Responsive Health Care Services Research Articles

Setting priorities in outpatient cardiovascular care to guarantee equitable access: the case of Tuscany region

Universal healthcare systems orient their actions towards promoting, restoring, and improving public health with a particular focus on the need to guarantee equitable access to care. Unwarranted variation in healthcare delivery poses significant challenges to health systems globally, impacting quality of care, financial sustainability, and equity of access. It is therefore important to assist healthcare management in measuring unwarranted variation in order to prioritise intervention strategies to ensure continuity of care and equity. Through an investigation of geographical variation in visit rates and waiting times, the study identifies vulnerable health districts which need priority interventions for patients with cardiovascular disease in the Tuscany region (Italy). Furthermore, a benchmarking-based method for identifying a quantitative estimate of the supply gap to be reduced is proposed. Results illustrate variation in visit rates and waiting times across local health districts in 2021, with some districts experiencing substantially lower rates and longer waiting times compared to the regional median. To address this gap, two targeted interventions aimed at increasing visit volumes and reduced waiting times through advanced training activities, technology integration, and multidisciplinary collaborations are presented. This study contributes to the topic of unwarranted variation by highlighting the necessity of tailored interventions to address diverse healthcare challenges across heterogeneous geographical areas. As healthcare systems globally navigate evolving complexities, the findings and tools presented here offer valuable guidance for policymakers and managers, aiming towards more equitable, efficient, and responsive healthcare services.

Experiences of internationally educated nurses working with older adults: A scoping review protocol.

Canada, like many other jurisdictions worldwide, is facing a nursing shortage. At the same time, high-income countries are facing a rapidly ageing and more complex older adult population. Demands for more responsive health care services are driving systems of care to meet the evolving needs of the ageing population. Internationally-educated nurses (IENs) can help fill gaps in the care of older adults, but may need considerable support to work in new social and health care environments. However, the experiences of IENs within the geriatric care literature have not been comprehensively reviewed. This protocol will outline a scoping review to determine: (1) what is known about the experiences and support needs of IENs in geriatric healthcare settings within high income countries? (2) what are current supportive-pathways for IENs in geriatric practice settings? And (3) what are the research gaps in the existing literature on the experiences and support needs of IENs within the context of geriatrics? A scoping review will be conducted guided by the methodological framework set out by Arksey and O'Malley (2005) and later advanced by Levac, Colquhoun and O'Brien (2010). The search strategy will be applied to seven databases (MEDLINE, PubMed (non-MEDLINE records), PsycINFO, PsychArticles, CINAHL, Scopus, Web of Science). Grey literature will be searched using Google search engines, targeted websites and consultation with content experts. Articles of any publication date will be included. A two-stage screening process will be conducted in duplicate (i.e., two reviewers per stage) to determine eligible articles. Data from eligible articles will be extracted using a piloted charting form. Extracted data will be analyzed using thematic and descriptive analyses. The findings of the upcoming will highlight opportunities and recommendations to inform future research and support training to support IENs working with older adults within high income countries. Publication, presentations and stakeholder meetings will disseminate our findings.

Audit tools for culturally safe and responsive healthcare practices with Aboriginal and Torres Strait Islander people: a scoping review

Aboriginal and Torres Strait Islander people in Australia face disparities in accessing culturally safe and appropriate health services. While current cultural safety and responsiveness frameworks set standards for improving healthcare...

Maternal satisfaction with basic emergency obstetric and new born care services and associated factors among mothers visiting public health facilities in Gedeo zone, Southern Ethiopia, 2020: A cross sectional study

IntroductionMeasuring clients’ satisfaction is important for improving healthcare services, and providing feedback on the quality, availability, and responsiveness of healthcare services. ObjectiveTo determine the level of maternal satisfaction with BEmONC services and associated factors among mothers visiting public health facilities in Gedeo zone, Southern, Ethiopia 2020. MethodsInstitution-based cross-sectional study was conducted among 413 mothers selected via a systematic random sampling technique. The data was collected through interviews using a structured questionnaire. Data were coded, entered, and cleaned using Epi- Info version 3.1 and analyzed using SPSS version 20. Binary logistic regression was used to identify the association between the dependent variable and independent variables. Variables that had P ≤ 0.25 on the bivariate binary logistic analysis were considered as candidates for multivariable binary logistic analysis. Variables, p-value < 0.05 with 95 % CI in multivariable binary logistic analysis, were considered statistically significant. ResultOverall mothers' satisfaction with BEmONC service in this study was 44.8 % at 95 %CI (39.7 %-49.4 %). Age ≥ 35 years and above [AOR = 3.44, 95 %CI (1.32, 9.97, presence of birth companion [AOR = 1.66, 95 %CI (1.02, 2.72)] were significantly associated with client satisfaction with BEmONC service. ConclusionThe overall satisfaction of mothers with BEmONC service in this study was sub-optimal. Maternal age and the presence of birth companions were factors that were significantly associated with mothers’ satisfaction with BEmONC service. The government has to emphasize working to improve the quality of basic emergency maternal obstetric and newborn care to improve maternal satisfaction and utilization.

Variation in the incidence of type 1 diabetes mellitus in children and adolescents by world region and country income group: A scoping review.

Around 18.7 million of the 537 million people with diabetes worldwide live in low-income and middle-income countries (LMIC), where there is also an increase in the number of children, adolescents, and young adults diagnosed with type 1 diabetes (T1D). There are substantial gaps in data in the current understanding of the epidemiological patterns and trends in incidence rates of T1D at the global level. We performed a scoping review of published studies that established the incidence of T1D in children, adolescents, and young adults aged 0-25 years at national and sub-national levels using PubMed, Embase and Global Health. Data was analyzed using R programming. The scoping review identified 237 studies which included T1D incidence estimates from 92 countries, revealing substantial variability in the annual incidence of T1D by age, geographic region, and country-income classification. Highest rates were reported in the 5-9 and 10-14 year age groups than in the 0-4 and 15-19 year age groups, respectively. In the 0-14 year age group, the highest incidence was reported in Northern Europe (23.96 per 100,000), Australia/New Zealand (22.8 per 100,000), and Northern America (18.02 per 100,000), while the lowest was observed in Melanesia, Western Africa, and South America (all < 1 per 100,000). For the 0-19 year age group, the highest incidence was reported in Northern Europe (39.0 per 100,000), Northern America (20.07 per 100,000), and Northern Africa (10.1 per 100,000), while the lowest was observed in Eastern and Western Africa (< 2 per 100,000). Higher incidence rates were observed in high-income countries compared to LMICs. There was a paucity of published studies focusing on determining the incidence of T1D in LMICs. The review reveals substantial variability in incidence rates of T1D by geographic region, country income group, and age. There is a dearth of information on T1D in LMICs, particularly in sub-Saharan Africa, where incidence remains largely unknown. Investment in population-based registries and longitudinal cohort studies could help improve the current understanding of the epidemiological trends and help inform health policy, resource allocation, and targeted interventions to enhance access to effective, efficient, equitable, and responsive healthcare services.

Summary findings from Tracks surveys implemented by First Nations in Saskatchewan and Alberta, Canada, 2018-2020.

The Public Health Agency of Canada's integrated bio-behavioural surveillance system-Tracks surveys-assesses the burden of HIV, hepatitis C and associated risks in key populations in Canada. From 2018-2020, Tracks surveys were successfully implemented by First Nations Health Services Organizations in Alberta and Saskatchewan. First Nations-led survey teams invited community members who identified as First Nations, Inuit or Métis to participate in Tracks surveys and testing for HIV, hepatitis C and syphilis. Information was collected on social determinants of health, use of prevention services, substance use, sexual behaviours and care for HIV and hepatitis C. Descriptive statistics are presented. Of the 1,828 survey participants, 97.4% self-identified as First Nations and 91.4% lived in an on-reserve community. Over half (52.2%) were cisgender female, average age was 36.3 years, 82.5% lived in stable housing, 82% had access to primary healthcare and 73.8% reported having good to excellent mental health. Most participants (97%) had a family member who had experienced residential school. High proportions experienced stigma and discrimination (65.6%), financial strain (64.3%) and abuse in childhood (65.1%). Testing for HIV (62.8%) and hepatitis C (55.3%) was relatively high. Prevalence of HIV was 1.6% (of whom 64% knew their infection status). Hepatitis C ribonucleic acid prevalence was 5% (44.9% of whom knew their current infection status). Historical and ongoing experiences of trauma, and higher prevalence of hepatitis C were identified, reaffirming evidence of the ongoing legacies of colonialism, Indian Residential Schools and systemic racism. High participation in sexually transmitted blood-borne infection testing and prevention reflect the importance of First Nations-led culturally sensitive, safe and responsive healthcare services and programs to effect improved outcomes for First Nations peoples.

Newcomer challenges with accessing healthcare services in Saskatchewan, Canada

Newcomers experience a variety of barriers to healthcare services. The study objective is to identify newcomers’ healthcare barriers. During 2014-2015, we conducted in-depth interviews with service providers, and newcomer parents who had been in Saskatchewan for under 5 years. Primary themes include: 1) navigation difficulty, 2) limited awareness, 3) language, 4) interpretation and translation, 5) health benefits, 6) service limitations and stigma, 7) gender and cultural concerns, 8) health attitudes and beliefs, and 9) work demands. The results exposed service gaps and suggest options to improve access to healthcare. Consideration should be given to the development of formal processes to ensure the provision of information concerning healthcare and health benefit programs, as well as responsive healthcare services, including convenient primary healthcare sites that offer comprehensive care in a culturally responsive manner with embedded interpretation services to ensure that the Saskatchewan healthcare system does not perpetuate or create health disparities.

PO-1524 On how COVID-19 has affected radiation therapy treatments

Purpose or Objective: Cancer diagnostics and surgery have been disrupted by the response of health care services to the coronavirus disease pandemic. With the COVID-19 irruption in 2020, some radiotherapy treatments were omitted, delayed, changed intent or shifted to a hypofractionated scheme. The purpose of this study is to investigate the effect, direct or indirect, that COVID-19 has had on radiotherapy treatments in comparison with previous years. Materials and Methods: All treatments from 2018 (1521), 2019 (1498) and 2020 (1613) were analysed. Treatments were separated into two categories regarding treatment intent: curative or palliative. Moreover curative treatments were classified by site or pathology: H&N, lung, rectum, prostate, breast, central nervous system (CNS), gynaecological, SBRT and other sites. Percentage of hypofractionated treatments per year (for those with curative intent) was also taken into account. Results: Regarding treatment intent, we have found that the number of palliative treatments was similar to previous years: 38% in 2020, 37 % in 2018 and 35% in 2019. Figure I shows the percentage of hypofractionated treatments. During 2020 there were 10% hypofractionated treatments more than 2019, which is more than a threefold increase compared to the growth between 2018 and 2019 (3%). (Figure Presented) Conclusion: On one side, reasons related directly or indirectly with COVID-19 do not had an effect on the treatment intent in our department: similar number of palliative treatments was reported during 2020. On the other side, the use of hypofractionated schemes was accelerated during the pandemic, following national and international recommendations. This has allowed reducing treatment time bringing more comfort to the patients. To resume, it is difficult to assess whether the pandemic had a negative effect on cancer treatments based on treatment intent. Deeper analysis of cancer staging could reveal a different result related to collateral damage to the pandemic.

Responsiveness of health care services towards the elderly in Tanzania: does health insurance make a difference? A cross-sectional study

BackgroundResponsiveness has become an important health system performance indicator in evaluating the ability of health care systems to meet patients’ expectations. However, its measurement in sub-Saharan Africa remains scarce. This study aimed to assess the responsiveness of the health care services among the insured and non-insured elderly in Tanzania and to explore the association of health insurance (HI) with responsiveness in this population.MethodsA community-based cross-sectional study was conducted in 2017 where a pre-tested household survey, administered to the elderly (60 + years) living in Igunga and Nzega districts, was applied. Participants with and without health insurance who attended outpatient and inpatient health care services in the past three and 12 months were selected. Responsiveness was measured based on the short version of the World Health Organization (WHO) multi-country responsiveness survey study, which included the dimensions of quality of basic amenities, choice, confidentiality, autonomy, communication and prompt attention. Quantile regression was used to assess the specific association of the responsiveness index with health insurance adjusted for sociodemographic factors.ResultsA total of 1453 and 744 elderly, of whom 50.1 and 63% had health insurance, used outpatient and inpatient health services, respectively. All domains were rated relatively highly but the uninsured elderly reported better responsiveness in all domains of outpatient and inpatient care. Waiting time was the dimension that performed worst. Possession of health insurance was negatively associated with responsiveness in outpatient (− 1; 95% CI: − 1.45, − 0.45) and inpatient (− 2; 95% CI: − 2.69, − 1.30) care.ConclusionThe uninsured elderly reported better responsiveness than the insured elderly in both outpatient and inpatient care. Special attention should be paid to those dimensions, like waiting time, which ranked poorly. Further research is necessary to reveal the reasons for the lower responsiveness noted among insured elderly. A continuous monitoring of health care system responsiveness is recommended.

Collateral damage: the impact on outcomes from cancer surgery of the COVID-19 pandemic

BackgroundCancer diagnostics and surgery have been disrupted by the response of health care services to the coronavirus disease 2019 (COVID-19) pandemic. Progression of cancers during delay will impact on patients' long-term survival.Patients and methodsWe generated per-day hazard ratios of cancer progression from observational studies and applied these to age-specific, stage-specific cancer survival for England 2013–2017. We modelled per-patient delay of 3 and 6 months and periods of disruption of 1 and 2 years. Using health care resource costing, we contextualise attributable lives saved and life-years gained (LYGs) from cancer surgery to equivalent volumes of COVID-19 hospitalisations.ResultsPer year, 94 912 resections for major cancers result in 80 406 long-term survivors and 1 717 051 LYGs. Per-patient delay of 3/6 months would cause attributable death of 4755/10 760 of these individuals with loss of 92 214/208 275 life-years, respectively. For cancer surgery, average LYGs per patient are 18.1 under standard conditions and 17.1/15.9 with a delay of 3/6 months (an average loss of 0.97/2.19 LYGs per patient), respectively. Taking into account health care resource units (HCRUs), surgery results on average per patient in 2.25 resource-adjusted life-years gained (RALYGs) under standard conditions and 2.12/1.97 RALYGs following delay of 3/6 months. For 94 912 hospital COVID-19 admissions, there are 482 022 LYGs requiring 1 052 949 HCRUs. Hospitalisation of community-acquired COVID-19 patients yields on average per patient 5.08 LYG and 0.46 RALYGs.ConclusionsModest delays in surgery for cancer incur significant impact on survival. Delay of 3/6 months in surgery for incident cancers would mitigate 19%/43% of LYGs, respectively, by hospitalisation of an equivalent volume of admissions for community-acquired COVID-19. This rises to 26%/59%, respectively, when considering RALYGs. To avoid a downstream public health crisis of avoidable cancer deaths, cancer diagnostic and surgical pathways must be maintained at normal throughput, with rapid attention to any backlog already accrued.

Clients' Experience and Satisfaction of Utilizing Healthcare Services in a Community Based Health Insurance Program in Bangladesh.

Background: Community-based health insurance is recognized as a promising tool for health system improvement for low-income people that improves the health status of enrolees and enhances productivity and labor supply. The experience and opinion of the clients who utilized health services through the insurance scheme are important for improving healthcare services, shaping health policies and providing feedback on the quality, availability, and responsiveness of healthcare services. However, studies focusing on clients’ satisfaction provided by the health insurance scheme are still limited globally. Objective: To address this knowledge gap, this current study attempted to measure the degree of clients’ satisfaction towards healthcare services and insurance scheme, based on their experience of health care which will serve the future reference point to implement potential quality improvement initiatives of community-based health insurance program. Methods: A cross-sectional household survey was conducted within the catchment area of a community-based health insurance pilot program named Labor Association for Social Protection (LASP) during April–June 2014 to compare the evaluation of healthcare services provided by LASP scheme. In the descriptive analyses, the characteristics of the study participants were presented regarding frequency and the percentages with 95% confidence interval. Spearman correlation analysis was conducted between the satisfaction score of each indicator and overall satisfaction score; multivariate linear regression analysis was used to identify the factors associated with overall health scheme satisfaction. Results: The overall satisfaction mean score was 4.17 ± 0.04 (95% CI: 4.08–4.26) out of 5.00. The most satisfied domains were related to the diagnostic services (4.46 ± 0.98), explanation about the prescribed medicine (4.23 ± 0.81), the surrounding environment of healthcare facility (4.21 ± 0.70) and the behavior of health personnel toward clients (4.18 ± 0.73). Conclusions: Our study observed that the overall satisfaction level towards health services is quite favorable, but satisfaction scores can still be improved. These findings could contribute towards developing and designing the healthcare services packages of community-based health scheme which is in line with the health care financing strategy of Bangladesh as well as the recommendation of the World Health Organization for developing social health insurance as part of path to Universal Health Coverage.

Living with Stroke: A Woman’s Experience of Stroke From Hospital to Home and Beyond

Stroke is a major public health concern with significant healthcare costs and high levels of morbidity and mortality. Increases in incidence are forecast alongside rising levels of chronic disease and population ageing. Understanding experiences of stroke and stroke survivorship can enable care providers, decision makers, and researchers to better understand patient needs, concerns, and priorities as they strive to develop sustainable, responsible, and responsive healthcare services.

\u201cWays and channels for voice regarding perceptions of maternal health care services within the communities of the Makamba and Kayanza provinces in the Republic of Burundi: an exploratory study\u201d

BackgroundIncreased availability of maternal health services alone does not lead to better outcomes for maternal health.The services need to be utilized first.One way to increase service utilization is to plan responsive health care services by taking into account the community’s views or expressed needs.Burundi has a high maternal mortality ratio, and despite improvements in health infrastructure, skilled staff and the abolition of user fees for pregnant women,utilization of maternal health services remains low. Possible reasons for this include a lack of responsive healthcare services.An exploratory study was conducted in 2013 in two provinces of Burundi (Makamba and Kayanza), with the aim to collect the experiences of women and men with the maternal health services,their views regarding those services, channels used to express these experiences, and the providers’ reaction.MethodsSemi-structured interviews were used to collect data from men and women and key informants, including community health workers, health committee members, health providers, local authorities, religious leaders and managers of non-governmental organizations. Data analysis was facilitated by MAXQDA 11 software.ResultsNegative experiences with maternal health services were reported and included poor staff behavior towards women and a lack of medicine. Health committees and suggestion boxes were introduced by the government to channel the community’s views. However, they are not used by the community members, who prefer to use community health workers as intermediaries. Fear of expressing oneself linked to the post-war context of Burundi, social and gender norms, and religious norms limit the expression of community members’ views, especially those of women. The limited appreciation of community health workers by the providers further hampers communication and acceptance of the community’s views by health providers.ConclusionIn Burundi, the community voice to express views on maternal health services is encountering obstacles and needs to be strengthened,especially the women’s voice. Community mobilization in the form of a mass immunization campaign day organized by women fora, and community empowerment using participatory approaches could contribute towards community voice strengthening.

Impact of clinical leadership in teams’ course on quality, efficiency, responsiveness and trust in the emergency department: study protocol of a trailing research study

IntroductionClinical leadership has long been recognised as critical for optimising patient safety, quality of care and interprofessional teamwork in busy and stressful healthcare settings. There is a need to compensate...

'That red flag on your file': misinterpreting physical symptoms as mental illness.

To ascertain the views and experiences of mental health consumers regarding the availability and quality of care and treatment received for their physical health needs. People diagnosed with mental illness have higher occurrence of physical health problems. Responsive health care services are crucial for prevention and management of physical health problems, and for reducing disparities in health between people diagnosed with mental illness and those who are not. There is limited research giving voice to consumer perspectives on their experiences with health care providers. Exploratory qualitative. Focus group interviews with mental health consumers accessed via a consumer network group in a region of Australia (n=31). All interview audio recordings were transcribed professionally. Interviews were thematically analysed. The main themes were: symptomising; failure to act and alertness to prejudice. The first two themes were consumer perceptions of the actions and behaviours of health professionals, and the third describes consumer responses to these behaviours and actions. Consumers described increased risks of illness and death because of undiagnosed physical illness despite their physical health advice-seeking as the reason for the health consultation. Health care providers' non-recognition of physical health problems presents a clear example of a significant and potentially life threatening health inequity. The service provider responses described by participants suggest that mental health consumers' physical health needs may not be taken seriously. Clinicians need to take seriously the physical health needs and concerns of people with mental illness. Nurses can play a crucial role in the prevention of diagnostic overshadowing as part of a broader direction of balancing biomedical perspectives with other approaches to health care.

Assessing responsiveness of health care services within a health insurance scheme in Nigeria: users’ perspectives

BackgroundResponsiveness of health care services in low and middle income countries has been given little attention. Despite being introduced over a decade ago in many developing countries, national health insurance schemes have yet to be evaluated in terms of responsiveness of health care services. Although this responsiveness has been evaluated in many developed countries, it has rarely been done in developing countries. The concept of responsiveness is multi-dimensional and can be measured across various domains including prompt attention, dignity, communication, autonomy, choice of provider, quality of facilities, confidentiality and access to family support. This study examines the insured users’ perspectives of their health care services’ responsiveness.MethodsThis retrospective, cross-sectional survey took place between October 2010 and March 2011. The study used a modified out-patient questionnaire from a responsiveness survey designed by the World Health Organization (WHO). Seven hundred and ninety six (796) enrolees, insured for more than one year in Kaduna State-Nigeria, were interviewed. Generalized ordered logistic regression was used to identify factors that influenced the users’ perspectives on responsiveness to health services and quantify their effects.ResultsCommunication (55.4%), dignity (54.1%), and quality of facilities (52.0%) were rated as “extremely important” responsiveness domains. Users were particularly contented with quality of facilities (42.8%), dignity (42.3%), and choice of provider (40.7%). Enrolees indicated lower contentment on all other domains. Type of facility, gender, referral, duration of enrolment, educational status, income level, and type of marital status were most related with responsiveness domains.ConclusionsAssessing the responsiveness of health care services within the NHIS is valuable in investigating the scheme’s implementation. The domains of autonomy, communication and prompt attention were identified as priority areas for action to improve this responsiveness. For the Nigerian context, we suggest that health care providers in the NHIS should pay attention to these domains, and the associated characteristics of users, when delivering health care services to their clients. Policy makers, and the insurance regulatory agency, should consider the reform strategies of monitoring and quality assurance which focus on the domains of responsiveness to lessen the gap between users’ expectations and their experiences with health services.

The health of Canada's children. Part IV: Toward the future

Canadian children's health is influenced, in large part, by the living circumstances that they experience. These living circumstances - also known as the social determinants of health - are shaped by public policy decisions made by governmental authorities. While public policy should be focused on providing all Canadian children with the living circumstances necessary for health, it appears that Canada is far from achieving this goal. Instead, there are programs directed at Canada's most severely disadvantaged families and children. While vital, these programs appear to achieve less than that which would be achieved if governmental action was designed to strengthen the social determinants of health for all children. Considering the governmental actions that would achieve this goal are well known - with rather little evidence of policy implementation - it is essential to understand the processes by which public policy is made. An important physician role - in addition to providing responsive health care services - is to become forceful advocates for public policy in the service of health. It is in the latter sphere that physician involvement may yield the strongest benefits for promoting children's health.

Patient experiences and health system responsiveness in South Africa

BackgroundPatients' views are being given more and more importance in policy-making. Understanding populations' perceptions of quality of care is critical to developing measures to increase the utilization of primary health care services. Using the data from the South African World Health Survey (WHS), the current study aims to evaluate the degree of health care service responsiveness (both out-patient and in-patient) and comparing experiences of individuals who used public and private services in South Africa.MethodsA population-based survey of 2352 participants (1116 men and 1236 women) was conducted in South Africa in 2003, the WHS – as part of a World Health Organization (WHO) project focused on health system performance assessment in member countries.ResultsHealth care utilization was among those who attended in-patient care 72.2% attended a public and 24.3% a private facility, and of those who attended out-patient care 58.7% attended a public and 35.7% a private facility. Major components identified for out-patient care responsiveness in this survey were highly correlated with health care access, communication and autonomy, secondarily to dignity, confidentiality and quality of basic amenities, and thirdly to health problem solution. The degree of responsiveness with publicly provided care was in this study significantly lower than in private health care. Overall patient non-responsiveness for the public out-patient service was 16.8% and 3.2% for private care. Discrimination was also one of the principal reasons for non-responsiveness in all aspects of provided health care.ConclusionHealth care access, communication, autonomy, and discriminatory experiences were identified as priority areas for actions to improve responsiveness of health care services in South Africa.