scholarly journals Collaborative model of intrapartum care: qualitative study on barriers and facilitators to implementation in a private Brazilian hospital

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e053636
Author(s):  
Mercedes Colomar ◽  
Franco Gonzalez Mora ◽  
Ana Pilar Betran ◽  
Newton Opiyo ◽  
Meghan A Bohren ◽  
...  
Keyword(s):  
Health System ◽  
Cultural Beliefs ◽  
Educational Interventions ◽  
Maternity Hospital ◽  
Barriers And Facilitators ◽  
System Structure ◽  
Quality Improvement Initiative ◽  
Intrapartum Care ◽  
Potential Barriers ◽  
Hospital Managers

IntroductionA collaborative (midwife-obstetrician) model of intrapartum care (CMIC) is associated with lower caesarean section (CS) rates than physician-led models. In 2019, the largest private maternity hospital in Latin America (14.000 deliveries/year, 89% CS) created a quality improvement initiative to optimise intrapartum care and safely reduce CS in low-risk women managed by its internal team of healthcare providers (HCP). We conducted formative research to identify potential barriers and facilitators to the implementation of a CMIC.MethodsThree groups of stakeholders participated in focus groups and interviews: hospital managers and clinical coordinators, HCP working in labour/delivery wards and pregnant women intending to give birth in the hospital. We explored participants’ views about the acceptability of implementing a CMIC where a nurse-midwife (NM) on shift would be the main intrapartum HCP, with continuous support/supervision of a dedicated, in-house, obstetrician-gynaecologist (OB-GYN). A thematic analysis approach was used.Results12 HCPs, 5 clinical coordinators, 2 hospital managers and 7 women participated. OB-GYNs, coordinators and managers highlighted health system, organisational and structural factors (NMs’ limited experience/skills, professional roles, financial reimbursement) as potential barriers. NMs identified logistical and human resources as additional barriers. Women viewed the CMIC with perplexity and insecurity because of cultural beliefs about the dominant role of OB-GYNs, and limited information about NM’s capabilities. All professionals agreed that women’s acceptance of a CMIC will require educational interventions and communication strategies to inform potential users about the advantages and safety of this model.ConclusionThere are important barriers and facilitators to implement a CMIC in a private Brazilian maternity hospital. Factors related to health system structure and organisation may have the greatest impact. A CMIC is more likely to succeed if stakeholders’ concerns about responsibilities, power and financial revenues are addressed, and educational interventions targeted at users are deployed prior to its implementation.

scholarly journals Implementation of the Moyo fetal heart rate monitor in district hospitals in Bihar, India: a feasibility study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e041071
Author(s):  
Hanna Oommen ◽  
Kunal Ranjan ◽  
Sudha Murugesan ◽  
Aboli Gore ◽  
Sunil Sonthalia ◽  
...  
Keyword(s):  
Heart Rate ◽  
Health System ◽  
Fetal Heart Rate ◽  
Clinical Training ◽  
Fetal Heart ◽  
Barriers And Facilitators ◽  
Fetal Heart Rate Monitoring ◽  
Cultural Challenges ◽  
District Hospitals ◽  
Bihar State

ObjectivesGlobally, half of all stillbirths occur during birth. Detection of fetal distress with fetal heart rate monitoring (FHRM), followed by appropriate and timely management, might reduce fresh stillbirths and neonatal morbidity. This study aimed to investigate the barriers and facilitators for the implementation of Moyo FHRM use in Bihar state, and secondarily, the feasibility of collecting reliable obstetrical and neonatal outcome data to assess the effect of implementation.SettingCARE Bihar and the hospital management at four district hospitals (DHs) in Bihar state, each with 6500 to 15 000 deliveries a year, agreed to testing the implementation of Moyo FHRM through a process of meetings, training sessions and collecting data. At each hospital, a clinical training expert was trained to train others, while a clinical assessment facilitator collected data.MethodologyObservational notes were taken at all training sessions and meetings. Individual interviews (n=4) were conducted with clinical training experts (CTEs) on training experiences and barriers and facilitators for Moyo FHRM implementation. The CTEs recoded field notes in diaries. Descriptive analyses performed on pre-implementation and post-implementation data (n=521) assessed quality and completeness.ResultsMain barriers to implementation of Moyo FHRM were health system and cultural challenges involving (1) existing practices, (2) insufficient human resources, (3) action delays and (4) cultural and local challenges. Another barrier was insufficient involvement of doctors. Facilitators for implementation were easy use of the Moyo FHRM device and adequate training for staff.Electronic collection of obstetrical data worked well but had substantial missing data.ConclusionHealth system and cultural challenges are a major constraint to Moyo FHRM implementation in low-resource settings. Improvements at all levels of infrastructure, practices and skills will be critical in busy DHs in Bihar. Full-scale implementation needs doctor-led leadership and ownership. Obstetrical data collection for the purpose of scientific analysis needs to be improved.

A description of barriers and facilitators to childhood vaccinations in the military health system

2012 ◽  
Vol 24 (12) ◽  
pp. 716-725 ◽  
Author(s):  
John Connors ◽  
Elena Arushanyan ◽  
Gregory Bellanca ◽  
Ruth Racine ◽  
Andrew Hoeffler ◽  
...  
Keyword(s):  
Health System ◽  
Barriers And Facilitators ◽  
Military Health System ◽  
Military Health ◽  
The Military

scholarly journals An Optimization Algorithms-based Approach to District Health System Population Areas in Iran

2020 ◽  
Author(s):  
Javad Tayyebi ◽  
Sobhan Mostafayi Darmian
Keyword(s):  
Differential Evolution ◽  
Health System ◽  
Healthcare System ◽  
Operations Management ◽  
Particle Swarm ◽  
Healthcare Management ◽  
System Structure ◽  
Particle Swarm Algorithm ◽  
District Health ◽  
Strategic Model

Background: One of important subject in the operations' management fields is partitioning matter that was investigated in the study. This topic has recently received more attention from researchers of the healthcare management systems' field. This subject is important because planning about improvement of the healthcare system structure is considered as one of the most important management problems in each society. The goal of solving this problem was to district a society into several areas, so that each area can cover its  health services completely. Methods: This fundamental-applied study was conducted based on the Genetic optimization algorithm, particle swarm, and differential evolution to improve the current structures with regard to the existing health structure in Iran. Moreover, the health system strategic model was applied to categorize the population regions into 10 partitions. According to nature of the investigated problem, the objective function is maximizing the equilibrium amount in each district. The constraints included exclusive assignment and not-existing unusual assignment. Unusual assignment is defined as existence of no contiguity and holes in partitions. Results: According to the obtained results, the particle swarm algorithm had the most efficiency, while differential evolution had the lowest efficiency. However, the stated constraints were satisfied completely in all algorithms, which represented appropriate efficiency of the modified algorithm in the generation solutions. Conclusion: The results obtained from solving this problem can be used as a useful tool in improving the existing healthcare system in Iran.

scholarly journals Factors influencing diagnosis and treatment initiation for multidrug-resistant/rifampicin-resistant tuberculosis in six sub-Saharan African countries: a mixed-methods systematic review

2020 ◽  
Vol 5 (7) ◽  
pp. e002280 ◽  
Author(s):  
Charity Oga-Omenka ◽  
Azhee Tseja-Akinrin ◽  
Paulami Sen ◽  
Muriel Mac-Seing ◽  
Aderonke Agbaje ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Health System ◽  
Barriers And Facilitators ◽  
Diagnosis And Treatment ◽  
Drug Resistant ◽  
African Countries ◽  
Drug Resistant Tuberculosis ◽  
Patient Level ◽  
Resistant Tuberculosis ◽  
Sub Saharan

BackgroundDrug-resistant tuberculosis burdens fragile health systems in sub-Saharan Africa (SSA), complicated by high prevalence of HIV. Several African countries reported large gaps between estimated incidence and diagnosed or treated cases. Our review aimed to identify barriers and facilitators influencing diagnosis and treatment for drug-resistant tuberculosis (DR-TB) in SSA, which is necessary to develop effective strategies to find the missing incident cases and improve quality of care.MethodsUsing an integrative design, we reviewed and narratively synthesised qualitative, quantitative and mixed-methods studies from nine electronic databases: Medline, Global Health, CINAHL, EMBASE, Scopus, Web of Science, International Journal of Tuberculosis and Lung Disease, PubMed and Google Scholar (January 2006 to June 2019).ResultsOf 3181 original studies identified, 55 full texts were screened, and 29 retained. The studies included were from 6 countries, mostly South Africa. Barriers and facilitators to DR-TB care were identified at the health system and patient levels. Predominant health system barriers were laboratory operational issues, provider knowledge and attitudes and information management. Facilitators included GeneXpert MTB/RIF (Xpert) diagnosis and decentralisation of services. At the patient level, predominant barriers were patients being lost to follow-up or dying due to lengthy diagnostic and treatment delays, negative public sector care perceptions, family, work or school commitments and using private sector care. Some patient-level facilitators were HIV positivity and having more symptoms.ConclusionCase detection and treatment for DR -TB in SSA currently relies on individual patients presenting voluntarily to the hospital for care. Specific interventions targeting identified barriers may improve rates and timeliness of detection and treatment.

scholarly journals Factors for late initiation of antenatal care in Dar es Salaam, Tanzania: A qualitative study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Saidi Mgata ◽  
Stephen Oswald Maluka
Keyword(s):  
Health Care ◽  
Antenatal Care ◽  
Health System ◽  
Pregnant Women ◽  
Health Care Workers ◽  
Cultural Beliefs ◽  
Dar Es Salaam ◽  
World Health ◽  
Health Providers ◽  
Care Workers

Abstract Background Antenatal care (ANC) provided by a trained health care provider is important for monitoring pregnancy thereby reducing potential risks for the mother and child during pregnancy and delivery. The World Health Organization (WHO) recommends at least four ANC visits to all pregnant women. While the proportion of women who attend at least one ANC in low-income countries is high, most pregnant women start their first ANC attendance very late. In Tanzania only 24% of pregnant women start their first ANC attendance before the fourth month of pregnancy. While factors for the utilization of antenatal care in general have been widely studied, there is paucity of studies on the factors affecting timing of the first ANC attendance. This study aimed to understand individual, community, and health system factors that lead to the delay in seeking ANC services among pregnant women in Ilala Municipal in Dar es Salaam region, Tanzania. Methods A qualitative exploratory study, using in-depth interviews with 20 pregnant women and five health care workers was conducted in three different health facilities in Dar es Salaam Tanzania. Thematic analysis approach was used to analyse the data. Results Individual perceptions of antenatal care, past experience with pregnancy, fear of pregnancy disclosure, and socio-cultural beliefs were the key individual and social factors for late ANC attendance. Shortage of trained health care workers, lack of spouse’s escort and health providers’ disrespect to pregnant women were the main health system barriers to early ANC attendance. Conclusions This study concludes that community members should be sensitized about the importance of early ANC attendance. Additionally, while spouse’s escort policy is important for promoting PMTCT, the interpretation of the policy should not solely be left to the health providers. District and regional health officials should provide correct interpretation of this policy.

scholarly journals Association Between Delivery System Structure and Intensity of End-of-Life Cancer Care

2020 ◽  
Vol 16 (7) ◽  
pp. e590-e600
Author(s):  
Lindsey A. Herrel ◽  
Ziwei Zhu ◽  
Jennifer J. Griggs ◽  
Deborah R. Kaye ◽  
James M. Dupree ◽  
...  
Keyword(s):  
Health System ◽  
End Of Life ◽  
Delivery System ◽  
End Of Life Care ◽  
Life Quality ◽  
Quality Measures ◽  
System Structure ◽  
Cancer Center ◽  
Life Care ◽  
Intensity Of Care

PURPOSE: To determine whether the type of delivery system is associated with intensity of care at the end of life for Medicare beneficiaries with cancer. PATIENTS AND METHODS: We used SEER registry data linked with Medicare claims to evaluate intensity of end-of-life care for patients who died of one of ten common cancers diagnosed from 2009 through 2014. Patients were categorized as receiving the majority of their care in an integrated delivery system, designated cancer center, health system that was both integrated and a certified cancer center, or health system that was neither. We evaluated adherence to seven nationally endorsed end-of-life quality measures using generalized linear models across four delivery system types. RESULTS: Among 100,549 beneficiaries who died of cancer during the study interval, we identified only modest differences in intensity of end-of-life care across delivery system structures. Health systems with no cancer center or integrated affiliation demonstrated higher proportions of patients with multiple hospitalizations in the last 30 days of life (11.3%), death in an acute care setting (25.9%), and lack of hospice use in the last year of life (31.6%; all P < .001). Patients enrolled in hospice had lower intensity care across multiple end-of-life quality measures. CONCLUSION: Intensity of care at the end of life for patients with cancer was higher at delivery systems with no integration or cancer focus. Maximal supportive care delivered through hospice may be one avenue to reduce high-intensity care at the end of life and may impact quality of care for patients dying from cancer.

scholarly journals AN ACADEMIC-HEALTH SYSTEM COLLABORATION TO DEVELOP A PROGRAM FOR FAMILY CAREGIVERS OF PERSONS WITH DEMENTIA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S439-S439
Author(s):  
Elena Siegel ◽  
Ladson Hinton ◽  
Elizabeth Rice ◽  
Nilpa Shah ◽  
Vanessa McElroy ◽  
...  
Keyword(s):  
Health System ◽  
Family Caregivers ◽  
Clinical Care ◽  
Organizational Capacity ◽  
Lessons Learned ◽  
System Level ◽  
Quality Improvement Initiative ◽  
Care Needs ◽  
Academic Practice ◽  
Time Investment

Abstract Hospitalization of persons with dementia can pose specific challenges for family caregivers, with post-discharge issues in managing acute clinical care needs coupled with dementia-related care that can exacerbate caregiver fatigue and capacity. We established an academic-practice collaboration to develop an evidence-based and innovative multi-component health system-level program to support family caregivers of persons with dementia in transition from hospital to community. Using an implementation science approach aimed to decrease the gap in translation of caregiver research into practice, we co-designed the program/implementation plan as a quality improvement initiative reflecting an integration of evidence from family caregiving literature and the health system’s unique context, workflows, stakeholder perspectives, resources, and values/priorities. This paper highlights insights gained and lessons learned in establishing a successful academic-practice collaboration, including time/investment to establish a shared project vision and identify/leverage existing organizational capacity to successfully deliver a program to improve the health and wellbeing of family caregivers.

scholarly journals Knowledge and Education as Barriers and Facilitators to Nicotine Replacement Therapy Use for Smoking Cessation in Pregnancy: A Qualitative Study with Health Care Professionals

2019 ◽  
Vol 16 (10) ◽  
pp. 1814 ◽  
Author(s):  
Ross Thomson ◽  
Lisa McDaid ◽  
Joanne Emery ◽  
Felix Naughton ◽  
Sue Cooper ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Replacement Therapy ◽  
Nicotine Replacement Therapy ◽  
Health Care Professionals ◽  
Educational Interventions ◽  
Barriers And Facilitators ◽  
Nicotine Replacement ◽  
Smoking During Pregnancy ◽  
Stop Smoking ◽  
In Pregnancy

Smoking during pregnancy is a leading cause of negative pregnancy and perinatal outcomes. While UK guidelines recommend nicotine replacement therapy (NRT) for smoking cessation during pregnancy, adherence to NRT is generally low and may partially explain why NRT appears less effective in pregnancy compared to non-pregnant smokers. This study aimed to identify and describe factors associated with NRT adherence from a health professional’s perspective. Two focus groups and one expert group were conducted with 26 professionals involved in antenatal stop smoking services and the data were analysed thematically using a template methodology. From our analyses, we extracted two main themes: (i) ‘Barriers to NRT use in pregnancy’ explores the issues of how misinformation and unrealistic expectations could discourage NRT use, while (ii) ‘Facilitators to NRT use in pregnancy’ describes the different information, and modes of delivery, that stop smoking professionals believe will encourage correct and sustained NRT use. Understanding the barriers and facilitators to improve NRT adherence may aid the development of educational interventions to encourage NRT use and improve outcomes for pregnant women wanting to stop smoking.

scholarly journals Contributions of the nursing team in the second stage of the Kangaroo-Mother Care Method: Implications for hospital discharge of the newborn

2018 ◽  
Vol 22 (4) ◽  
Author(s):  
Isabela Maria Magalhães Sales ◽  
José Diego Marques Santos ◽  
Silvana Santiago da Rocha ◽  
Márcia Teles de Oliveira Gouveia ◽  
Nalma Alexandra Rocha de Carvalho
Keyword(s):  
Hospital Discharge ◽  
Educational Interventions ◽  
Maternity Hospital ◽  
Kangaroo Mother Care ◽  
Warning Sign ◽  
Structured Interviews ◽  
Hospital Data ◽  
Second Stage ◽  
Nursing Team ◽  
Nursing Professionals

Abstract Objective: To know the main care procedures of the nursing team in the second stage of the Kangaroo Care Method that contribute to the hospital discharge of the newborn and the continuation of home care, and to prepare an explanatory brochure to guide professionals in the management of hospital discharge. Method: Qualitative, convergent care study, carried out with 17 nursing professionals from a reference maternity hospital. Data were collected through semi-structured interviews and focus groups and analyzed through content analysis. Results: There were relevant concerns about the use of kangaroo position, about the skin-to-skin care and hygiene of the newborn, and about respiratory changes as a warning sign for intervention. A brochure was developed to showcase the essential care provided by the nursing professionals - its goal is the proper continuation of health care of premature or underweight babies. Conclusion and implications for the practice: Nursing teams can contribute to the clinical stability of the newborn in the second stage of the Kangaroo-Mother Care Method and elaborate educational interventions that guarantee the continuation of care.

Health System Barriers and Facilitators Influencing TB/HIV Integration in Ghana

2015 ◽  
Vol 9 (2) ◽  
pp. 1-12 ◽  
Author(s):  
Gloria Ansa ◽  
John Walley ◽  
Kamran Siddiqi ◽  
Xiaolin Wei
Keyword(s):  
Health System ◽  
Barriers And Facilitators ◽  
Hiv Integration
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