Structure Of Service Provision Research Articles

Dentistry as a professional career: the views of London's secondary school pupils (2011-2017)

Aim To explore young people's perceptions of dentistry as a potential future career, including features which would attract or deter them from wanting to become dentists and the perceived influences on these views.Methods Purposive sampling of London schools was undertaken. Exploration of academically-able, science-minded young people's (aged 14-18 years) perceptions of dentistry as a potential career was achieved through a series of focus groups conducted at various types of school in the Greater London region (13 focus groups and 91 students). A topic guide, informed by the literature and previous research, explored the perceived motivating and demotivating factors and associated influences, identified by these pupils, on studying dentistry at university. Data were analysed using framework methodology.Results Multiple factors were identified by London secondary school pupils that would attract them to dentistry. Pull factors were: 1) science-based; 2) status and security - extrinsic rewards; 3) structure of service provision; 4) career opportunities; 5) social interactions; 6) personal skills and care - intrinsic rewards; and 7) being a vocational degree. Push factors away from the career included lack of diversity within the job and the 'negative image' of dentists, with medicine having greater social status and more varied career options. Individual and wider influences on pupils' perceptions included their personal experience with dentistry, social and community networks, the school environment, as well as system and societal level influencers.Conclusions These findings suggest that a wide range of influences determine teenagers' perceptions of a dental career. Pupils in London schools report similar features of dentistry as being attractive as dental students, as well as its importance as a vocational degree, and although dentistry appears to lack status and profile when compared with medicine, it may be more acceptable in relation to its lifestyle. Individual sociodemographic characteristics and wider environmental factors may influence the relative importance of these features.

7.I. Workshop: Data for health services research: what can we learn from other countries?

High-quality, comprehensive, and timely data is essential for health services research. Increasingly, health services research requires using not only individual datasets but linked data, which use common key variables to bring together information from multiple data sources. This can include clinical data (e.g., results from clinical examination and diagnostic tests), routinely collected data on utilization (e.g., insurance claims) and further, partially unstructured data produced in daily life - as well as data from other areas (economic, environment, social). The need for linked data is reinforced by digital transformation in health care around the world and the availability of new data resources (‘big data') as well as the recent COVID-19 pandemic. We carried out an international comparison of data for health services research - both regarding databases with individual level data as well as those on a geographical or population level. We asked experts from more than ten countries to provide feedback on data linkage initiatives to determine the content of the data, how the data is collected, how the data is linked and cleaned, how the data is stored, and how the data is used for research. In some countries, data collected in the health system is largely fragmented and there is no unique identifier to facilitate linkage across datasets. In other countries, the government supports data linkage initiatives and provides summary data for all public data (down to the census) which can be used on request for projects that are in the public interest. The development - and possible linkage - of relevant databases is closely related to the organizational design of the health care system, especially the structure of service provision and the corresponding billing and reimbursement mechanisms. The accessibility of these databases is also influenced by data protection regulations and standards, including cultural considerations. The objective of this research is to identify important and potentially useful case studies that could provide insights into the different approaches to data linkage that exist worldwide and to perhaps provide ideas for future more or less ‘disruptive' solutions to countries undertaking the ambitious endeavor of health data linking. Therefore, we designed the analysis in such a way that findings on data structure and flow in selected countries are, to the extent possible, system-independent and transferable, while simultaneously also capturing some country-specific regulatory frameworks. This workshop will explore how countries govern and use data generated in the health system and what additional insights about best practices can be learned from the international experience. The workshop will begin with a presentation about the analytical framework, followed by a panel discussion of the experience from country case studies, continue with an audience contribution, and wrap up with a conclusions round.Key messages Data linkage initiatives that bring together information from clinical, utilization, social, and other data sources are increasingly important in health services research.An international comparison of data linkage initiatives provides best practices for data linkage that could be applied in individual country settings.

Expenditures on Mental Health Care in the Czech Republic in 2015

Expenditures on mental health care in the Czech Republic are not being published regularly, yet they are indispensable for evaluation of the ongoing reform of Czech mental health care. The main objective of this study is to estimate the size of these expenditures in 2015 and make a comparison with the last available figures from the year 2006. The estimation is based on an OECD methodology of health accounts, which structures health care expenditures according to health care functions, provider industries, and payers. The expenditures are further decomposed according to diagnoses, and inputs used in service production. The amount spent on mental health care in 2015 reached more than 13.7 billion Czech korunas (EUR 501.6 million), which represented 4.08% of the total health care expenditures. This ratio is almost identical with the 2006 share (4.14%). There are no significant changes in the relative expenditures on mental health care and in the structure of service provision. The Czech mental health care system remains largely hospital based with most of all mental health care expenditures being spent on inpatient care. Future developments in the expenditures will indicate the success of the current effort to deinstitutionalise mental health care.

Preventable perinatal deaths in indigenous Wix\xe1rika communities: an ethnographic study of pregnancy, childbirth and structural violence

BackgroundPreventable maternal and infant mortality continues to be significantly higher in Latin American indigenous regions compared to non-indigenous, with inequalities of race, gender and poverty exacerbated by deficiencies in service provision. Standard programmes aimed at improving perinatal health have had a limited impact on mortality rates in these populations, and state and national statistical data and evaluations of services are of little relevance to the environments that most indigenous ethnicities inhabit. This study sought a novel perspective on causes and solutions by considering how structural, cultural and relational factors intersect to make indigenous women and babies more vulnerable to morbidity and mortality.MethodsWe explored how structural inequalities and interpersonal relationships impact decision-making about care seeking during pregnancy and childbirth in Wixarika communities in Northwestern Mexico. Sixty-two women were interviewed while pregnant and followed-up after the birth of their child. Observational data was collected over 18 months, producing more than five hundred pages of field notes.ResultsOf the 62 women interviewed, 33 gave birth at home without skilled attendance, including 5 who delivered completely alone. Five babies died during labour or shortly thereafter, we present here 3 of these events as case studies. We identified that the structure of service provision, in which providers have several contiguous days off, combined with a poor patient-provider dynamic and the sometimes non-consensual imposition of biomedical practices acted as deterrents to institutional delivery. Data also suggested that men have important roles to play supporting their partners during labour and birth.ConclusionsStillbirths and neonatal deaths occurring in a context of unnecessary lone and unassisted deliveries are structurally generated forms of violence: preventable morbidities or mortalities that are the result of systematic inequalities and health system weaknesses. These results counter the common assumption that the choices of indigenous women to avoid institutional delivery are irrational, cultural or due to a lack of education. Rather, our data indicate that institutional arrangements and interpersonal interactions in the health system contribute to preventable deaths. Addressing these issues requires important, but achievable, changes in service provision and resource allocation in addition to long term, culturally-appropriate strategies.

Inequality and interconnectivity: Urban spaces of justice in Mexico

Cities in different parts of the world are going through intensive transformations based on institutional efforts to govern urban spaces and populations in the face of global environmental change and neoliberalization of governance. This essay examines inequalities and interconnectivities in urban governance and justice, drawing on a case-study of three, socially-differentiated sectors of the city of Villahermosa, Mexico, between 2011 and 2016. My analysis contributes to a multi-dimensional approach toward justice, and the cognate fields of right to the city, and segregation and inequality, that encompasses: (1) (re)distribution of residents’ exposure to risks and access to services; (2) recognition of the causes and consequences of risks and vulnerabilities; (3) fields of representation available for different residents; and (4) residents’ capabilities to recover from disasters and achieve everyday well-being within the existing urban governance and service provision structures. Instead of conceptualizing segregated cities as composed of isolated worlds, I argue that it is only possible to understand how the prevailing forms of governance produce multifaceted inequalities through a relational analysis of how residents from different parts of the city interact with the authorities and with each other. The study shows how residents’ tactics to accommodate, reconfigure and contest institutional endeavors to place them in hierarchical positions link to their differentiated ways of constructing urban space.

Gay Men with Learning Disabilities: UK Service Provision

SUMMARY Whilst the UK's National Health Service (NHS) offers a solid structure of service provision for people with learning disabilities, sexuality issues are often overlooked. This paper offers an examination of how it may be possible that gay men with learning disabilities (GMLD) experience a complex set of increased difficulties in forming a functioning identity. A clinical case example is presented which allows the implications of below average functioning and stereotyping by the majority group to be explored. To conclude, suggestions are made regarding how practitioners could offer the best psychological service to gay men with learning disabilities. It is hoped practitioners will be more proactive and creative in helping gay men with learning disabilities explore their sexuality.

Systematic review of resource utilization in the hospital management of deliberate self-harm

Deliberate self-harm (DSH) is a significant public health problem, representing a major burden in terms of morbidity to the individual and health-service utilization. While clinical guidelines suggest good practice for the short-term hospital management of DSH, there remains considerable variability in the way that services are provided. A systematic review of the literature was undertaken to examine the current evidence on hospital resource use and costs involved in the short-term hospital management of adults following DSH and to elucidate the factors that influence these differences, in terms of clinical characteristics and service provision. Twenty-one papers reporting on 17 studies met the inclusion criteria for review. Clinical characteristics associated with an increase in resource use included overdose with tricyclic antidepressants (TCAs) compared with selective serotonin re-uptake inhibitors (SSRIs) (weighted ratio 2.6:1) and co-ingestion of alcohol with SSRIs. Variations in service provision, including medical admissions policy and provision of a specialist liaison service, affected resource utilization independently of the clinical needs of patients. Overdoses of TCAs incur substantially greater hospital costs than overdoses of SSRIs. Variations in the medical seriousness of DSH, and in the structure of service provision, affect the resources used in its short-term hospital management, with little evidence about the impact these differences have on clinical outcome. Research is needed to evaluate the impact of different styles of service provision on outcome, and to incorporate these factors into the trial design of future cost-effectiveness studies of interventions following DSH.

Services and benefits for medical rehabilitation and integrated health care

Although created already under the Law on statutory health insurance reform 2000, implementation and actual practice of the instrument of "integrated health care" (section 140 a-g of the German Social Code, Book V) have noticeably been gaining momentum only since the Law on statutory health insurance modernization (GMG) came into force on January 1, 2004. In this process, the issue of coping with the interface between medical acute care and medical rehabilitation emerges as an increasing focus of the debate over future-oriented development of service provision structures. When Book IX of the German Social Code -- Rehabilitation and Participation of People with Disabilities -- came into force on July 1, 2001 its stipulations became binding also for the Statutory Health Insurance domain (Book V of the German Social Code), notably in as far as regulations of healthcare infrastructure, contents of benefits and services as well as their performance are concerned. Moreover, more than 75 % of the medical rehabilitation benefits granted are performed by rehabilitation providers outside the scope of the health insurance system. This contribution points out that the development of integrated care structures which also cover medical rehabilitation benefits and services is subject to interdisciplinary and multidisciplinary requirements that, partly to a considerable extent, differ from or go beyond the framework conditions usually applicable in the acute-care sector.

Service responses to South Asian women who attempt suicide or self-harm: challenges for service commissioning and delivery

This article draws on an investigation of service responses to women of South Asian background who have attempted suicide or self-harm within northwest England to outline policy challenges for adequate provision to this population. This article highlights, in particular, the challenges for service managers arising from and documented within the study, outlining implications for improving policy, service commissioning and provision. We suggest that these omissions have resulted in the distress of South Asian women going unrecognized in the name of respect for cultural diversity, thereby sanctioning policies and practices that further the oppression of South Asian women. Four main issues emerging from the interviews are discussed: 1) the impact of the contract culture on the form and structure of service provision; 2) limitations of current partnership arrangements with South Asian communities; 3) practical and conceptual problems within models of both consultation and change; and, 4) key practical consequences of the covert ways in which the structure and interpretation of service responses work to treat `race' as more important than gender. In terms of specific implications, it is suggested that the current policy focus on addressing service inequalities via recruitment of South Asian workers warrants critical re-evaluation, while training and management development should take as central the intersections of `race', culture, class and gender as systemic issues to be worked with rather than marginal or optional considerations. It is argued that attending to the specific needs and conditions of South Asian women attempting suicide or self-harm by providing integrated culturally and gender-sensitive services highlights good practice for everyone.