Health Quality Improvement Research Articles

The impact of the Country’s health services’ expenditure on the success of MDGs, Goal 4/SDG 3: Reduction of child mortality in Uganda (2000-2016).

Safeguarding access to health services is a serious challenge for poor countries if the Sustainable Development Goals are to (SDGs) are to be achieved. This paper scrutinizes the case of Uganda, a country which is trying to improve its health sector amid a lot of challenges between 2000-2016 to assess how the country has performed in the reduction of child mortality given its expenditure. This study involved analyzing the available data drawn from various sources i.e., time series data on public health expenditure was obtained from Ministry of Health reports and the budget and Ministerial Policy Statements for the period 2000-2016. This data was further demarcated into parameters such as per capita government spending on health in Uganda shillings, health spending as a proportion of Gross Democratic Product (GDP) and private health spending as a proportion of total health spending. Findings revealed that non-significant negative effect of GDP per capita growth on infant mortality rate from 2000 to 2016, a negative effect of GDP per capita on under-five mortality in Uganda from 2000 to 2016, albeit the effect is non-significant (P>0.05), decline in Maternal Mortality Rate (MMR) from 527 death per 100,000 live birth in 1995 to 336 death per 100,000 live birth in 2016, and there is a negative but insignificant effect of health sector budget allocation on the MMR in Uganda since the P-value (0.199). Maternal mortality fell significantly in Uganda due to some interventions in the health sector. The decline is likely to have been cause due to supply and demand situations. There is need to improve funding in the health sector in order to improve quality health services through better coordination, health management, transportation, access, infrastructure at the district level.

E-INEBRIA Special Interest Group Roadmap for Best Practices for Research on Brief Digital Interventions for Problematic Alcohol and Illicit Drug Use

There is great potential for scaling up the delivery of brief interventions for alcohol and illicit drug use, given the increasing coverage of mobile devices and technologies for digital interventions, including apps for smartphones and tablets. However, while the number of digital interventions is increasing rapidly, the involvement of brief-intervention researchers and the development of good practices has just begun. In 2018, the Special Interest Group on digital interventions of the International Network on Brief Interventions for Alcohol & Other Drugs (e-INEBRIA SIG) initiated a conversation regarding possible avenues of future research, which subsequently became a roadmap for digital interventions. This roadmap consists of points considered relevant for future research, ongoing technological developments, and their implementation across a continuum of prevention and care. Moreover, it outlines starting points for the diversification of brief digital interventions, as well as next steps for quality improvement and implementation in public health and clinical practice. The roadmap of the e-INEBRIA SIG on digital interventions is a starting point that indicates relevant next steps and provides orientation for researchers and interested practitioners with regard to the ambiguous literature and the complexity of current digital interventions.

Routine Health Information System (RHIS) improvements for strengthened health system management.

BackgroundA well‐functioning routine health information system (RHIS) can provide the information needed for health system management, for governance, accountability, planning, policy making, surveillance and quality improvement, but poor information support has been identified as a major obstacle for improving health system management.ObjectivesTo assess the effects of interventions to improve routine health information systems in terms of RHIS performance, and also, in terms of improved health system management performance, and improved patient and population health outcomes.Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE Ovid and Embase Ovid in May 2019. We searched Global Health, Ovid and PsycInfo in April 2016. In January 2020 we searched for grey literature in the Grey Literature Report and in OpenGrey, and for ongoing trials using the International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov. In October 2019 we also did a cited reference search using Web of Science, and a ‘similar articles’ search in PubMed.Selection criteriaRandomised and non‐randomised trials, controlled before‐after studies and time‐series studies comparing routine health information system interventions, with controls, in primary, hospital or community health care settings. Participants included clinical staff and management, district management and community health workers using routine information systems.Data collection and analysisTwo authors independently reviewed records to identify studies for inclusion, extracted data from the included studies and assessed the risk of bias. Interventions and outcomes were too varied across studies to allow for pooled risk analysis. We present a 'Summary of findings' table for each intervention comparisons broadly categorised into Technical and Organisational (or a combination), and report outcomes on data quality and service quality. We used the GRADE approach to assess the certainty of the evidence.Main resultsWe included six studies: four cluster randomised trials and two controlled before‐after studies, from Africa and South America. Three studies evaluated technical interventions, one study evaluated an organisational intervention, and two studies evaluated a combination of technical and organisational interventions. Four studies reported on data quality and six studies reported on service quality.In terms of data quality, a web‐based electronic TB laboratory information system probably reduces the length of time to reporting of TB test results, and probably reduces the overall rate of recording errors of TB test results, compared to a paper‐based system (moderate certainty evidence). We are uncertain about the effect of the electronic laboratory information system on the recording rate of serious (misidentification) errors for TB test results compared to a paper‐based system (very low certainty evidence). Misidentification errors are inaccuracies in transferring test results between an electronic register and patients' clinical charts. We are also uncertain about the effect of the intervention on service quality (timeliness of starting or changing a patient's TB treatment) (very low certainty evidence).A hand‐held electronic device probably improves the length of time to report TB test results, and probably reduces the total frequency of recording errors in TB test results between the laboratory notebook and the electronic information record system, compared to a paper‐based system (moderate‐certainty evidence). We are, however, uncertain about the effect of the intervention on the frequency of serious (misidentification) errors in recording between the laboratory notebook and the electronic information record, compared to a paper‐based system (very low certainty evidence).We are uncertain about the effect of a hospital electronic health information system on service quality (length of time outpatients spend at hospital, length of hospital stay, and hospital revenue collection), compared to a paper‐based system (very low certainty evidence).High‐intensity brief text messaging (SMS) may make little or no difference to data quality (in terms of completeness of documentation of pregnancy outcomes), compared to low‐intensity brief text messaging (low‐certainty evidence).We are uncertain about the effect of electronic drug stock notification (with either data management support or product transfer support) on service quality (in terms of transporting stock and stock levels), compared to paper‐based stock notification (very low certainty evidence).We are uncertain about the effect of health information strengthening (where it is part of comprehensive service quality improvement intervention) on service quality (health worker motivation, receipt of training by health workers, health information index scores, quality of clinical observation of children and adults) (very low certainty evidence).Authors' conclusionsThe review indicates mixed effects of mainly technical interventions to improve data quality, with gaps in evidence on interventions aimed at enhancing data‐informed health system management. There is a gap in interventions studying information support beyond clinical management, such as for human resources, finances, drug supply and governance. We need to have a better understanding of the causal mechanisms by which information support may affect change in management decision‐making, to inform robust intervention design and evaluation methods.

Changes in Care- A Systematic Scoping Review of Transitions for Children with Medical Complexities.

Background Children with medical complexity (CMC) and their parents are affected physically and mentally during transitions in care. Coordinated models of care show promise in improving health outcomes.Objective The purpose of this scoping review was to examine research related to CMC and their parents and transitions in care. The aim was 3-fold: (1) to examine the extent, range, and nature of research activity related to the impact of transitions on physical and mental health for CMC and their parents; (2) to summarize and disseminate research findings for key knowledge users; and (3) to identify research gaps in the existing literature to inform future studies.Methods Twenty-three sources were identified through database searches and five articles met the inclusion criteria of CMC (multi-organ involvement or technology-dependent) (or parents of CMC) transitioning from hospital to alternate levels of care where outcome measures were physical or mental health-related.Results Numerical analysis revealed substantial variation in methodological approaches and outcome measures. Content analysis revealed two themes for parents of CMC during this transition: (1) emotional distress, and (2) high expectations; and three themes for CMC: (1) improved health, (2) changes in emotion, and (3) disrupted relationships.Conclusion The findings from this scoping review reveal for parents, transitions in care are fraught with emotional distress and high expectations; and for CMC there are improvements in quality of life and emotional health post- hospital to home transitions when collaborative models of care are available. This review serves as an early attempt to summarize the literature and demonstrate a need for further research.

A scoping review of the use of co-design methods with culturally and linguistically diverse communities to improve or adapt mental health services.

Mental health services are increasingly encouraged to use co-design methodologies to engage individuals and families affected by mental health problems in service design and improvement. This scoping review aimed to identify research that used co-design methods with Culturally and Linguistically Diverse (CALD) communities in mental health services, and to identify methodological considerations for working with this population. In October 2019, we searched five electronic databases (CINAHL, PsycINFO, EMBASE, MEDLINE, Web of Science) to identify papers published in which people from CALD backgrounds were engaged in the co-design of a mental health service or program. Searches were limited to peer-reviewed articles published in English in the last 25years (1993-2019). The search identified nine articles that matched the inclusion criteria. Using a scoping review methodology, the first author charted the data using extraction fields and then used qualitative synthesis methods to identify themes. Data were grouped into themes relevant to the research question. The two key themes relate first, to improving the experience for CALD communities when engaging in co-design research and second, to the development of co-design methods themselves. These findings support the need for further research into the transferability of co-design tools with CALD communities, particularly if co-design is to become a best practice method for service design and improvement. This scoping review identified methodological and practical consideration for researchers looking to use co-design with CALD communities for mental health service design, re-design or quality improvement initiatives. Further research is required to explore experiences of co-design methods, including documented protocols such as experience-based co-design, with CALD communities. This review indicates that explanatory models of mental health, community and co-design impact partnerships with CALD communities, and need to be understood to optimise the quality of these relationships when using co-design methods.

Analysis of Drug Logistics Planning at Medical Management Agency in Ambon City Health Office (Qualitative study)

In health services, the drug can save lives and improve health quality. So the provision of essential medicines is mandatory and requires government support at all levels, both central, provincial and Regency/city. The existence of such support can be activities, budgets and commitments. The purpose of this research is to know the system of drug planning in the technical implementation Unit of the Regional Office of Medicine management in Ambon City Health office. This type of research is a qualitative study. Data collection is done through in-depth interviews, observation and document study. Information collected from 6 people who are involved in the management of drugs in the technical implementation Unit of the Regional Office of the Department of Medicine of the city Health office in Ambon. The results showed that drug planning uses a special team with the calculation of drug needs using method of consumption. The emptiness and excess medication are still common due to the change in public health centers affecting the drug prescribing patterns. Therefore, it needs a good coordination between the planning team in the technical implementation Unit of the regional office of the District Health Care office in Ambon City with a doctor at the Public health center in the area to be obedient in writing prescriptions according to the medication that has been ordered.

Ethnic and Racial Disparities in Acute Myocardial Infarction.

Significant racial and ethnic healthcare disparities exist in the management and outcomes of patients with acute myocardial infarction (AMI). This review will highlight the recent studies focusing on disparities in AMI care and how practice patterns have changed over time, and discuss solutions and future directions to overcome disparities in AMI care. AMI continues to be a leading cause of morbidity and mortality in the USA. Racial and ethnic disparities continue to be present in the care and outcomes associated with AMI. Non-white individuals continue to receive less guideline-concordant care and experience higher rates of adverse outcomes compared with white individuals. Health policy and quality improvement interventions have helped to narrow the gap; however, ongoing efforts are needed to continue to attempt to eliminate this disparity. Racial and ethnic disparities persist in the presentation, management, and outcomes of patients with AMI. Improvements in care have narrowed some of the inequalities. Ongoing research and efforts directed at improving access to care, eliminating bias in healthcare, and focusing on coronary heart disease prevention are needed to eliminate disparities.

Pain resilience and catastrophizing combine to predict functional restoration program outcomes.

Whereas decades of research have been devoted to psychological factors that confer vulnerability to disability and other negative outcomes in the face of chronic pain, recent studies have begun to emphasize psychological characteristics that contribute to enhanced adaptation and better clinical outcomes. Accordingly, the present study was conducted as a longitudinal assessment of the predictive utility of pain resilience and pain catastrophizing as indicators of clinical outcomes among patients receiving a standardized treatment for chronic pain. Using an observational design, analyses were conducted on measures of pain resilience, pain catastrophizing, quality of life, and clinical pain administered to 149 patients upon admission and prior to discharge from an 8-week outpatient functional restoration program. Hierarchical linear regressions were conducted to predict improvement in physical and mental health quality of life and clinical pain intensity at discharge based on individual differences in admission levels of pain-related catastrophizing and resilience. Results of the primary analyses indicated that pain catastrophizing and pain resilience independently predicted physical and mental health quality-of-life outcomes at discharge but did not significantly predict clinical pain intensity. Specifically, higher baseline pain resilience was associated with better quality-of-life outcomes, whereas higher baseline catastrophizing was associated with poorer outcomes. This study provides additional support for the notion that pain resilience assessment may help identify those most likely to benefit from targeted efforts to bolster resilience resources during treatment. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

PENINGKATAN KUALITAS USAHA KESEHATAN SEKOLAH (UKS) MELALUI PENYEGARAN KADER UKS DI SMP SATYA SAI

Background: Improving the quality of life of Indonesian people can be done through educational efforts both at school and outside of school. The School Health Business (UKS) is a basic health business aimed at schools and is the duty of the public health center to achieve health and improve learning achievement of school children). One of the functions of the UKS is as a forum for providing early health education especially for school children. The objectives of health education include having skills in maintenance, assistance and health care, having healthy living habits, and applying the principles of disease prevention (Budiono and Sulistyowati, 2014). Method: Before the implementation of the activity, the number of students involved amounted to 40 people, while the selection of students based on grade 8 and grade 9 would be selected again after getting extension activities and transforming as a UKS cadre. Activity Methods Used (1) Lecture and Demonstration Methods to discuss General Knowledge about School Health Enterprises (UKS), the role and participation of students in UKS activities, Efforts to Encourage, (2) Learning Methods Used to Transfer Assistance or Skills from the Value System Owned resource person to students. As a guest speaker providing health examination exercises for special UKS cadre students consisting of general physical examination and vital signs (blood pressure, temperature, pulse and breathing). Results: The results of the data collection obtained for SMP did not have its own UKS room, but it was still combined with the primary school room which was still in the same building. Schools do not have UKS cadres and have never done UKS program activities. The level of student knowledge related to UKS is also very low. Conclusion: the level of student knowledge after counseling was found as many as 36 (86%) people have good knowledge and 6 people (14%) have enough knowledge. This shows that the provision of counseling and training can increase student knowledge. Suggestions, for SatyaSai Junior High School and Denut 3 Public Health Center to make a policy about the importance of UKS and to continue the program to have UKS space and to form a UKS structure so that good student behavior is formed to increase PHBS in schools and to follow up the UKS guidance program to schools as an effort to improve health quality in the school setting.

A multi-method quality improvement approach to systematically improve and promote the quality of national health and social care information.

Safe and reliable healthcare depends on access to health information that is accurate, valid, reliable, timely, relevant, legible and complete. National data collections are repositories of health and social care data and play a crucial role in healthcare planning and clinical decision-making. We describe the development of an evidence-informed multi-method quality improvement program aimed to improve the quality of health and social care data in Ireland. Specific components involved: development of guidance to support implementation of health information standards; review program to assess compliance with standards; and educating health information stakeholders about health data and information quality. Observations from implementation of the program indicate enhanced health information stakeholder awareness of, and increased adoption of information management standards. The methodology used in the review program has proved to be a robust approach to identify areas of good practice and opportunities for improvement in information management practices. There has been positive adoption of the program among organisations reviewed and acceptance of the proposed recommendations. Early indications are that this multi-method approach will drive improvements in information management practices, leading to an improvement in health and social care data quality in Ireland. Aspects of this approach may be adapted to meet the needs of other countries.

Calorie Restriction and Aging in Humans.

Calorie restriction (CR), the reduction of dietary intake below energy requirements while maintaining optimal nutrition, is the only known nutritional intervention with the potential to attenuate aging. Evidence from observational, preclinical, and clinical trials suggests the ability to increase life span by 1-5 years with an improvement in health span and quality of life. CR moderates intrinsic processes of aging through cellular and metabolic adaptations and reducing risk for the development of many cardiometabolic diseases. Yet, implementation of CR may require unique considerations for the elderly and other specific populations. The objectives of this review are to summarize the evidence for CR to modify primary and secondary aging; present caveats for implementation in special populations; describe newer, alternative approaches that have comparative effectiveness and fewer deleterious effects; and provide thoughts on the future of this important field of study.

Quality of and barriers to routine childbirth care signal functions in primary level facilities of Tigray, Northern Ethiopia: Mixed method study.

Efforts to expand access to institutional delivery alone without quality of care do not guarantee better survival. However, little evidence documents the quality of childbirth care in Ethiopia, which limits our ability to improve quality. Therefore, this study assessed the quality of and barriers to routine childbirth care signal functions during intra-partum and immediate postpartum period. A sequential explanatory mixed method study was conducted among 225 skilled birth attendants who attended 876 recently delivered women in primary level facilities. A multi stage sampling procedure was used for the quantitative phase whilst purposive sampling was used for the qualitative phase. The quantitative survey recruitment occurred in July to August 2018 and in April 2019 for the qualitative key informant interview and Focus Group Discussions (FGD). A validated quantitative tool from a previous validated measurement study was used to collect quantitative data, whereas an interview guide, informed by the literature and quantitative findings, was used to collect the qualitative data. Principal component analysis and a series of univariate and multivariate linear regression analysis were used to analyze the quantitative data. For the qualitative data, verbatim review of the data was iteratively followed by content analysis and triangulation with the quantitative results. This study showed that one out of five (20.7%, n = 181) mothers received high quality of care in primary level facilities. Primary hospitals (β = 1.27, 95% CI:0.80,1.84, p = 0.001), facilities which had staff rotation policies (β = 2.19, 95% CI:0.01,4.31, p = 0.019), maternal involvement in care decisions (β = 0.92, 95% CI:0.38,1.47, p = 0.001), facilities with maternal and newborn health quality improvement initiatives (β = 1.58, 95% CI:0.26, 3.43, p = 0.001), compassionate respectful maternity care training (β = 0.08, 95% CI: 0.07,0.88, p = 0.021), client flow for delivery (β = 0.19, 95% CI:-0.34, -0.04, p = 0.012), mentorship (β = 0.02, 95% CI:0.01, 0.78, p = 0.049), and providers' satisfaction (β = 0.16, 95% CI:0.03, 0.29, p = 0.013) were predictors of quality of care. This is complemented by qualitative research findings that poor quality of care during delivery and immediate postpartum related to: work related burnout, gap between providers' skill and knowledge, lack of enabling working environment, poor motivation scheme and issues related to retention, poor providers caring behavior, unable translate training into practice, mismatch between number of provider and facility client flow for delivery, and in availability of essential medicine and supplies. There is poor quality of childbirth care in primary level facilities of Tigray. Primary hospitals, facilities with staff rotation, maternal and newborn health quality improvement initiatives, maternal involvement in care decisions, training on compassionate respectful maternity care, mentorship, and high provider satisfaction were found to have significantly increased quality of care. However, client flow for delivery service is negatively associated with quality of care. Efforts must be made to improve the quality of care through catchment-based mentorship to increase providers' level of adherence to good practices and standards. More attention and thoughtful strategies are required to minimize providers' work-related burnout.

INTRAVENOUS MEDICATION ADMINISTRATION ERRORS AND THIS CAN ENDANGER THE LIVES OF PATIENTS

Objective: Intravenous errors are one of the most frequent and common medical errors, but no direct causes found. The theory of human error is the most common expression of errors in hospitals, and this can endanger the lives of patients. This research study aims to identify the errors in the vein and try to find solutions to avoid those errors where the study conducted on a sample of hospitals in Baghdad.
 Methods: The study conducted to improve health quality in some hospitals. During the study period, a group of severe cases was detected, which based on intravenous infusions. Patients’ data and information were collected through five sources, examined and documented venous errors found and placed in a standard classification according to an incorrect dose and incorrect medication. The incorrect dose includes the following: Overdose, extra dose, underdose, wrong strength, and wrong form.
 Results: During the period of study, a total of 99 cases, among these cases, 52 incorrect medications include (drug-drug interaction, drug-disease interaction, and not indicated medication) the incorrect dose 42 and route of administration and incorrect rate also take place in mistakes.
 Conclusion: Intravenous errors can cause significant harm to patients and health-care providers, so proper attention paid to them. Several reasons may cause medication errors such as lack of experience and knowledge of health-care providers, inaccurate communications that do not explain the drug, and the exact dose. The prescribing errors in the medication or dosage were collected, discussed, and clarified so that the risks arising from them observed so that health-care providers and hospital specialists would be alerted and the study would serve as an alarm for health organizations.

The Dimensions of Tokenism in Patient and Family Engagement: A Concept Analysis of the Literature.

Patient engagement (PE) has become embedded in discussions about health service planning and quality improvement, and the goal has been to find ways to observe the potential beneficial outcomes associated with PE. Patients and health care professionals use various terms to depict PE, for example, partnership and collaboration. Similarly, tokenism is consistently used to describe PE that has gone wrong. There is a lack of clarity, however, on the meanings and implications of tokenism on PE activities. The objective of this concept analysis was to examine the peer-reviewed and gray literature that has discussed tokenism to identify how we currently understand and use the concept. This review discusses 4 dimensions of tokenism: unequal power, limited impact, ulterior motives, and opposite of meaningful PE. These dimensions explicate the different components, meanings, and implications of tokenism in PE practice. The findings of this review emphasize how tokenism is primarily perceived as negative by supporters of PE, but this attribution depends on patients’ preferences for engagement. In addition, this review compares the dimensions of tokenism with the levels of engagement in the International Association of the Public Participation spectrum. This review suggests that there are 2 gradations of tokenism; while tokenism represents unequal power relationships in favor of health care professionals, this may lead to either limited or no meaningful change or change that is primarily aligned with the personal and professional goals of clinicians, managers, and decision-makers.

How Do We Align Health Services Research and Quality Improvement?

Quality improvement (QI) initiatives and health services research (HSR) are commonly used to target health care quality. These disciplines are increasingly important because of the movement toward value-based health care as alternative payment and care delivery models drive institutions and investigators to focus on reducing unnecessary health care use and improving care coordination. QI efforts frequently target medical error and/or efficiency of care through the Plan-Do-Study-Act methodology. Within the QI framework, strategies for data display (e.g., Pareto charts, run charts, histograms, scatter plots) are leveraged to identify opportunities for intervention and improvement. HSR is a multidisciplinary field of study that seeks to identify the most effective way to organize, deliver, and finance health care to maximize the quality and value of care at both the individual and population levels. HSR uses a diverse set of quantitative and qualitative methodologies, such as case-control studies, cohort studies, randomized control trials, and semistructured interview/focus group evaluations. This manuscript provides examples of methodologic approaches for QI and HSR, discusses potential challenges associated with concurrent quality efforts, and identifies strategies to successfully leverage the strengths of each discipline in care delivery.

Barriers and Strategies in Promoting and Improving Patient Safety Culture Among Indonesian Nurses: A Systematic Review

Introduction: Patient Safety Culture (PSC) is one of the indicators in the quality of care and services. The nurse has an important role to promoteand improve PSC in the hospital. As a developing country, Indonesia still struggles to improve quality health care by increasing PSC among healthprofessional including nurses. This systematic review aims to identify Indonesian nurses’ barriers and strategies to promote and improve PSC inhospitals.Method: This systematic review study used the PRISMA protocol to select appropriate resources. Nine journal databases of CINAHL, DOAJ,GARUDA, Google Scholar, MDPI, Medline, Proquest, PUBMED, and Science Direct were searched in this regard.Results: The barriers that nurses faced in PSC promotion and improvement in the Indonesian hospital settings were nursing capabilities, regulation,organizational culture, equality, equally and supports, and natural resources. While the strategies are incorporating patient safety topics into thenursing curriculum, leaders’ supervision, integrative team, and regular training and workshop.Conclusion: This review finding both the barriers and strategies in PSC promotion and improvement differ among Indonesian nurses. The majorbarrier was predominantly related to nurses’ capabilities and competences. Hence, the strategies were related to improving nurses’ capabilitiesand competences in patient safety both through improvement nursing curriculum, and continuing nursing education programs.

Making and Presentation of "Mooghurt" as a Healthy Drink to Improve Health Quality

Mooghurt is a trademark of fermented cow's milk similar to yoghurtyang made by the KWU unit of the Student Association majoring in Biology FMIPA UNP. Mooghurt is a biotechnological product of fermented milk that is beneficial for improving the health of the digestive tract, reducing cholesterol in the blood, and stimulating the nervous system. Fresh cow's milk as the main raw material for mooghurt is obtained from the city of Padang Panjang. Padang Panjang is one of the centers of good quality cow's milk production in West Sumatra. Cow dairy farm products in Padang Panjang provide business opportunities for the surrounding community, including the academics of Biology FMIPA UNP in increasing student entrepreneurial spirit. The process of making Mooghurt consists of: 1) making a starter; 2) making mooghurt; 3) manufacture fruit extracts or jellies to complement the presentation.

General Practice and the Community: Research on health service, quality improvements and training. Selected abstracts from the EGPRN Meeting in Vigo, Spain, 17–20 October 2019

Community participation in primary healthcare is enshrined in international policies since the 1970s and has been re-emphasised since then, most recently in the 2018 WHO Astana Declaration (https://www.who.int/primary-health/conference-phc/declaration). The concept comes from a social justice perspective. It emphasises that the participation of communities who experience poverty and social exclusion is essential to the development of primary health care services shaping these services and making them relevant to those with the greatest need. This is important if we are to address the well-documented Inverse Care Law.There is, however, a translational gap between policy and practice. The stability of policies for community participation in primary healthcare is patchy. The implementation of policies into conventional ways of working is patchy. Where implementation has occurred, the coverage of community participation initiatives can be patchy – not all community members are involved. The literature shows a pattern of exclusion whereby so-called ‘hard to reach’ groups are not adequately involved in primary healthcare decision-making. This is the case for refugees and migrants who arrive to settle and integrate into host countries in Europe. The recent WHO Strategy and Action Plan for Refugee and Migrant Health (2016; http://www.euro.who.int/en/health-topics/health-determinants/migration-and-health/publications/2016/strategy-and-action-plan-for-refugee-and-migrant-health-in-the-who-european-region) is a call for action to disrupt this pattern of exclusion and improve the health of refugees and migrants.Drawing on the rich tradition of participatory health research is a valuable way forward because it provides important concepts, tools and techniques for research that is more inclusive and primary care practice. This presentation will describe innovative examples of success in family practice settings from around Europe. These have brought together refugees and migrants with primary care stakeholders and enabled them to work together to introduce and sustain changes in clinical practice. This evidence can be used to guide and strengthen community participation in primary healthcare, for all.

Social determinant and the health behavior of indigenous Asmat society

This study aims to identify social determinants that influence health of indigenous Asmat society in Papua, Indonesia. The research used a case study qualitative approach. Data source was obtained from Focus Group Discussion (FGD) and in-depth interviews with various key informants to deepen the field findings. Data analysis used was a qualitative technique. This study identifies four main elements of social determinants which affect health behavior of indigenous Asmat society. First, Asmat society has low levels of educational background because lack of accessibility to schools due to the extreme geographical conditions. Second, Asmat culture places women as subordinate groups that create high rates of violence against women. Third, the Catholic Church institution play important role to improve health quality of Asmat society. Culture factors influence the social life of the Asmat community. Especially, the position of women in the Asmat socio-cultural strata.

Home Visits for Children With Asthma Reduce Medicaid Costs.

We conducted a multicomponent, low-cost, home intervention for children with uncontrolled asthma, the Reducing Ethnic/Racial Asthma Disparities in Youth (READY) study, to evaluate its effect on health outcomes and its return on investment. From 2009 through 2014 the study enrolled 289 children aged 2 to 13 years with uncontrolled asthma and their adult caregivers in Boston and Springfield, Massachusetts. Community health workers (CHWs) led in-home asthma management and environmental trigger remediation education over 5 visits spanning 6 months. Asthma health outcomes and indoor environment data were collected via survey, and health use costs were accessed through Massachusetts Medicaid (MassHealth). Results showed significant improvements in asthma control, health care use, and environmental trigger reduction and a positive return on investment (1.34) for participants who had 2 or more emergency department visits 1 year prior to the first home visit. The CHW asthma home visiting intervention improved trigger management, clinical outcomes, and Medicaid cost savings, demonstrating that asthma home visits improve health quality and reduce costs.