scholarly journals The impact of COVID‐19 on patient engagement in the health system: Results from a Pan‐Canadian survey of patient, family and caregiver partners

2022 ◽  
Author(s):  
Laura Tripp ◽  
Meredith Vanstone ◽  
Carolyn Canfield ◽  
Myles Leslie ◽  
Mary Anne Levasseur ◽  
...  
2020 ◽  
Author(s):  
Pothik Chatterjee ◽  
Adam Michael Beck ◽  
Jenna Ashley Levenson Brager ◽  
Daniel James Durand

BACKGROUND Revisits within 30-days to an emergency department (ED), observation care unit, or inpatient setting following patient discharge continue to be a challenge, especially in urban settings. In addition to the consequences for the patient, these revisits have a negative impact on a health system’s finances in a value based care or global budget environment. LifeBridge Health, a community health system in Maryland, implemented an automated patient digital engagement application as part of the overall organization’s digital health strategy to improve patient engagement and reduce revisits to the ED. OBJECTIVE To evaluate the effectiveness of a customized automated digital patient engagement application (GetWell Loop) to reduce 30-day revisits after home discharge from an ED or hospital inpatient setting. METHODS The LifeBridge Health Innovation Department and ED staff from two participating health system hospitals collaborated with the GetWell Network to customize their patient engagement application (GetWell Loop) with automated check-in questions and resources. An application link was e-mailed to adult patients discharged home from the ED. A retrospective study of ED visits for patients treated for general medicine and cardiology conditions between 8/1/2018 through 7/31/2019 was conducted using CRISP, Maryland’s state-designated health information exchange. We also used data within GetWell Loop to track patient activation and engagement. The primary endpoint was a comparison of ED patients that experienced a 30-day revisit and who did or did not activate their GetWell Loop account. Secondary end points included overall activation rate and the rate of engagement as measured by the number of logins, alerts, and comments generated by patients through the application. Statistical significance was calculated using the Fisher’s exact test with a P-value < 0.05. RESULTS Patients discharged from the ED who were treated for general medicine conditions (n=2087) and activated their GetWell Loop account experienced a 30-day revisit rate of 17.3% compared to 24.6% who did not activate their account (P<.001). For patients treated for cardiology conditions (n = 1779), 12.8% of patients who activated their GetWell account experienced a 30-day revisit compared to 17.7% not activating their account (P=.01). During this one-year study, 25% of all emergency patients receiving an invite to use the digital application activated their account (n=4125), logged in a total of 8935 times, generated 1911 alerts, and submitted 771 open ended comments/questions. CONCLUSIONS These results indicate the potential value of digital health applications to reduce 30-day revisit rates. The results also indicate patients are willing to utilize a digital application post-discharge to proactively engage in their own care. LifeBridge Health’s experience demonstrates that healthcare systems can leverage automated mobile applications to improve patient engagement and successfully impact clinical outcomes at scale.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Suhrcke ◽  
M Pinna Pintor ◽  
C Hamelmann

Abstract Background Economic sanctions, understood as measures taken by one state or a group of states to coerce another into a desired conduct (eg by restricting trade and financial flows) do not primarily seek to adversely affect the health or health system of the target country's population. Yet, there may be indirect or unintended health and health system consequences that ought to be borne in mind when assessing the full set of effects of sanctions. We take stock of the evidence to date in terms of whether - and if so, how - economic sanctions impact health and health systems in LMICs. Methods We undertook a structured literature review (using MEDLINE and Google Scholar), covering the peer-reviewed and grey literature published from 1970-2019, with a specific focus on quantitative assessments. Results Most studies (23/27) that met our inclusion criteria focus on the relationship between sanctions and health outcomes, ranging from infant or child mortality as the most frequent case over viral hepatitis to diabetes and HIV, among others. Fewer studies (9/27) examined health system related indicators, either as a sole focus or jointly with health outcomes. A minority of studies explicitly addressed some of the methodological challenges, incl. control for relevant confounders and the endogeneity of sanctions. Taking the results at face value, the evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. Conclusions Quantitatively assessing the impact of economic sanctions on health or health systems is a challenging task, not least as it is persistently difficult to disentangle the effect of sanctions from many other, potentially major factors at work that matter for health (as, for instance, war). In addition, in times of severe economic and political crisis (which often coincide with sanctions), the collection of accurate and comprehensive data that could allow appropriate measurement is typically not a priority. Key messages The existing evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. There is preciously little good quality evidence on the health (system) impact of economic sanctions.


Author(s):  
Serena Barello ◽  
Rosario Caruso ◽  
Lorenzo Palamenghi ◽  
Tiziana Nania ◽  
Federica Dellafiore ◽  
...  

Abstract Purpose The purpose of the present cross-sectional study is to investigate the role of perceived COVID-19-related organizational demands and threats in predicting emotional exhaustion, and the role of organizational support in reducing the negative influence of perceived COVID-19 work-related stressors on burnout. Moreover, the present study aims to add to the understanding of the role of personal resources in the Job Demands-Resources model (JD-R) by examining whether personal resources—such as the professionals’ orientation towards patient engagement—may also strengthen the impact of job resources and mitigate the impact of job demands. Methods This cross-sectional study involved 532 healthcare professionals working during the COVID-19 pandemic in Italy. It adopted the Job-Demands-Resource Model to study the determinants of professional’s burnout. An integrative model describing how increasing job demands experienced by this specific population are related to burnout and in particular to emotional exhaustion symptoms was developed. Results The results of the logistic regression models provided strong support for the proposed model, as both Job Demands and Resources are significant predictors (OR = 2.359 and 0.563 respectively, with p < 0.001). Moreover, healthcare professionals’ orientation towards patient engagement appears as a significant moderator of this relationship, as it reduces Demands’ effect (OR = 1.188) and increases Resources’ effect (OR = 0.501). Conclusions These findings integrate previous findings on the JD-R Model and suggest the relevance of personal resources and of relational factors in affecting professionals’ experience of burnout.


2021 ◽  
Vol 10 (s1) ◽  
Author(s):  
Pablo Marshall

Abstract Objectives: Coronavirushas had profound effects on people’s lives and the economy of many countries, generating controversy between the need to establish quarantines and other social distancing measures to protect people’s health and the need to reactivate the economy. This study proposes and applies a modification of the SIR infection model to describe the evolution of coronavirus infections and to measure the effect of quarantine on the number of people infected. Methods: Two hypotheses, not necessarily mutually exclusive, are proposed for the impact of quarantines. According to the first hypothesis, quarantine reduces the infection rate, delaying new infections over time without modifying the total number of people infected at the end of the wave. The second hypothesis establishes that quarantine reduces the population infected in the wave. The two hypotheses are tested with data for a sample of 10 districts in Santiago, Chile. Results: The results of applying the methodology show that the proposed model describes well the evolution of infections at the district level. The data shows evidence in favor of the first hypothesis, quarantine reduces the infection rate; and not in favor of the second hypothesis, that quarantine reduces the population infected. Districts of higher socio-economic levels have a lower infection rate, and quarantine is more effective. Conclusions: Quarantine, in most districts, does not reduce the total number of people infected in the wave; it only reduces the rate at which they are infected. The reduction in the infection rate avoids peaks that may collapse the health system.


2020 ◽  
Vol 41 (1) ◽  
Author(s):  
Adweeti Nepal ◽  
Santa Kumar Dangol ◽  
Anke van der Kwaak

Abstract Background The persistent quality gap in maternal health services in Nepal has resulted in poor maternal health outcomes. Accordingly, the Government of Nepal (GoN) has placed emphasis on responsive and accountable maternal health services and initiated social accountability interventions as a strategical approach simultaneously. This review critically explores the social accountability interventions in maternal health services in Nepal and its outcomes by analyzing existing evidence to contribute to the informed policy formulation process. Methods A literature review and desk study undertaken between December 2018 and May 2019. An adapted framework of social accountability by Lodenstein et al. was used for critical analysis of the existing literature between January 2000 and May 2019 from Nepal and other low-and-middle-income countries (LMICs) that have similar operational context to Nepal. The literature was searched and extracted from database such as PubMed and ScienceDirect, and web search engines such as Google Scholar using defined keywords. Results The study found various social accountability interventions that have been initiated by GoN and external development partners in maternal health services in Nepal. Evidence from Nepal and other LMICs showed that the social accountability interventions improved the quality of maternal health services by improving health system responsiveness, enhancing community ownership, addressing inequalities and enabling the community to influence the policy decision-making process. Strong gender norms, caste-hierarchy system, socio-political and economic context and weak enforceability mechanism in the health system are found to be the major contextual factors influencing community engagement in social accountability interventions in Nepal. Conclusions Social accountability interventions have potential to improve the quality of maternal health services in Nepal. The critical factor for successful outcomes in maternal health services is quality implementation of interventions. Similarly, continuous effort is needed from policymakers to strengthen monitoring and regulatory mechanism of the health system and decentralization process, to improve access to the information and to establish proper complaints and feedback system from the community to ensure the effectiveness and sustainability of the interventions. Furthermore, more study needs to be conducted to evaluate the impact of the existing social accountability interventions in improving maternal health services in Nepal.


2021 ◽  
Author(s):  
Michael Livingston ◽  
Kerri Coomber ◽  
Dominique de Andrade ◽  
Nicholas Taylor ◽  
Jason Ferris ◽  
...  

2017 ◽  
Vol 54 (1) ◽  
pp. 70-74 ◽  
Author(s):  
Elinton Adami CHAIM ◽  
José Carlos PAREJA ◽  
Martinho Antonio GESTIC ◽  
Murillo Pimentel UTRINI ◽  
Everton CAZZO

ABSTRACT BACKGROUND Bariatric surgery has become the gold standard treatment for morbid obesity, but access to surgery remains difficult and low compliance to postoperative follow-up is common. To improve outcomes, enable access and optimize follow-up, we developed a multidisciplinary preoperative approach for bariatric surgery. OBJECTIVE To determine the impact of this program in the outcomes of bariatric surgery in the Brazilian public health system. METHODS A prospective evaluation of the individuals who underwent a preoperative multidisciplinary program for bariatric surgery and comparison of their surgical outcomes with those observed in the prospectively collected historical database of the individuals who underwent surgery before the beginning of the program. RESULTS There were 176 individuals who underwent the multidisciplinary program and 226 who did not. Individuals who underwent the program had significantly lower occurrence of the following variables: hospital stay; wound dehiscence; wound infection; pulmonary complications; anastomotic leaks; pulmonary thromboembolism; sepsis; incisional hernias; eventrations; reoperations; and mortality. Both loss of follow-up and weight loss failure were also significantly lower in the program group. CONCLUSION The adoption of a comprehensive preoperative multidisciplinary approach led to significant improvements in the postoperative outcomes and also in the compliance to the postoperative follow-up. It represents a reproducible and potentially beneficial approach within the context of the Brazilian public health system.


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