Secondary Healthcare Providers Research Articles

Evaluation of lived experience Peer Support intervention for mental health service consumers in Primary Care (PS-PC): study protocol for a stepped-wedge cluster randomised controlled trial

BackgroundThe demand for mental health services in Australia is substantial and has grown beyond the capacity of the current workforce. As a result, it is currently difficult for many to access secondary healthcare providers. Within the secondary healthcare sector, however, peer workers who have lived experience of managing mental health conditions have been increasingly employed to intentionally use their journey of recovery in supporting others living with mental health conditions and their communities. Currently, the presence of peer workers in primary care has been limited, despite the potential benefits of providing supports in conjunction with GPs and secondary healthcare providers.MethodsThis stepped-wedge cluster randomised controlled trial (RCT) aims to evaluate a lived experience peer support intervention for accessing mental health care in primary care (PS-PC). Four medical practices across Australia will be randomly allocated to switch from control to intervention, until all practices are delivering the PS-PC intervention. The study will enrol 66 patients at each practice (total sample size of 264). Over a period of 3–4 months, 12 h of practical and emotional support provided by lived experience peer workers will be available to participants. Scale-based questionnaires will inform intervention efficacy in terms of mental health outcomes (e.g., self-efficacy) and other health outcomes (e.g., healthcare-related costs) over four time points. Other perspectives will be explored through scales completed by approximately 150 family members or carers (carer burden) and 16 peer workers (self-efficacy) pre- and post-intervention, and 20 medical practice staff members (attitudes toward peer workers) at the end of each study site’s involvement in the intervention. Interviews (n = 60) and six focus groups held toward the end of each study site’s involvement will further explore the views of participants, family members or carers, peer workers, and practice staff to better understand the efficacy and acceptability of the intervention.DiscussionThis mixed-methods, multi-centre, stepped-wedge controlled study will be the first to evaluate the implementation of peer workers in the primary care mental health care sector.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623001189617. Registered on 17 November 2023, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386715

Distributions of recorded pain in mental health records: a natural language processing based study

ObjectiveThe objective of this study is to determine demographic and diagnostic distributions of physical pain recorded in clinical notes of a mental health electronic health records database by using natural...

Cohort profile: the National Congenital Anomaly Registration Dataset in England

PurposeThe National Congenital Anomaly and Rare Disease Registration Service (NCARDRS), part of National Disease Registration Service in National Health Service England, quality assures, curates and analyses individual data on the...

Spatial Accessibility Models of the Efficient Network of Secondary Healthcare Providers in Slovenia

The main purpose of our research was to assess the accessibility of existing providers of secondary healthcare using established theoretical models of spatial accessibility. In the study, we analyzed the optimal locations and the optimal number of healthcare providers needed for an efficient network of secondary healthcare providers in Slovenia. We used four different location–allocation models and found that the MA-model is the most suitable for planning a potentially efficient network of general hospitals in Slovenia. We showed various scenarios for the development of the general hospital network based on three distinct accessibility travel time intervals, while also taking into account various population coverage proportions that can access hospital services within a given travel time interval. The key finding is that the same coverage of the population with hospital services could be achieved with a smaller number of general hospitals, if the hospitals were optimally located.

Measuring Patient Hazard Exposure–The Missing Middle in Disaster Mortality Prevention

Introduction:Interventions that mitigate hazard exposures offer the most efficient means of reducing disaster mortality. However, such interventions require an evidence base that describes the relationship between hazard exposure dynamics and health risk. Medical practitioners have long used patient specific hazard exposure assessments to determine acute and chronic disease risk and align medical treatment and care. This study compared patient-specific hazard exposure data collected from people seeking healthcare during seven different natural hazard disaster events and compared the minimum patient data set standards recommended at the time.Method:Patient data collection forms used by primary and secondary health care providers during emergency health and medical responses to seven natural hazard disasters were reviewed. Data fields relating to potential exposure characteristics were recorded and compared to patient data fields used by health services prior to the disaster event. A literature review of definitions of disaster ‘exposure’ adopted by UN disaster management agencies were compared with the health and medical sector.Results:Only the SARS-CoV-2 disaster consistently assessed and recorded details about patient exposure characteristics. Patient hazard exposure data was typically limited to the time of onset of symptoms and duration relative to hazard impact. Little qualitative or quantitative assessment of the magnitude of exposure to any hazard was included, or patient-environmental data. While variables of hazard and vulnerability were extensively studied, and discussed in scholarly and industry literature, the concept of exposure received comparably little attention.Conclusion:Building an evidence base to correlate hazard and environmental exposure characteristics with patient health effects must be prioritized, especially for cohorts vulnerable from physiological or co-morbid factors. Such advances can be made through simple inclusions in minimum patient dataset recommendations. Understanding hazard-exposure dynamics are vital for advancing emergency health responses toward early intervention and health protection from future hazards that threaten functioning of whole health systems.

Ethnicity and survival after a dementia diagnosis: a retrospective cohort study using electronic health record data

BackgroundIndividuals from minority ethnic groups in the UK are thought to be at higher risk of developing dementia while facing additional barriers to receiving timely care. However, few studies in the UK have examined if there are ethnic disparities in survival once individuals receive a dementia diagnosis.MethodsWe conducted a retrospective cohort study using electronic health record data of individuals diagnosed with dementia from a large secondary mental healthcare provider in London. Patients from Black African, Black Caribbean, South Asian, White British, and White Irish ethnic backgrounds were followed up for a 10-year period between 01 January 2008 and 31 December 2017. Data were linked to death certificate data from the Office of National Statistics to determine survival from dementia diagnosis. Standardised mortality ratios were calculated to estimate excess deaths in each ethnicity group as compared to the gender- and age-standardised population of England and Wales. We used Cox regression models to compare survival after dementia diagnosis across each ethnicity group.ResultsMortality was elevated at least twofold across all ethnicity groups with dementia compared to the general population in England and Wales. Risk of death was lower in Black Caribbean, Black African, White Irish, and South Asian groups as compared to the White British population, even after adjusting for age, gender, neighbourhood-level deprivation, indicators of mental and physical comorbidities. Risk of death remained lower after additionally accounting for those who emigrated out of the cohort.ConclusionsWhile mortality in dementia is elevated across all ethnic groups as compared to the general population, reasons for longer survival in minority ethnic groups in the UK as compared to the White British group are unclear and merit further exploration. Implications of longer survival, including carer burden and costs, should be considered in policy and planning to ensure adequate support for families and carers of individuals with dementia.

How Can a Bundled Payment Model Incentivize the Transition from Single-Disease Management to Person-Centred and Integrated Care for Chronic Diseases in the Netherlands?

To stimulate the integration of chronic care across disciplines, the Netherlands has implemented single-disease management programmes (SDMPs) in primary care since 2010; for example, for COPD, type 2 diabetes mellitus, and cardiovascular diseases. These disease-specific chronic care programmes are funded by bundled payments. For chronically ill patients with multimorbidity or with problems in other domains of health, this approach was shown to be less fit for purpose. As a result, we are currently witnessing several initiatives to broaden the scope of these programmes, aiming to provide truly person-centred integrated care (PC-IC). This raises the question if it is possible to design a payment model that would support this transition. We present an alternative payment model that combines a person-centred bundled payment with a shared savings model and pay-for-performance elements. Based on theoretical reasoning and results of previous evaluation studies, we expect the proposed payment model to stimulate integration of person-centred care between primary healthcare providers, secondary healthcare providers, and the social care domain. We also expect it to incentivise cost-conscious provider-behaviour, while safeguarding the quality of care, provided that adequate risk-mitigating actions, such as case-mix adjustment and cost-capping, are taken.

Implementation of a palliative care intervention for patients with COPD – a mixed methods process evaluation of the COMPASSION study

ObjectivesLittle direction exists on how to effectively implement palliative care for patients with COPD. In the COMPASSION study, we developed, executed, and evaluated a multifaceted implementation strategy to improve the uptake of region-tailored palliative care intervention components into routine COPD care. We evaluated the implementation strategy and assessed the implementation process, barriers, and facilitators.MethodsA mixed methods process evaluation was performed. Primary and secondary healthcare providers in four hospital regions in the Netherlands were trained. Patients identified during hospitalisation for an acute exacerbation received palliative care and were followed for a year. Various sources were used: process data, questionnaires including the End-of-life Professional Caregiver Survey (EPCS), medical records, monitoring meetings, and interviews. The Consolidated Framework of Implementation Research (CFIR) was used to categorize implementation determinants.ResultsThe training sessions with roleplay were positively evaluated and increased professionals’ self-efficacy in providing palliative care statistically significantly. Of 98 patients identified, 44 (44.9%) received one or more palliative care conversations at the outpatient clinic. Having those conversations was highly valued by healthcare providers because it led to clarity and peace of mind for the patient and higher job satisfaction. Coordination and continuity remained suboptimal. Most important barriers to implementation were time constraints, the COVID-19 pandemic, and barriers related to transmural and interdisciplinary collaboration. Facilitators were the systematic screening of patients for palliative care needs, adapting to the patient’s readiness, conducting palliative care conversations with a pulmonologist and a COPD nurse together, and meeting regularly with a small team led by a dedicated implementation leader.ConclusionsProviding integrated palliative care for patients with COPD is highly valued by healthcare providers but remains challenging. Our findings will guide future implementation efforts. Future research should focus on how to optimize transmural and interdisciplinary collaboration.Trial registrationThe COMPASSION study is registered in the Netherlands Trial Register (NTR): NL7644. Registration date: 07/04/2019.

Attributes of funding flows and quality of maternal health services in a mixed provider payment system: A cross‐sectional survey of 108 healthcare providers in Indonesia

AbstractStrategic purchasing of health services requires developing a coherent set of incentives across financing sources. In many countries, including Indonesia, healthcare providers engage with multiple financing sources. It is not well known how multiple funding flows in these mixed provider payment systems may interact at the facility level to influence provider behavior, quality of care, and ultimately health outcomes. Our study explored the association between facility capacity to provide high‐quality maternal and newborn care at delivery and various attributes of facility funding, including funding flexibility, sufficiency of funds to cover direct costs, predictability of funds in timing and amount, and facility autonomy to make management decisions (decision space). We used survey data collected from primary and secondary maternal healthcare providers (n = 108) across eight provinces in Indonesia. We constructed a technical quality index that measures facility capacity to provide high‐quality delivery care and several financing measures that summarize provider perceptions of flexibility, sufficiency, predictability of fund flows, and provider decision space. We found a statistically significant association between the decision space index score and the technical quality index score among hospitals and public primary care providers. One additional point on the decision space index was associated with an additional 0.15 (p = 0.021; 95% confidence interval: 0.024–0.275) on the quality index score after controlling for provider characteristics and geographic location. Our findings suggest that increasing facility autonomy to make management decisions may be one avenue for improving facility capacity to provide high‐quality care in systems where providers deal with multiple fund flows with varying attributes. Design of strategic purchasing reforms must consider the full context in which providers operate to streamline incentives and ensure providers have the capacity to respond to those incentives appropriately.

Monkeypox: A Review of Clinical Features, Diagnosis, and Treatment.

Monkeypox virus (MPXV) is an enveloped double-stranded DNA virus that results in a smallpox-like human disease. This causative organism belongs to the Orthopoxvirus genus. It is known to affect the neurological, respiratory, and gastrointestinal systems. The past few decades have seen endemic outbreaks of this viral infection due to the eradication of smallpox and subsequent laxity in vaccination efforts. Since it was initially diagnosed in 1970 in the Democratic Republic of Congo, it has spread to many countries worldwide, including the United States of America, becoming a disease of significant epidemiological importance. The most recent outbreak occurred in 2022. Although this viral disease is considered self-limiting, it poses serious public health concerns due to its complications and pandemic potential. This review will introduce a general overview of MPXV and describe the epidemiology, clinical features, evaluation, and treatment of monkeypox patients. It will also provide a means to raise awareness among primary and secondary healthcare providers. Furthermore, our review focuses on the most up-to-date clinical information for the effective management, prevention, and counselling of monkeypox patients worldwide.

Systematic Process to Determine Clinical Harm From Delayed Communication Between Primary and Secondary Healthcare

Introduction: Timely written communication between primary and secondary healthcare providers is paramount to ensure effective patient care. In 2020, there was a technical issue between two interconnected electronic patient record (EPR) systems that were used by a large hospital trust and the local community partners. The trust provides healthcare to a diverse multiethnic inner-city population across three inner-city London boroughs from two extremely busy acute district general hospitals. Consequently, over a four-month period, 58,521 outpatient clinic letters were not electronically sent to general practitioners following clinic appointments. This issue affected 27.9% of the total number of outpatient clinic letters sent during this period and 42,251 individual patients. This paper describes the structure, methodological process, and outcomes of the review process established to examine the harm that may have resulted due to the delay. Methodology: Senior clinicians examined the letters following training to ensure a standardized consistent approach to the evaluation. They searched whether any actions that had been requested to be undertaken by primary care had been completed in a timely fashion. Thereafter, they indicated whether in their opinion there was any potential “predefined” harm. All letters that were identified as “potential” harm were reexamined by the leads to determine that the harm or inaction was truly accurate. The trust then contacted the patient to apologize and urgently expedite the outstanding action. Patients were not contacted in those situations where no actions were required or already undertaken (99.5%), as this could potentially cause unnecessary anxiety. If an actual harm was detected, it would then be declared as a serious incident and investigated appropriately, including a duty of candor (if the harm was moderate or severe). A “clinical harm review panel” convened regularly to monitor the quality of this process and thereby provide quality assurance. Governance of the process of review was assured by this panel being overseen by a regularly convened regionwide group. Results: 58,521 letters were evaluated over three months by 36 evaluators. No serious untoward incidents were identified, but 1,323 inactions were identified from these letters. These were then all cross-checked with information from EPR. Consequently, only 327 were deemed to be inactions that required further contact with the patient (of the 58,521 letters evaluated, this constituted 0.56%). Certain departments made more requests compared to others (e.g., cardiology, dermatology, and gastroenterology). Most surgical specialties did not generate any actions. Reassuringly, no letters related to cancer had any outstanding actions. The frequency of actions not enacted due to the delay was as follows: did not attend (n=3), medication change (n=173), blood tests (n=73), other investigations (n=31), onward referral (n=47). An audit trail of all outstanding actions has been maintained to allow monitoring in case there was any query in future. We also reviewed those patients who had died to investigate whether the death could be in any way linked to nonreceipt of the letter. There were 367 deaths, and an independent review revealed that no deaths were linked to the nonreceipt of the letter. Ten percent of the deaths (n=36) had a full structured clinical review to further validate the process. Discussion: This paper has described a systematic process of analyzing a large cohort of electronic correspondence to determine any potential harm to patients that may occur due to the delay in communication between primary and secondary care. The structured methodology, well supported by relevant community stakeholders and closely monitored by the clinical harm review panel, could serve as a template to other organizations that may face similar incidents in future.

Challenges and solutions in communication with patients with low health literacy: Perspectives of healthcare providers.

Insights in the challenges that healthcare providers encounter in serving low health literate patients is lagging behind. This study explored challenges perceived by healthcare providers and provides strategies in communication with low health literate patients. Primary and secondary healthcare providers (N = 396) filled in an online survey. We assessed the frequency of challenges prior to, during and following a consultation, and which strategies were used and recommended. Survey outcomes were validated in in-depth interviews with healthcare providers (N = 7). Providers (76%) reported one or more challenges that were subscribed to patients’ difficulties in comprehending or applying health-related information, in communicating with professionals, or in taking responsibility for their health. Providers (31%) perceived difficulties in recognizing low health literate patients, and 50% rarely used health literacy specific materials. Providers expressed needs for support to recognize and discuss low health literacy, to adapt communication and to assess patient’s comprehension. Future research should focus on developing strategies for providers to ensure patients’ understanding (e.g. applying teach-back method), to recognize low health literate patients, and to support patients’ in taking responsibility for their health (e.g. motivational interviewing).

Shared Care Practices in Community Addiction and Mental Health Services: A Qualitative Study on the Experiences and Perspectives of Stakeholders.

Shared care involves collaboration between primary care, secondary and tertiary care that enables the allocation of responsibilities of care according to the treatment needs of patients over the course of a mental illness. This study aims to determine stakeholders’ perspectives on the features of an ideal shared care model and barriers to practicing shared care within addiction and mental health programs in Edmonton, Canada. This is a qualitative cross-sectional study with data collected through focus group discussions. Participants included patients, general practitioners, psychiatrists, management, and therapists working in primary and secondary addiction and mental health. Responses were audio-recorded, transcribed, and analyzed thematically. Perceived barriers to the implementation of an ideal shared care model identified by participants include fragmented communication between primary and secondary healthcare providers, patient and family physician discomfort with discussing addiction and mental health, a lack of staff capacity, confidentiality issues, and practitioner buy-in. Participants also identified enablers to include implementing shared electronic medical record systems, improving communication and collaboration, physical co-location, and increasing practitioner awareness of appropriate referrals and services. This original research provides stakeholders’ perspectives on the features of an ideal shared care model and barriers to practicing shared care within addiction and mental health programs.

Türkiye'de Sağlıkta Dönüşüm Üzerine Tarihsel Bakış

Turkey has undertaken major reforms since 2003 to transform and improve its healthcare system and health outcomes. This historical evaluation aims to shares experiences gained from Turkey’s Health Transformation Program (HTP) with scholars, policymakers, and the public. Until today from the establishment of the Republic of Turkey, the legal regulations and practices for improving health services have been explained, and the results have been evaluated from a historical perspective. Our review shows that HTP has created a model that achieved goals for universal health insurance, family medicine, access to health services, and service quality. HTP increased access to health services and affected service quality. However, it has not achieved full decentralization of secondary and tertiary healthcare providers. Public hospital associations and public health directorates were reunited under the Provincial Health Directorate. It is stated that various factors such as having three different bodies in administration, problems with the competence of appointed managers, unsettled organizational structure, more than one managers being appointed and frequent changes in office, dissatisfaction of healthcare workers, and problems in communication and coordination. Countries wishing to reform may be more productive in implementing decentralization considering in their own circumstances.

The impact of COVID-19-related social restriction and containment measures on admissions for orthopedic surgery in a private hospital: cross-sectional data from a secondary healthcare provider in Turkey

The impact of COVID-19-related social restriction and containment measures on admissions for orthopedic surgery in a private hospital: cross-sectional data from a secondary healthcare provider in Turkey

Driving digital health transformation in hospitals: a formative qualitative evaluation of the English Global Digital Exemplar programme

BackgroundThere is currently a strong drive internationally towards creating digitally advanced healthcare systems through coordinated efforts at a national level. The English Global Digital Exemplar (GDE) programme is a large-scale...

How is patient activation related to healthcare service utilisation? Evidence from electronic patient records in England

BackgroundThere is increasing awareness of the importance of patient activation (knowledge, skills, and confidence for managing one’s health and health care) among clinicians and policy makers, with emerging evidence showing higher levels of patient activation are associated with better health outcomes and experiences of health care. This study aimed to examine the association between patient activation and a wide range of specific types of healthcare service utilisation in England, including GP and non-GP primary care, elective and emergency hospital admissions, outpatient visits, and attendances at the Accident and Emergency department.MethodsData were derived from linked electronic patient records collected by primary and secondary healthcare providers in North West London between January 2016 and November 2019. Our analyses focused on adults (18+) with a valid Patient Activation Measure (PAM). After excluding patients with missing data, we had an analytical sample of 15,877 patients. Data were analysed using negative binomial regression and logistic regression models depending on the outcome variable.ResultsPatients had a mean activation score of 55.1 and a standard deviation (SD) of 17.7 (range: 0–100). They had an average of 5.4 GP visits (SD = 8.0), 26.8 non-GP visits (SD = 23.4) and 6.0 outpatient attendances (SD = 7.9) within a one-year follow-up. About 24.7% patients had at least one elective admission, 24.2% had one or more emergency admissions, and 42.3% had one or more A&E attendance within the follow-up. After accounting for a number of demographic and health factors, we found a linear (or proximately linear) association between patient activation and the number of GP visits, emergency admissions and A&E attendance, but a non-linear relationship between patient activation and the number of non-GP visits, the number of outpatient attendance and elective inpatient admission.ConclusionsThis study has provided strong empirical evidence from England linking patient activation with healthcare service utilisation. It suggests the value of supporting patient activation as a potential pathway to ease the burden of healthcare system.

The Current Status of the Administrative Dispositions of Nurses: A Nationwide Survey in South Korea.

In South Korea, the professional role of nurse has been redefined from "assistant to" to "partner of" doctors as part of an overall national health promotion strategy. This descriptive survey was designed to describe the current status of administrative dispositions related to nurses in South Korea. Data were collected between January 2014 and December 2018. The raw data were obtained from 3,553 public health centers nationwide after a request for the disclosure of information related to the administrative disposition of nurses in each city and province. The data included details on administrative dispositions, laws related to administrative dispositions, violations, and standards for administrative dispositions. Most of the nurses affected by administrative dispositions worked for primary and secondary healthcare providers. The most common type of administrative disposition was license suspension (n = 66, 80.5%), and most violations for administrative disposition involved unlicensed medical practice (n = 38, 46.3%). Nurses who had more-specific standards provided as evidence of the disposition faced longer periods of license suspension (p = .035). Nurses should avoid providing nursing care to patients that is not in compliance with medical laws because the administrative action may vary depending on the violation and the severity of their legal infractions. This study was the first to examine administrative actions specifically affecting nurses in South Korea. The administrative actions of medical personnel were found to depend on the number and degree of violations. Nurses must understand the details of nurse-related administrative dispositions to avoid violating medical laws.

Measuring the efficiency of the Portuguese public hospitals: A value modelled network data envelopment analysis with simulation

In contrast to conventional data envelopment analysis (DEA), where a system is considered as a ”black-box”, network DEA acknowledges its internal structure to generate more enlightening results. It goes without saying that putting network DEA in practice is natural- and progressively rarer as the complexity of a system’s structure increases. In particular, its employment in healthcare is no exception. Thus, we designed a slacks-based model to measure the efficiency of the Portuguese secondary healthcare providers bearing in mind their internal services. However, the absence of data regarding the connections between those services called for the additional use of a simulation method – the well-known Monte Carlo method –, modelled with the judgements of a decision-maker. This unprecedented application of static systems with a matrix-type structure found that two-thirds of those providers were inefficient and allowed the identification of target areas for future policy reforms in the Portuguese National Health Service.

Nurses indispensable role during COVID-19

There is a new public health crisis threatening the world with the emergence and spread of 2019 novel coronavirus (2019-nCoV) or the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), as it is now called, is rapidly spreading from its origin in Wuhan City of Hubei Province of China to the rest of the world. Coronaviruses are enveloped positive-sense RNA viruses that are diversely found in humans and wildlife originated in bats ranging from 60 nm to 140 nm in diameter with spike-like projections on its surface giving it a crown-like appearance under the electron microscope, hence the name coronavirus. A total of six species have been identified which are known to infect the neurological, respiratory, enteric, and hepatic systems. The epicenter of infection was linked to seafood and exotic animal wholesale markets in the city. SARS-CoV-2 is highly contagious and has resulted in a rapid pandemic of COVID-19. As the number of cases continues to rise, it is clear that these viruses pose a threat to public health. The disease is transmitted by inhalation or contact with infected droplets and the incubation period ranges from 2 to 14 days. The symptoms are usually fever, cough, sore throat, breathlessness, fatigue, and malaise among others. The disease is mild in most people; in some (usually the elderly and those with comorbidities), it may progress to pneumonia, acute respiratory distress syndrome (ARDS), and multiorgan dysfunction. Many people are asymptomatic. The case fatality rate is estimated to range from 2 to 3%. Treatment is essentially supportive; role of antiviral agents is yet to be established. Prevention entails home isolation of suspected cases and those with mild illnesses and strict infection control measure at hospitals that include contact and droplet precautions. The global impact of this new epidemic is yet uncertain. We conducted a literature review of publicly available information to summarize knowledge about the pathogen and the current epidemic. In this literature review, the causative agent, epidemiology, pathogenesis, diagnosis, and nurses role regarding disease, control, and prevention strategies are all reviewed. It will also provide a means to raise awareness among primary and secondary health-care providers during the current pandemic.