Wide Range Of Health Care Services Research Articles

Outpatient appointment systems: A new heuristic with patient classification

PurposeThis study aims to develop a heuristic for an outpatient appointment system considering patient classification. Design/methodology/approachThe proposed heuristic was applied in simulations with eighteen scenarios, combining different environmental factors. Total cost was adopted as a performance metric, composed of the patient's wait time and the service provider's idleness and overtime. The patients were divided into two classes according to their no-show probability, in an arrivals sequence with a binomial distribution. As a significance test of the results, Bonferroni-adjusted repeated measures analysis was applied. FindingsHaving Dome rule as baseline, an increase in performance in terms of total cost (TC) was observed, which varied between 0.46 % and 5.94 % among the means of the simulated environments, validated using the proposed significance test. The greatest benefits were obtained in the scenarios with lower ratios between service provider costs and patient costs (CR), as well as lower coefficients of variation for service times (Cv). It was also found that the heuristic is more efficient when patients from the class with the highest no-show rate predominate in the session. OriginalityThe single study identified in the literature that contemplates recalculations adopts deterministic service times to make its model viable. The present research, in turn, makes more realistic assumptions for the simulated environments, considering the variables and probability distributions most commonly observed in practical contexts Practical implicationsThe proposed heuristic provided a significant increase in performance for some combinations of environmental factors analyzed, preserving flexibility in the choice of appointment slots and covering a wide range of healthcare services found in practice.

Mobile clinics for opioid use disorders: What they do and how they do it. A qualitative analysis

IntroductionPeople with substance use disorders (SUD) face many barriers to receiving evidence-based treatments including access to and cost of treatment. People who use drugs face stigma that limits access to traditional office-based clinics. With the goal of reducing morbidity and mortality, mobile clinics reduce many of these barriers by providing harm reduction and on-demand low-threshold medical care. MethodsIn 2020 Massachusetts Department of Public Health (DPH) Mobile Addiction Services Program expanded a program called Community Care in Reach building on its success in reducing barriers to care and increasing patient encounters. In the current evaluation we conducted site visits to the four new mobile clinics and conducted one individual semi-structured provider interview at each of the four clinics. In addition, we supported a monthly learning collaborative of staff in four agencies involved with this initiative. The current evaluation used the RE-AIM framework to analyze the implementation of the mobile clinics. ResultsClinicians described many challenges and opportunities. The typical patient is unhoused, having a substance use disorder, and disconnected from traditional pathways to care. Clinicians are able to initiate people on buprenorphine largely due to the trust they establish with patients. Referral networks are facilitated by established community linkages. The philosophy of care is patient-centered. Mobile clinics provide a wide range of healthcare services including harm reduction, although finding a location to park and relations with police can be challenging. The workflow is uneven due to the model that is built on unscheduled visits. ConclusionThis study provides insight into how mobile clinics address the gaps in care for persons with OUD and fatal opioid overdoses. Harm reduction services are a critical intervention and financial sustainability of mobile clinics has to be tested.

Understanding the issues and challenges in the implementation of nursing services in primary health care: A qualitative study in Garut, West Java, Indonesia

Background: Primary healthcare centers provide a wide range of healthcare services, with nurses playing pivotal roles in maintaining the quality of care. To enhance nurse performance, it is essential to gain insights into their experiences regarding the implementation of nursing services in these institutions. Objective: This study aimed to explore the issues and challenges related to nursing services in primary health care centers through the perspectives of Indonesian nurses. Methods: Qualitative research using a phenomenological approach was conducted. Twelve nurses from primary health care centers were purposively selected as study participants. Data were collected through face-to-face, semi-structured interviews between January 2022 and March 2022. Thematic analysis was employed for data analysis. Results: The analysis yielded five main themes: 1) Working with additional roles and duties, 2) Uncertainty regarding nurses’ roles and functions, 3) Nurses' concerns about the nursing profession, 4) Barriers to implementing nursing services, and 5) Nurses' expectations concerning nursing services. Conclusion: Nurses in primary health care centers face challenges in fully carrying out nursing services. Numerous issues and obstacles exist in the provision of nursing services at primary healthcare facilities. Therefore, it is essential to strengthen the authority and autonomy of nurses working in primary health care settings.

Care coordination and unmet need for specialised health services among children with special healthcare needs in the USA: results from a cross-sectional analysis of the national survey of children with special healthcare needs

ObjectiveTo report rates of need and unmet need for specialised health services (occupational and speech therapies, durable medical equipment, home healthcare, and mobility and communication aids) from the National Survey...

Limited waiting areas in outpatient clinics: an intervention to incorporate the effect of bridging times in blueprint schedules

BackgroundDistancing measures enforced by the COVID-19 pandemic impose a restriction on the number of patients simultaneously present in hospital waiting areas.ObjectiveEvaluate waiting area occupancy of an intervention that designs clinic...

Annual out-of-pocket expenditure associated with healthcare use among Australian older women with osteoporosis: a cross-sectional study

Osteoporosis is a common skeletal condition among women that has a considerable impact on quality of life. The purpose of this study is to determine the prevalence of healthcare use and to estimate associated out-of-pocket expenditure for the management of osteoporosis in older Australian women. Data was obtained from 393 Australian women from the 45 and Up Study who had osteoporosis. The women were asked about healthcare use for their osteoporosis, including conventional medicine, complementary medicine, and self-care practices or self-care products, and associated out-of-pocket expenditure for that use over 12months. The average age of participants was 72.0years. Over a 12-month period, the majority of participants (72%) consulted a doctor for their osteoporosis, 24% consulted an allied health practitioner, and 20% consulted a complementary medicine practitioner. Participants had a mean of 6.8 consultations with healthcare practitioners in the previous 12months for the osteoporosis. In addition, 46% participants used three or more types of complementary medicine products/practices in the previous 12months. Overall, the participants incurred a (arithmetic) mean ofAU$594 (median = $350; inter-quartile range = $450) in out-of-pocket expenditure for healthcare use over the 12-month period. Women with osteoporosis use a wide range of healthcare services that are associated with significant annual out-of-pocket expenditure. Preventive strategies can help decrease the cost burden of osteoporosis on the healthcare system.

A pilot evaluation of Swasthya Pahal program using SMAART informatics framework to support NCD self-management.

Empirical research acknowledges the capability of mHealth and eHealth interventions for ensuring high-quality and tailored healthcare to individuals. People living with various health conditions get access to a wide range of healthcare services through digital interventions. The aim of the study is to examine the usefulness of Swasthya Pahal, a community-based Health for all program, aimed to enhance screening and self-management of diabetes, hypertension, and obesity among police personnel. A convenient sample of 64 individuals aged 18 years and above present at the Police Sanchar Training Centre, Dehradun, Uttarakhand were enrolled over 2 days in January 2020. The Swasthya Pahal pilot program was approved by the Uttarakhand State Police authorities. Individuals' health data was recorded using an interactive, bi-lingual, touch screen, computer-based program. Subjective data was collected and self-reported information was gathered about (I) socio-demographics, (II) health behaviors, (III) clinical status, and (IV) Knowledge, Attitudes, and Practices (KAP). Objective data assessments included measurements such as weight, blood pressure, and blood sugar levels using a series of physiological sensors. Additional information gathered at 1 month follow up included modifications that individuals made in their self-management of diabetes and hypertension, diet, physical activity, alcohol consumption, and smoking. Information was gathered related to individuals' interest in receiving SMS based health messages. The average age of study participants was 37 (SD =8) years, 88% were males, and 42% had graduate education. Hypertension (31%) was found to be the most common family history. Thirty-six percent of individuals were presently smokers or consumed alcohol. Sixty-two percent of them self-reported doing some form of exercise. Walking, jogging and yoga were the most common exercise types. Eighty-seven percent of them were not receiving any treatment to self-manage hypertension. Based on the JNC 8 criteria, 37% of the individuals were hypertensive. Fifty of the 64 individuals expressed interest to receive SMS message, 64% of them expressed keenness to receive weekly SMS messages. Messages related to diet, physical activity, sleep, and smoking and alcohol consumption were perceived as important. The Swasthya Pahal program using the SMAART informatics framework is a useful tool to enhance screening and self-management of non-communicable diseases (NCDs) among police personnel.

Performing Analysis of Quality of Service Parameters of 4G Long Term Evolution in Health Care System

Long Term Evolution (LTE) is a leading 4G wireless broadband technology developed by the Third Generation Partnership Project (3GPP) Release 8. LTE is expected to provide very fast, highly responsive and cost effective data services and appears itself to be the right technology at the right time. LTE is becoming an ultimate choice for 4G services around the world due to its higher data rates and lower latency objectives. E-Health services comprise a wide range of healthcare services delivered by utilizing information and communication technology. In order to help existing and emerging e-Health services over converged next generation network (NGN) architectures, there is a need for network QoS control mechanisms that meet the often stringent requirements of such services. The mobile Health (m-health) is currently uniting major academic research worldwide to achieve innovative arrangements in the areas of healthcare. However, there are several challenges and issues that need to be addressed. In this paper we have proposed m-health care system based on 4G LTE network communication instead of existing 3G communication system. We will be monitoring QoS parameters like Delay, Throughput, Jitter, Energy Efficiency and Packet Data Rate for comparing 3G and 4G LTE usage over health care applications. We will further experiment the parameters with graph based analysis.

Compressive Sensing of Medical Images With Confidentially Homomorphic Aggregations

Efficient medical image sampling and transferring becomes one of key research areas in computer science and healthcare application industries. In particular, the technique of body area networking and personal area networking are very useful in various image-based medical monitoring systems that cover a wide range of healthcare services, such as early detecting of emergency conditions and remote online instructing of surgeries. However, medical images are highly privacy sensitive and redundant. Thus, proper protection on privacy and secure data aggregation/compression are also highly expected in medical image processing. Based on compressive sensing theory, we conceive a so-called “one-stone-three-bird” solution for medical image acquisition and transmission in this paper. The size of the original medical images can be reduced to 20%, the resulted images have very well confidentiality and supporting additively homomorphic aggregation.

Critical evaluation of two approaches to achieve universal health coverage in India

The WHO report on the path to Universal Health Coverage (UHC) emphasizes that every person should receive the necessary healthcare without enduring financial hardship at the time of getting care. United Nations’ Sustainable Development agenda incorporates one goal (Goal 3) that is related to health and well-being of the population and one of the specific targets of the goal is to improve financial risk protection through the achievement of universal health coverage. More than 100 countries in the world have either started their reforms towards UHC or have already achieved it and India is one of the countries trying to achieve UHC. Out of the 1.324 billion people in India, only 11% of the population has any form of health insurance coverage. Around, 42% of India’s population is Below Poverty Line (BPL). Rashtriya Swasthya Bima Yojana is a health insurance program started in 2007 that provides a wide range of healthcare services for BPL families. Rajiv Aarogyasri Community Health Insurance is a state health insurance program started in Andhra Pradesh as one of the first programs in India to provide health insurance to poor people. In India, 39 million people are being impoverished due to OOP health expenditures each year, and a quarter of these expenditures are contributed by hospitalization Out-of-pocket expenditures even after the financial protection provided by a number of health insurance programs. This review will critically evaluate the two health insurance approaches which aim to achieve UHC in India by providing health protection to the indigent.

Pain and pain assessment in people with intellectual disability: Issues and challenges in practice

Accessible summary Pain is difficult to identify when people cannot communicate. If pain is not identified, it cannot be managed and causes stress. Pain assessment is essential in order to identify pain. Pain assessment requires a combination of knowledge, health assessments and observations. AbstractBackgroundIndividuals with intellectual disability experience the same chronic diseases and conditions as the general population, but are more likely to have physical and psychological co‐morbidities, resulting in a higher risk of experiencing pain and having more frequent or severe pain.MethodThis position paper aims to highlight the importance of pain assessment for people with intellectual disability.ResultsAs people with intellectual disability live within the community and/or remain in the family home, they are accessing a wide range of healthcare services. This necessitates that nurses across all care settings are knowledgeable regarding appropriate/alternative pain assessment methods for people with intellectual disability. While many pain assessment tools are available for use with the intellectual disability population, they are often not well established or infrequently used to establish their validity.ConclusionAlthough self‐report is the gold standard in pain assessment, pain assessment for people with intellectual disability is often challenging as they may be unable to self‐report their pain due to their levels of communication or cognitive ability. Assessment requires a combination of approaches amalgamating: pain assessment, health assessment and observation of behaviours.

Care experiences of young people with eating disorders and their parents: a qualitative study

BackgroundIn the UK, young people with eating disorders have different care pathways—general to highly specialised—depending on geographical location. A clear consensus on the most cost-effective and most valued treatment pathway is currently lacking. This study aimed to identify the most beneficial aspects of care through the perspectives of young people and their parents. We aimed to add depth to a parallel investigation of the cost-effectiveness of UK community-based eating disorder pathways. MethodsThis qualitative study recruited participants and used online focus groups through Beat (Beating Eating Disorders, a UK National Charity). 19 young women aged 16–25 years with an existing or past eating disorder and 11 parents participated in four and two focus groups, respectively. The sample size was informed by saturation of themes. Data were analysed using thematic analysis. All participants provided written informed consent. The study was approved by the University of Exeter Medical School Research Ethics Committee. FindingsFocus group discussions showed that seven features were essential for a good level of care: professionals' knowledge of eating disorders and care pathways, and early provision of psychoeducation to young people and their families; a holistic approach balancing physical and psychological aspects of care from referral and early intervention to recovery and relapse prevention; early, rapid access to services including crisis and out-of-hours support; peer support for young people and support for family members; consistency and continuity, especially around interprofessional communication and transition from child to adult services; long-term view focusing on recovery and lifelong skills to facilitate relapse prevention; and an individually tailored, flexible approach. InterpretationTo our knowledge, this is the first exploration through online focus groups of patients' perspectives of UK-based eating disorder pathways. Our findings suggest that no existing pathway is more beneficial; rather, a cluster of features are perceived as essential for a good level of care across services. Although small, our study collated the views of both young people and parents from various geographical locations, and covered a wide range of health-care services. FundingNone.

Staff Nurses and Physicians Attitudes toward the Use of Electronic Patient Record

Background: Electronic Patient record (EPR) links consumers, payers and providers across the continuum of care and provides relevant information to them. It is essential that information can be accessed from anywhere in the healthcare delivery system, even in remote locations. Aim: The current study aimed to assess and compare staff nurses' and physicians' attitudes toward EPR. Design: The study used a descriptive survey using self-report questionnaire. Setting: The present study was carried out at a private hospital namely Al Salama New Hospital and it is considered the first and the only hospital in Alexandria governorate at Egypt that implemented the EPR documentation system since 2004. It is equipped with around 100 beds, with a wide range of healthcare services. Subjects: One hundred and twenty five nurses and 90 physicians who were working in the previously mentioned setting. Tool: The data gathering tool staff nurses and physicians' attitudes toward EPR questionnaire. It was developed by the researcher based on Noble James nurses' attitudes toward computerization questionnaire (2002) and the current related literature to determine staff nurses and physicians' attitudes toward the use of EPR. It consists of five main dimensions and 56 sub- dimensions. Results: Around two- third 65.6% of staff nurses had positive attitudes toward the use of EPR. On the other hand, more than three quarters of physicians 75.6% had positive attitudes toward the use of EPR. In addition with no significant difference was found between staff nurses and physicians. The total score percent of the physicians' attitudes (75.6) was higher than the total mean score of the staff nurses' attitudes (65.6). Conclusion: Knowledge, training, and attitude need continual reinforcement to improve implementation for EPR. These results provide valuable information that could be used to encourage the implementation of EPR in Egypt. Recommendations: This study recommended for assuring electronic based documentation as criteria for magnet hospitals on the road of accreditation of healthcare organization. Develop clear policies and guidelines to address issues related to computer based documentation. It should be written and communicated to all healthcare organizations.

Effect of Sedation on Pain Perception

Sedation or anesthesia is used to facilitate many cases of an estimated 45 million diagnostic and therapeutic medical procedures in the United States. Preclinical studies have called attention to the possibility that sedative-hypnotic drugs can increase pain perception, but whether this observation holds true in humans and whether pain-modulating effects are agent-specific or characteristic of IV sedation in general remain unclear. To study this important clinical question, the authors recruited 86 healthy volunteers and randomly assigned them to receive one of three sedative drugs: midazolam, propofol, or dexmedetomidine. The authors asked participants to rate their pain in response to four experimental pain tasks (i.e., cold, heat, ischemic, or electrical pain) before and during moderate sedation. Midazolam increased cold, heat, and electrical pain perception significantly (10-point pain rating scale change, 0.82 ± 0.29, mean ± SEM). Propofol reduced ischemic pain and dexmedetomidine reduced both cold and ischemic pain significantly (-1.58 ± 0.28, mean ± SEM). The authors observed a gender-by-race interaction for dexmedetomidine. In addition to these drug-specific effects, the authors observed gender effects on pain perception; female subjects rated identical experimental pain stimuli higher than male subjects. The authors also noted race-drug interaction effects for dexmedetomidine, with higher doses of drug needed to sedate Caucasians compared with African Americans. The results of the authors' study call attention to the fact that IV sedatives may increase pain perception. The effect of sedation on pain perception is agent- and pain type-specific. Knowledge of these effects provides a rational basis for analgesia and sedation to facilitate medical procedures.

Intimate Partner Violence and its Implication for Pregnancy

Intimate partner violence (IPV) is a common occurrence in pregnancy and results in an increased risk of adverse outcomes. Homicide may be the most common cause of maternal death. Women who are pregnant and the victims of IPV have high rates of stress, are more likely to smoke or use other drugs, deliver a preterm or low birth weight infant, have an increase in infectious complications, and are less likely to obtain prenatal care. The IPV continues in the postpartum period. Adolescents may be at even higher risk than their adult counterparts. Children raised in violent homes have both immediate and life long adverse health outcomes as a result of their exposure to IPV. IPV adds substantially to healthcare costs both for direct services to treat the injuries and higher utilization of a wide range of healthcare services. Healthcare providers, particularly those who care for pregnant women, are in a unique position to identify these women and direct them and their families to the help they need to end the violence in their lives.

An Ethical Argument for Integrated Palliative Care.

‘In the midst of life, we are in death’from The Book of Common PrayerThe Palliative Care, or comfort care, movement in the USA is on the rise. Currently, palliative services are not integrated in an organized way throughout healthcare. If we accept the argument that palliative care is ethically desirable and that all patients are entitled to palliative services regardless of a terminal diagnosis, it follows that it needs to be integrated across a wide range of healthcare services. Ethical questions regarding palliative care and well-known ethical frameworks are discussed and an argument is made for integrating palliative healthcare services throughout the healthcare system and not simply at the end of life. Complementary and alternative medicine (CAM) therapies are discussed as useful and necessary components of palliative care. If we as a society look beyond separating cures and palliation, we will come closer to incorporating compassionate care throughout the disease process.