Terms Of Health Care Services Research Articles

Medical Legal Aspects of Telemedicine in Italy: Application Fields, Professional Liability and Focus on Care Services During the COVID-19 Health Emergency.

Telemedicine services can be classified into the macro-categories of specialist Telemedicine, Tele-health and Tele-assistance. From a regulatory perspective, in Italy, the first provision dedicated to the implementation of Telemedicine services is represented by the Agreement between the Government and the Regions on the document bearing “Telemedicine—National guidelines,” approved by the General Assembly of the Superior Health Council in the session of 10th July 2012 and by the State Regions Conference in the session of 20th February 2014. Scientifically, several studies in the literature state that information and communication technologies have great potential to reduce the costs of health care services in terms of planning and making appropriate decisions that provide timely tools to patients. Another clear benefit is the equity of access to health care. The evolution of telemedicine poses a series of legal problems ranging from the profiles on the subject of authorization and accreditation to those concerning the protection of patient confidentiality, the definition and solution of which, in the absence of specific regulatory provisions, is mainly left to the assessment of compatibility of the practices adopted so far, with the general regulatory framework. In terms of professional liability, it is necessary to first clarify that the telemedicine service is comparable to any diagnostic-therapeutic health service considering that the telemedicine service does not replace the traditional health service, but integrates the latter to improve its effectiveness, efficiency and appropriateness.

Dostępność świadczeń zdrowotnych w perspektywie założeń i realizacji ustawy „o sieci szpitali”

The article analysed the availability of healthcare services in terms of assumptions and implementation of the act “hospital network”. The aim of the research was to try to answer the question about the impact of the creation of a hospital network on the availability of healthcare. The provisions of the act and implementing acts were analysed, as well as the effects of the reform, including: the structure of the hospital network, the number and value of healthcare services, the degree of performance by hospitals of contracts with the NFZ, waiting time for healthcare services and the number of people waiting, the degree of use of hospital beds, expenditure on healthcare, the financial situation of hospitals. The summary concluded that the creation of a hospital network did not increase the availability of healthcare services. It was the result of the failure to take into account epidemiological and demographic conditions and insufficient funding. The situation does not cross out the legitimacy of the creation of a hospital network, but it points the direction of further reforms.

An Empirical Study On The Prevalence Of Ict On Healthcare And Healthcare Services

Experts say “Health is Wealth”. Human resources are the driving resources for any nation and health is the driving force for any human. Health and health care services happen to be the strategic threshold for any nation. This sector happens to be crucial irrespective of the GDP of the nation and the purchasing power of its citizens, henceforth due care and attention need to be given to this crucial sector of the nation. In this present era of digitalization, it has become inevitable to be including technology in every progressive field of the nation in order to enhance the performance and increase the efficiency of the services. One such variant of the digital world is Information and communication technology (ICT). The World Health Organization (WHO) details the advantages associated with the use of ICT in primary healthcare services in terms of better and easy access to information, providing learning tools for healthcare professionals, patients, and community as a whole. Information and communication technology are being widely utilized in healthcare control structures. Rapid advancements in ICT in the last decade or so provide solutions to the problems in healthcare management structures. Those encompass a huge spectrum of troubles together with affected person safety, nutritional management, telemedicine, virtual imaging, file Control, and many others. This paper makes an attempt to detail the role of the rising technology that is getting used for the development of the healthcare process and become aware of the problems and their probable answers. Telemedicine gives a medium of enhancing the same old pattern of healthcare specifically in the developing global. The growing countries can make the most of it to the present better healthcare services as proper health Training. This paper highlights the boom of ICT area within the growing world and explores its viable uses in healthcare zone. Those may also assist healthcare specialists and community health employees to carry out their work in a better manner especially in far off region.

Clustering of European Countries in terms of Healthcare Indicators

Health is always considered as one of the most important issues related to human being. Due to this importance, governments should primarily provide the best healthcare services to their citizens. Some indicators can show the quality of healthcare services in the country. However, one country can have a higher value of one indicator and can have a lower value of another. Thus, countries can be categorized in terms of quality of healthcare services. Clustering is a useful tool for comparing countries and defining the similar countries in terms of healthcare services. In this study, 28 European Union (EU) countries were evaluated on 14 health factors and the number of clusters was determined by the generally accepted rule of thumb. To cluster countries, k-means clustering method is run in WEKA software for two cluster numbers and four different initial solution approaches. The resulting clusters were evaluated according to the Spearman rank correlation coefficient using the order of the GDP per capita values of the countries in each cluster. It seems using four clusters with Canopy initial solution approach is the most appropriate way of clustering.

Exploration of Patients Value as in Accordance with Bugis Philosophy in Public Hospital at the Sulawesi Selatan, Indonesia

In this new era of globalization, Business organizations around the world are struggling to develop effective quality measurement parameters, and strategies to survive in competition, and to achieve customer satisfaction, business organizations such as hospitals must be able to understand the needs, desires and expectations of customers and be able to create value. This study aims to explore the value of patients according to Bugis Philosophy at the Regional Public Hospital in South Sulawesi. The study was conducted at 4 hospitals in 4 regency where the majority of the population were ethnic Bugis namely Siwa Regional Public Hospital Wajo Regency, Lamadukelleng Regional Public Hospital Sengkang Regency, Tenriawaru Regional Public Hospital Bone Regency and AndiMakkassau Hospital Pare-Pare City in South Sulawesi Province. The research method is qualitative. The results of this study indicate that identification of customer needs in terms of health care services is good even though medical devices are not complete. The underlying reason for patients to choose treatment is mostly because the distance is close enough, good and complete health services, and referral factors from the health center. Health services that should be available in hospitals are improving health services that are prime for all aspects both in terms of nurse care and doctor's vision. The types of services or other supporting facilities needed are still lacking, and presumably the hospital allows families to come to visit even though briefly. The conclusion of this study is that patients’ needs related to health services from all aspects are classified as not running optimally because it is caused by several factors such as lack of health human resources (expert doctors), incomplete health equipment, and other supporting facilities that are not yet available. (Marenrengperru’) between families within the scope of the region it is advisable to maintain the existing bugis values without violating the rules that apply within the scope of the hospital.

Minimising Transfusion Therapy and Alloimmunisation in Patients with Sickle Cell Disorder in the Era of Hydroxyurea

In the UK, 700 patients with sickle cell disease are on a transfusion programme1. Red blood cell (RBC) AI occurs in 4.4-76%2 of regularly transfused sickle patients. Contributing factors include repeated transfusions and ethnic differences between sickle cell patients and their donors. This results in higher rates of mismatch in phenotyped and genotyped blood. There is a continued lack of availability of blood products from more compatible ethnic donors.Sickle patients on transfusion programmes are transfused every 3-6 weeks, creating a large burden on healthcare services in terms of time, labour and resources such as extended red cell typing in order to reduce antibody formation. The presence of RBC antibodies in patients can cause significant delays in obtaining cross matched blood and reductions in phenotype matched blood being transfused.The aims of this project were to a) review transfusion use in relation to the use of hydroxyurea (HU) patients treated at Alder Hey (AH) and b) review rates of AI in these patients. At AH we have changed our practice to offer HU from age 9 months as a disease modifying therapy 20-35mg/kg/day.We retrospectively reviewed the use of blood products in our cohort of 60 patients, age between 0-20 years (mean 11yrs). Patients were observed over their life period treated at AH, mean 10.1 patient years, range 0-20years, total of 439 patient years. We studied retrospectively the number of RBC transfusions and the historical presence of antibodies. We then re-tested all patients to determine current antibody status.Prior to commencement of hydroxyurea, 342 units of bloods were transfused to 21 patients over 243 patient years, which is 1.41 units per patient per year.After commencement of hydroxyurea, 114.5 units were transfused to 17 patients in 187.1 patient years, 0.61 units per patient per year.Indications for transfusion included acute chest syndrome, aplastic crisis, prolonged crisis, increased acute anaemia, hydroxyurea induced anaemia, pre-operatively.3 patients in our cohort had previous antibodies. Upon repeat antibody screening, no patients had detectable RBC antibodies.All patients have an extended red cell phenotype as part of their initial workup on referral to our service. Elective, non-acute patients (transfusion programme, pre-operative, hydroxycarbamide induced anaemia) all receive fully phenotyped blood. This cannot be guaranteed in acute situations where patients receive the best matched blood available.This practice of minimising blood transfusion use in patients with sickle cell anaemia can reduce blood product usage and as a result reduce the demand for ethnic minority transfusion donors. The subsequent donor exposure would therefore also decrease transfusion related complication of AI.1 National Haemoglobinopathy Registry Annual Report 2016/172G. da Cunha Gomes, E & A. F. Machado, L & C. de Oliveira, L & F. N. Neto, J. (2018). The erythrocyte alloimmunisation in patients with sickle cell anaemia: a systematic review: Erythrocyte alloimmunisation in sickle cell anaemia. Transfusion Medicine. 10.1111/tme.12543. DisclosuresNo relevant conflicts of interest to declare.

Decentralized Governance in the Management of Urban Health Care Systems in Developing Countries

Enhanced Health care services address not only one of the key Sustainable Development Goals (SDG) which is goal No 3, but also the development strategies for most developing countries. Good governance is critical to improving health care systems. Many developing countries therefore have decentralized health care systems as a way of improving good governance and as a means of attaining improved access to and delivering quality health care services to both urban and rural population. Decentralization involves the extent of planning, management and decision making from national to lower levels of government. From the 1990s the capacity of governments in developing countries to deliver public goods and services was stretched to the extent there was dire for partnerships. The Public Private Partnerships (PPP) therefore became fundamental in the provision of health services under decentralization. The nature of PPP differed from country to country and the level of decision making within each level of government. The paper has discussed the extent to which decentralized governance has facilitated the management of health care systems in the urban centres through Public Private Partnership initiatives, by conducting a comparative case study analysis of existing literature on urban health care systems under different forms of decentralized governance in Kenya, Uganda, Ghana and India, respectively. The study established that access to health care services differed with forms of decentralization. Secondly, there were more public private partnerships in devolved governments which also registered higher improvement in access to health care services in urban centres. The paper concluded that the more the involvement of public private partnership, the better health care services in terms of access was noted.

Beneficial Role of Mg2+ in Prevention and Treatment of Hypertension.

Hypertension constitutes one of the most widespread pathological conditions in developed and developing countries. Currently, more than 1 billion people worldwide are affected by the condition, either as frank hypertension or as prehypertension, raising the risk for major long-term complications and life-threatening pathologies. The costs in terms of health care services, medications for the treatment of hypertension and its complications, and associated loss in productivity represent a major economic burden for the various countries. The necessity of developing treatments that are economically more sustainable and with better compliance has been increasing alongside the incidence of the pathology. Along these lines, attention has been paid to the implementation of affordable but nutritious diets that deliver appropriate levels of macro- and micronutrients as integral part of the diets themselves or as supplements. In particular, experimental and clinical evidence suggests that an appropriate intake of dietary magnesium can be beneficial in controlling blood pressure. Additional advantages of a more diffuse therapeutic and/or preventive utilization of magnesium supplements are the virtual absence of side-effects and their affordable costs. The present review will attempt to frame our knowledge of how magnesium exerts its beneficial effects on blood pressure maintenance, which may lead to the development of more effective treatments of hypertension and its main complications.

Assessing Nepal's health policies and programs from a human rights perspective.

The right to health is a fundamental part of human rights. Ensuring right to health is not straightforward; there are several challenges. Factors such as capacity of right holders and duty-bearers and practices of providing and utilizing services among others determine to ensure health rights for the whole population. The objective of this paper is to analyze whether the health policies and programs follow a human rights-based approach (HRBA) and assess the situation of rights to health among the poor and vulnerable population. The study assessed domestic instruments against human rights policies and analyzed the implementation status of the policies and programs. An analytical case study method is used by utilizing qualitative and quantitative data. Around 90% medicines are available in the facilities; however, 22% of health worker posts are vacant. Persistence of unequal distribution of health facilities, high out-of-pocket payment, and cultural and language barriers does not ensure accessibility of health services. Acceptability of health-care services in terms of utilization rate and client satisfaction is improved after introduction of new policy. Nepal has made significant progress in improving maternal mortality ratio, infant/child mortality, immunization rates, and life expectancy at birth. Although a progressive realization of the right to health is being achieved, more efforts are still needed to follow HRBA so as to achieve quality and equity in health-care services.

Trust and Communication in a Doctor- Patient Relationship: A Literature Review.

Background: The changing pattern in the doctor-patient relationship is becoming more of a challenge for health care providers. For a healthy and effective doctor-patient relation, trust and communication is considered to play a vital role. Aim: This literature review was conducted with the aim to gather the knowledge and concepts pertaining to communication and trust in a doctor-patient relationship and how they influence patient satisfaction and perceived quality of health care services. Method: Various electronic databases including PubMed, Hinari, Cochrane, Scopus and Google Scholar were used to search for the articles. Related article titles were selected which was narrowed down to abstract of interested articles and the final 17 selected full articles were reviewed. Results: All the articles reviewed showed that both trust and communication were positively related to patient satisfaction and perceived quality of health care services in-terms of better compliance with medication and following medical advice; both in developed and developing country. Though, the determinants of trust differed slightly between rural and urban setting. Apart from the doctor’s communication skills, level of interpersonal treatment and knowledge about the patient, respect for the doctors and treatment assurance lead to better trust as well in rural setting. Patient -centered communication with two-way conversation using open-ended questions leads to better communication. Collaborative decision-making leads to better management and better chances of compliance with treatment. Conclusion: The current evidence suggests that patient-centered approach with effective communications skills and trust leads to better management and improved patient satisfaction. This is associated to better adherence to the treatment, better health outcomes and better perceived quality of healthcare services.

Do health care reforms in Turkey have a significant effect in equal access to maternal and child health services in Turkey: An evidence from 20years.

This study aimed to investigate whether there was an improvement in the equitable access to maternal and child health care services by examining the effects of socioeconomic and individual factors in Turkey from 1993 to 2013 and determine the effectiveness of health care reforms implemented mainly under the Health Transformation Program since 2003 on equitable access t;o maternal and child health care services in terms of years. The study used nationally representative 5 Turkey Demographic and Health Surveys (1993, 1998, 2003, 2008, and 2013). Prenatal care utilization rate increased from 67.0% in 1993 to 96.2% in 2013 while the rate of women giving birth at health care facilities increased from 63.8% to 98.1% in 2013. Prenatal care utilization and giving birth at health care facilities were higher among women who were under health insurance coverage, first time mothers, those staying in the western region and urban areas, and those with the highest level of wealth. The findings suggest that the issue of equity in the utilization of maternal and child health care services exists in Turkey, and the latest health care reforms under HTP are not effective in diminishing the effect of wealth.

Pharmacogenomic Inequalities: Strategies for Justice in Biomedical Research and Healthcare

The paper discusses the possibility that the benefits of pharmacogenomics will not be distributed equally and will create orphan populations. I argue that since these inequalities are not substantially different from those produced by ‘traditional’ drugs and are not generated with the intention to discriminate, their production needs not be unethical. Still, the final result is going against deep-seated moral feelings and intuitions, as well as broadly accepted principles of just distribution of health outcomes and healthcare. I thus propose two provisos that would prevent the most offensive outcomes and moderate the scope of the produced inequalities. The first proviso rejects pharmacogenomics innovations that worsen existing group inequalities and aggravate the disadvantage of communities with a history of discrimination. The second proviso requires that there is a strategy in place to even out as much as possible the distribution of benefits in the future and that a system of compensations (in terms of healthcare services) is in place for pharmacogenomic orphans. Given that only one moral problem generated by pharmacogenomics has been tackled, the list of provisos might be expanded when other issues are considered.

Mere prevencije i suzbijanja infekcije coxsackie virusom u zdravstvenim ustanovama

Hospital (nosocomial, intrahospital) infections have become a significant indicator of the global quality of healthcare services in terms of frequency and influence on the increase of morbidity and mortality of the infected and in terms of overall treatment expenses. An increase in the rate of viral hospital infections is evident in last few decades as a consequence of the changes in the epidemic characteristics of the causer and of resistance to antiviral drugs. Coxsackie virus, among other existing human pathogens, has been detected as a significant causative agent for a series of diseases. The work presents the basic epidemiological characteristics and manifestations of Coxsackie virus infections; also it represents general and specific measures of prevention and suppression of the infection in hospital environment and a special role of the nurses in the process. Occurrence and widespread of the Coxsackie virus infections imposes the need for corrections and amendments of existing preventive and treatment solutions in hospital praxis, also it demands an integrated approach based on enhanced measures of epidemic surveillance, education of the staff and programs of promotion of a quality healthcare service. Since the suppressing of hospital infections lies in legal obligation of all the participants in a healthcare service, conscientious and professional attitude of the nurses can be of great significance in the reduction of the patients and staffs’ exposure to the infective agents.

Overall satisfaction of health care users with the quality of and access to health care services: a cross-sectional study in six Central and Eastern European countries.

BackgroundThe measurement of consumer satisfaction is an essential part of the assessment of health care services in terms of service quality and health care system responsiveness. Studies across Europe have described various strategies health care users employ to secure services with good quality and quick access. In Central and Eastern European countries, such strategies also include informal payments to health care providers. This paper analyzes the satisfaction of health care users with the quality of and access to health care services. The study focuses on six Central and Eastern European countries (Bulgaria, Hungary, Lithuania, Poland, Romania and Ukraine).MethodsWe use data on past experience with health care use collected in 2010 through uniform national surveys in these countries. Based on these data, we carry out a multi-country analysis to investigate factors associated with the satisfaction of health care users in the six countries.ResultsThe results indicate that about 10-14 % of the service users are not satisfied with the quality of, or access to health care services they used in the preceding year. However, significant differences across countries and services are observed, e.g. the highest level of dissatisfaction with access to outpatient services (16.4 %) is observed among patients in Lithuania, while in Poland, the level of dissatisfaction with quality of outpatient and inpatient services are much lower than dissatisfaction with access. The study also analyses the association of users’ satisfaction with factors such as making informal payments, inability to pay and relative importance of service attributes stated by the service users.ConclusionsThese multi-country findings provide evidence for health policy making in the Central and Eastern European countries. Although the average rates of satisfactions per country are relatively high, the results suggest that there is ample room for improvements. Specifically, many service-users still report dissatisfaction especially those who pay informally and those unable to pay. The high shares of informal payments and inability of users to deal with the health expenditures lead to doubts about the fairness of the health care provision in Central and Eastern Europe. There is an urgent need for policy makers in the region to not only acknowledge but also to effectively address this key problem.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1585-1) contains supplementary material, which is available to authorized users.

Overcoming Opioid Abuse in Rural U.S. Requires Varied Approach

Overcoming Opioid Abuse in Rural U.S. Requires Varied Approach

Importance of Quality in Health Care Sector

Customer satisfaction is the most important parameter for judging the quality of service being provided by a service provider to the customer. Positive feedback from the customer leads to the goodwill of service providers in the market, which indirectly expands their business, whereas negative feedback makes it shrink. This theory is also applicable to health care providers. Nowadays, patients are aware of their rights in terms of health care services and the quality of health care services being delivered to them. There are various tools or indicators which are set to provide the quality of services for patients without any acquired infection. In this article, literature review has been done to study various tools given by distinct authors and customer satisfaction and quality indicators given by health organizations to measure quality in the health care sector.

Health Care Convergence Analysis in Turkey on the Province Level: Spatial Quantile Method

Abstract The purpose of this study is to investigate the imparity of health care service in Turkey on the province level. Generally, β convergence hypothesis is used for determining whether imparities are lowered. β-convergence refers to an inverse relation between the relative growth rate of macroeconomic variable and its initial level. As a proxy variable for health care service, the number of practicing physicians per 10,000 individuals is used. The convergence hypothesis for health care service during the period from 2002 until 2010 is investigated by using the spatial quantile method. The results confirmed that there is convergence on province-basis for the period studied. In other words, it can be concluded that the imparity in terms of health care services offered to people in Turkey has decreased on the province level. There is also spatial interaction between provinces in terms of health care services.

Technology challenges to healthcare service innovation in aging Asia: Case of value co-creation in emergency medical support system

The trend of the aging populations in Asia countries will increase at an average of 30% in 2050. Healthcare service innovation is an essential mechanism to support and increase the well-being of the elderly. The emergency medical support system is a critical process that challenge providers to implication healthcare innovation and technology for physical helps to life threatening cases. There is a need to provide flexible applications that enable the elderly to communicate their desires with others in emergency cases. This research is aimed at identifying the technological challenges that face healthcare services in terms of the emergency medical service system created to support elderly patients' demands. We conduct a statistical analysis based on secondary data from the World Health Organization (WHO) and use systematic reviews to identify the needs of healthcare technology related to aging based on the service system. The results show that value co-creation concept in emergency medical service system are positively significant system influencing healthcare service innovation for selected countries. This paper support E-health development and promote activities that co-created value between healthcare providers and patients through the preparation of alternative service systems.

The Fly-in Fly-out and Drive-in Drive-out model of health care service provision for rural and remote Australia: benefits and disadvantages

Rural Australians experience poorer health and poorer access to health care services than their urban counterparts, and there is a chronic shortage of health professionals in rural and remote Australia. Strategies designed to reduce this rural-urban divide include fly-in fly-out (FIFO) and drive-in drive-out (DIDO) services. The aim of this article is to examine the opportunities and challenges involved in these forms of service delivery. This article reviews recent literature relating to FIFO and DIDO healthcare services and discusses their benefits and potential disadvantages for rural Australia, and for health practitioners. FIFO and DIDO have short-term benefits for rural Australians seeking healthcare services in terms of increasing equity and accessibility to services and reducing the need to travel long distances for health care. However, significant disadvantages need to be considered in the longer term. There is a potential for burnout among health professionals who travel long distances and work long hours, often without adequate peer support or supervision, in order to deliver these services. A further disadvantage, particularly in the use of visiting medical practitioners to provide generalist services, is the lack of development of a sufficiently well-resourced local primary healthcare system in small rural communities. Given the potential negative consequences for both health professionals and rural Australians, the authors caution against the increasing use of FIFO and DIDO services, without the concurrent development of well-resourced, funded and staffed primary healthcare services in rural and remote communities.

An axiomatic design-based approach for the patient-value-oriented design of a sustainable Lean healthcare system

The global healthcare expenditures have grown steadily in the last decades. However, this spending is not reflected in significant healthcare improvements due to obvious inefficiencies in processes and resource consumption. To stop and reverse this unhealthy trend, a completely new approach is needed to sustainably improve healthcare services in terms of costs, response times, service quality, and resource utilisation. To address this, an integrated target system was developed and top-down decomposed using the axiomatic design method in order to comprehensively redesign healthcare organisation starting from a strict patient value focus. This methodology was chosen because it provides a systematic mapping procedure for the design of large and complex systems. The mapping was accomplished within a regional health system, involving healthcare experts from the medical, nursing and administrative areas. Results prove that the method yields a clear system view and is useful when it comes to systematically improving healthcare operational processes.