State Health Care Research Articles

PCR105 Examination of Surgical Indications and Previous Hip Replacement Surgery Among Hip Prosthesis Patients in State and Private Health Care

The aim of our study is to compare data on previous hip replacement surgery and indication of the operation in state (S) and private (P) health care in Hungary.

Healthcare status of adults with pulmonary hypertension due to congenital heart disease.

In the long-term course of treated and untreated congenital heart defects (CHD), pulmonary hypertension (PH) is one of the most relevant complications. Since PH carries a high risk for mortality and morbidity, it is important to improve the status of healthcare and medical knowledge regarding the affected patients. Therefore, this study aimed to determine the current medical care status, health-related knowledge, and specific counseling needs of adults with various forms of CHD (ACHD) who are at increased risk of developing PH, as well as those with manifest PH. In this retrospective cross-sectional study, a representative sample of 803 ACHD were analyzed. Patients were split into three groups based on CHD: low risk for PH, at risk for pre- or post-capillary PH, and manifest PH. Data collection took place between September 2017 until February 2018 in a tertiary care center for ACHD. Healthcare status and specific needs for information or advice were analyzed using a questionnaire designed by our group. The state of knowledge of the patients was assessed by comparing this questionnaire and the corresponding medical records. Both patients with manifest PH (n=51) and patients at risk to develop PH (n=629) were insufficiently informed about their health status, specific care structures available to them, and patient organizations. About 50% of the patients had specific counseling needs, especially regarding physical capability and sports, daily stress, rehabilitation measures, and pregnancy. Only 47.8% of patients with manifest PH were aware of suffering from PH (P<0.001). In particular, the patients had large knowledge deficits regarding comorbidities related to their health condition. PH is a quantitatively and qualitatively underestimated residuum or sequela of CHD that significantly affects outcome and prognosis in ACHD. Multidisciplinary, structured, and specific counseling of affected individuals with corresponding risk constellations is urgently needed. A prerequisite for this is closer collaboration between primary care physicians (PCPs), such as general practitioners, family physicians, internists, or general cardiologists, and ACHD specialists. Targeted patient counseling and care could have a positive impact on the level of awareness of those affected and favorably influence their prognosis.

PCR88 How Does the Quality of Life of Hip Replacement Patients Operated in State and Private Health Care Change in the Postoperative Period?

PCR88 How Does the Quality of Life of Hip Replacement Patients Operated in State and Private Health Care Change in the Postoperative Period?

PCR213 Rehabilitation After Hip Replacement Surgery in the State and Private Health Care in Hungary

PCR213 Rehabilitation After Hip Replacement Surgery in the State and Private Health Care in Hungary

Analysis of financial security of health care in Ukraine

The paper examines the theoretical principles of managing the financial support of health care institutions, in particular, the economic essence and sources of their formation. The content of the concept of "financial resources of health care institutions" was studied and the legal framework was considered, which is mainly formed in accordance with the principles and priorities of the state health care policy defined by the Constitution of Ukraine, the Basics of legislation on health care and others adopted in accordance with them by acts of legislation regulating public relations in the field of health care. The financing system of health care institutions of Ukraine was analyzed. It was concluded that in the modern conditions of the development of the medical industry of Ukraine, the search for additional sources of health care financing is especially relevant. The necessity to improve the process of financing domestic healthcare system is substantiated. Condition of funding of healthcare facilities in Ukraine in recent years of medical reform was analyzed. It is determined that financing of healthcare system is one of the main priorities of the budget today, and the budgetary expenditures for “Health Care” in 2021 grew compared to 2020 due to changes in the mechanism of medical services provision. Important areas are ensuring the provision of highquality medical services for all citizens, increase in the salaries of doctors. Condition of implementation of the budgetary program of state guarantees of health care in 2021 was analyzed. Ways to improve the financing of the health care sector are proposed. Conclusions and proposals are of practical importance and can be implemented in the activities of state administration bodies in order to improve the formation and use of financial resources of health care institutions. It is determined that the process of financing of healthcare institution provided for the itemized distribution of budget funds for the maintenance of medical infrastructure, not the expenditures related to maintaining of health of every citizen and improving quality of life, the funds were used inefficiently and not for their intended purpose.

The Oral Health Status and Treatment Needs of Pediatric Patients Living with Autism Spectrum Disorder: A Retrospective Study.

The objective of this retrospective study was to assess the oral health status and treatment needs of children with ASD and to explore the differences in risk factors and oral health care status and the risk factors for treatment under GA. Dental charts of children between 6 and 14 years of age who were examined at a dental facility associated with the College of Dentistry, University of Saskatchewan between 2016 to 2019 were assessed. Children who were identified as having ASD, as well as an age- and gender-matched control group consisting of otherwise healthy children were included in the study. The sample included 346 dental records, with 173 children having a diagnosis of ASD. Children diagnosed with ASD had significantly higher experience with caries (91.3% vs. 65.9%, p = 0.003) and severity (mean DMFT/dmft = 8.18 ± 1.62 vs. 4.93 ± 0.58 p = 0.007). Children with ASD were also older when visiting the dentist for the first time (age of 5.97 ± 1.18 vs. 2.79 ± 1.09, p = 0.02)). Children with ASD were less likely to brush once a day (66.5% vs. 88.4%, p = 0.02), were more likely to have bruxism (35.8% vs. 10.4%, p = 0.003) and were less likely to have class I occlusion (64.7% vs. 80.9%, p = 0.03). Findings from the logistic regression analysis revealed that children with ASD were also 2.13 times more likely to receive a referral for general anesthesia when all other variables were held constant (p = 0.03). This research demonstrates that children diagnosed with ASD may face more barriers with access to oral health care, leading to poorer outcomes and greater treatment dental needs.

Liminality as wage penalty for India's women community health workers

AbstractIn this paper, I analyze the experiences of the world's largest all‐women community health workforce through the lens of liminality. Originally used to describe transition from one state to the other, the concept of liminality in the study of work and organizations can frame workers' experiences of being in‐between established structures and roles in varying degrees, times, and/or places. India's ASHAs, or Accredited Social Health Activists, are community women at the frontlines of the state's health care provisioning. But the state does not categorize them as workers or employees. ASHAs are considered volunteers. Instead of salaries, they are paid task‐based incentives. Based on 14 months of ethnographic fieldwork, including 80 interviews, I find that ASHAs' liminal occupational status as ‘paid volunteers’ produces conditions of chronic underpayment and control for them, further lowering their already low wages. This has implications for how we understand the gender wage gap. I argue that we need to consider not just how much women are paid, but how the payment is structured, and how that places marginalized women workers in relation to others in the workplace. Moving beyond whether liminality is a negative or positive experience, future research should delineate the conditions under which liminality is negative or positive.

Regional Health System Coordination via a Hospital Association: A Successful Model for Managing Downstate New York's Second COVID-19 Wave.

Based on the experiences and lessons of its first COVID-19 patient surge in spring of 2020 (Wave 1), the New York hospital community recognized the importance of preparation and coordination for the anticipated winter 2020-2021 surge (Wave 2). This case study describes the coordination function of the Greater New York Hospital Association in downstate New York during the second wave, carried out using 4 key elements: enhanced situational awareness coupled with proactive outreach, partnerships between independent hospitals and health systems, frequent coordination meetings with hospitals, and routine coordination meetings with the Governor's Office and the New York State Department of Health. Given the existing relationships, functions, and support structures of hospital associations, this type of collaborative structure between state government and an association can be valuable in any situation that broadly impacts a state's healthcare community.

Determining staffing needs for improving primary health care service delivery in Kaduna State, Nigeria.

Background: The equitable distribution of a skilled health workforce is critical to health service delivery. Kaduna state has taken significant steps to revamp the primary health care system to ensure access to health care for its populace. However, these investments are yet to yield the desired outcomes due to health workforce shortages and the inequitable distribution of those available. Methods: A Workload Indicator for Staffing Need (WISN) study was conducted at Kaduna state's primary health care level. The study focused on estimating staffing requirements; Nurses/Midwives and Community Health Worker practitioners, Community Health Officers, Community Health Extension Workers, and Junior Community Health Extension Workers in all government-prioritised primary health care facilities. A total of ten focal primary health care facilities in Kaduna North Local Government Area (LGA) were included in the study. Results: Findings from the study revealed a shortage of Nurses/Midwives and Community Health Workers across the study facilities. For the Nurse/Midwife staffing category, nine of the ten PHCs have a WISN ratio < 1, indicating that the number of staff in the Nurse/Midwife category is insufficient to cope with the workload. In two of the ten primary health care facilities, there is an excess in the number of CHWs available; a WISN ratio > 1 was calculated. Conclusion: The WISN study highlights staffing needs in Kaduna State's government-prioritised primary health care facilities. This evidence establishes the basis for applying an evidence-based approach to determining staffing needs across the primary health care sector in the State to guide workforce planning strategies and future investments in the health sector. The World Health Organisation (WHO) WISN tool is useful for estimating staffing needs required to cope with workload pressures, particularly in a resource-constrained environment like Kaduna State.

The association between antibiotics and community-associated Staphylococcus aureus colonization in the United States population: Analysis of the National Health and Nutrition Examination Survey (NHANES).

Staphylococcus aureus nasal colonization is a seriously opportunistic infection. However, there is a lack of research of relationship between antibiotics and S aureus colonization in the general population. Through a cross-sectional investigation, this study intends to establish the parameters related to S aureus nasal colonization, specifically the function antibiotics play in colonization. The key information from 2001 to 2004 was abstracted from National Health and Nutrition Examination Survey (NHANES), including information on general demographics, health care status, antibiotic prescription, diabetes, alcohol consumption, and tobacco smoke exposure. The participants colonized with methicillin-susceptible S aureus (MSSA), or methicillin-resistant S aureus (MRSA) were defined as the case group, and the control group was subjects without positive S aureus colonization. Univariate and multivariate logistic regression models were used to identify the variables associated with MSSA and MRSA colonization. The records of 18,607 individuals were included, involving 13,205 cases without S aureus colonization, 5195 cases with MSSA, and 207 cases with MRSA. In the multivariate logistic regression analysis, the risk of MSSA colonization was significantly reduced with fluoroquinolone use (75% risk reduction, P = .02), sulfonamide use (98% risk reduction, P < .01), tetracycline use (81% risk reduction, P < .01) and antibiotic combination therapy (risk reduction 76%, P < .01). Female, race and total household size were strongly associated with MSSA carriage. On the other hand, regarding MRSA colonization, fluoroquinolone use, long-term care, and former smoker were positively associated with MRSA colonization, while high income was negatively associated with MRSA colonization. More proper use of broad-spectrum antibiotics contributes to reducing MSSA colonization. Former smokers should also practice better personal hygiene to limit the possibility of MRSA colonization.

Total cost of care associated with opioid use disorder treatment

The opioid epidemic in the United States disproportionately affects Medicaid beneficiaries than other groups. This results in a significant financial burden on state Medicaid programs. In this analysis, we investigate the association of medication for opioid use disorder (MOUD) treatment initiation and linkage to ongoing care on overall healthcare costs of Medicaid Fee-for-Service patients. We conducted a retrospective study among adult patients diagnosed with opioid use disorder (OUD) and who had a clinical encounter at a safety-net institution in Denver Colorado in 2020. Three categories of MOUD status of patients were defined: 1) identified with OUD but did not receive MOUD; 2) initiated MOUD but not linked to ongoing treatment and 3) received MOUD and linked to ongoing treatment. Our outcome variable was per-member per-month total healthcare cost. We estimated a multivariable model to test the association between healthcare cost and MOUD status, while controlling for demographic and risk classification variables. We found that in individuals with OUD who initiated MOUD treatment but were not linked to ongoing care had the highest healthcare cost, while those who were linked to ongoing MOUD treatment had the lowest healthcare cost. MOUD treatment is not only effective at addressing the significant morbidity and mortality burden of OUD but also associated with decreased financial cost, which is disproportionately incurred by Medicaid. Additional policy and care delivery changes are needed to focus efforts to improve linkage to ongoing treatment.

Lower socioeconomic status is associated with increased co-morbidity burden and independently associated with time to surgery, length of hospitalisation, and readmission rates of hip fracture patients.

The effect of socioeconomic status on hip fracture outcomes remains controversial. We examine the relationship between SES and patient comorbidity, care access, and clinical outcomes of surgically managed hip fracture patients. Using healthcare payor status as a surrogate for SES, patients operated for fragility hip fractures between 2013 and 2016 were dichotomised based on payor status, namely private healthcare (PRIV) versus subsidised healthcare (SUB). PRIV patients were compared with SUB patients in terms of demographic data, ASA scores, co-morbidity burden (Charlson comorbidity index, CCI), time to surgery, length of acute hospitalisation, and 90-day readmission rates. A total of 145 patients in group PRIV and 1146 patients in group SUB were included. SUB patients had a higher mean Charlson Co-morbidity Index (CCI) (p = 0.01), a longer length of hospitalisation (p = 0.001), an increased delay in surgery (p = 0.005), and higher 90-day readmission rates (p = 0.013). Lower SES (p = 0.01), older age (p = 0.01), higher CCI (p &lt; 0.01), and a higher American Society of Anaesthesiologists score (ASA) (p = 0.03) were predictive of time to surgery. Lower SES (p = 0.02) and higher CCI (p &lt; 0.001) were predictive of the length of hospitalisation. Lower SES (p = 0.04) and higher CCI (p &lt; 0.001) were predictive of 90-day readmission rates. Low SES is associated with higher CCI in surgically treated hip fracture patients. However, it is independently associated with slower access to surgery, a longer hospital stay, and higher readmission rates. Hence, lower SES, with its associated higher CCI and independent impact on surgical access and outcomes, can be considered a "double setback" in the management of fragility hip fractures.

Strategic Health Care Management: Challenges and Realities of Emergencies

The article is devoted to strategic management system improvement in the sphere of health care in conditions of emergencies by the example of Ukraine. Pandemic conditions and military actions substantiate the relevance of the research. The study aims to improve the system of health care system’s strategic management in emergencies. The research’s novelty is proposing a new model of interaction between emergency response bodies. An analysis of foreign experience, scientific literature, and normative regulation was carried out to find problem solutions. Methods of analysis, synthesis, induction, and deduction allow to find weaknesses of strategic management and offer ways of liquidation. The study results show the current state of strategic management in healthcare by systematizing the strengths, weaknesses, opportunities, and threats and conducting a SWOT analysis. As a result, weaknesses of the system are identified, and directions for their elimination are proposed. For this purpose, it is necessary to change the work of the Cabinet of Ministers and Health Service with the Emergency Services. The practical value of the research consists in the possibility of application of its results in forming new, more effective strategic aims of public health system development in the case of military operations.

Depression in primary care and the role of evidence-based guidelines: cross-sectional data from primary care physicians in Germany

BackgroundDepression is the most common mental health burden worldwide. Primary care physicians (PCPs) play a key role in the care provision for people with depression. The first objective of the present study was to examine the health care situation of depression in primary care, focusing on the cooperation between PCPs and mental health specialists. Secondly, we aimed at examining the role of the German S3 Guideline for Unipolar Depression in the primary care provision.MethodsData of N = 75 PCPs were analysed from a cross-sectional online survey. Analysis of descriptive information on the current status of primary health care and depression was conducted. Further, to examine factors that are related to the usage of guidelines, multiple regression was performed.ResultsOnly 22.1% of PCPs described the quality of cooperation with ambulatory mental health specialist as good. The most frequent problems in the cooperation were of structural nature (49.3%, long waiting list, few therapy units, as well as barriers in the communication and the information exchange). With regard to the role of the guideline, 65% of PCPs reported never or seldom using the guideline and 31.7% of PCPs perceived the guideline as not useful at all. In addition, perceived usefulness of the S3 guideline was positively associated with the usage of the guideline. Results of the logistic regression revealed a significant association between the usage of the German S3 Guideline for Unipolar Depression and rating of perceived usefulness of the guideline (OR: 4.771; 95% CI: 2.15–10.59; p < 0.001).ConclusionThis study highlights the central role of PCPs and demonstrates major barriers in the outpatient health care provision of depression. Present findings suggest a strong need for collaborative health care models to resolve obstacles resulting from fragmented mental health care systems. Finally, reported perceived barriers in the implementation of the German S3 Guideline for Unipolar Depression indicate the urge to involve PCPs in the development of evidence-based guidelines, in order to ensure a successful implementation and usage of guidelines in clinical practice.

Perspectives of refugees and community pharmacists on refugees’ healthcare situation in Lebanon: Implication on pharmacy education and workforce

Background: Pharmacists serve on the frontline of healthcare provision for refugees. This study aimed to explore (1) Syrian refugees’ healthcare status from the perspectives of the refugees and Lebanese community pharmacists; (2) refugees’ barriers to healthcare access; and (3) the challenges pharmacists encounter in the provision of healthcare. Methods: A cross-sectional study was conducted during July-August 2019 in Bekaa Region. Syrian refugees and Lebanese community pharmacists anonymously completed two different questionnaires. SPSS Statistics Version 22.0 was used to analyse the data. Results: A total of 671 refugees and 103 pharmacists responded to the questionnaires. The responding refugees and pharmacists identified the inability to afford physician and drug fees as the primary and secondary barriers to healthcare access for refugees; while health illiteracy was the primary challenge identified by the responding pharmacists when providing care to refugees. Conclusion: Addressing the determinants of health will reduce healthcare barriers and challenges substantially, thus fostering overall improvements in the health of Syrian refugees.

Oral Health Care in Europe: Financing, Access and Provision

Abstract With growing awareness of the large burden of oral diseases and how limited coverage affects both access and affordability, oral health policy has been receiving increased attention in recent years. This culminated in the adoption of the WHO resolution on Oral Health in 2021, which urges Member States to better integrate oral health into their universal health coverage and noncommunicable disease agendas. This study investigates major patterns and developments in oral health status, financing, coverage, access, and service provision of oral health care in 31 European countries. While most countries cover oral health care for vulnerable population groups, the level of statutory coverage varies widely across Europe resulting in different coverage and financing schemes for the adult population. On average, one third of dental care spending is borne by public sources and the remaining part is paid out-of-pocket or by voluntary health insurance. This has important ramifications for financial protection and access to care, leaving many dental problems untreated. Overall, unmet needs for dental care are higher than for other types of care and particularly affect low-income groups. Dental care is undergoing various structural changes. The number of dentists is increasing, and the composition of the health workforce is starting to change in many countries. Dental care is increasingly provided in group practices and by practices that are part of private equity firms. Although there are early signs of a shift towards more prevention of oral diseases, dental care overall remains focused on treatment. A lack of data affects all areas of oral health care and impede to inform policy-making on the underlying causes and the prevalence of oral disease, as well as the effectiveness of community preventive activities and oral health services.

Promoting oral and dental healthcare among the elderly in a residential care home in Isfahan: a best practice implementation project.

Oral health is an important aspect of general health, which affects the wellbeing and quality of life of older adults. Residents in aged care facilities often suffer from overall dental neglect and insufficient oral healthcare, leading to moderate-to-high levels of oral diseases. Furthermore, physical or mental health concerns may result in difficulties in maintaining good oral health. This implementation project aims to audit and improve the oral healthcare status of the elderly living in a residential care home in Isfahan, Iran using the JBI evidence summary. The methods are preimplementation and postimplementation design using audit and feedback with a situational analysis to guide implementation planning. Seven evidence-based quality indicators were used to measure preintervention compliance with the best practice. Situational analysis was used to identify and target barriers through locally developed practice change strategies following which a repeat audit was conducted at 4 months. Four nursing staff, 11 caregivers, and 38 residents were interviewed for both the baseline and the follow-up audit. Compliance rates improved for all seven criteria except the use of a soft-bristled toothbrush (criterion 6). All eight categories of criterion 2 measuring assessment of oral health improved by at least 10%, with the largest improvements in saliva assessment and gingiva assessment. Criterion 1 (oral health training for caregivers) reached the greatest compliance rate (100%). The implemented strategies included improving knowledge and changing the attitudes of the caregivers through organizing educational sessions. These strategies were developed to address process and structural barriers to best practice and were helpful for staff uptake of evidence.

Optimization of interdepartmental electronic interaction of the military commissariat in the organization and conduct of medical examination of citizens subject to conscription

The military commissariat requests information characterizing their state of health in order to study the state of health of citizens subject to conscription before the next conscription of citizens for military service. An interdepartmental request for this informations provision to medical organizations and institutions of medical and social expertise is encouraging to be issued in the form of an electronic document using a unified system of interdepartmental electronic interaction, taking into account the trends in the development of the public administration system. Interdepartmental interaction optimization through creation of an electronic interaction mechanism will allow military commissariats to promptly exchange information in real-time characterizing the citizens state of health subject to conscription for military service with medical organizations of the state and municipal health care system, and federal state institutions of medical and social expertise. The direct connection of the military commissariat to the state information system in the field of healthcare of the subject of the Russian Federation by means of cryptographic protection of information will contribute to improving the quality as well as deceasing the medical examination time of citizens subject to conscription, thus improving the efficiency of providing medical services to citizens in medical organizations. The public administration system was successfully reoriented to provide state and municipal services in a remote format during the unstable epidemiological situation caused by the pandemic of a new coronavirus infection. Optimization of interdepartmental electronic interaction will allow military commissariats to take additional preventive measures to avoid infection and avert the spread of a new coronavirus infection during the recruitment campaign. Modern digital technologies and solutions are able to provide a qualitative leap in the organization of conscription of citizens for military service, which can be implemented without significant financial costs in the short term. However, there is a growing need to involve a proper number of participants of the military command and other state authorities in solving this complex problem.

Surveillance for Sickle Cell Disease - Sickle Cell Data Collection Program, Two States, 2004-2018.

Surveillance for Sickle Cell Disease - Sickle Cell Data Collection Program, Two States, 2004-2018.

Artificial Intelligence in e-Health: A Review of Current Status in Healthcare and Future Possible Scope of Research

Artificial Intelligence in e-Health: A Review of Current Status in Healthcare and Future Possible Scope of Research