in authoritarian contexts through these three interrelated mechanisms. Further analysis though suggests that the overall effect of state capacity dissipates in the long run.

Women’s adoption of wearable health-monitoring technology: empirical evidence from a least developed country

PurposeAlthough wearable health-monitoring technology (WHMT) has become a stimulus for public health, women’s acceptance rate of this technology appears to be low. Thus, this study intends to investigate the factors affecting women’s adoption of WHMT.Design/methodology/approachThe unified theory of acceptance and use of technology–2 model has been used in this study as a research framework that has been extended to include lifestyle and attitude. The proposed extended framework is validated using primary data (n = 314) collected from female respondents using a structured questionnaire; the partial least square-based structural equation modeling technique is subsequently used to test the proposed hypothesis.FindingsThe results show that effort expectancy, social influence, price value, habit, attitude and lifestyle have significant positive effects on women’s behavioral intention to use WHMT and accelerate actual usage behavior. Notably, effort expectancy and habit exhibit the largest impact on behavioral intention. However, performance expectancy, facilitating conditions and hedonic motivation are not significantly associated with behavioral intentions.Practical implicationsThe findings of this study are important for healthcare practitioners and service providers to comprehensively understand the factors that affect women’s behavioral intentions in line with their actual usage behavior. This insight will help policymakers design viable strategies regarding WHMT to promote its sustainable usage in least developed countries.Originality/valueThis study contributes novelty by using an extended model that links women’s attitudes and lifestyles to their adoption of WHMT. This study also fills the gaps in the existing literature on women’s behavioral intentions in the context of WHMT by showing novel associations in the domain of WHMT uptake.

Regulatory innovation and (de)legitimisation: accountability challenges in the healthcare field

ABSTRACT Accounting research examines accountability in the healthcare field but little attention is paid to how contemporary regulatory innovations (e.g. AI-driven data algorithms) impact accountability objectives. We address this concern through a study of how regulatory innovations may appropriate accountability by (de)legitimising healthcare actions. This is examined in the case of a regulatory innovation enacted in the US healthcare sector. Specifically, we employ a field study of a healthcare provider subject to oversight to highlight how actors (de)legitimise the provision of healthcare services. Our findings show that regulatory innovation generates debates around illegitimate services as determined by healthcare oversight contractors. These contractors are incentivised to appropriate AI-driven data algorithms towards a focus on reducing costs of non-standard healthcare services while healthcare providers legitimate those services as quality healthcare. Additionally, findings suggest that more extensive implementation of AI-driven data algorithms in the healthcare field may serve to limit healthcare options, particularly when combined with private contracting. This study contributes to the literature by showing the (de)legitimising consequences that regulatory innovations combining the use of algorithmic decision-making and private incentive contracts have for accountability and delivery of services in the healthcare field.

Determinants of Patient Satisfaction in Healthcare Industry in Delhi using PLS-SEM

The healthcare industry in India has advanced significantly in recent years. As a result of corporatisation, hospitals’ classes and quality have significantly changed in modern times. The intangible nature of healthcare services imposes a great challenge to healthcare service providers to measure the quality of service hence satisfaction of patients. The present study highlights the role of corporatisation in the assessment of patient satisfaction (PS). The aim of this article is to evaluate how doctors’ services, nurse services, administrative services, pathological services (PHS) and pricing affect the level of PS in corporate hospitals of Delhi. An exploratory research technique was used. A sample of 342 patients was analysed using a questionnaire. Using partial least squares to a structural equation model, a cross-sectional study was applied. The results revealed that doctor services, nurse services, administrative services and PHS have positive impact on PS and pricing of hospitals negatively influences satisfaction of patients. It indicates that corporatisation of healthcare services has mainly leaded to improvement of satisfaction level. At the same time, research will direct healthcare providers in the right direction towards the rectification and reconsideration of pricing policies making them more pocket-friendly.

Medication error in the provision of healthcare services

Medication errors are the most common and widespread medical adverse event that occurs in healthcare settings and can lead to increased patient morbidity, mortality, and healthcare costs. The availability of a wide range of over-the-counter and prescribed medications in the healthcare market, which the general public seems to use on a frequent basis to treat their health complications, has rapidly increased the chances of medication errors. Furthermore, the medication chain has several steps that require different people, and errors can occur at different stages in patient care, from ordering the medication to the time the patient is administered the drug. So each stage of the medication chain is exposed to risks that could result in medication errors. Thereby, medication errors prompt patient harm, preclude immediate discharges, and enhance healthcare costs. As a result, it is important to set up a medication safety culture that can light up in the context of effectively putting strategies into action, and everyone's collaboration and participation to adhering to medication safety strategy can improve patient safety. This review of the literature aims to provide a concept of medication errors, explore the pattern of errors, causes and consequences of errors, and error-related adverse events in all types of healthcare settings, risk factors for medication errors, and strategies to avoid and minimize medication errors.

Evaluating and Ranking e-Service Desks Managed by Treatment Affairs at Medical Sciences Universities: A Cross-Sectional Study in a Developing Country

Introduction: As a key custodian of public health, the Vice-Chancellor for Treatment Affairs in medical sciences universities plays a pivotal role in delivering healthcare services to the citizens through electronic service desk. In this study, we conducted an evaluation and ranking of the e-service desks managed by the Vice-Chancellor of Treatment Affairs at Iranian medical sciences universities.Material and Methods: A cross-sectional study conducted in Iran between 2022 and 2023 assessed e-service desks in medical sciences universities. The study included 51 desks categorized by their electronic service methods. Subsequently, e-services were evaluated and scored based on components, which are provided by the national administrative organization for employment. The evaluation components encompassed a) use of an e-service desk to provide services; b) provision of an information package; c) availability of a flowchart outlining the service; d) clarity of the service recipient; and e) electronic collection of user opinions. The total points and the average of each desk were calculated to rank them.Results: The assessed e-service desks were categorized into three groups based on the method of providing electronic services: service provider, service recipient, and not categorized. After evaluating each e-service desk, the highest and lowest points of e-service desks were 708 and 2. The result indicated that only 31 e-service desks achieved an average score of 50% or above.Conclusion: It could be concluded that electronic government (e-government) has been partially implemented in the field of treatment throughout a developing country. However, the absence of a unified model to serve as a guideline for designing e-service desks has resulted in an undesirable diversity in the services offered and their delivery methods. It is recommended that medical sciences universities adopt and adhere to a unified model when designing e-service desks for the provision of healthcare services electronically.

THE DISPOSAL PRACTICES OF UNUSED AND EXPIRED PHARMACEUTICAL PRODUCTS AMONG NON-GOVERNMENTAL HEALTHCARE PROVIDERS IN NORTH EASTERN NIGERIA

The disposal practices of unused and expired medicines have become a worldwide challenge. Due to the state of insecurity in the North Eastern Nigeria, Non-Governmental Healthcare providers provide healthcare services and medication to populations in distress and are also positioned to possess unused and expired health products. The objective of the study was to evaluate the knowledge, attitude, and practices of Non-Governmental Healthcare providers working in Borno State Nigeria towards handling unused and expired pharmaceuticals. A cross-sectional research design using questionnaires was employed among all Non-Governmental Healthcare providers registered under the Borno State Agency for Coordination of Sustainable Development and Humanitarian Response (BACSDAHR) and all donor agencies implementing health programmes within the state. A total of 43 respondents participated in the study. About 86.0% showed good knowledge of the environmental impact of improper disposal, 95.5% showed a good attitude on disposal of unused and expired medicine, 62.8% exhibited good practices in the handling of unused and expired medicines. A significant association was found between the profession and the disposal practices of unused and expired medicines. Between 80% to 93% of respondents do not know of the availability of any medicine disposal guideline document in their organization. The staff of Non-Governmental Healthcare providers show good knowledge, good attitude as well as good practices on the disposal of unused and expired medicines. The profession of respondents significantly influenced their disposal practices.

A Study on Decision-Making for Improving Service Efficiency in Hospitals

The provision of efficient healthcare services is essential, driven by the increasing demand for healthcare resources and the need to optimize hospital operations. In this context, the motivation to innovate and improve services while addressing urgent concerns is critical. Hospitals face challenges in managing internal dispatch services efficiently. Outsourcing such services can alleviate the burden on hospital staff, reduce costs, and introduce professional expertise. However, the pressing motivation lies in enhancing service quality, minimizing costs, and exploring innovative approaches. With the rising demand for healthcare services, there is an immediate need to streamline hospital operations. Delays in internal transportation services can have far-reaching implications for patient care, necessitating a prompt and effective solution. Drawing upon dispatch data from a healthcare center in Taiwan, this study constructed a decision-making model to optimize the allocation of hospital service resources. Employing simulation techniques, we closely examine how hospital services are currently organized and how they work. In our research, we utilized dispatch data gathered from a healthcare center in Taichung, Taiwan, spanning from January 2020 to December 2020. Our findings underscore the potential of an intelligent dispatch strategy combined with deployment restricted to the nearest available workers. Our study demonstrates that for cases requiring urgent attention, delay rates that previously ranged from 5% to 34% can be notably reduced to a much-improved 3% to 18%. However, it is important to recognize that the realm of worker dispatch remains subject to a multifaceted array of influencing factors. It becomes evident that a comprehensive dispatching mechanism must be established as part of a broader drive to enhance the efficiency of hospital service operations.

Healthy Aging from the Perspective of Older Adults: A Descriptive Qualitative Study

Background: Healthy aging is an important concept developed by the World Health Organization with the aim of enhancing the health of older adults, highlighting the positive aspects of aging, and reinforcing their social roles. Objectives: Since the concept of healthy aging can be interpreted differently by older adults in various societies, this study aimed to explore the perspectives of Iranian older adults regarding healthy aging. Methods: A qualitative descriptive design and content analysis was employed to gather data from 15 purposively selected community-dwelling older adults aged over 60 years in Ilam and Khuzestan provinces, Iran. Semi-structured interviews were conducted and analyzed following Graneheim and Lundman's (2004) content analysis guide. Results: Five main themes and 16 subthemes emerged. These 5 main themes include social participation, mental health, a healthy lifestyle, maintenance of functional ability, and adequacy of economic status. Conclusions: Based on the results, healthy aging is a multidimensional concept. It is recommended that health policy-makers and providers of elderly healthcare services take these factors into account when planning and delivering services aimed at promoting the health of older adults.

Exploring fathers’ experiences of caring for a child with complex care needs through ethnography and arts-based methodologies

BackgroundAlthough the number of children living with complex care needs (CCN) is increasing worldwide, there is limited data on the experience of fathers caring for children with CCN. This paper reports on findings specific to fathers’ experiences of caring for their child with CCN and highlights recommendations provided for parents of children with CCN, service providers, and policymakers. The findings emerged from a larger study designed to examine how Canadian families of children with CCN participate in society.MethodsWe used the qualitative research approach of ethnography and arts-based methodologies (ecomaps and photovoice) as well as purposive and snowball sampling techniques. Four parents were engaged as advisors and twenty-nine fathers participated in interviews (all were married or in a relationship; age range of 28 to 55 years). In line with an ethnographic approach, data analysis involved several iterative steps including comparing data from the first, second, and third set of interviews and refining themes.ResultsOne overarching theme, striving to be there for the child with CCN, was identified. Five supporting themes further exemplified how fathers strived to be there for their child: 1) contributing to the parental team through various roles; 2) building accessibility through adaptation; 3) engaging in activities with the child; 4) expressing admiration and pride in their children; and 5) meaning making. Recommendations for parents included making and nurturing connections and asking for help while recommendations for healthcare and social service providers included communicating authentically with families and listening to parents. Fathers also indicated that leadership and funding for programs of families of children with CCN should be priorities for policymakers.ConclusionsIn addition to documenting fathers’ active involvement in their child’s care and development, our findings provide new insights into how fathers make participation in everyday life accessible and inclusive for their children. Study findings also point to 1) priority areas for policymakers (e.g., accessible physical environments); 2) factors that are critical for fostering collaborative care teams with fathers; and 3) the need for complex care teams in the adult health care system. Implications for those providing psychosocial support for these families are noted as well as knowledge gaps worthy of future exploration such as the role of diversity or intersectionality in fathering children with CCN.