scholarly journals Long-term effects of payment for performance on maternal and child health outcomes: evidence from Tanzania

2021 ◽  
Vol 6 (12) ◽  
pp. e006409
Author(s):  
Josephine Borghi ◽  
Peter Binyaruka ◽  
Iddy Mayumana ◽  
Siri Lange ◽  
Vincent Somville ◽  
...  
Keyword(s):  
Health Workers ◽  
Healthcare Providers ◽  
Household Survey ◽  
Long Term Effects ◽  
Experience Of Care ◽  
Care Giving ◽  
Programme Design ◽  
Before And After ◽  
Ongoing Assessment ◽  
Over Time

BackgroundThe success of payment for performance (P4P) schemes relies on their ability to generate sustainable changes in the behaviour of healthcare providers. This paper examines short-term and longer-term effects of P4P in Tanzania and the reasons for these changes.MethodsWe conducted a controlled before and after study and an embedded process evaluation. Three rounds of facility, patient and household survey data (at baseline, after 13 months and at 36 months) measured programme effects in seven intervention districts and four comparison districts. We used linear difference-in-difference regression analysis to determine programme effects, and differential effects over time. Four rounds of qualitative data examined evolution in programme design, implementation and mechanisms of change.ResultsProgramme effects on the rate of institutional deliveries and antimalarial treatment during antenatal care reduced overtime, with stock out rates of antimalarials increasing over time to baseline levels. P4P led to sustained improvements in kindness during deliveries, with a wider set of improvements in patient experience of care in the longer term. A change in programme management and funding delayed incentive payments affecting performance on some indicators. The verification system became more integrated within routine systems over time, reducing the time burden on managers and health workers. Ongoing financial autonomy and supervision sustained motivational effects in those aspects of care giving not reliant on funding.ConclusionOur study adds to limited and mixed evidence documenting how P4P effects evolve over time. Our findings highlight the importance of undertaking ongoing assessment of effects over time.

scholarly journals The effect of community dialogues and sensitization on patient reporting of adverse events in rural Uganda: uncontrolled before-after study

2018 ◽  
Author(s):  
Helen Byomire Ndagije ◽  
Leonard Manirakiza ◽  
Dan Kajungu ◽  
Edward Galiwango ◽  
Donna Kusemererwa ◽  
...  
Keyword(s):  
Adverse Events ◽  
Community Engagement ◽  
Adverse Drug Events ◽  
Health Workers ◽  
Household Survey ◽  
Rural Setting ◽  
Health Issues ◽  
Community Members ◽  
Cross Sectional ◽  
Before And After

AbstractBackgroundThe patients that experience adverse events are in the best position to report them, only if they were empowered to do so. Systematic community engagement and support to patients in a rural setting to monitor any potential harm from medicines should provide evidence for patient safety.MethodsThis paper describes an uncontrolled before and after study aimed at assessing the effect of a community engagement strategy, the Community Dialogues and Sensitization (CDS) intervention between January and April 2017, on the knowledge, attitude and practice of reporting adverse drug events by community members in the two eastern Ugandan districts. A representative cross-sectional baseline household survey was done prior to the intervention in September 2016 (n=1034) and the end-line survey (n=827) in July 2017.ResultsAfter implementation of the CDS intervention, there was an overall 20% (95% CI=16- 25) increase in awareness about adverse drug events in the community. The young people (15- 24 years) demonstrated a 41% (95% CI =31-52) increase and the un-educated showed a 50% (95% CI=37-63) increase in awareness about adverse drug events. The attitudes towards reporting increased overall by 5% in response to whether there was a need to report ADEs (95% CI =3-7). An overall 115% (95% CI =137-217) increase in the population that had ever experienced ADEs was also reported.ConclusionOur evaluation shows that the CDS intervention increases knowledge, improves attitudes by catalyzing discussions among community members and health workers on health issues and monitoring safety of medicines.

Bitter Harvest: the Implications of Continuing War-related Stress on Reminiscence Theory and Practice

1997 ◽  
Vol 17 (3) ◽  
pp. 337-348 ◽  
Author(s):  
M. P. BENDER
Keyword(s):  
Health Workers ◽  
Traumatic Event ◽  
Theory And Practice ◽  
Mental Health Workers ◽  
Long Term Effects ◽  
Group Leaders ◽  
Before And After ◽  
The Media ◽  
Related Stress ◽  
Clinical Awareness

This paper, after reporting some research indicating the long-term effects of the experience of the Second World War, looks at how such a traumatic event and its sequelae should be understood in terms of the theoretical framework supporting the use of reminiscence work, most especially Erikson's life stages. Traumatic memories of the war are rarely reported in published accounts of reminiscence work. It is pointed out that this may be partly due to people with painful memories not volunteering for reminiscence groups, and that Coleman's (1986) research data would support this conclusion. Coleman's work has not been sufficiently ‘heard’ because of the much stronger framing of reminiscence as stimulation by such authors as Norris (1986). The paper looks at interpersonal difficulties of servicemen and civilians in communicating about the war; and why they might well find it easier to utilise the emotionally simpler and less unpleasant accounts offered by the media, especially film. The leaders of reminiscence groups, often having had little training, operate without awareness of such issues, and within a framework where ‘reminiscence as stimulation’ has been transmuted into the trivialising ‘reminiscence as fun’. It is suggested that mental health workers should offer regular supervision and training to reminiscence group leaders. The need for clinical awareness of the importance of the war in shaping people's lives both before and after the war is highlighted, as is the need for readily available and sympathetic psychotherapeutic services for this cohort.

Weekly Exercise Consistently Reinstates Positive Mood

1998 ◽  
Vol 3 (4) ◽  
pp. 271-280 ◽  
Author(s):  
Hannah Steinberg ◽  
Briony R. Nicholls ◽  
Elizabeth A. Sykes ◽  
N. LeBoutillier ◽  
Nerina Ramlakhan ◽  
...  
Keyword(s):  
Physical Exercise ◽  
Negative Mood ◽  
Real Life ◽  
Positive Mood ◽  
Field Investigation ◽  
Single Bout ◽  
Before And After ◽  
Exercise Class ◽  
Negative Feelings ◽  
Over Time

Mood improvement immediately after a single bout of exercise is well documented, but less is known about successive and longer term effects. In a “real-life” field investigation, four kinds of exercise class (Beginners, Advanced, Body Funk and Callanetics) met once a week for up to 7 weeks. Before and after each class the members assessed how they felt by completing a questionnaire listing equal numbers of “positive” and “negative” mood words. Subjects who had attended at least five times were included in the analysis, which led to groups consisting of 18, 20, 16, and 16 subjects, respectively. All four kinds of exercise significantly increased positive and decreased negative feelings, and this result was surprisingly consistent in successive weeks. However, exercise seemed to have a much greater effect on positive than on negative moods. The favorable moods induced by each class seemed to have worn off by the following week, to be reinstated by the class itself. In the Callanetics class, positive mood also improved significantly over time. The Callanetics class involved “slower,” more demanding exercises, not always done to music. The Callanetics and Advanced classes also showed significantly greater preexercise negative moods in the first three sessions. However, these differences disappeared following exercise. Possibly, these two groups had become more “tolerant” to the mood-enhancing effects of physical exercise; this may be in part have been due to “exercise addiction.”

Pengaruh Perawatan Metode Kanguru (PMK) terhadap Pencegahan Hipotermi pada Bayi Baru Lahir

2020 ◽  
Vol 2 (2) ◽  
pp. 66-71
Author(s):  
Parti ◽  
Sumiati Malik ◽  
Nurhayati
Keyword(s):  
Birth Weight ◽  
Infant Mortality ◽  
Low Birth Weight ◽  
Health Workers ◽  
Kangaroo Mother Care ◽  
Infant Mortality Rate ◽  
P Value ◽  
Low Birth Weight Infants ◽  
Low Birth Weight Babies ◽  
Before And After

Most causes of infant death are problems that occur in newborn/neonatal (0-28 days old), Low Birth Weight Babies (LBW) is one of the factors which has a contribution to infant mortality, especially in the neonatal period. Infant Mortality Rate (IMR) is a benchmark in determining the degree of public health, both at the National and Provincial levels. This study aimed to determine the effect of the Kangaroo Mother Care Method (KMC) on the prevention of hypothermia in low birth weight infants at Morowali District Hospital in 2019. The type of research used was a quasi-experiment. The population is all low birth weight babies born from May to July 2019. The sample in this study was all newborns with low birth weight born from May to July 2019, totaling 30 babies. There is a difference (influence) on the baby's body temperature before and after KMC with a p-value=0,000. The kangaroo mother care can continue to be affiliated considering its benefits for both infants and mothers, as well as increasing the ability of health workers in conducting KMC so that they can provide in-house training for mothers to be carried out at home.

UK Fiscal Squeezes over a Century

2017 ◽  
Author(s):  
Christopher Hood ◽  
Rozana Himaz
Keyword(s):  
Data Sources ◽  
Fiscal Consolidation ◽  
Financial Outcomes ◽  
Financial Conditions ◽  
Deficit Reduction ◽  
Before And After ◽  
The Uk ◽  
Changes Over Time ◽  
Spending Cuts ◽  
Over Time

This chapter draws on historical statistics reporting financial outcomes for spending, taxation, debt, and deficit for the UK over a century to (a) identify quantitatively and compare the main fiscal squeeze episodes (i.e. major revenue increases, spending cuts, or both) in terms of type (soft squeezes and hard squeezes, spending squeezes, and revenue squeezes), depth, and length; (b) compare these periods of austerity against measures of fiscal consolidation in terms of deficit reduction; and (c) identify economic and financial conditions before and after the various squeezes. It explores the extent to which the identification of squeeze episodes and their classification is sensitive to which thresholds are set and what data sources are used. The chapter identifies major changes over time that emerge from this analysis over the changing depth and types of squeeze.

scholarly journals Ten-year trends in epidemiology and outcomes of pediatric kidney replacement therapy in Europe: data from the ESPN/ERA-EDTA Registry

2021 ◽  
Author(s):  
Marjolein Bonthuis ◽  
Enrico Vidal ◽  
Anna Bjerre ◽  
Özlem Aydoğ ◽  
Sergey Baiko ◽  
...  
Keyword(s):  
Replacement Therapy ◽  
Cox Regression ◽  
Patient Survival ◽  
Healthcare Providers ◽  
Resource Planning ◽  
Policy Makers ◽  
Age Related ◽  
Kidney Replacement Therapy ◽  
Over Time ◽  
Related Population

Abstract Background For 10 consecutive years, the ESPN/ERA-EDTA Registry has included data on children with stage 5 chronic kidney disease (CKD 5) receiving kidney replacement therapy (KRT) in Europe. We examined trends in incidence and prevalence of KRT and patient survival. Methods We included all children aged <15 years starting KRT 2007–2016 in 22 European countries participating in the ESPN/ERA-EDTA Registry since 2007. General population statistics were derived from Eurostat. Incidence and prevalence were expressed per million age-related population (pmarp) and time trends studied with JoinPoint regression. We analyzed survival trends using Cox regression. Results Incidence of children commencing KRT <15 years remained stable over the study period, varying between 5.5 and 6.6 pmarp. Incidence by treatment modality was unchanged over time: 2.0 for hemodialysis (HD) and peritoneal dialysis (PD) and 1.0 for transplantation. Prevalence increased in all age categories and overall rose 2% annually from 26.4 pmarp in 2007 to 32.1 pmarp in 2016. Kidney transplantation prevalence increased 5.1% annually 2007–2009, followed by 1.5% increase/year until 2016. Prevalence of PD steadily increased 1.4% per year over the entire period, and HD prevalence started increasing 6.1% per year from 2011 onwards. Five-year unadjusted patient survival on KRT was around 94% and similar for those initiating KRT 2007–2009 or 2010–2012 (adjusted HR: 0.98, 95% CI:0.71–1.35). Conclusions We found a stable incidence and increasing prevalence of European children on KRT 2007–2016. Five-year patient survival was good and was unchanged over time. These data can inform patients and healthcare providers and aid health policy makers on future resource planning of pediatric KRT in Europe.

scholarly journals Feasibility and Enjoyment of Exercise Video Games in Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 559-559
Author(s):  
Sara Freed ◽  
Briana Sprague ◽  
Lesley Ross
Keyword(s):  
Older Adults ◽  
Video Games ◽  
Game Design ◽  
Long Term Effects ◽  
Short Term ◽  
Qualitative And Quantitative ◽  
Before And After ◽  
Xbox Kinect ◽  
Game Developers

Abstract Interventions using exercise video games, or exergames, have shown short-term cognitive and physical benefits to older adults, though long-term effects are less promising. Enjoyment of exergames may promote exergame use after the intervention period, though little work has examined older adults’ views of exergames before and after gameplay experience. We invited 20 older adults between 65 and 84 years of age (M=73.30, SD=5.95) to play two Xbox Kinect games, Just Dance and Kinect Sports Rivals, for twenty minutes. In our presentation, we will present qualitative and quantitative findings of this pilot study, including findings that older adults reported that they were not likely to play similar exergames in the future and that they did not find the exergames to be more fun compared to other ways of exercising. We will discuss implications for game design and research relevant to game developers, manufacturers, and researchers. Part of a symposium sponsored by Technology and Aging Interest Group.

Improving Genetics Clinic Efficiency and Capacity Using Design and Human Factors Methods

2021 ◽  
Vol 10 (1) ◽  
pp. 204-210
Author(s):  
Maryam Attef ◽  
Mireille Cloutier ◽  
Meredith Gillespie ◽  
Chantal Trudel ◽  
Kym Boycott
Keyword(s):  
Human Factors ◽  
Task Analysis ◽  
Healthcare Providers ◽  
Time On Task ◽  
Prenatal Genetics ◽  
Factors Influencing ◽  
Number Of Patients ◽  
Clinic Efficiency ◽  
Before And After ◽  
Improve Access

This quality improvement study focused on developing an understanding of factors influencing the ability of prenatal genetics counsellors (GCs) to efficiently see patients during the COVID-19 pandemic and strategies to improve their workflow using techniques from human factors and design. The demand for Prenatal Genetics Clinics is rising which has increased pressure on GCs to become more efficient. Genetics counsellors can improve access to their services by reducing the time spent on the tasks performed before and after a genetic counselling encounter, thereby increasing the number of patients they see. We were limited to certain methods to understand the differences in workflow before and during the COVID-19 pandemic. This study involved a literature review, archival analysis of workflow studies conducted before the pandemic, stakeholder meetings and mapping, a brainstorming session, as well as documenting time-on-task in a diary and naturalistic observation sessions. A task analysis was developed to identify factors influencing efficiency related to the design of the space, processes and the use of artefacts. Virtual and on-site workflows show that GCs spend at least half of their time on tasks before and/or after the patient’s appointment. Looking at potential inefficiencies or bottlenecks in workflow formed the development of a strategic plan for improving GC workflows at the prenatal Genetics Clinic. Improvements suggested through this analysis were constrained to support the current number of healthcare providers working within the existing space configuration.

scholarly journals Land Policy and Food Prices: Evidence from a Land Consolidation Program in Rwanda

2021 ◽  
Vol 19 (1) ◽  
pp. 63-73
Author(s):  
Aimable Nsabimana ◽  
Fidele Niyitanga ◽  
Dave D. Weatherspoon ◽  
Anwar Naseem
Keyword(s):  
Food Prices ◽  
Land Policy ◽  
Land Consolidation ◽  
Easy Access ◽  
Food Crops ◽  
White Potato ◽  
Before And After ◽  
Price Differences ◽  
The Impact ◽  
Over Time

Abstract Rwanda’s “Crop Intensification Program (CIP)” is primarily a land consolidation program aimed at improving agricultural productivity and food security. The program, which began in 2007, focuses on monocropping and commercialization of six priority crops: maize, wheat, rice, white potato, beans, and cassava. CIP has facilitated easy access to improved seed stocks, fertilizer, extension services, and postharvest handling and storage services. Although studies have documented the impact of CIP on changes in farm yield, incomes, and productivity, less is known about its impact on food prices. In this study, we examine the crop-food price differences in intensive monocropped CIP and non-intensive monocropped CIP zones in Rwanda. Specifically, the study evaluates price variations of beans and maize along with complementary food crops in intensive and non-intensive monocropped zones before and after the introduction of the CIP policy. We find that the CIP policy is not associated with differences in CIP crop prices between the intensive and non-intensive monocropped zones. Over time, prices increased for CIP crops but generally, the crop prices in the two zones were cointegrated. Prices for non-CIP crops in the two different zones did show price differentials prior to the implementation of CIP, with the prices in intensive monocropped zones being greater than in the non-intensive monocropped zones. Moreover, the prices in intensive areas are cointegrated with prices in non-intensive areas for maize and beans and these prices are converging. This indicates that farmers who intensively produced one CIP crop were able to go to the market and purchase other food crops and that price differences between zones have decreased over time, potentially making the CIP intensive farmers better off.

scholarly journals 139. Impact of Pharmacist Driven Outpatient Fluoroquinolone Stewardship Initiative in Community Based Setting

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S81-S81
Author(s):  
Sarah Norman ◽  
Sara Jones ◽  
Cara Acklin ◽  
Christian Cheatham
Keyword(s):  
Antimicrobial Stewardship ◽  
Healthcare Providers ◽  
Hospital Setting ◽  
Secondary Outcome ◽  
Quality Improvement Initiative ◽  
Oral Antibiotic ◽  
Ambulatory Care Setting ◽  
Community Based ◽  
Before And After ◽  
Physician Network

Abstract Background Antimicrobial stewardship initiatives and efforts have historically had a greater emphasis in the inpatient hospital setting. There is a need for outpatient stewardship, and additionally, accreditation standards are starting to require antimicrobial stewardship efforts in the ambulatory care setting. Fluoroquinolones are a target for antimicrobial stewardship based on their broad-spectrum activity, pharmacokinetics/pharmacodynamics, safety profile, downstream resistance, and risk of super infections. The objective of this study was to compare outpatient fluoroquinolone prescribing rates before and after pharmacist led initiative. Methods This was a prospective, quality improvement initiative between October 1, 2019 to June 1, 2020 at a community-based physician network across Indiana. The pharmacist initiative incorporated a live, educational presentation with intervention 1 and an informational letter to healthcare providers across the outpatient physician network with intervention 2. Data was collected from a computer-generated, prescription report. The primary outcome was fluoroquinolone prescribing rates at Central Indiana (CI) sites before and after pharmacist led interventions. Rate of fluoroquinolone prescribing was defined as total number of fluoroquinolone prescriptions per month. The secondary outcome included percentage of fluoroquinolone use at CI sites. Percentage of fluoroquinolone use was defined as monthly number of fluoroquinolones prescriptions compared to monthly number of all oral antibiotic prescriptions. Results There was a 29.8% decrease (382 vs 268 prescriptions) in outpatient fluoroquinolone prescriptions at CI sites after intervention 1 compared to same month of previous year. There was a 43.7% decrease (428 vs 241 prescriptions) in outpatient fluoroquinolone prescriptions at CI sites after intervention 2. There was an overall 2.4% decrease (4.9% vs 2.5%) in percentage of fluoroquinolone use compared to all oral antibiotics at CI sites after intervention 2 compared to same month of previous year. Conclusion These findings suggest the pharmacist led outpatient antimicrobial stewardship initiative successfully decreased fluoroquinolone prescribing rates across the network. Disclosures Christian Cheatham, PharmD, BCIDP, Antimicrobial Resistance Solutions (Shareholder)

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