Quality Of Care Services Research Articles

The impact of regulation on the quality of care in nursing homes in Ireland: a time-series analysis of change in compliance

Background Quality in health and social care is of paramount importance. Regulation is often used for ensuring or promoting quality in care services. Services are typically regulated by independent public authorities, which monitor services for compliance with regulations. There is limited research, however, on services’ compliance with regulations to provide a high quality of care. This study aims to examine nursing home compliance with regulations relating to quality. Methods Secondary legislation used for regulating nursing homes in Ireland was mapped to the Donabedian’s quality framework with each regulation categorised as either “structure”, “process” or “outcome”. The regulations categorised as “outcome” were determined to be quality-related regulations; such regulations were extracted and became this study’s area of focus. Published inspection reports from the regulator in Ireland for a three year period (2019 to 2021) (n=1,153) were assessed. The frequency with which the “outcome regulations” were inspected in nursing homes, and the proportion of compliance achieved, was calculated. Change in compliance levels across the three years was evaluated using Chi2 tests. Results Ten regulations were categorised as “outcome regulations” and addressed the following areas: positive behaviour; protection; residents' rights; communication; visits; personal possessions; food and nutrition; information for residents; medicines and pharmaceutical services; and complaints procedures. Compliance with two regulations (‘Regulation 9: Residents’ rights’ and ‘Regulation 11: Visits’) significantly improved during the three years (p<0.05). Compliance with ‘Regulation 12: Personal Possessions’ significantly decreased over the three years, however, so did the proportion found not compliant. While there was no significant change in the other regulations examined, compliance trended towards improvement, except for one regulation, ‘Regulation 20: Information for residents’, which trended downwards. Conclusion This analysis of national-level data found improvements in compliance across nearly all quality-related regulations demonstrating that regulation can be a positive influence on quality maintenance and improvement.

Assessment of modern maternal health care usage in Ethiopia

Ethiopia, like many developing nations, has struggled with the problem of low utilization of maternal healthcare services. The main objective of this study is to investigate the awareness and application of modern maternal healthcare usage and to identify the determinant factors that affect the usage of modern maternal healthcare services in Ethiopia. A quantitative approach to the survey questionnaire was employed. A simple random sampling technique was used to select 240 respondents from a sample of women aged between 18 and 49. Using statistical software, the collected data were analyzed using categorical variable tests and binary logistic regression. The findings showed that, from the total of 240 respondents, some of the respondents had not attended Antenatal care, delivery care, and postnatal care. Therefore, from the findings of the study, the researchers have concluded that to increase health care utilization, the concerned bodies should be expanding access to health services, improving the quality of antenatal care services, conducting awareness-raising promotions, and providing training for health workers to increase their skills and professional ethics. Keywords: Health care; maternity; modern health care service; women.

Corporatisation and financialisation of social reproduction: Care homes and childcare in the United Kingdom

The ownership and financial strategies of companies providing care for children or older people have become an increasingly salient concern, in both research and policy, because of their implications for the quality and availability of care services, as well as working conditions. However, analysis has tended to be sector specific. This article provides the first comparison of ownership, business models and workforces across childcare and adult social care in the United Kingdom. It reveals growing convergence in terms of the dominance of large companies and their financial strategies, which can reward investors while undermining access to care and worsening working conditions for large, low-paid workforces. We conceptualise these developments in terms of corporatisation and the related process of financialisation. They are, we argue, underpinned by the political economy of low wages for care work, which we explain using feminist social reproduction theory – highlighting the devaluation of feminised and racialised caring labour. The article identifies the need for further research to account for differences between the sectors, to map the geographies and political economies of care, and to compare these processes internationally.

Effective cataract surgical coverage in India: Evidence from 31 districts.

Effective Cataract Surgical Coverage (eCSC) is a core outcomes domain indicator to assess accessibility and quality of eye care services with limited available information. To generate baseline estimates of eCSC for India. We performed the analysis of data pooled from Rapid Assessment of Avoidable Blindness surveys conducted in 31 districts of India during 2015-2019 among persons aged 50+ years. eCSC was calculated at various thresholds, the primary being operable cataract at best corrected visual acuity <6/12, good outcome at presenting visual acuity of 6/12. Age-sex standardized and weighed eCSC in India was 36.7% (95% CI: 33.6, 39.9), and cataract surgical coverage (CSC) was 57.3% (95% CI: 53.3, 61.2), a relative quality gap in cataract surgery being 36.0%. eCSC in males was higher at 38.0% than females (35.6%). eCSC increased with education from 31.0% in illiterate participants to 59.7% in class 10 educated. On multivariate analysis, rural setting, increasing age, and residence in eastern or northeastern zones of India continued to be associated with poor/worse eCSC, while female gender was associated with higher eCSC. District-wide variations in eCSC were observed. Developmental factors have an important bearing on eCSC in India. Geographical variations point toward the need for targeted, locally relevant strategies.

The comparison of spatial patterns and factors associated with healthcare provider knowledge in palliative care in various regions of China

As an integral part of the overall life cycle, it is crucial to ensure equity and accessibility to palliative care services at the end of life. The knowledge of healthcare providers has a significant beneficial impact on the quality of palliative care services. This study aimed to compare the nationwide geographic distribution of healthcare providers’ knowledge of palliative care at the provincial level in China and identify the possible factors associated with its geographic disparities. A descriptive cross-sectional study was conducted in all provinces (n = 29) that implemented palliative care pilot programs in China. Data were collected online using a structured questionnaire. The possible factors associated with healthcare providers’ knowledge including economy, demographics, and health, were explored by using exploratory regression and ordinary least squares. In addition, spatial autocorrelation was also examined with Moran’s I, LISA, and Geographically Weighted Regression. A total of 18,272 participants from 903 health institutions in 87 palliative care pilot cities were included across 29 out of 31 provinces in China. The average knowledge score (mean ± standard deviation [SD]) was 8.61 ± 2.85. A positive spatial correlation was observed in healthcare providers’ palliative care knowledge level in China. The high level of knowledge was significantly associated with fewer hospitals per 10,000 population (β = −0.384, 95% CI: −0.601 to −0.168, p = 0.001), more primary healthcare institutions per 10,000 population (β = 0.220, 95% CI: 0.032–0.407, p = 0.024), and more community health center visits (β = 0.259, 95% CI: 0.054–0.465, p = 0.016), with higher coefficients being observed in the northwest and northeast regions. This study suggested that the knowledge level of palliative care among healthcare providers nationwide was relatively low, indicating the existence of a disparity between the supply and demand of palliative care services. There may be regional disparities in palliative care services based on the substantial geographical variation in healthcare provider knowledge, emphasizing the necessity of tailored interventions targeting areas with the greatest need.

Factors impacting clinical data and documentation quality in Australian aged care and disability services: a user-centred perspective

BackgroundResearch has highlighted a need to improve the quality of clinical documentation and data within aged care and disability services in Australia to support improved regulatory reporting and ensure quality and safety of services. However, the specific causes of data quality issues within aged care and disability services and solutions for optimisation are not well understood.ObjectivesThis study explored aged care and disability workforce (referred to as ‘data-users’) experiences and perceived root causes of clinical data quality issues at a large aged care and disability services provider in Western Australia, to inform optimisation solutions.MethodsA purposive sample of n = 135 aged care and disability staff (including community-based and residential-based) in clinical, care, administrative and/or management roles participated in semi-structured interviews and web-based surveys. Data were analysed using an inductive thematic analysis method, where themes and subthemes were derived.ResultsEight overarching causes of data and documentation quality issues were identified: (1) staff-related challenges, (2) education and training, (3) external barriers, (4) operational guidelines and procedures, (5) organisational practices and culture, (6) technological infrastructure, (7) systems design limitations, and (8) systems configuration-related challenges.ConclusionThe quality of clinical data and documentation within aged care and disability services is influenced by a complex interplay of internal and external factors. Coordinated and collaborative effort is required between service providers and the wider sector to identify behavioural and technical optimisation solutions to support safe and high-quality care and improved regulatory reporting.

The use of positive deviance approach to improve health service delivery and quality of care: a scoping review

BackgroundQuality has been a persistent challenge in the healthcare system, particularly in resource-limited settings. As a result, the utilization of innovative approaches is required to help countries in their efforts to enhance the quality of healthcare. The positive deviance (PD) approach is an innovative approach that can be utilized to improve healthcare quality. The approach assumes that solutions to problems are already available within the community and identifying and sharing those solutions can help others to resolve existing issues. Therefore, this scoping review aimed to synthesize the evidence regarding the use of the PD approach in healthcare system service delivery and quality improvement programs.MethodsArticles were retrieved from six international databases. The last date for article search was June 02, 2023, and no date restriction was applied. All articles were assessed for inclusion through a title and/or abstract read. Then, articles that passed the title and abstract review were screened by reading their full texts. In case of duplication, only the full-text published articles were retained. A descriptive mapping and evidence synthesis was done to present data with the guide of the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews checklist and the results are presented in text, table, and figure formats.ResultsA total of 125 articles were included in this scoping review. More than half, 66 (52.8%), of the articles were from the United States, 11(8.8%) from multinational studies, 10 (8%) from Canada, 8 (6.4%) from the United Kingdom and the remaining, 30 (24%) are from other nations around the world. The scoping review indicates that several types of study designs can be applied in utilizing the PD approach for healthcare service and quality improvement programs. However, although validated performance measures are utilized to identify positive deviants (PDs) in many of the articles, some of the selection criteria utilized by authors lack clarity and are subject to potential bias. In addition, several limitations have been mentioned in the articles including issues in operationalizing PD, focus on leaders and senior managers and limited staff involvement, bias, lack of comparison, limited setting, and issues in generalizability/transferability of results from prospects perspective. Nevertheless, the limitations identified are potentially manageable and can be contextually resolved depending on the nature of the study. Furthermore, PD has been successfully employed in healthcare service and quality improvement programs including in increasing surgical care quality, hand hygiene practice, and reducing healthcare-associated infections.ConclusionThe scoping review findings have indicated that healthcare systems have been able to enhance quality, reduce errors, and improve patient outcomes by identifying lessons from those who exhibit exceptional practices and implementing successful strategies in their practice. All the outcomes of PD-based research, however, are dependent on the first step of identifying true PDs. Hence, it is critical that PDs are identified using objective and validated measures of performance as failure to identify true PDs can subsequently lead to failure in identifying best practices for learning and dissemination to other contextually similar settings.

Adapting care provision in family practice during the COVID-19 pandemic: a qualitative study exploring the impact of primary care reforms in four Canadian regions

BackgroundOver the past two decades, Canadian provinces and territories have introduced a series of primary care reforms in an attempt to improve access to and quality of primary care services, resulting in diverse organizational structures and practice models. We examine the impact of these reforms on family physicians’ (FPs) ability to adapt their roles during the COVID-19 pandemic, including the provision of routine primary care.MethodsAs part of a larger case study, we conducted semi-structured qualitative interviews with FPs in four Canadian regions: British Columbia, Newfoundland and Labrador, Nova Scotia, and Ontario. During the interviews, participants were asked about their personal and practice characteristics, the pandemic-related roles they performed over different stages of the pandemic, the facilitators and barriers they experienced in performing these roles, and potential roles FPs could have filled. Interviews were transcribed and a thematic analysis approach was applied to identify recurring themes in the data.ResultsSixty-eight FPs completed an interview across the four regions. Participants described five areas of primary care reform that impacted their ability to operate and provide care during the pandemic: funding models, electronic medical records (EMRs), integration with regional entities, interdisciplinary teams, and practice size. FPs in alternate funding models experienced fewer financial constraints than those in fee-for-service practices. EMR access enhanced FPs’ ability to deliver virtual care, integration with regional entities improved access to personal protective equipment and technological support, and team-based models facilitated the implementation of infection prevention and control protocols. Lastly, larger group practices had capacity to ensure adequate staffing and cover additional costs, allowing FPs more time to devote to patient care.ConclusionsRecent primary care system reforms implemented in Canada enhanced FPs’ ability to adapt to the uncertain and evolving environment of providing primary care during the pandemic. Our study highlights the importance of ongoing primary care reforms to enhance pandemic preparedness and advocates for further expansion of these reforms.

Primary Health Care: the Relational Aspects of Social Interaction between Family Doctors and People with Disabilities

Strategic documents of the United Nations and the European Union express the belief that primary health care is a fundamental part of health care services and it must be accessible to all people and funded according to the means. Many research studies prove that enhancement of the primary health care system helps to effectively eliminate causes and risk factors for poor health and to prevent likely impairment of health in the future. However, the data of recent investigations demonstrate that the quality of health care services in Lithuania is much poorer than the average of the EU, and the institution of family doctors providing services of this type suffers from problems related to the efficiency of functioning. Therefore, it is worth investigating possible causes for this problem, to identify them and search for solutions. The paper presents the research that is aimed at examining one part of the aspects of the problem, specifically the relational aspects of social interaction between family doctors and people with disabilities from the point of view of people with disabilities and their relatives. 555 people with disabilities (PWD) and 540 respondents who had relatives with disabilities and took care of them (PWDcare) participated in the survey carried out in 2019–2020 and reported about their experience of social interaction with family doctors. The research indicated many positive tendencies, of which the most prominent was the satisfaction of the relationship, trust and understandment with family doctors. But at the same time the research revealed some more problematic areas, such as the lack of family doctors’ compassion and warmth to many patients. These results are important for improving the primary health care service and quality as well for strengthening the family doctors’ education.

The effect of the continuous care model on the adherence to the medication regimen of patients hospitalized in the psychiatric ward: A quasi-experimental study

The present study aims to determine the effect of the continuous care model on the adherence to the medication regimen of patients hospitalized in the psychiatric ward. This quasi-experimental research was carried out on a sample of 46 patients who were admitted to the psychiatric ward. The data collection tools employed in this research included a demographic questionnaire and an 8-item MMAS-8 medication adherence questionnaire. Before the intervention, the adherence rate to the medication regimen was 2.82 (SD=1.62) in the intervention group and 3.20 (SD=2.50) in the control group. The Mann-Whitney U test revealed no significant difference between the two groups pre-intervention. Post-intervention, the adherence level to the medication regimen increased to 5.56 (SD=1.70) in the intervention group and 3.51 (SD=2.73) in the control group. The Mann-Whitney U test indicated a significant difference (P=0.006) between the two groups post-intervention. The analysis of covariances (ANCOVA) test, after controlling for the pre-test effect, demonstrated that the continuous care model significantly influenced the adherence to the medication regimen among patients admitted to the psychiatric ward (eta=0.26, P&lt;0.01). Consequently, the continuous care model can be attributed to 26% of the changes in adherence to the medication regimen in patients. Owing to the demonstrated efficacy and cost-effectiveness of the continuous care model, it can be integrated into nursing education and management. The implementation of such care models and approaches has been shown to enhance the quality of patient care services. Therefore, it is a viable strategy for improving healthcare outcomes and efficiency.

Maternal Mortality at Al-Wahda Tertiary Hospital/ Derna -Lybia

Maternal mortality is one of the major challenges which face the developing countries throughout the world. The maternal mortality ratio (MMR) is the main public health indicator that determines the quality of health care services and the women’s status. However, maternal mortality is much higher in developing countries compared to developed nations due to lack of adequate medical care; high prevalence of infectious diseases, higher total fertility rate and due to health care system difference. Countries with high maternal mortality ratio have less reliable vital statistics registry system; as a result level of maternal mortality is usually underestimated and little information is available regarding locally specific risk factors for maternal death. The aim of this study is to calculate, identify the risk factors and the causes of maternal mortality at Al-WhahdaTertiaryhospital/Derna- Libya. This was a retrospective descriptive study of ten years conducted at Al-Wahda hospital Derna,Libya. Detailed retrospective reviews of the data were undertaken from the casenotes of 31782 admissions in the obstetrics unit during 10 years period from 2013 to 2022. The information was retrieved from the case notes available in the medical records department of the hospital as well as from the daily records in the maternity and delivery worlds of the hospital during the study period. There was a total of 31782 deliveries conducted during the study period. The maternal mortality ratio was 34.84 per 100,000 live-births in the year 2013 to 2022. The mean age of maternal deaths was34.36±5.54 years. Most of deaths occur in postpartum period.The major causes of deaths were pulmonary and amniotic fluid embolism followed by postpartum haemorrahge. The maternal mortality is high despite the availability of comprehensive emergency obstetric care at the hospital. Pulmonary and amniotic fluid embolism are the leading causes of death in one of the tertiary care teaching hospitals in Libya.

Challenges of home care: a qualitative study

BackgroundDespite countless benefits of home care, unfortunately, the variety and quality of services provided by homecare centers are uncertain. This study was conducted to explore of home care challenges.MethodsThe present qualitative study used the content analysis approach. A total of 17 participants, including nurses, managers of home care centers, and patients, were enrolled through purposive sampling. Data were collected using semi-structured interviews and analyzed through Granheim’s qualitative content analysis method.ResultsIn order to explain the challenges of home care, after analyzing the data, 700 primary codes, 15 initial categories, sub-subcategories and two main categories, including ‘infrastructural challenges’ and ‘challenges related to the process of home care services provision’ emerged. The main category, “infrastructural challenges”, consisted of 4 sub-categories (the challenge of acculturalization of home care services, economic challenges of providing services, challenges related to human resources, and the challenge of policymaking and setting regulations and rules for home care). The second main category, “challenges related to the process of home care services provision”, consisted of 2 subcategories: challenges of improving the quality of home care services and the challenge of facilities for service provision.ConclusionIn order to promote and improve the quality of home care services, in addition to providing insurance coverage for the services, acculturalization and revising the bylaws, empowering the human resource, enhancing the monitoring of the performance of home care centers, and employing modern technology need to be taken into account.

Assessment of the Barriers and Enablers of the Use of mHealth Systems in Sub-Saharan Africa According to the Perceptions of Patients, Physicians, and Health Care Executives in Ethiopia: Qualitative Study.

Digital technologies are increasingly being used to deliver health care services and promote public health. Mobile wireless technologies or mobile health (mHealth) technologies are particularly relevant owing to their ease of use, broad reach, and wide acceptance. Unlike developed countries, Sub-Saharan Africa experiences more challenges and obstacles when it comes to deploying, using, and expanding mHealth systems. In addition to barriers, there are enabling factors that could be exploited for the design, implementation, and scaling up of mHealth systems. Sub-Saharan Africa may require tailored solutions that address the specific challenges facing the region. The overall aim of this study was to identify the barriers and enablers for using mHealth systems in Sub-Saharan Africa from the perspectives of patients, physicians, and health care executives. Multi-level and multi-actor in-depth semistructured interviews were employed to qualitatively explore the barriers and enablers of the use of mHealth systems. Data were collected from patients, physicians, and health care executives. The interviews were audio recorded, transcribed verbatim, translated, and coded. Thematic analysis methodology was adopted, and NVivo software was used for the data analysis. Through this rigorous study, a total of 137 determinants were identified. Of these determinants, 68 were identified as barriers and 69 were identified as enablers. Perceived barriers in patients included lack of awareness about mHealth systems and language barriers. Perceived enablers in patients included need for automated tools for health monitoring and an increasing literacy level of the society. According to physicians, barriers included lack of available digital health systems in the local context and concern about patients' mHealth capabilities, while enablers included the perceived usefulness in reducing workload and improving health care service quality, as well as the availability of mobile devices and the internet. As perceived by health care executives, barriers included competing priorities alongside digitalization in the health sector and lack of interoperability and complete digitalization of implemented digital health systems, while enablers included the perceived usefulness of digitalization for the survival of the highly overloaded health care system and the abundance of educated manpower specializing in technology. mHealth systems in Sub-Saharan Africa are hindered and facilitated by various factors. Common barriers and enablers were identified by patients, physicians, and health care executives. To promote uptake, all relevant stakeholders must actively mitigate the barriers. This study identified a promising outlook for mHealth in Sub-Saharan Africa, despite the present barriers. Opportunities exist for successful integration into health care systems, and a user-centered design is crucial for maximum uptake.

Professional development, professionalisation and successful professional performance of the Bachelor of Optometry and Opticianry

Introduction: Health Technology has integrated technological advances in health services, requiring professional improvement programmes to improve the performance of technologists. In the field of ophthalmology in Cuba, the quality of services depends on optometrists and opticians, and their continuous training is essential in an increasingly technological environment with a growing demand due to the increase in refractive disorders and the ageing population.Development: Professional development, defined as a continuous pedagogical process, is essential to maintain the quality of health services. It has been widely researched and its importance in improving the quality of services, satisfaction and social recognition of health professionals has been highlighted. In the specific case of Optometry and Optics, professional development is considered a necessary process to ensure successful performance. Several principles and distinctive features of this process are highlighted, including its systemic character, its connection with initial and postgraduate training, and its evaluation through professional performance.Conclusions: The professional development of Optometry and Optics graduates is crucial to their successful performance, as it contributes to their professionalisation and the development of competencies needed in a constantly evolving eye health environment. The importance of integrating initial and continuing education, as well as assessing the impact of further education on professional performance, is highlighted. These findings underline the need for well-structured and contextualised professional development programmes to ensure the quality and effectiveness of eye care services.

Multi-directional Robust Benefit of the Doubt model: An application to the measurement of the quality of acute care services in OECD countries

While individual metrics in evaluating healthcare quality offer in-depth insights into particular areas, they frequently fail to encompass all pertinent information. Consequently, there is a growing need to develop composite measures that comprehensively assess the overall quality or performance of specific care services, especially those not covered by official OECD measures. A novel multi-directional robust Benefit-of-the-doubt approach is proposed to measure overall acute care services quality through a composite indicator while, at the same time, highlighting the potential improvement directions for each single component indicator. First, an approach based on simulated data has been carried out to better describe the advantages of the proposed approach, and then the methodology has been applied to country-level OECD data drawn from the Healthcare Quality and Outcomes programme.

Factors Influencing Thai Health Workers’ Attitudes toward Providing Health Services to Migrants

Many migrants currently use local Thai healthcare services while living and working in Thailand. Health workers’ attitudes toward providing health services to migrants significantly influence the quality of their healthcare. This study aimed to describe and compare health workers’ attitudes toward providing health services to migrants between health professionals and supportive health workers and examine the personal and system factors that predict health workers’ attitudes towards health services. A cross-sectional design was applied in this study. A total of 1,356 health workers in Thailand were selected using multi-stage random sampling. The research instruments included the Migrants’ Cultures and Contexts Questionnaire and the Health Workers’ Attitudes toward Providing Health Services to Migrants Questionnaire. Data were analyzed using the Mann-Whitney U test and binary logistic regression.Most health professionals (91.05%) and supportive health workers (91.71%) had positive attitudes toward health services for migrants. The appropriateness of health workers’ numbers and knowledge about migrants’ cultures and contexts could mutually influence the health workers’ attitudes, accounting for only 3.6% of the variance. Reinforcing positive attitudes among health workers can be done by providing praise for good health services. However, further studies on the accessibility, quality of care services, cost, and migrants’ satisfaction are needed before appropriate intervention and policy can be improved.

Barriers and Enablers of Postnatal Care by Accredited Social Health Activist (ASHA) Workers: A Community-Based Qualitative Study From Tribal Gujarat.

Background The care provided to the mother and child from delivery to six weeks after is defined as postnatal care. The postnatal period is both a happy and critical phase for the mother and the newborn. However, the provision of high-quality care services is often ignored during this time. The objective of this study was to assess postnatal care services quality by Accredited Social Health Activist (ASHA) workers and associated factors such as newborn care in rural tribal areas of Gujarat, India. Methodology An ethnographic approach was adopted. Four primary health centers (PHCs) were selected purposively from Sankheda Block, Chhotaudepur, a tribal district in the eastern part of Gujarat. Information on obstacles and facilitators of postnatal care services was collected using in-depth interviews (IDIs) with a purposive sample of 22 ASHAs working in selected PHCs. Qualitative data were analyzed using thematic analysis. Results The median age of the ASHA workers was 39 years and ranged from 30 to 51 years (N = 22). Most ASHAs encountered logistical challenges when offering postnatal care services (e.g., they struggled to care for the mother and her babies because they were missing essential equipment, such as a thermometer and a salter-type baby weighing machine, or they had broken equipment). The two main issues facing ASHAs were incentives and timely payments. There were concerns about their safety and physical security during fieldwork. The majority of ASHA workers had good experiences during postnatal home visits, and they received support from other healthcare workers. There were many misconceptions and false assumptions in the community regarding breastfeeding, prelacteal feeding, family planning, and contraception methods. ASHAs wanted to become long-term government employees and believed they were entitled to sufficient training, assistance, recognition, and remuneration for the duties they performed. Conclusions Postnatal mothers receive considerably less attention than antenatal mothers because it mostly depends on ASHA workers and field staff. ASHA workers are doing their best regarding postnatal care. This study revealed some issues ASHAs face, including logistic issues, transportation issues, regular and timely payment issues, and local-level acceptance issues.

Impact of the Mbarara University of Science and Technology residency training on increasing access to specialty care workforce.

Graduate tracer studies provide an avenue for assessing the impact of residency training on the distribution and access to specialty care and exploring job and professional satisfaction of alumnus. This study examined how the Mbarara University of Science and Technology (MUST) clinical residency training program influenced the spatial distribution and career paths of specialists. We conducted a mixed methods study involving an online survey and 12 in-depth interviews (IDIs) from June to September 2022. The online survey was distributed to a convenient sample of clinical residency alumnus from MUST via email and Whatsapp groups. Alumnus were mapped across the countries of current work in QGIS (version 3.16.3) using GPS coordinates. Descriptive and thematic analyses were also conducted. Ninety-five alumni (34.3%) responded to the tracer survey. The majority were males (80%), aged 31-40 years (69%), and Ugandans (72%). Most graduated after 2018 (83%) as obstetricians/gynecologists (38%) and general surgeons (19%). There was uneven distribution of specialists across Uganda and the East-African community-with significant concentration in urban cities of Uganda at specialized hospitals and academic institutions. Residency training helped prepare and equip alumnus with competencies relevant to their current work tasks (48%) and other spheres of life (45%). All respondents were currently employed, with the majority engaged in clinical practice (82%) and had obtained their first employment within six months after graduation (76%). The qualitative interviews revealed the reported ease in finding jobs after the training and the relevance of the training in enhancing the alumnus' ability to impact those they serve in teaching, research, management, and clinical care. Graduates cited low payment, limited resources, and slow career advancement concerns. Residency training improves the graduates' professional/career growth and the quality of health care services. Strategic specialty training addressing imbalances in subspecialties and rural areas coverage could optimize access to specialist services.

Exploring advanced clinical practitioner perspectives on training, role identity and competence: a qualitative study

BackgroundAdvanced Clinical Practitioners (ACPs) are a new role that have been established to address gaps and support the existing medical workforce in an effort to help reduce increasing pressures on NHS services. ACPs have the potential to practice at a similar level to mid-grade medical staff, for example independently undertaking assessments, requesting and interpreting investigations, and diagnosing and discharging patients. These roles have been shown to improve both service outcomes and quality of patient care. However, there is currently no widespread formalised standard of training within the UK resulting in variations in the training experiences and clinical capabilities of ACPs. We sought to explore the training experiences of ACPs as well as their views on role identity and future development of the role.MethodsFive online focus groups were conducted between March and May 2021 with trainee and qualified advanced clinical practitioners working in a range of healthcare settings, in the North of England. The focus groups aimed to explore the experiences of undertaking ACP training including supervision, gaining competence, role identity and career progression. Thematic analysis of the focus group transcripts was performed, informed by grounded theory principles.ResultsFourteen advanced clinical practitioners participated. Analysis revealed that training was influenced by internal and external perceptions of the role, often acting as barriers, with structural aspects being significant contributory factors. Key themes identified (1) clinical training lacked structure and support, negatively impacting progress, (2) existing knowledge and experience acted as both an enabler and inhibitor, with implications for confidence, (3) the role and responsibilities are poorly understood by both advanced clinical practitioners and the wider medical profession and (4) advanced clinical practitioners recognised the value and importance of the role but felt changes were necessary, to provide security and sustainability.ConclusionsAppropriate structure and support are crucial throughout the training process to enable staff to have a smooth transition to advanced level, ensuring they obtain the necessary confidence and competence. Structural changes and knowledge brokering are essential, particularly in relation to role clarity and its responsibilities, sufficient allocated time to learn and practice, role accreditation and continuous appropriate supervision.

Maternal Mortality from 2014 To 2017: Trend and Risk Factors at the Kintambo Maternity Ward, Democratic Republic of Congo

Introduction: Maternal mortality is a tragedy and constitutes a triple scourge. It is dramatic for the family (which falls apart after the death of the woman), unacceptable for the medical profession (since there are obstetric means to save mothers), and unacceptable for society (dying while giving birth). However, it seems to increase every year in the city of Kinshasa, due to several factors including the lack of easy access to quality care and childbirth services. The main objective for this study was to investigate the trend in maternal mortality at the Kintambo maternity ward from 2014-2017 including the relative contribution of risk factors linked to the lack of easy access to care and services quality delivery. Methods: This is an observational case-control study among pregnant women who followed ANC or not at the Kintambo maternity ward, but who all gave birth from January 2014 until December 2017. The use of the survey method, based on the analysis of registers, with a data collection sheet (check list) which was used for the collection of data, proved essential to bring this to fruition research. The sample size was exhaustive for cases (63 cases) and 63 controls. Results: Trend in female mortality between 2014-2017 at the Kitambo maternity ward in the city of Kinshasa has been decreasing, i.e. 22 cases in 2014, 17 cases in 2015, 14 cases in 2016 and 10 cases in 2017. It was observed that the variables show a very significant difference in relation to the factors which are the age of the pregnant woman, attendance at the CPN, delivery in the same center, the number of doctors in the delivery room and the distance between the residence and the center with an added value (P) less than 0.008; In comparison to pregnant women who die or not during childbirth and the factors in relation to their Chi-square, the age of gestation has a higher. Conclusion: Reducing this mortality requires strengthening the capacities of midwives /midwives in the care of pregnant women from conception to delivery and in the postpartum period , providing maternity wards with all the assets for good operationalization in the farthest corners of the city center , raising awareness among pregnant women of the importance of attending the CPN, ensuring good monitoring of the pregnant woman during her pregnancy and during childbirth, and for women to be always accompanied by their husbands during the CPN in order to help them internalize certain notions.