Variety Of Health Care Services Research Articles

Navigating the Future: The Integration of Artificial Intelligence in Primary Care Medicine in Pakistan

The recent past has witnessed a paradigm shift with the usage of artificial intelligence (AI) within a variety of healthcare services. This transition of incorporating AI has brought about multiple favours for enhancing current services and a lot of promising results in the primary care setup of Pakistan. Primary care has diverse and sophisticated provisions hence the challenges are complicated too. The authors examine the existing practices as well as future options for incorporating AI in primary care in Pakistan.

The Impact of Temporary Housing Assistance Expenditures on Subcategories of Health Care Cost for U.S. Veterans Facing Housing Instability.

We sought to estimate the impact of temporary financial assistance (TFA) for housing-related expenses from the U.S. Department of Veterans Affairs on costs for a variety of health care services. We conducted a retrospective cohort study of Veterans who entered the Supportive Services for Veteran Families (SSVF) program between 10/2015 and 9/2018. We assessed the effect of TFA on health care costs using a multivariable difference-in-difference approach. Outcomes were direct medical costs of health care encounters (i.e., emergency department, outpatient mental health, inpatient mental health, outpatient substance use disorder treatment, and residential behavioral health) in the VA system. Temporary financial assistance was associated with a decrease in ED (-$11, p<.003), outpatient mental health (-$28, p<.001), outpatient substance use disorder treatment (-$25, p<.001), inpatient mental health (-$258, p<.001), and residential behavioral health (-$181, p<.001) costs per quarter for Veterans in the rapid re-housing component of SSVF. These results can inform policy debates regarding proper solutions to housing instability.

A Worker-Centered Personal Health Record App for Workplace Health Promotion Using National Health Care Data Sets: Design and Development Study.

BackgroundPersonal health record (PHR) technology can be used to support workplace health promotion, and prevent social and economic losses related to workers’ health management. PHR services can not only ensure interoperability, security, privacy, and data quality, but also consider the user’s perspective in their design.ObjectiveUsing Fast Healthcare Interoperability Resources (FHIR) and national health care data sets, this study aimed to design and develop an app for providing worker-centered, interconnected PHR services.MethodsThis study considered the user’s perspective, using the human-centered design (HCD) methodology, to develop a PHR app suitable for occupational health. We developed a prototype after analyzing quantitative and qualitative data collected from workers and a health care professional group, after which we performed a usability evaluation. We structured workers’ PHR items based on the analyzed data, and ensured structural and semantic interoperability using FHIR, Systematized Nomenclature of Medicine–Clinical Terms (SNOMED-CT), and Logical Observation Identifiers Names and Codes (LOINC). This study integrated workers’ health information scattered across different Korean institutions through an interface method, and workers’ PHRs were managed through a cloud server, using Azure API for FHIR.ResultsIn total, 562 workers from industrial parks participated in the quantitative study. The preferred data items for PHR were medication, number of steps walked, diet, blood pressure, weight, and blood glucose. The preferred features were ability to access medical checkup results, health information content provision, consultation record inquiry, and teleconsultation. The worker-centered PHR app collected data on, among others, life logs, vital signs, and medical checkup results; offered health care services such as reservation and teleconsultation; and provided occupational safety and health information through material safety data sheet search and health questionnaires. The app reflected improvements in user convenience and app usability proposed by 19 participants (7 health care professionals and 12 end users) in the usability evaluation. The After-Scenario Questionnaire (ASQ) was evaluated with a mean score of 5.90 (SD 0.34) out of 7, and the System Usability Scale (SUS) was evaluated a mean score of 88.7 (SD 4.83) out of 100.ConclusionsThe worker-centered PHR app integrates workers’ health information from different institutions and provides a variety of health care services from linked institutions through workers’ shared PHR. This app is expected to increase workers’ autonomy over their health information and support medical personnel’s decision making regarding workers’ health in the workplace. Particularly, the app will provide solutions for current major PHR challenges, and its design, which considers the user’s perspective, satisfies the prerequisites for its utilization in occupational health.

Pharmacist interventions for persons with intellectual disabilities: A scoping review.

Persons with intellectual disabilities (ID) often have complex health needs due to the development of multiple comorbidities. Given the higher associated use of problematic medications, such as antipsychotics, and polypharmacy, persons with ID may be particularly vulnerable to adverse side effects. With their medication expertise, pharmacists have the potential to address medication related challenges experienced by this population. Explore what is known about the care pharmacists provide to persons with ID. Following Arksey and O'Malley's 5-stage framework for scoping reviews, searches of the PubMed (MEDLINE), Ovid EMBASE, Ovid International Pharmaceutical Abstracts, Scopus and APA PsycINFO databases were conducted in January 2019 with no limits on publication date. Studies of participants diagnosed with ID or healthcare providers/caregivers of persons with ID that referenced a pharmacist care intervention were included. Studies with non-human populations and editorials, commentaries, letters to the editor or discussion papers were excluded. Twenty-six studies were included in the review. Seventy-six pharmacist care interventions were identified in cognitive pharmacy services (n=46); educational and advisory services (n=20); and medication prescription processing (n=10). Fifty-one outcomes were referenced including drug-related interventions (n=14), drug related problems (n=9), cost/time-effectiveness (n=7), secondary symptoms (n=6), other outcomes (n=5), general medication usage (n=4), caregiver and healthcare team satisfaction levels (n=3), and educational/knowledge (n=3). Pharmacists perform a variety of health care services to persons with ID but the impact of these interventions cannot be accurately measured due to a lack of: 1) universal definitions for ID; 2) reporting of multifactorial conditions contributing to a spectrum of ID severity; and 3) standardized reporting of ID-specific outcomes. Addressing these gaps is necessary for the development of a comprehensive evidence base regarding pharmacist involvement for medication challenges in persons with ID.

A Study of Cross-Sector Health Care Services for the Homeless: Community Health Service Capacity Measured and Tested

Communities across the U.S. have been challenged with effectively and efficiently addressing the incidence of homeless. The needs of those experiencing homelessness are varied and complex, and chief among these needs is access to affordable primary health care services. Research indicates that individuals experiencing homelessness are at higher risk of preventable diseases and also are less likely to access health care systems than most other populations. Because federal law delegates the provision of health and human services to local entities such as nonprofits, local governments, and private hospitals, communities create collaborative networks known as Continuum of Care (CoCs) to pool local resources and coordinate community-based health and human services. We conduct an original research by launching a national survey to community service networks, and from data collected, we offer knowledge about the type and variety of health care services made available across communities and the multidimensional factors that are associated with the extent to which communities are responding to the primary health care needs of a vulnerable population. We found that homeless medical service needs and community service resources are associated with the degree to which a CoC provides health care services.

Supporting older military veterans in the rural US

Purpose The purpose of this paper is to provide an overview of rural older veterans in the US and discuss how the US Department of Veterans Affairs (VA) is increasing access to health care for older veterans in rural areas. Design/methodology/approach This is a descriptive paper summarizing population and program data about rural veterans. Findings VA provides a variety of health care services and benefits for older veterans to support health, independence, and quality of life. With the creation of the Veterans Health Administration Office of Rural Health (ORH) in 2006, the needs of rural veterans, who are on average older than urban veterans, are receiving greater attention and support. ORH and VA have implemented several programs to specifically improve access to health care for rural veterans and to improve quality of care for older veterans in rural areas. Originality/value This paper is one of the first to describe how VA is addressing the health care needs of older, rural veterans.

Do physicians discuss end-of-life decisions with family members? A mortality follow-back study

ObjectiveDeaths from chronic illness are often preceded by a potentially life-shortening end-of-life decision (ELD). Involving family in these ELDs may have psychosocial benefits for them and the dying person. This study aims to examine how often ELDs are discussed with relatives of the dying person and which characteristics determine their involvement in those ELDs. MethodsA questionnaire survey was conducted in 2013 among physicians attending a large, stratified and representative sample of deaths (n = 6188) in Flanders. ResultsIn 72.3% of ELDs preceding death, family of the dying person were involved. Discussion of an ELD with family members was more likely when the decision was also discussed with the dying person, the ELD was made with the explicit intention to shorten life, specialized palliative care was provided or death occurred in an ICU. ConclusionsInvolving family in end-of-life decision making appears to be related to the type of formal care services involved, communication with the dying person and the motives behind the decision. Practice implicationsOur findings suggest a need to further expand a palliative care approach with a focus on both the dying person and their family within and across a variety of health care services.

Social justice, access and quality of healthcare in an age of austerity: users’ perspective from rural Iceland

ABSTRACTIceland is sparsely populated but social justice and equity has been emphasised within healthcare. The aim of the study is to examine healthcare services in Fjallabyggð, in rural northern Iceland, from users’ perspective and evaluate social justice, access and quality of healthcare in an age of austerity. Mixed-method approach with transformative design was used. First, data were collected with questionnaires (response rate of 53% [N=732] in 2009 and 30% [N=415] in 2012), and analysed statistically, followed by 10 interviews with healthcare users (2009 and 2014). The results were integrated and interpreted within Bronfenbrenner’s Ecological Model. There was significantly less satisfaction with accessibility and variety of healthcare services in 2012 after services downsizing. Solid primary healthcare, good local elderly care, some freedom in healthcare choice and reliable emergency services were considered fundamental for life in a rural area. Equal access to healthcare is part of a fundamental human right. In times of economic downturn, people in rural areas, who are already vulnerable, may become even more vulnerable and disadvantaged, seriously threatening social justice and equity. With severe cutbacks in vitally important healthcare services people may eventually choose to self-migrate.

Family Carers of People with Young-Onset Dementia: Their Experiences with the Supporter Service.

Background: Family carers and people with young-onset dementia (YOD) require tailored assistance as dementia progresses. A variety of health care services is needed, including supporter services. To our knowledge, research focusing on experiences with the supporter service is scarce. Aim: To evaluate the supporter service by examining how primary family carers experience the assistance provided. Method: Qualitative interviews with 16 primary family carers of people with YOD were performed from 2014 to 2015. Content analysis was used to analyze the data. Results: Three main themes emerged from the interviews. First, a good match focused on the carers’ experiences of the relationship between the supporter and the person with YOD and included three subthemes: a nice, empathetic personality, a friendship-like relationship, and the content of the meetings. The second theme, relief, addressed the carers’ experiences with the service. The third, coordination, concerned the carers’ relationship with the health care service. Conclusion: Developing tailored services and assistance initiatives is important. A well-organized supporter service is a valuable supplement to formal programs and should be developed as part of an overall support package.

Performance analysis on algorithms for selection of desired healthcare services

In recent years, there has been a tremendous growth in healthcare services. Different hospitals with the support of many specialists provide a wide variety of healthcare services. The information about different hospitals and their health care service capabilities are quite not well integrated. However, IT based solutions are being developed for effective sharing of health care service capabilities and for selection of desired health care service providers. As different hospitals provide a wide variety of health care services and since different users have different criteria in selecting the health care providers, the selection of health care providers can be modelled as a multi-criteria decision making problem. In this paper, attempts were made to apply different multi-criteria solution methodologies such as ELECTRE, PROMETHEE, AHP for health care service applications. The algorithms were implemented and their performance were analyzed and investigated. The experimental results prove that the PROMETHEE method is best suited for solving multi-criteria decision making problem in the selection of desired health care services.

Lower Quality of Colonoscopy in Veterans Referred Outside the VA

The U.S. Veterans Affairs (VA) hospital system has limits on allowable waiting periods for a variety of healthcare services. When those limits are

Capsule commentary on Goetz et al., The effect of charge display on cost of care and physician practice behaviors: a systematic review.

In response to the rising cost of health care in the United States, third-party payers are shifting more of the cost burden to patients. Physicians are often confronted with clinical decisions that have important economic implications for patients and health care payers. Providing physicians with information about the cost of health care services and pharmaceuticals serves two main purposes: first, it enables physicians to make informed decisions on the cost and effectiveness of diagnostic and treatment alternatives; second, it increases transparency and awareness among the medical community regarding the affordability of such treatment options for patients. Health professionals rely on the biomedical literature as part of their clinical practice, often neglecting the economic literature that has extensively illustrated the theory of incentives and its effects on the health care provider’s behavior. The significance of the study by Goetz et al. (2015) would have been further enhanced had the authors1 included the economic literature on payment mechanisms and provider behaviors.2–5 In addition, an assessment of the quality of studies included in the review would be helpful for explaining the implications of the different methodological designs used (Cross-sectional, Cohort, Case-control studies). The literature review could also discern the effect of including studies conducted in distinct health care systems (USA, South Africa, Sweden, France), assessing a variety of health care services (laboratory test, imaging and radiology, pharmaceuticals, emergency visits), provided in different health care settings (hospital, outpatient, emergency), to different patients (adult, pediatric). A more comprehensive and systematic literature review could disentangle these factors and result in more robust findings. Health care systems coverage, funding, and reimbursement mechanisms are significantly correlated with the provision of care. These are also key factors driving providers’ decision-making processes, clinical practice, and prescribing behaviors. The effect of the display of cost information (or, alternatively, charges and fees to proxy cost) on physicians’ behavior is a timely policy issue of high clinical and economic importance. Further research is needed to assess the effect of providing outcomes and cost information to health care providers on the efficient allocation of scarce health care resources.

NFC를 이용한 모바일 응급 의료 시스템 구현에 관한 연구

최근 IT와 BT를 융합한 스마트 헬스케어를 통해 다양한 의료 서비스를 제공하는 연구가 활발하게 진행되고 있다. 짧은 시간에 최상의 응급 의료 서비스를 제공하기 위해서는 응급 상황 발생시 신속한 응급 조치가 필수적이다. 본 논문에서는 NFC 태그를 휴대하거나 NFC 기능을 적용한 스마트폰을 휴대한 사람이 의식을 잃는 사고를 당했을 때 효율적으로 응급 조치를 취할 수 있는 응급 의료 서비스 플랫폼을 제안한다. NFC를 이용하면 일상생활 중에서 낙상과 같은 사고로 의식이 없는 응급 환자에게 신체 접촉 없이 도움을 주는 것이 가능하다. 본 논문에서는 모바일 응급 의료시스템을 구현하여 환자가 스마트폰을 활용하여 응급 상황 발생시 주위 사람들에게 도움을 청하고 응급 조치 정보를 전달할 수 있음을 보였다. Recently the study about a smart health care which is combined IT with BT to provide a variety of health care services are being actively investigated. In order to provide the best possible emergency medical services in a short period of time, it is necessary that the rapid emergency measures in the event of an emergency essential. In this paper, we propose an emergency medical service platform to take effective first aid to person who has a NFC tag or NFC-enabled mobile smart phones in an accident. Using NFC, it is possible to help without physical contact to the patient unconscious to emergency incidents such as falling down in everyday life. In this paper, we design and implement an mobile emergency medical system that can deliver first aid information ask for help in case of emergency.

Development of a College Student's Mistrust of Health Care Organizations Scale

Objective: The purpose of this study was to develop a College Student's Mistrust of Health Care Organizations (CSMHCO) scale and determine the relationship between medical mistrust with the use of a variety of health care services. Methods: A convenience sample of college students (n = 545) at 2 universities in the United States was recruited in the academic year 2010–2011. Results: Using principal components analysis we found that the scale was unidimensional, internal reliability (Cronbach's α = 0.85) was good, test–retest reliability was acceptable (r = 0.71), and readability (SMOG = 11 grade) was good. Higher mistrust of health care organizations was found to be statistically significantly associated with all 5 measures of underutilization of health services: failure to take medical advice, failure to seek needed medical care, failure to fill a prescription, postponing needed medical care, and failure to keep a follow-up appointment. This scale seems to be a satisfactory predictor of failure to obtain needed health care services. Conclusions and Translation to Health Education Practice: To help ensure appropriate use of health services by college students this scale could be used to assess levels of mistrust of health care organizations in student populations and then outreach efforts could be implemented for those students most likely to avoid needed health care services.

Price elasticity of expenditure across health care services

Policymakers in countries around the world are faced with rising health care costs and are debating ways to reform health care to reduce expenditures. Estimates of price elasticity of expenditure are a key component for predicting expenditures under alternative policies. Using unique individual-level data compiled from administrative records from the Chilean private health insurance market, I estimate the price elasticity of expenditures across a variety of health care services. I find elasticities that range between zero for the most acute service (appendectomy) and −2.08 for the most elective (psychologist visit). Moreover, the results show that at least one third of the elasticity is explained by the number of visits; the rest is explained by the intensity of each visit. Finally, I find that high-income individuals are five times more price sensitive than low-income individuals and that older individuals are less price-sensitive than young individuals.

School-Based Health Centers in an Era of Health Care Reform: Building on History

School-based health centers (SBHCs) provide a variety of health care services to youth in a convenient and accessible environment. Over the past 40 years, the growth of SBHCs evolved from various public health needs to the development of a specific collaborative model of care that is sensitive to the unique needs of children and youth, as well as to vulnerable populations facing significant barriers to access. The SBHC model of health care comprises of on-school site health care delivery by an interdisciplinary team of health professionals, which can include primary care and mental health clinicians. Research has demonstrated the SBHCs' impacts on delivering preventive care, such as immunizations; managing chronic illnesses, such as asthma, obesity, and mental health conditions; providing reproductive health services for adolescents; and even improving youths' academic performance. Although evaluation of the SBHC model of care has been complicated, results have thus far demonstrated increased access to care, improved health and education outcomes, and high levels of satisfaction. Despite their proven success, SBHCs have consistently faced challenges in securing adequate funding for operations and developing effective financial systems for billing and reimbursement. Implementation of health care reform (The Patient Protection and Affordable Care Act [P.L. 111-148]) will profoundly affect the health care access and outcomes of children and youth, particularly vulnerable populations. The inclusion of funding for SBHCs in this legislation is momentous, as there continues to be increased demand and limited funding for affordable services. To better understand how this model of care has and could further help promote the health of our nation's youth, a review is presented of the history and growth of SBHCs and the literature demonstrating their impacts. It may not be feasible for SBHCs to be established in every school campus in the country. However, the lessons learned from the synergy of the health and school settings have major implications for the delivery of care for all providers concerned with improving the health and well-being of children and adolescents.

QoS Provisioning in Wireless Body Area Networks: A Review on MAC Aspects

Wireless Body Area Networks (WBANs) deal with variety of healthcare services with diverse Quality of Service (QoS) requirements. However, QoS handling is a challenging problem in such networks. In general, QoS related problems can be addressed from different layers in the networking protocol suite. Design of an efficient QoS aware Medium Access Control (MAC) protocol can address this problem in MAC layer. This paper analyzes the QoS requirements of WBAN, identifies the requisites of QoS handling system, and outlines the trends that are being followed for its advancement with focus on QoS issues at MAC layer. We review some prior works, compare them, and analyze the current research concerned with problem of providing QoS in WBAN. We also explore some open issues and discuss them.

Health care usage in Dutch systemic lupus erythematosus patients

As a first step in the improvement of the organization of care for patients with systemic lupus erythematosus (SLE) we studied their health care usage and its determinants. A questionnaire was sent to 161 outpatients of the rheumatology clinic of a Dutch university hospital. The questionnaire comprised questions on health care usage, quality of life and sociodemographic characteristics. Disease characteristics were extracted from the medical record. Among the 102 responders (63% response rate) the proportions of patients reporting contacts with a rheumatologist because of SLE since onset of the disease and over the past 12 months were 100% and 83%, respectively. These proportions were 93% and 68% for all other medical specialists, 88% and 44% for the general practitioner, 78% and 44% for any health professional, 29% and 9% for care at home, 48% and 17% for hospital admissions and 29% and 2% for day-patient care. Younger age, major organ involvement, the use of immunosuppressants and worse physical functioning were found to be significantly associated with greater health care use. This study demonstrated that health care usage by SLE patients is substantial and involves a variety of health care services. Further research should be directed at patients' satisfaction and patients' needs regarding the optimal organization of integrated, multidisciplinary services that are accessible for SLE patients of all ages.

Putting the Pieces Together: How Public Health Nurses in Rural and Remote Canadian Communities Respond to Intimate Partner Violence

Intimate partner violence is a recognized public health problem with direct impacts, including cuts, bruises, and broken bones as well as longer-term effects, including headaches, insomnia, depression, anxiety, substance abuse, and a greater likelihood of developing Post-Traumatic Stress Disorder (PTSD) (Dutton, et al., 2006; Loxton, Scholfield, Hussain, & Mishra, 2006; Plichta, 2004; Romito, Molzan Turan, & Muarchi, 2005). As a result, women who experience IPV use a variety of health care services, including emergency departments, primary care physicians, and public health nurses (Campbell, 2002; Plichta, 2004; Van Hook, 2000). Although rates of IPV identification vary by practice setting, the results suggest that utilization of these services by victims of IPV is common. For example, 13 percent of 1,526 women at 31 outpatient clinics were identified as victims of abuse (Wasson et al., 2000), as were 14 per cent of 2,465 women using a variety of obstetrician/gynecologist offices, emergency departments, primary care offices, pediatrics, and addition recovery (McCloskey, et al., 2005), and 44.3 percent of 399 women at one family medicine clinic (Peralta & Fleming, 2003). Given the prevalence of IPV in these settings, health care providers have a central role in dealing with immediate injuries and other health impacts of IPV. However, it is also crucial for these providers to appropriately identify and refer women to much needed community resources which may prevent further injury and support women in working toward reducing and eliminating violence in their lives. For victims of IPV who live in remote and rural communities, support offered by health care providers is more crucial, as there is often few other resources and services.

Associations Between Maternal Age and Infant Health Outcomes Among Medicaid-Insured Infants in South Carolina: Mediating Effects of Socioeconomic Factors

The objective of this study was to investigate whether infants who are born to adolescent mothers are at greater risk for health problems than those who are born to older mothers. Data represent all health care encounters for infants who were born in South Carolina between 2000 and 2002 and were healthy at birth and continuously enrolled in fee-for-service Medicaid (n = 41696). We separately examined in the first and second years of life use of preventive care doctor visits, sick-infant doctor visits, emergency department visits, hospital admissions, and both emergency department visits and hospitalizations for ambulatory care-sensitive conditions. We compared these outcomes for infants of adolescent mothers (aged 11-17 years) and older mothers (aged 18-47 years), adjusting for individual characteristics of mothers and infants. In unadjusted results, infants of adolescent mothers used more health care in 9 of 12 use categories. For example, in year 1, they had an average of 1.71 emergency department visits and 1.39 hospitalizations, compared with 1.26 and 1.18, respectively, for infants of older mothers. In results that were adjusted only for infant and delivery characteristics, they similarly used more services in most categories. After adjustment for either mothers' characteristics alone or those of both the infant/delivery and mothers, there was evidence that they had modestly more sick-infant doctor visits and hospital admissions in year 1 and notably more hospital admissions for ambulatory care-sensitive conditions. Infants of adolescent mothers are more likely than infants of older mothers to use a variety of health care services that suggest poorer health. A considerable proportion of this greater use seems to be attributable to specific characteristics of mothers, such as socioeconomic characteristics, rather than to an inability that is common among adolescents to promote infant health or to use health care appropriately.