Resilient Healthcare Systems Research Articles

Impact of the Covid-19 Pandemic on Care of Patients with Diabetes Mellitus at Kitwe Teaching Hospital in 2021

Coronavirus disease 2019 (Covid-19) pandemic tested the resilience of the health care system in many countries including Zambia. At the peak, disruption of the global supply chain affected availability of essential commodities needed to manage many health ailments like diabetes mellitus (DM). The study was aimed to understand the challenges faced by DM patients in accessing specialist services at KTH DM specialist clinic during the Covid-19 pandemic in 2021. A cross sectional descriptive study was conducted with a total of 293 participants (109 males and 184 females) recruited using a designed structured questionnaire and results analyzed using Microsoft Office Excel 2016 and the Statistical Package for Social Sciences (SPSS) version 16.0 software. The mean age was 54.0 ± 13.0 years old with 78(26.6%) being below the age of 45 years. 197(67.2%) were married and 157(53.6%) had primary education or less. 216(73.7%) and 222(75.8%) were earning <US$5.00 per day before and during Covid-19 pandemic respectively while the majority were spending one fifth of their earned income on medication from private pharmacies alone. 231(78.8%) had T2DM while 149(50.8%) had high plasma glucose levels; high BMI, high waist circumference and hypertension 184(62.8%). The study suggested that disruption of outpatient services led to patients presenting with high plasma glucose levels, poorly controlled weight (high BMI and high waist circumference). Commonest complications included hypertension and peripheral neuropathy. There is a need to devise a more pragmatic and resilient healthcare system in future to minimize the effects of any pandemic should they arise. Keywords: Covid-19, Diabetes medication, Diabetes mellitus, Essential healthcare services, Hypertension, Lifestyle modification.

Digital health systems strengthening in Africa for rapid response to COVID-19.

The COVID-19 pandemic has painfully exposed the constraints of fragile health systems in low- and middle-income countries, where global containment measures largely set by high-income countries resulted in disproportionate collateral damage. In Africa, a shift is urgently needed from emergency response to structural health systems strengthening efforts, which requires coordinated interventions to increase access, efficiency, quality, transparency, equity, and flexibility of health services. We postulate that rapid digitalization of health interventions is a key way forward to increase resilience of African health systems to epidemic challenges. In this paper we describe how PharmAccess' ongoing digital health system interventions in Africa were rapidly customized to respond to COVID-19. We describe how we developed: a COVID-19 App for healthcare providers used by more than 1,000 healthcare facilities in 15 African countries from May-November 2020; digital loans to support private healthcare providers with USD 20 million disbursed to healthcare facilities impacted by COVID-19 in Kenya; a customized Dutch mobile COVID-19 triage App with 4,500 users in Ghana; digital diaries to track COVID-19 impacts on household expenditures and healthcare utilization; a public-private partnership for real-time assessment of COVID-19 diagnostics in West-Kenya; and an expanded mobile phone-based maternal and child-care bundle to include COVID-19 adapted services. We also discuss the challenges we faced, the lessons learned, the impact of these interventions on the local healthcare system, and the implications of our findings for policy-making. Digital interventions bring efficiency due to their flexibility and timeliness, allowing co-creation, targeting, and rapid policy decisions through bottom-up approaches. COVID-19 digital innovations allowed for cross-pollinating the interests of patients, providers, payers, and policy-makers in challenging times, showing how such approaches can pave the way to universal health coverage and resilient healthcare systems in Africa.

Hospital discharge for stroke patients: Transitional Care is Brain

Abstract Background Among cerebrovascular disease, stroke is a life-threatening neurological event and a main cause of serious long-term disability, with relevant healthcare and economic burden. Treatment of stroke is time dependent and organised integrated stroke care enables quick and effective responses to reduce stroke-related death and disability. This study aimed at evaluating the amount of hospital discharge to transitional care facilities for stroke patients to support integrated care models in the city of Pavia (Italy). Methods In 2017 in Pavia, Fondazione IRCCS Policlinico San Matteo started a partnership with Fondazione Mondino to build a specific stroke pathway, becoming a leading centre for stroke treatment. We conducted a retrospective chart review (RCR) of patient-centred data to quantify the volume of discharge for stroke patients. Two trained public health residents reviewed medical records with stroke admission diagnosis during 2021, analysing onset (e.g., Emergency Room, other hospital, emergency network), ward, treatment and discharge types (e.g., home, death, transitional care facility). Results Our RCR found 669 patients with a stroke diagnosis treated at San Matteo hospital in 2021, the vast majority of which were admitted to the neurology ward (375 patients, 56%). The recanalization rate was 32% (150 on 464 ischemic stroke patients). Regarding the discharge type, 299 patients (45%) were sent home, while 297 patients (44%) needed transfer to rehabilitation or long-term care facilities. About 8% (52 patients) of the overall sample died in hospital. Conclusions Our analysis showed that, while most stroke patients were discharged and sent home, more than two-third need to be transferred to continue to get the right healthcare from the right professional. Transitional care facilities should receive the greatest consideration by systems and providers seeking to implement care models to reduce residual neurological disabilities for stroke patients. Key messages • A fast and accessible emergency chain is essential to reduce residual neurological disabilities and the related healthcare and economic burden in stroke patients. • Extending the stroke path model to other time-dependent diseases is increasingly high-priority to shape a strong and resilient healthcare system, ensuring qualified health coverage.

11.J. Workshop: Enabling participation of vulnerable groups in primary health and long-term care

Abstract Enabling individual and collective participation or vulnerable people in health and social care is fundamental to achieving equitable, people-centered care. However, for vulnerable groups and clients, unfolding opportunities for participation in their care is closely related with experiences of empowerment and disempowerment. The workshop focuses on primary health and long-term care, as those are the pillars of resilient health care systems able to meet the complex care needs of vulnerable people. From a public health perspective, the facets of participation range from providing access to comprehensive services for people in need, to developing a shared understanding between clients and health professionals regarding clients’ everyday and care preferences, to sharing decision-making on health and care matters. In this workshop, we will discuss how helpful public health interventions between individual, professional and systemic-structural approaches should or could be designed, to (better) enable participation of vulnerable groups in primary and long-term care. The workshop presentations draw on empirical research with members of vulnerable groups, health professionals and key informants in care policy and practice conducted in Brazil, Germany, India, and Spain. By focusing on different primary and long-term care settings as well as vulnerable groups (undocumented persons, older people in need of care, people living with chronic illnesses) we will address and discuss the following questions: • What ideas can we find to strengthen participation of vulnerable groups in primary and long-term care settings? • Which opportunities and barriers are involved? • How can individual, professional, and structural approaches ‘fit together’ to enable greater participation of vulnerable groups in their (self-)care? Key messages • Practitioners’ efforts to enable participation have to be accompanied by qualification- and governance-oriented public health approaches to achieve patient oriented health and social care systems. • Present barriers and opportunities for vulnerable groups are instructive indicators for broader challenges towards comprehensive people-centered care.

11.G. Round table: Resilient health systems: harnessing health information to improve population health

Abstract Health systems are built to improve the health of the population. When the COVID-19 crisis hit Europe, the sustained performance of these health systems was challenged. The resilience of these health systems, defined as the ability to absorb, adapt, and transform to cope with shocks (Observatory, 2021), was found to be different in the many European countries, leaving some important lessons to be learned and best practices to be showcased to help countries assess their own response to the COVID-19 pandemic and support efforts to strengthen health systems in Europe. A common denominator is health information; the data and information that is needed to monitor the health of patients as well as the general population. Especially in times of crisis, the availability and trustworthiness of these data is of utmost importance. The COVID-19 pandemic showed that within a substantial number of European countries, health information systems were not always equipped to accommodate the data and information flows that were needed in order for researchers to provide the best available evidence to underpin health policy decisions. Ad-hoc surveillance and monitoring systems were set up (under emergency legislation) and clear governance of health information was lacking. In addition, sharing data and information across European borders and ensuring comparability of data and indicators proved to be difficult in a timely manner during the COVID-19 crisis. This resulted in a European landscape with different national and federal health policies, based on sometimes poor scientific findings. However, when the crisis progressed, numerous national and international initiatives were set up aiming to harmonize the available health information and as of now, many of these initiatives are forming a solid foundation of the health systems, rendering their performance sustainable for the future. In this workshop, which is organized as a round table discussion, we will discuss the resilience of health information systems in European countries, with regards to lessons learned from the COVID-19 crisis, barriers to sharing health information within and across borders, best practices and future perspectives. The topic will be highlighted from multiple perspectives, bringing together experts from different backgrounds, including the European level (European Commission and European Observatory on Health Systems and Policies), the country level, and the perspective of European projects. The audience will be able to provide their view on the different topics through an interactive voting poll during the session. Throughout the session, the exchange of knowledge, experiences and opinions with the audience will be facilitated by the chairs. Key messages • Population health information plays a key role in times of crisis, with trustworthy information flows facilitating evidence-informed policies and decision-making. • Sharing and harmonising health information is key to building resilient healthcare systems that are prepared for the future. Speakers/Panellists Ebba Barany European Commission, Luxembourg, Luxembourg Cianrán Nicholl European Commission, JRC, Ispra, Italy Kenneth Grech Public Health Medicine, Mater Dei Hospital, L-Imsida, Malta Miriam Saso Sciensano, Brussels, Belgium Anna Sagan European Observatory on Health Systems and Policies, London, UK

Global engagement of pharmacists in test and treat initiatives: Bringing care from clinics to communities

The coronavirus disease 2019 pandemic has placed substantial strain on the global health care workforce, disrupting essential and nonessential services. Task sharing of test and treat services to nontraditional prescribers, such as pharmacists, can facilitate more resilient health care systems by expanding access to health services while simultaneously decreasing the pressure on traditional health care providers. Expansion of pharmacists’ scope of work has historically been hindered by sociopolitical, resourcing, and competency considerations; addressing these challenges will be key to including pharmacists in testing and treatment of priority diseases. Sociopolitical considerations include migrating to flexible national legislation and scope of practices as well as engagement with other health care providers and the public to increase the acceptance of pharmacists participating in test and treat services. Resourcing issues include health care financing for test and treat services to parallel established systems or use voucher systems and service competition. In addition, pharmacists can use their training in supply chain management to ease and prevent medication stockouts in test to treat initiatives. Investments in technologies that support disease surveillance, basic reporting, and interoperability with health management information systems can integrate these initiatives into health care systems. Competency considerations comprise test and treat specific education for the pharmacy profession to equip them with the knowledge and confidence to execute successfully. Monitoring and evaluating the outcomes of these services can facilitate the scalability of test and treat initiatives. Pharmacists are uniquely positioned to bring testing and treatment from the clinic to the community.

Disruption in accessing sexual and reproductive health services among border populations during COVID-19 lockdown in Uganda.

BackgroundThe spread of COVID-19 exposed the inadequacies inherent in the health care systems of many countries. COVID-19 and the attendant demands for emergency treatment and management put a significant strain on countries’ health care systems, including hitherto strong health systems. In Uganda, as the government strived to contain COVID-19, other essential health care services were either disrupted or completely crowded out. Balancing the provision of COVID-19 treatment and management services and at the same time offering sexual and reproductive health and rights services (SRHR) proved to be a considerable challenge in these circumstances. COVID-19 prevention-related travel restrictions and border closures had far-reaching negative consequences on the mobility of individuals to access essential health services in Uganda. The situation may have been worse for cross-border communities that sometimes access services across the borders.MethodsUsing quantitative data from 1521 respondents and qualitative data (20 key informant interviews and 12 focus group discussions), we investigate the disruption in accessing SRHR services for border communities in Uganda during COVID-19.ResultsResults indicate that females (adjusted odds ratio (aOR) = 1.3; 95% confidence interval CI = 1.08-1.79), those with primary education (aOR = 1.47; 95% CI = 1.61-2.57), currently employed (aOR = 2.03; 95% CI = 1.61-2.57) and those with the intention to leave current residence (aOR = 2.09; 95% CI = 1.23-3.55) were more likely to have experienced a disruption in accessing SRHR services. However, respondents aged 35 years, or more were less likely to have experienced a disruption compared to their younger counterparts.ConclusionsResults shed light on the disruption of access toSRHR services during pandemics such as COVID-19 among a highly mobile population. There is a need to invest in building strong and resilient health care systems that can guarantee continuous access to essential health services including SRHR provisions among mobile populations during pandemics.

Use of Health Care Chatbots Among Young People in China During the Omicron Wave of COVID-19: Evaluation of the User Experience of and Satisfaction With the Technology.

BackgroundLong before the outbreak of COVID-19, chatbots had been playing an increasingly crucial role and gaining growing popularity in health care. In the current omicron waves of this pandemic when the most resilient health care systems at the time are increasingly being overburdened, these conversational agents (CA) are being resorted to as preferred alternatives for health care information. For many people, especially adolescents and the middle-aged, mobile phones are the most favored source of information. As a result of this, it is more important than ever to investigate the user experience of and satisfaction with chatbots on mobile phones.ObjectiveThe objective of this study was twofold: (1) Informed by Deneche and Warren’s evaluation framework, Zhu et al’s measures of variables, and the theory of consumption values (TCV), we designed a new assessment model for evaluating the user experience of and satisfaction with chatbots on mobile phones, and (2) we aimed to validate the newly developed model and use it to gain an understanding of the user experience of and satisfaction with popular health care chatbots that are available for use by young people aged 17-35 years in southeast China in self-diagnosis and for acquiring information about COVID-19 and virus variants that are currently spreading.MethodsFirst, to assess user experience and satisfaction, we established an assessment model based on relevant literature and TCV. Second, the chatbots were prescreened and selected for investigation. Subsequently, 413 informants were recruited from Nantong University, China. This was followed by a questionnaire survey soliciting the participants’ experience of and satisfaction with the selected health care chatbots via wenjuanxing, an online questionnaire survey platform. Finally, quantitative and qualitative analyses were conducted to find the informants’ perception.ResultsThe data collected were highly reliable (Cronbach α=.986) and valid: communalities=0.632-0.823, Kaiser-Meyer-Olkin (KMO)=0.980, and percentage of cumulative variance (rotated)=75.257% (P<.001). The findings of this study suggest a considerable positive impact of functional, epistemic, emotional, social, and conditional values on the participants’ overall user experience and satisfaction and a positive correlation between these values and user experience and satisfaction (Pearson correlation P<.001). The functional values (mean 1.762, SD 0.630) and epistemic values (mean 1.834, SD 0.654) of the selected chatbots were relatively more important contributors to the students’ positive experience and overall satisfaction than the emotional values (mean 1.993, SD 0.683), conditional values (mean 1.995, SD 0.718), and social values (mean 1.998, SD 0.696). All the participants (n=413, 100%) had a positive experience and were thus satisfied with the selected health care chatbots. The 5 grade categories of participants showed different degrees of user experience and satisfaction: Seniors (mean 1.853, SD 0.108) were the most receptive to health care chatbots for COVID-19 self-diagnosis and information, and second-year graduate candidates (mean 2.069, SD 0.133) were the least receptive; freshmen (mean 1.883, SD 0.114) and juniors (mean 1.925, SD 0.087) felt slightly more positive than sophomores (mean 1.989, SD 0.092) and first-year graduate candidates (mean 1.992, SD 0.116) when engaged in conversations with the chatbots. In addition, female informants (mean 1.931, SD 0.098) showed a relatively more receptive attitude toward the selected chatbots than male respondents (mean 1.999, SD 0.051).ConclusionsThis study investigated the use of health care chatbots among young people (aged 17-35 years) in China, focusing on their user experience and satisfaction examined through an assessment framework. The findings show that the 5 domains in the new assessment model all have a positive impact on the participants’ user experience and satisfaction. In this paper, we examined the usability of health care chatbots as well as actual chatbots used for other purposes, enriching the literature on the subject. This study also provides practical implication for designers and developers as well as for governments of all countries, especially in the critical period of the omicron waves of COVID-19 and other future public health crises.

Special Pathogens Readiness in the United States: From Ebola to COVID-19 to Disease X and Beyond.

Special Pathogens Readiness in the United States: From Ebola to COVID-19 to Disease X and Beyond.

Supporting Non-Communicable Disease Patients in Time of The Covid-19 Pandemic: From Motivating Them to Qualifying the Role of Their Caregivers

Evidence collected globally during the pandemic show that Covid-19 has had a significant impact on patients suffering from non-communicable diseases (NCDs). Indeed, oncological and chronic patients have been left almost alone for several months, especially during the first wave of the pandemic. At the European level, the hope is that the measures adopted thanks to the Next Generation EU Fund [1] can have, in the shortest period possible, a significant impact towards more resilient healthcare systems in each Member State, in which the issue of health acts as a key element within their National Resilience and Recovery Plans (NRRPs). In addition to this, it is extremely essential to act on two sides: to motivate patients to not neglect their treatment path, and to support as much as possible the ones who informally help them in the shadow. In fact, behind every sick person there is often a caregiver, for many of whom every day the work of care takes up almost all of their daily time, with considerable expenditure of physical and mental energy. What is the situation of caregivers across Europe? While challenges faced by patients are a frequently discussed topic, not much is known about the issues caregivers face daily. To shed light on the latter in Italy has been a civic survey carried out along 2020 by the Italian NGO Cittadinanzattiva [2], engaged also at the European level in order to motivate patients and, as an Ambassador of the EU Pillar of Social Rights [3], committed with EU institutions to implement the 20 principles of the Pillar for the benefit of both patients and their caregivers.

Creating Effective, Evidence-Based Video Communication of Public Health Science (COVCOM Study): Protocol for a Sequential Mixed Methods Effect Study.

BackgroundThe nonlinear nature of contagious diseases and the potential for exponential growth can be difficult to grasp for the general public. This has strong implications for public health communication, which needs to be both easily accessible and efficient. A pandemic is an extreme situation, and the accompanying strict societal measures are generally easier to accept if one understands the underlying reasoning behind them. Bringing about informed attitude change and achieving compliance to strict restrictions requires explanations of scientific concepts and terminologies that laypersons can understand.ObjectiveThe aim of the project is to develop effective, evidence-based modes of video communication for translating complex, but important, health messages about pandemics to both the general population and decision makers. The study uses COVID-19 as a case to learn and prepare society for handling the ongoing and future pandemics, as well as to provide evidence-based tools for the science communication toolbox.MethodsThe project applies a mixed methods design, combining qualitative methods (eg, interviews, observational studies, literature reviews) and quantitative methods (eg, randomized controlled trials [RCTs]). The project brings together researchers from a wide range of academic fields, as well as communication industry professionals.ResultsThis study has received funding from the Trond Mohn Foundation through the Research Council of Norway’s “COVID-19 Emergency Call for Proposals” March 2020. Recruitment and data collection for the exploratory first phase of the project ran from February 2021 to March 2021. Creative communication work started in May 2021, and the production of videos for use in the RCTs in the final phase of the project started in September 2021.ConclusionsThe COVCOM project will take on several grand challenges within the field of communicating science and provide evidence-based tools to the science communication toolbox. A long-term goal of the project is to contribute to the creation of a more resilient health care system by developing communication responses tailormade for different audiences, preparing society for any future pandemic.International Registered Report Identifier (IRRID)DERR1-10.2196/34275

Report from the Ready for the Next Round Thought-Leadership Roundtables on Building Resilience in Cancer Care and Control in Canada-Colorectal Cancer Canada; 2021.

(1) Background: The COVID-19 pandemic illuminated vulnerabilities in the Canadian health care system and exposed gaps and challenges across the cancer care continuum. Canada is experiencing significant disruptions to cancer-related services, and the impact these disruptions (delays/deferrals/cancellations) have on the health care system and patients are yet to be determined. Given the potential adverse ramifications, how can Canada’s health care systems build resilience for future threats? (2) Methods: To answer this question, CCC facilitated a series of four thought-leadership roundtables, each representing the views of four different stakeholder groups: patients, physicians, health care system leaders, and researchers. (3) Results: Six themes of strength were identified to serve as a springboard for building resilience including, (1) advancing virtual care and digital health technologies to prevent future interruptions in cancer care delivery. (2) developing real-time data metrics, data sharing, and evidence-based decision-making. (3) enhancing public–private-non-profit partnerships to advance research and strengthen connections across the system. (4) advancing patient-centricity in cancer research to drive and encourage precision medicine approaches to care. (5) investing in training and hiring a robust supply of health care human resources. (6) implementing a national strategy and infrastructure to ensure inter-provincial collaborative data sharing (4). Conclusions: A resilient health care system that can respond to shocks and threats is not an emergency system; it is a robust everyday system that can respond to emergencies.

Strategic Planning for a Very Different Nursing Workforce

The COVID-19 pandemic amplified and intensified dramatic changes already emerging within the nursing workforce. This article examines and extrapolates from current trends to enable nurse leaders to prepare for the future nursing workforce and practice environment. Suggestions for strategic planning including imaging and prioritizing from a set of options for achieving a desired future state are offered. Strategic planning focusing on the wise use of nursing expertise and creating a positive professional practice environment can support the transition from the current crisis to a more resilient health care system supported by the full utilization of the knowledge and skills of registered nurses.

Developing a framework to enhance the seismic resilience of the electricity distribution system feeding the healthcare system

Delivering electricity to hospitals is vital for maintaining hospitals' functionality. Given the seismic vulnerability of electrical substations, providing effective rehabilitation plans for repairing these systems seems necessary for a resilient healthcare system. Studies concerning interdependent systems' functionality have not thoroughly addressed the interdependency of healthcare and electrical distribution systems. A framework to identify the effectiveness of different post-disaster rehabilitation plans for electrical substations to enhance the resilience of the healthcare system electricity is developed in this study, which increases the recoverability of the healthcare system after an earthquake. The vulnerability analysis for electrical facilities is done using modified fragility functions, considering the effects of aging as well. The geographical information system is used for assigning patients to hospitals given several patients' decision criteria. The framework uses a stochastic discrete event simulation to determine the effectiveness of different rehabilitation scenarios for five days after an earthquake occurs while using patients’ waiting time as the performance measure. Finally, the proposed framework is applied to Ghazvin city in the north-west of Iran. The results show that the best scenario would increase system resilience by 85%, highlighting the importance of identifying and implementing the best scenario.

Dilemma in Health During Pandemic in OECD Countries: Increasing Health Expenditures for Preventing Against the Pandemic Will Cause a Crowding-out in Increasing the Employment in Nursing Service or not?

In the early of December 2021, the COVID-19 related cases has exceeded 263 million and deaths 5.2 million. With COVID-19, it has been seen that the health system and health personnel are indispensable in the fight against the virus, even during the pandemic period. For a strong a resilient healthcare system need for nurses has emerged as the COVID-19 spreads very fast. According to WHO 19.3 million of the global nursing workforce which is 27.9 million, and 59% of the health professions are professional nurses. In OECD countries, there are 13.4 million nurses, and 987 nurses per 100,000 population. While health expenditures are made for treatment and vaccination, it should not be neglected to train health personnel, especially nurses. Increasing health expenditures against pandemic may mostly go to for preventing, vaccines and medical treatment and cause a crowding-out in increasing the employment in nursing service.

The best use of technology in the health emergency operation centers during COVID-19 pandemic

Since the outbreak of the coronavirus in the Kingdom of Saudi Arabia in 2020, National Health Emergency Center aligned itself to the Saudi Arabia&amp;apos;s Vision 2030 and has played a key role to link the different health sectors in the country with Ministry of Health, through the use of state-of-the-art infrastructure, innovative digital technologies, location intelligence, data analysis, and real time data. Thereby, General Directorate of Emergency, Disasters and Medical Transportation - Deputyship of Curative Services, launched the National Health Emergency Operation Center, which integrates digital technologies to deliver substantial improvements to emergency healthcare management. Through real-time maps, apps, and dashboards, the innovative integration of different technologies has revolutionized the Center&amp;apos;s operations by providing location intelligence and evidence-based analysis that shapes sound policy and saves lives. Disaster health management has become a key goal for every nation in order to reduce the impact of disasters on human health and wellbeing. It is an important aspect of any resilient healthcare system.

Responses against infectious disease pandemics: a narrative review on COVID-19

Currently, the world is facing the coronavirus disease 2019 (COVID-19) pandemic. With this, an emerging infectious disease pandemic in the absence of effective antiviral agents and vaccines for a novel virus is no different from the 1918 influenza pandemic, which became a great disaster for humankind. We also experienced a global lockdown with a stringent implementation of social distancing, which is a first for mankind living in the present day, and has led to enormous economic damage and restrictions on individual freedom. The microorganism that will cause the next pandemic may be a highly fatal avian influenza virus, another coronavirus, or a completely different microorganism. This COVID-19 pandemic is an enormous lesson for humankind and is tantamount to a vaccine in preparation for the next pandemic. Important and urgent undertakings were given to each country in terms of complementing laws and regulations for a stronger and more resilient healthcare system, such as investment in research and development for new rapid diagnostic technologies, vaccines, new therapeutic agents, among others.

General Practitioners' Roles in Disaster Health Management: Perspectives of Disaster Managers.

General Practitioners (GPs) are inevitably involved when disaster strikes their communities. Evidence of health care needs in disasters increasingly suggests benefits from greater involvement of GPs, and recent research has clarified key roles. Despite this, GPs continue to be disconnected from disaster health management (DHM) in most countries. The aim of this study was to explore the perspectives of disaster management professionals in two countries, across a range of all-hazard disasters, regarding the roles and contributions of GPs to DHM, and to identify barriers to, and benefits of, more active engagement of GPs in disaster health care systems. A qualitative research methodology using semi-structured interviews was conducted with a purposive sample of Disaster Managers (DMs) to explore their perspectives arising from experiences and observations of GPs during disasters from 2009 through 2016 in Australia or New Zealand. These involved all-hazard disasters including natural, man-made, and pandemic disasters. Responses were analyzed using thematic analysis. These findings document support from DM participants for greater integration of GPs into DHM with New Zealand DMs reporting GPs as already a valuable integrated contributor. In contrast, Australian DMs reported barriers to inclusion that needed to be addressed before sustained integration could occur. The two most strongly expressed barriers were universally expressed by Australian DMs: (1) limited understanding of the work GPs undertake, restricting DMs' ability to facilitate GP integration; and (2) DMs' difficulty engaging with GPs as a single group. Other considerations included GPs' limited DHM knowledge, limited preparedness, and their heightened vulnerability.Strategies identified to facilitate greater integration of GPs into DHM where it is lacking, such as Australia, included enhanced communication, awareness, and understanding between GPs and DMs. Experience from New Zealand shows systematic, sustained integration of GPs into DHM systems is achievable and valuable. Findings suggest key factors are collaboration between DMs and GPs at local, state, and national levels of DHM in planning and preparedness for the next disaster. A resilient health care system that maximizes capacity of all available local health resources in disasters and sustains them into the recovery should include General Practice.

HIV Service Interruptions During the COVID-19 Pandemic in China: The Role of COVID-19 Challenges and Institutional Response from Healthcare Professional's Perspective.

During the COVID-19 pandemic, HIV-related services have been unavoidably disrupted and impacted. However, the nature and scope of HIV service disruptions due to COVID-19 has rarely been characterized in China. A cross-sectional online survey was conducted among 1029 HIV healthcare providers in Guangxi, China, from April to May 2020. Latent class analysis (LCA) was first used to identify HIV service disruption levels, then hierarchical multilevel logistic regression was conducted to analyze the relationships of COVID-19 challenges, institutional responses, and HIV service disruption levels adjusting for the clustering effect of institutional ownership levels. Four classes of HIV service disruption were identified, with 22.0% complete disruption, 15.4% moderate disruption, 21.9% minor disruption, and 40.7% almost no disruption. COVID-19 challenges were positively associated with the probabilities of service disruption levels. Institutional responses were negatively associated with the probabilities of being classified as “minor disruption” and moderated the association of COVID-19 challenges with complete and moderate disruptions compared with no disruption group. To maintain continuity of core HIV services in face of a pandemic, building a resilient health care system with adequate preparedness is necessary.

Ethical insights from the COVID-19 pandemic in Germany: considerations for building resilient healthcare systems in Europe.

Ethical insights from the COVID-19 pandemic in Germany: considerations for building resilient healthcare systems in Europe.