Tailored Health Care Research Articles

Stakeholder Perspectives of PATH (Plan for Appropriate Tailored Healthcare in Pregnancy) Telemedicine Recommendations [ID 2683565

INTRODUCTION: The COVID-19 pandemic has propelled innovation in prenatal care delivery including use of telemedicine for routine prenatal visits. The Plan for Appropriate Tailored Healthcare in Pregnancy (PATH), a consensus-based prenatal care recommendation developed by a multidisciplinary panel of prenatal care experts, includes two recommendations regarding telemedicine: 1) telemedicine should be an option for all visits aside from four key in-person contacts requiring in-person visits; and 2) home monitoring is an appropriate option for most routine parameters during pregnancy. A national listening tour was conducted to elicit stakeholder feedback for incorporating telemedicine recommendations into practice. METHODS: We conducted nine, 120-minute virtual focus groups with more than 25 organizations including professional (8), patient advocacy (8), public health (5), and payer groups (4). Focus groups were transcribed, coded by recommendation. Data were next analyzed with matrix coding across positive attitudes, negative attitudes, and implementation considerations. RESULTS: Focus groups included 110 participants. Most participants supported telemedicine use as a care modality for routine prenatal care. Positive attitudes included the belief that telemedicine increased care flexibility, care access, and patients' health agency. Negative attitudes included concerns that poor digital literacy, insufficient access to devices, and high cost could perpetuate existing health disparities. Implementation considerations included the importance of relationship building with patients, technical support staff use, home monitoring device validation, and patient education on telehealth best practices. Participants also emphasized needed improvements to telehealth infrastructure and funding. CONCLUSION: Interprofessional stakeholders broadly support telemedicine use in routine prenatal care. Improvements in existing advocacy efforts, research, and infrastructure in underserved communities are needed to facilitate increased access to telemedicine.

Stakeholder Implementation Considerations for PATH (Plan for Appropriate Tailored Healthcare in Pregnancy) Social Needs Recommendations [ID 2683568

INTRODUCTION: Unmet social needs negatively affect health care access and outcomes, and are disproportionately experienced by groups marginalized by racism, socioeconomic status, and geography. The Plan for Appropriate Tailored Healthcare in Pregnancy (PATH), a consensus-based prenatal care recommendation developed by a multidisciplinary panel of prenatal care experts, includes two recommendations regarding social needs: 1) early screening for medical and social determinants of health; and 2) management of social needs in prenatal care. A national listening tour was conducted to capture stakeholder feedback for implementing social needs recommendations into practice. METHODS: We conducted nine, 120-minute virtual focus groups with more than 25 organizations including professional (8), patient advocacy (8), public health (5), and payer groups (4). Focus groups were transcribed, coded by recommendation, and analyzed with matrix coding across patient, clinic, and policy level implementation considerations. RESULTS: Focus groups included 110 participants. Patient-level considerations for implementation included the importance of relationship building, shared decision-making, resources-first screening, and delivery of trauma-informed, culturally concordant care. On the clinic level, participants stressed robust clinic-level processes for providing effective social needs care, including multidisciplinary care navigation, social needs toolkit utilization, dynamic patient needs assessments, and provision of closed-loop referrals. Policy-level considerations included the need for improved provider incentives, interprofessional group collaboration, evidence-based research, and social needs infrastructure. CONCLUSION: Key considerations for implementing social needs care at the individual, clinic, and policy levels must be operationalized for successful integration into routine prenatal care. Further evidence is needed to identify and test the best approaches to addressing unmet social needs across practice settings.

Stakeholder Perspectives of the PATH (Plan for Appropriate Tailored Healthcare in Pregnancy) Targeted Visit Schedule Recommendation [ID 2683601

INTRODUCTION: Traditional prenatal care delivery guidelines recommend 12–14 in-person visits for all patients, although care can be safely delivered to average-risk patients with 8–9 targeted visits. These additional visits may result in oversurveillance and unnecessary interventions. The Plan for Appropriate Tailored Healthcare in Pregnancy (PATH), a consensus-based prenatal care recommendation developed by a multidisciplinary team of prenatal care experts, recommends tailoring care delivery to patients' needs by using targeted visit schedules for average-risk patients. A national listening tour was conducted to obtain stakeholder feedback for incorporating this care delivery model into practice. METHODS: We conducted nine, 120-minute virtual focus groups with more than 25 organizations including professional (8), patient advocacy (8), public health (5), and payer groups (4). Focus groups were transcribed and coded by recommendation, and analyzed with matrix coding across positive attitudes, negative attitudes, and implementation considerations. RESULTS: Focus groups included 110 participants. Positive attitudes included the belief that targeted visit schedules would improve visit attendance, care flexibility, and resource equity. Negative attitudes included concerns for inappropriate targeted visit schedule application, inadequate safety net systems for missed services, and reduced payer reimbursement. Providers were also concerned about decreased opportunities for relationship building and counseling in targeted visit schedules. Implementation considerations included the importance of shared decision-making, serial needs assessments, and clear risk stratification guidelines. Participants emphasized the need for multidisciplinary safety net processes to ensure timely, adequate care. CONCLUSION: Participants were receptive to incorporating targeted visit schedules for average-risk individuals into routine prenatal care. Greater infrastructure investment is needed to implement more flexible care models successfully.

Examining the Veterans Health Administration whole health model of care within the context of posttraumatic stress disorder.

The Veterans Health Administration's Whole Health system of care focuses on offering veterans holistic health approaches and tailoring health care to individual's goals and preferences. The present study assessed factors associated with Whole Health use and its potential benefits among veterans with posttraumatic stress disorder (PTSD) receiving Veterans Health Administration care. This cohort study used retrospective electronic health records combined with survey data (baseline, 6 months) from 18 Veterans Affairs Whole Health pilot implementation sites and compared patient-reported outcomes between veterans who used Whole Health services versus those who did not, among veterans with (n = 1,326) and without (n = 3,243) PTSD. Patient-reported outcomes assessed were pain (PEG), patient-reported outcomes measurement information system physical and mental health functioning, and a one-item global meaning and purpose assessment. Veterans with PTSD were more likely to have used Whole Health (38% vs. 21%) than those without PTSD. Veterans with PTSD who used Whole Health services experienced small improvements over 6 months in physical (Cohen's d = .12) and mental (Cohen's d = .15) health functioning. Veterans without PTSD who used Whole Health services experienced small improvements in physical health (Cohen's d = .09) but not mental health (Cohen's d = .04). Veterans with PTSD were frequently connected with Whole Health services even though implementation efforts were not explicitly focused on reaching this population. Results suggest Whole Health may play an important role in how veterans with PTSD engage with health care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Symptomatology and Quality of Life of Older People With HIV and Comorbid Chronic Obstructive Pulmonary Diseases From an HIV Clinic in Birmingham, Alabama.

Psychological symptomatology and quality of life (QoL) have been studied in older people with HIV (PWH) and those with chronic obstructive pulmonary disease (COPD), respectively, but there is a dearth of studies in older PWH with COPD. Our study compared depressive symptoms, anxiety, and QoL between older PWH with and without COPD using data from an HIV clinic in Birmingham, Alabama, from January 2018 to February 2020. Data on depressive symptoms (Patient Health Questionnaire-9), anxiety (Patient Health Questionnaire-5 Anxiety), and QoL (EuroQoL-5 Dimension) were analyzed. Among 690 PWH aged 50 years or older, 102 individuals (14.8%) had COPD. Significant differences were found between the two groups in depressive symptoms and components of QoL (e.g., mobility, self-care, usual activities, and pain/discomfort), but not in anxiety and general health. Experiencing COPD may worsen depressive symptomatology and QoL in older PWH, highlighting the need for tailored health care and research for this population.

Digital Health Equity and Tailored Health Care Service for People With Disability: User-Centered Design and Usability Study.

As digital health services advance, digital health equity has become a significant concern. However, people with disability and older adults still face health management limitations, particularly in the COVID-19 pandemic. An essential area of investigation is proposing a patient-centered design strategy that uses patient-generated health data (PGHD) to facilitate optimal communication with caregivers and health care service providers. This study aims to conceptualize, develop, and validate a digitally integrated health care service platform for people with disability, caregivers, and health care professionals, using Internet of Things devices and PGHD to contribute to improving digital health equity. The methodology consists of 5 stages. First, a collaborative review of the previous app, Daily Healthcare 1.0, was conducted with individuals with disabilities, caregivers, and health care professionals. Secondly, user needs were identified via personas, scenarios, and user interface sketches to shape a user-centered service design. The third stage created an enhanced app that integrated these specifications. In the fourth stage, heuristic evaluations by clinical and app experts paved the way for Daily Healthcare 2.0, now featuring Internet of Things device integration. Conclusively, in the fifth stage, an extensive 2-month usability evaluation was executed with user groups comprising individuals with disabilities using the app and their caregivers. Among the participants, "disability welfare information and related institutional linkage" was the highest priority. Three of the 14 user interface sketches the participants created were related to "providing educational content." The 11 heuristic evaluation experts identified "focusing on a single task" as a crucial issue and advocated redesigning the home menu to simplify it and integrate detailed menus. Subsequently, the app Daily Healthcare 2.0 was developed, incorporating wearable devices for collecting PGHD and connecting individuals with disabilities, caregivers, and health care professionals. After the 2-month usability evaluation with 27 participants, all participants showed an increase in eHealth literacy, particularly those who used the caregiver app. Relatively older users demonstrated improved scores in health IT usability and smartphone self-efficacy. All users' satisfaction and willingness to recommend increased, although their willingness to pay decreased. In this study, we underscore the significance of incorporating the distinct needs of individuals with disabilities, caregivers, and health care professionals from the design phase of a digital health care service, highlighting its potential to advance digital health equity. Our findings also elucidate the potential benefits of fostering partnerships between health consumers and providers, thereby attenuating the vulnerability of marginalized groups, even amid crises such as the COVID-19 pandemic. Emphasizing this imperative, we advocate for sustained endeavors to bolster the digital literacy of individuals with disabilities and champion collaborative cocreation, aiming to uphold the collective ethos of health and digital health equity.

A Simulation Model of the Effects of Tailored Prenatal Care Delivery on Care Access [ID: 1377136

INTRODUCTION: The Michigan Plan for Appropriate Tailored Healthcare in pregnancy (PATH) recommends tailoring prenatal care delivery to patients’ risk factors for visit number (for low risk: 8–9 visits; for high-risk patients: 12–14 visits) and preferences for care modality (in-person only or hybrid with virtual visits). We used simulation to explore how tailored prenatal care recommendations affect care access. METHODS: A discrete event simulation was created in C++ to assess the operational effects of tailored recommendations in comparison to standard care. Patients enter the system and are divided into low-risk and high-risk categories based on medical conditions. The simulation models dynamic patient arrivals, varied patient classifications, tailored pathways, heterogeneous durations of total care, and patient flow until each patient's pathway ends (eg, childbirth). Metrics captured include patient delays, overbooked appointments, and unused capacity. The model was run with 1,000 replications during a 52-week period with a 10-year warm-up period to reach steady-state equilibrium within the simulation. The IRB designated this analysis of de-identified data exempt. RESULTS: Transitioning to the new prenatal care model reduced mean care delays per patient in all care modalities by 3.5 weeks for low-risk patients (9.79 weeks–6.37 weeks) and 0.4 weeks for high-risk patients (9.8 weeks–9.4 weeks). Tailoring care reduced the percentage of overbooked appointments by an average of 9.4% and the average unused capacity by 7.4%. CONCLUSION: Tailored prenatal care models including telemedicine result in improved operational efficiencies.

Evaluation of Patient Cost Savings in Tailored Prenatal Pathways [ID: 1375747

INTRODUCTION: The Plan for Appropriate Tailored Healthcare in pregnancy (PATH) recommends tailoring prenatal visit schedules and modality (eg, telemedicine visits) to patients' risk factors and preferences. We simulated PATH recommendations to explore financial implications from the patient perspective. METHODS: In this IRB-exempt study, a dataset of 4,992 patients from a single academic health system was used to establish key assumptions for financial modeling. The model was constructed using several key parameters: patient risk, travel, and employment variables. We report patient-perspective cost and time savings across three models: traditional care (all patients seen for 12–14 in-person visits), tailored prenatal care (visit number tailored to patient risk), and hybrid tailored care (tailored care with telemedicine and in-person visits). RESULTS: Implementation of tailored care resulted in substantial cost and time savings. In the traditional model, average travel time was 26 hours and average total cost per patient was $1,374 (time off cost, $1,310; travel cost, $64). In the tailored model, patients saved on average 5 hours of travel time and $172 (total cost, $1,201; time off cost, $1,145; travel cost, $56). In the hybrid tailored model, patients saved on average 18 hours of travel and $792 (total cost, $581; time-off cost, $525; travel cost, $21; at-home supplies, $35). Extrapolated across all patients who sought prenatal care in 2020, estimated national cost savings range from approximately $0.5B and $2B annually for the in-person tailored and hybrid tailored model, respectively. CONCLUSION: Tailored prenatal care delivery policies, particularly those that include telemedicine, result in significant time and cost savings for patients.

Implementation Science in Surgery: Translating Outcomes to Action.

Implementation Science in Surgery: Translating Outcomes to Action.

Long-term health outcomes of Q-fever fatigue syndrome patients.

This study determined long-term health outcomes (≥10 years) of Q-fever fatigue syndrome (QFS). Long-term complaints, health-related quality of life (HRQL), health status, energy level, fatigue, post-exertional malaise, anxiety, and depression were assessed. Outcomes and determinants were studied for the total sample and compared among age subgroups: young (<40years), middle-aged (≥40-<65years), and older (≥65years) patients. 368 QFS patients were included. Participants reported a median number of 12.0 long-term complaints. Their HRQL (median EQ-5D-5L index: 0.63) and health status (median EQ-VAS: 50.0) were low, their level of fatigue was high, and many experienced post-exertional malaise complaints (98.9%). Young and middle-aged patients reported worse health outcomes compared with older patients, with both groups reporting a significantly worse health status, higher fatigue levels and anxiety, and more post-exertional malaise complaints and middle-aged patients having a lower HRQL and a higher depression risk. Multivariate regression analyses confirmed that older age is associated with better outcomes, except for the number of health complaints. QFS has thus a considerable impact on patients' health more than 10 years after infection. Young and middle-aged patients experience more long-term health consequences compared with older patients. Tailored health care is recommended to provide optimalcare for each QFS patient.

Treatment exposure-based risk-stratification for care of survivors of childhood cancer: A report from the Childhood Cancer Survivor Study.

10056 Background: Treatment exposure-based risk-stratification oflong-term cancer survivors is needed to allocate tailored health care in survivorship clinics. Investigators from the United Kingdom (UK) developed a treatment exposure-based algorithm that stratifies survivors into low, medium, and high risk groups. Because this algorithm has not been validated, we sought to use the large, diverse population of the Childhood Cancer Survivor Study (CCSS) to validate risk for poor outcomes. Methods: Five-year survivors of childhood cancer (diagnosed between 1970-1999 at &lt; 21 years of age) were categorized into low, medium, and high risk groups based on treatment exposures and diagnoses (Table). Primary endpoints included cumulative health-related (i.e., non-recurrence, non-external) late mortality and cumulative incidence of grade 3-5 chronic conditions (CTCAEv4.03) conditional on reaching age 20 without the outcome. Siblings were a comparison group for chronic conditions. Cox proportional hazards models among survivors estimated hazard ratios (HRs) and 95% confidence intervals (CI) adjusted for sex and race. Results: A total of 21,504 survivors were analyzed with a median follow-up of 22 years. Application of the risk stratification algorithm resulted in 3,152 low risk, 6,443 medium risk, and 11,909 high risk survivors. Among those who survived to age 20 without any grade 3-5 conditions, the risk of developing one by age 35 was 12.2% (95% CI 1.0-14.7%), 14.2% (12.8-15.7%) and 25.4% (24.2-26.6%) for low, medium, and high-risk patients, respectively, and 6.9% (6.1-7.9%) for siblings. HRs of grade 3-5 conditions for medium (HR 1.8, 95% CI 1.6-2.1) and high (HR 3.9, 95% CI 3.5-4.4) risk relative to low risk survivors, respectively, were elevated. Cumulative health-related mortality was similarly associated with risk categories; conditional on being alive at age 20, survivors within low, medium, and high risk groups had cumulative incidences of 2.3% (95% CI 1.7-3.1%), 3.3% (2.8-3.9%) and 6.1% (5.6-6.6%), respectively, by age 35. Conclusions: Risk categorizations based on treatment exposures were effective at providing generalized risk stratification within the CCSS with respect to risk of grade 3-5 conditions and health related mortality, particularly for identifying high risk survivors. These risk groups may be useful to physicians in determining follow-up intervals and guiding management and long-term surveillance of these survivors. [Table: see text]

Michigan Plan for Appropriate Tailored Healthcare in Pregnancy Prenatal Care Recommendations: A Practical Guide for Maternity Care Clinicians.

Prenatal care is an important preventive service designed to improve the health of pregnant patients and their infants. Prenatal care delivery recommendations have remained unchanged since 1930, when the 12-14 in-person visit schedule was first established to detect preeclampsia. In 2020, the American College of Obstetricians and Gynecologists, in collaboration with the University of Michigan, convened a panel of maternity care experts to determine new prenatal care delivery recommendations. The panel recognized the need to include emerging evidence and experience, including significant changes in prenatal care delivery during the COVID-19 pandemic, pre-existing knowledge of the importance of individualized care plans, the promise of telemedicine, and the significant influence of social and structural determinants of health (SSDoH) on pregnancy outcomes. Recommendations were derived using the RAND-UCLA appropriateness method, a rigorous e-Delphi method, and are designed to extend beyond the acute public health crisis. The resulting Michigan Plan for Appropriate Tailored Healthcare in pregnancy (MiPATH) includes recommendations for key aspects of prenatal care delivery: (1) the recommended number of prenatal visits, (2) the frequency of prenatal visits, (3) the role of monitoring routine pregnancy parameters (blood pressure, fetal heart tones, weight, and fundal height), (4) integration of telemedicine into routine care, and (5) inclusion of (SSDoH). Resulting recommendations demonstrate a new approach to prenatal care delivery that incorporates medical, SSDoH, and patient preferences, to develop individualized prenatal care delivery plans. The purpose of this document is to outline the new MiPATH recommendations and to provide practical guidance on implementing them in routine practice.

Dementia caregivers identify challenges and facilitators to attending health care visits

AbstractBackgroundThe 2020 National Research Summit on Care, Services, and Supports for Persons with Dementia and Their Caregivers identified the need for person‐centered dementia care throughout the care continuum. Challenges include adapting health care to meet the complex needs of persons with dementia and their caregivers across a variety of settings.MethodTo understand dementia caregivers’ experience of the health care system, we conducted qualitative interviews with twenty‐four middle‐to‐older age caregivers of community‐dwelling people with dementia. Data were analyzed using conventional content analysis whereby the coding team sought to identify barriers and facilitators to person‐centered dementia care.ResultWe identified three categories and associated sub‐categories related to caregiver experience: 1) Preparing for the Visit, with sub‐categories Physical Challenges and Emotional Preparation; 2) Visit‐Related Time and Travel, with sub‐categories General Travel Challenges, Physical Limitations, Cognitive Limitations, and Benefits; and, 3) In‐visit Experience, with sub‐categories Physical Challenges and Emotional Preparation. Preparing for visit statements revealed barriers, such as patient resistance to attending visits due to not understanding the need. Visit‐related time and travel statements reflected a balance of challenges and facilitators, including general challenges such as traffic and dementia‐specific challenges such as patient agitation around visit wait times. Facilitators reflected the benefit of visits as opportunities for social participation. In‐visit experience statements reflected a mix of challenges and facilitators. Challenges included person with dementia difficulty participating in the health care visit due to poor insight and inability to answer questions, while facilitators included caregivers’ positive engagement with the care team. Across categories, caregivers assumed high‐level responsibility to accommodate for person with dementia physical and cognitive challenges.ConclusionCategories underscore the complexity of health care management for a person with dementia both in and around actual clinic appointments, highlighting both challenges related to person with dementia cognitive deficits and perceived benefits related to visits as opportunities for social participation and accessing resources. This study offers relevant insights about tailoring health care to accommodate for person with dementia deficits while supporting their caregivers.

Health-Related Quality of Life and Its Contributors According to a Preference-Based Generic Instrument in Cirrhosis.

It is essential to determine contributors around impairment in health‐related quality of life (HRQoL) in patients with cirrhosis aiming at improving health care and therapeutic strategy. Studies simultaneously incorporating disease severity based on biochemical parameters and other physical/psychological effects (i.e., sleep disturbance and frailty) are heterogeneous and the subject of the present study. We analyzed and compared HRQoL, using the EuroQol Group 5 Dimension (EQ‐5D) questionnaire and the utility index retrieved, in patients with cirrhosis and across groups stratified by sleep disturbance or frailty phenotype. Sleep disturbance and frailty were determined by the Pittsburgh Sleep Quality Index (PSQI) and Frailty Index, respectively. Multiple linear regression was implemented to clarify contributors of poor HRQoL. In this cohort of 227 patients with mean age of 61.7 years and 47.2% male, more than half of the study population represented impairment in HRQoL in at least one domain, according to EQ‐5D. Furthermore, sleep disturbance and frailty have proved to be independently associated with poor HRQoL in two separate regression models, whereas conventional scoring systems such as Child‐Pugh classification and Model for End‐Stage Liver Disease are not closely relevant. Intriguingly, not all health domains within EQ‐5D correlated well with PSQI and Frailty Index, with the exception of usual activities. Pain and anxiety/depression were the most frequently affected HRQoL domains even in patients without sleep disturbance or frailty. Conclusion: Impaired HRQoL is prevalent in patients with decompensated cirrhosis. Sleep disturbance and frailty are independently associated with poor HRQoL. It is imperative to timely intervene with these symptoms and deliver tailored health care.

The Michigan Plan for Appropriate Tailored Healthcare in Pregnancy Prenatal Care Recommendations.

To describe MiPATH (the Michigan Plan for Appropriate Tailored Healthcare in pregnancy) panel process and key recommendations for prenatal care delivery. We conducted an appropriateness study using the RAND Corporation and University of California Los Angeles Appropriateness Method, a modified e-Delphi process, to develop MiPATH recommendations using sequential steps: 1) definition and scope of key terms, 2) literature review and data synthesis, 3) case scenario development, 4) panel selection and scenario revisions, and 5) two rounds of panel appropriateness ratings with deliberation. Recommendations were developed for average-risk pregnant individuals (eg, individuals not requiring care by maternal-fetal medicine specialists). Because prenatal services (eg, laboratory tests, vaccinations) have robust evidence, panelists considered only how services are delivered (eg, visit frequency, telemedicine). The appropriateness of key aspects of prenatal care delivery across individuals with and without common medical and pregnancy complications, as well as social and structural determinants of health, was determined by the panel. Panelists agreed that a risk assessment for medical, social, and structural determinants of health should be completed as soon as individuals present for care. Additionally, the panel provided recommendations for: 1) prenatal visit schedules (care initiation, visit timing and frequency, routine pregnancy assessments), 2) integration of telemedicine (virtual visits and home devices), and 3) care individualization. Panelists recognized significant gaps in existing evidence and the need for policy changes to support equitable care with changing practices. The MiPATH recommendations offer more flexible prenatal care delivery for average-risk individuals.

A Review of Prenatal Care Delivery to Inform the Michigan Plan for Appropriate Tailored Healthcare in Pregnancy Panel.

To perform a literature review of key aspects of prenatal care delivery to inform new guidelines. A comprehensive review of Ovid MEDLINE, Elsevier's Scopus, Google Scholar, and ClinicalTrials.gov. We included studies addressing components of prenatal care delivery (visit frequency, routine pregnancy assessments, and telemedicine) that assessed maternal and neonatal health outcomes, patient experience, or care utilization in pregnant individuals with and without medical conditions. Quality was assessed using the RAND/UCLA Appropriateness Methodology approach. Articles were independently reviewed by at least two members of the study team for inclusion and data abstraction. Of the 4,105 published abstracts identified, 53 studies met inclusion criteria, totaling 140,150 participants. There were no differences in maternal and neonatal outcomes among patients without medical conditions with reduced visit frequency schedules. For patients at risk of preterm birth, increased visit frequency with enhanced prenatal services was inconsistently associated with improved outcomes. Home monitoring of blood pressure and weight was feasible, but home monitoring of fetal heart tones and fundal height were not assessed. More frequent weight measurement did not lower rates of excessive weight gain. Home monitoring of blood pressure for individuals with medical conditions was feasible, accurate, and associated with lower clinic utilization. There were no differences in health outcomes for patients without medical conditions who received telemedicine visits for routine prenatal care, and patients had decreased care utilization. Telemedicine was a successful strategy for consultations among individuals with medical conditions; resulted in improved outcomes for patients with depression, diabetes, and hypertension; and had inconsistent results for patients with obesity and those at risk of preterm birth. Existing evidence for many components of prenatal care delivery, including visit frequency, routine pregnancy assessments, and telemedicine, is limited.

Financing employee healthcare: fusing the preferences of employees in decision-making

Purpose Good health is important for the happiness and productivity of employees of any organization and a nation. With the declining government funding for public Universities in Kenya, providing health cover for employees is a real challenge. Thus, the universities have to explore widely acceptable and sustainable options. This study aims to explore the correlations of employee preferences for health care schemes and evaluated the cost implications of each of the available Schemes.Design/methodology/approach The study applied a multinomial probit analysis on cross-sectional data from Taita Taveta University (TTU) in Kenya's coastal region. Cost-benefit analysis was used to rank alternative healthcare schemes. For triangulation of information, individual interviews were supplemented with key informant interviews.Findings Two sets of factors, personal attributes of employees and the attributes of the health care provider, were found to drive employee preferences for health care schemes. Thus, the universities need to consider these attributes in their choice sets of health care schemes to gain employee support.Research limitations/implications The study was based on a cross-sectional survey that may not capture the dynamic elements in institutional management. Thus, future research may build panel data on the current one for further analysis.Practical implications The study found that household characteristics and the perceived attributes of the healthcare providers are key drivers of the preferences. Thus, it is important to consider the characteristics of the employees (for example, age, family sizes, etc.) and attributes of healthcare providers before selecting a healthcare scheme for the workersOriginality/value This is a pioneer study on the choice of healthcare scheme for institutions of higher learning in Kenya. Universities are made aware of what informs employee's preferences for health schemes. This is important for tailoring health care schemes to match employee preferences for greater satisfaction.

Endotrophin: Nominated for best supporting actor in the fibro-inflammatory saga.

As the population ages, more individuals are at risk of developing age-related chronic diseases, often leading to death. Identifying individuals most at risk for developing multiple co-morbidities could help tailor health care strategies in this growing population. Fibrosis and inflammation are key biological processes involved in the development and progression of a myriad of diseases, including chronic kidney disease, diabetes and cardiovascular diseases.

Age disparities in unmet need for contraception among all sexually active women in Colombia: Demographic Health Survey 2015

ABSTRACT The Unmet need for contraception increases unintended pregnancies and jeopardizes women’s health and reproductive rights. Social determinants are associated with an unmet need for contraception. Still, it is unclear if age is a social determinant of disparities in reproductive health-related outcomes in all Colombian women regardless of marital status. This study used the 2015 Colombian Demographic and Health Survey to determine the unmet need for contraception among 24,245 sexually active women aged 13–49. Age was associated with the unmet need for contraception using a multivariate analysis. Absolute and relative inequalities were estimated using differences in prevalence and odds ratios, respectively. The prevalence of unmet need for contraception was significantly higher in married women aged 13–19 years old (19.8%) than their unmarried counterparts (16.8%), and all older age groups either married or unmarried. Women 13–19 years old [OR = 2.98 (2.49–3.57)] and 20–29 years old [OR = 1.71(1.48–1.97)] are more likely to have an unmet need for contraception than those 40–49 years old. Age disparities are barriers to attaining the Sustainable Development Goals for sexual and reproductive health. Cultural, social, and access barriers demand societies to tailor health care services to meet younger women’s needs to narrow the age gap.

Laboratory for innovation in Primary Health Care: implementation and results.

This article presents and problematizes innovation actions aimed at improving the quality of Primary Health Care (PHC), describing an experience that can be adapted to different contexts, considering diverse sociodemographic, economic, cultural and epidemiological realities. We conducted an exploratory study using documentary sources referring to the implementation of the Campo Grande Laboratory for Innovation in Primary Health Care (INOVAAPS). The project proposes the reorientation of the care model adopted in the municipality's public primary care services, redefining work processes and improving the quality of practice. We identified product, process and organizational innovations that have the potential to transform and tailor health care practices to the population's health needs. It is concluded that the proposals implemented by the project focus on the consolidation and expansion of access to primary care, recruitment and training of adequately qualified health professionals, adoption of resolutive technologies, regulatory improvement, and strengthening the mediating role of primary health care.