scholarly journals Essential medicines for emergency care in Africa

2018 ◽  
Vol 35 (7) ◽  
pp. 412-419 ◽  
Author(s):  
Morgan C Broccoli ◽  
Jennifer L Pigoga ◽  
Mulinda Nyirenda ◽  
Lee Wallis ◽  
Emilie J Calvello Hynes
Keyword(s):  
Emergency Care ◽  
Online Survey ◽  
Care Delivery ◽  
Careful Consideration ◽  
Essential Medicines ◽  
Health Priorities ◽  
Consensus Process ◽  
Expert Review ◽  
District Hospitals ◽  
Care Systems

ObjectivesEssential medicines lists (EMLs) are efficient means to ensure access to safe and effective medications. The WHO has led this initiative, generating a biannual EML since 1977. Nearly all countries have implemented national EMLs based on the WHO EML. Although EMLs have given careful consideration to many public health priorities, they have yet to comprehensively address the importance of medicines for treating acute illness and injury.MethodsWe undertook a multistep consensus process to establish an EML for emergency care in Africa. After a review of existing literature and international EMLs, we generated a candidate list for emergency care. This list was reviewed by expert clinicians who ranked the medicines for overall inclusion and strength of recommendation. These medications and recommendations were then evaluated by an expert group. Medications that reached consensus in both the online survey and expert review were included in a draft emergency care EML, which underwent a final inperson consensus process.ResultsThe final emergency care EML included 213 medicines, 25 of which are not in the 2017 WHO EML, but were deemed essential for clinical practice by regional emergency providers. The final EML has associated recommendations of desirable or essential and is subdivided by facility level. Thirty-nine medicines were recommended for basic facilities, an additional 96 for intermediate facilities (eg, district hospitals) and an additional 78 for advanced facilities (eg, tertiary centres).ConclusionThe 25 novel medications not currently on the WHO EML should be considered by planners when making rational formularies for developing emergency care systems. It is our hope that these resource-stratified lists will allow for easier implementation and will be a useful tool for practical expansion of emergency care delivery in Africa.

scholarly journals Development of performance indicators for systems of urgent and emergency care in the Republic of Ireland. Update of a systematic review and consensus development exercise

2019 ◽  
Vol 1 ◽  
pp. 6 ◽  
Author(s):  
Siobhan Boyle ◽  
Rebecca Dennehy ◽  
Orla Healy ◽  
John Browne
Keyword(s):  
Systematic Review ◽  
Emergency Care ◽  
Performance Indicators ◽  
Online Survey ◽  
Urgent Care ◽  
Nominal Group ◽  
Consensus Development ◽  
Republic Of Ireland ◽  
Care Systems ◽  
The Republic

Objectives: To develop a set of performance indicators to monitor the performance of emergency and urgent care systems in the Republic of Ireland. Design: This study comprised of an update of a previously performed systematic review and a formal consensus development exercise. The literature search was conducted in PubMed and covered the period 2008 to 2014. The results of the review were used to inform a consensus group of 17 national experts on urgent and emergency care in Ireland. The consensus development exercise comprised an online survey followed by a face-to-face nominal group technique meeting. During this meeting participants had the opportunity to revise their preferences for different indicators after listening to the views of other group members. A final online survey was then used to confirm the preferences of participants. Results: Initial literature searches yielded 2339 article titles.  After further searches, sixty items were identified for full-text review. Following this review, fifty-seven were excluded. Three articles were identified for inclusion in the systematic review. These papers produced 42 unique indicators for consideration during the consensus development exercise. In total, 17 indicators had a median of greater than 7 following the meeting and met our pre-specified criterion for acceptable consensus. Discussion: Using this systematic review and nominal group consensus development exercise, we have identified a set of 17 indicators, which a consensus of different experts regard as potentially good measures of the performance of urgent and emergency care systems in Ireland. Pragmatic implications are discussed with reference to three subsequently performed original studies which used some of the indicators

scholarly journals Perspectives on the current state of Nigeria’s emergency care system among participants of an emergency medicine symposium: a qualitative appraisal

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e043869
Author(s):  
Agnes Usoro ◽  
Benjamin Aiwonodagbon ◽  
Jonathan Strong ◽  
Sean Kivlehan ◽  
Babatunde A Akodu ◽  
...  
Keyword(s):  
Health System ◽  
Emergency Care ◽  
Care Delivery ◽  
Prehospital Care ◽  
Current State ◽  
Emergency Care Systems ◽  
Emergency Care System ◽  
Care Systems ◽  
Health System Governance ◽  
Care System

IntroductionEmergency care systems provide timely and relevant care to the acutely ill and injured. Published commentaries have characterised deficiencies in the Nigerian emergency care system and offered potential solutions but have not included the perspectives of the Nigerian public. A more inclusive approach that includes feedback from the public may help improve the Nigerian emergency care system through better understanding of the needs, values and expectations of the community.MethodsParticipants of an emergency medicine symposium participated in focus group discussions that were randomly divided into small groups led by two trained facilitators. These facilitators asked open-ended, semistructured questions to lead discussions in the English language. Participant responses were audio-recorded and transcribed verbatim into transcripts. Two independent investigators employed conventional content analysis to code the transcripts until thematic saturation was achieved.ResultsThree descriptive themes emerged characterising the current state of Nigeria’s emergency care system as it relates to prehospital care delivery, hospital care delivery and health system governance: rudimentary, vulnerable and disconnected. At the prehospital level, concepts revolved around emergency recognition and response, ambulance and frontline providers, and cultural norms. At the hospital level, concepts centred around the health workforce, clinical competency, hospital capacity and the burden of financial hardship. At the health system level, concepts concentrated on healthcare access and healthcare financing. Opportunities for emergency care system improvement at each component level were identified and explored.ConclusionsThe participants in this study identified shortcomings and opportunities to improve prehospital care, hospital care and health system governance. The results of this study may help healthcare professionals, policy makers and community leaders identify gaps in the emergency care system and offer solutions in harmony with the needs, values and expectations of the community. If successful, these community-informed interventions may serve as a model to improve emergency care systems throughout Africa.

Implementation science of district cancer care delivery model (Pendharkar model).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19024-e19024
Author(s):  
Dinesh Pendharkar ◽  
Chandramauli Tripathi
Keyword(s):  
Human Resource ◽  
Cancer Care ◽  
Care Delivery ◽  
Health Care Systems ◽  
Implementation Process ◽  
Care Program ◽  
Essential Medicines ◽  
Cancer Drug ◽  
Care Delivery Model ◽  
District Hospitals

e19024 Background: Health care systems are fighting with issues related to multiple elements of access to care. The problems include non availability of physical facilities and qualified human resource. Here we report successful intervention results of a scalable, replicable, cancer care model starting with two and expanding to nearly 198 districts, using standard processes. This has brought specialised cancer care to government run general district hospitals using existing human resource, through empowerment of alternate oncology workforce, capacity building, decentralisation, and task sharing with impactful outcome. Methods: Government run general district hospitals were involved to train one physician and nurse in principles of oncology care over one month period, followed by constant 24 x7 support and continued training etc. (techno-mentoring). Administrative changes enabled creation of identity of nodal cancer units and organised process of cancer drug delivery. Results: The implementation process was experimented in two hospitals and later on extended to nearly 198 hospitals, over a period of six years (Table). Majority of states have formulated the innovation as state run district cancer care program with published operational guidelines. The state governments designated physicians as nodal cancer officers and created their identity with physical allocation of space and providing cancer drug formulary. The physicians are assisting cancer patients from diagnosis up to end of life care including chemotherapy, palliative care. More then 45000 patients have availed services. Few thousand chemotherapy sessions have been performed by alternate oncology workforce. Drug availability is maintained through routine government supplies by adding anticancer drugs to list of essential medicines. Satisfaction survey conducted amongst patients, has proved its usefulness, acceptability. Conclusions: Impactful implementation at scale is feasible for cancer care delivery, using existing physical infrastructure and empowerment of alternate oncology workforce, through this model. It can ideally serve areas with no access to cancer care, including LMIC. [Table: see text]

Think Globally, Prescribe Locally: How Rational Pharmaceutical Policy in the U.S. Can Improve Global Access to Essential Medicines

2008 ◽  
Vol 34 (2-3) ◽  
pp. 125-139 ◽  
Author(s):  
Aaron S. Kesselheim
Keyword(s):  
Care Delivery ◽  
Policy Issue ◽  
International Health ◽  
Developed Countries ◽  
Essential Medicines ◽  
World Health ◽  
Health Priorities ◽  
Local Health ◽  
Middle Income ◽  
Access To Essential Medicines

Improving access to essential medicines in low- and middle-income countries (LMICs) has become a critical health policy issue. Millions more people die each year in poorer countries from diseases that are treated by pharmaceutical agents currently available in higher income nations. Recent medical innovation has tended to focus on problems affecting populations in developed countries and avoid those found exclusively or predominantly in LMICs. The etiology of these disparities is multifactorial, and can include high costs of products, inadequate cooperation between governments and aid agencies, rigid protection of intellectual property rights, and poor local health leadership regarding dissemination of products.Over the past two decades, there have been growing efforts to reduce global disparities in availability of essential medicines. At the forefront of these efforts have been international agencies such as the World Health Organization, or groups like Médicins Sans Frontières and Partners in Health, which have helped set international health priorities and sought to improve local health care delivery systems.

scholarly journals COVID-19 in Gastroenterology Departments: The Impact of the First Wave

2021 ◽  
pp. 1-7
Author(s):  
Tiago Leal ◽  
Margarida Gonçalves ◽  
Irina Mocanu ◽  
Rita Carvalho ◽  
Luísa Glória ◽  
...  
Keyword(s):  
Online Survey ◽  
Screening Program ◽  
Health Care Systems ◽  
Recovery Period ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
District Hospitals ◽  
Care Systems ◽  
Almost All ◽  
The Impact

<b><i>Introduction:</i></b> Coronavirus disease 2019 (COVID-19) is a global pandemic that has severely affected health care systems around the world. During the emergency state declared in Portugal in the months of March and April 2020, there was a severe reduction in medical activity in order to reduce the pressure on health systems. This study aimed to assess the impact of COVID-19 in gastroenterology departments across Portugal and the strategies developed to overcome this challenge. <b><i>Methods:</i></b> This was a cross-sectional study based on an online survey. A detailed questionnaire concerning different aspects of gastroenterology department activity was sent via e-mail to the heads of gastroenterology departments of Portuguese District Hospitals (Núcleo de Gastroenterologia dos Hospitais Distritais). Two periods were assessed, i.e., the emergency state and the recovery period between May and September. The responses were collected between September and October 2020. <b><i>Results:</i></b> A total of 21 hospitals were enrolled (80.8% response rate). Twenty-eight percent of the responders reported healthcare professionals from their unit infected with COVID-19. At least 1 member (mostly fellows) of the department was deployed to another workplace in 66.7% of the hospitals. During the emergency state, 47.6% of the hospitals only performed urgent/emergent endoscopic procedures. In 38.5% of the hospitals the need to ration personal protective equipment led to the suspension of endoscopic training. Regarding the recovery period, nonurgent procedures were restarted in almost all of the centers. The same was reported for the colorectal cancer screening program. Remarkably, 81% of the responders confirmed that they had postponed procedures at patients’ request for “fear of getting infected.” Remote consultation was maintained in 81% of the hospitals. Globally, the fellows had resumed their training. <b><i>Discussion/Conclusion:</i></b> This study provides a snapshot of the impact and consequences of the first wave of the COVID-19 pandemic across Portuguese hospitals. It is important to understand how the gastroenterology world dealt with the first impact of COVID-19 and what strategies were implemented in order to better prepare for what might follow.

scholarly journals Defining quality indicators for emergency care delivery: findings of an expert consensus process by emergency care practitioners in Africa

2018 ◽  
Vol 3 (1) ◽  
pp. e000479 ◽  
Author(s):  
Morgan C Broccoli ◽  
Rachel Moresky ◽  
Julia Dixon ◽  
Ivy Muya ◽  
Cara Taubman ◽  
...  
Keyword(s):  
Quality Indicators ◽  
Emergency Care ◽  
Low Income ◽  
Care Delivery ◽  
Consensus Conference ◽  
Expert Consensus ◽  
Consensus Process ◽  
African Region ◽  
Middle Income ◽  
The Impact

Facility-based emergency care delivery in low-income and middle- income countries is expanding rapidly, particularly in Africa. Unfortunately, these efforts rarely include measurement of the quality or the impact of care provided, which is essential for improvement of care provision. Our aim was to determine context-appropriate quality indicators that will allow uniform and objective data collection to enhance emergency care delivery throughout Africa. We undertook a multiphase expert consensus process to identify, rank and refine quality indicators. A comprehensive review of the literature identified existing indicators; those associated with a substantial burden of disease in Africa were categorised and presented to consensus conference delegates. Participants selected indicators based on inclusion criteria and priority clinical conditions. The indicators were then presented to a group of expert clinicians via on-line survey; all meeting agreements were refined in-person by a separate panel and ranked according to validity, feasibility and value. The consensus working group selected seven conditions addressing nearly 75% of mortality in the African region to prioritise during indicator development, and the final product at the end of the multiphase study was a list of 76 indicators. This comprehensive process produced a robust set of quality indicators for emergency care that are appropriate for use in the African setting. The adaptation of a standardised set of indicators will enhance the quality of care provided and allow for comparison of system strengthening efforts and resource distribution.

scholarly journals Investigating competencies needed by European-trained doctors in rural South African hospitals

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
James R. Barnacle ◽  
Oliver Johnson ◽  
Ian Couper
Keyword(s):  
South Africa ◽  
South African ◽  
Online Survey ◽  
Rural District ◽  
Eastern Cape ◽  
Rural Medicine ◽  
Rural South ◽  
District Hospitals ◽  
Kwazulu Natal ◽  
Postgraduate Diploma

Background: Many European-trained doctors (ETDs) recruited to work in rural district hospitals in South Africa have insufficient generalist competencies for the range of practice required. Africa Health Placements recruits ETDs to work in rural hospitals in Africa. Many of these doctors feel inadequately prepared. The Stellenbosch University Ukwanda Centre for Rural Health is launching a Postgraduate Diploma in Rural Medicine to help prepare doctors for such work.Aim: To determine the competencies gap for ETDs working in rural district hospitals in South Africa to inform the curriculum of the PG Dip (Rural Medicine).Setting: Rural district hospitals in South Africa.Methods: Nine hospitals in the Eastern Cape, KwaZulu-Natal and Mpumalanga were purposefully selected by Africa Health Placements as receiving ETDs. An online survey was developed asking about the most important competencies and weaknesses for ETDs when working rurally. The clinical manager and any ETDs currently working in each hospital were invited to complete the survey.Results: Surveys were completed by 19 ETDs and five clinical managers. The top clinical competencies in relation to 10 specific domains were identified. The results also indicate broader competencies required, specific skills gaps, the strengths that ETDs bring to South Africa and how ETDs prepare themselves for working in this context.Conclusion: This study identifies the important competency gaps among ETDs and provides useful direction for the diploma and other future training initiatives. The diploma faculty must reflect on these findings and ensure the curriculum is aligned with these gaps.

Vaccinations in patients with multiple sclerosis: A Delphi consensus statement

2020 ◽  
pp. 135245852095231 ◽  
Author(s):  
Agostino Riva ◽  
Valeria Barcella ◽  
Simone V Benatti ◽  
Marco Capobianco ◽  
Ruggero Capra ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Seasonal Influenza ◽  
Careful Consideration ◽  
Delphi Consensus ◽  
Consensus Process ◽  
Disease Modifying Drugs ◽  
Risks And Benefits ◽  
Modified Delphi ◽  
Increased Risk ◽  
Evidence Based Decision Making

Background: Patients with multiple sclerosis (MS) are at increased risk of infection. Vaccination can mitigate these risks but only if safe and effective in MS patients, including those taking disease-modifying drugs. Methods: A modified Delphi consensus process (October 2017–June 2018) was used to develop clinically relevant recommendations for making decisions about vaccinations in patients with MS. A series of statements and recommendations regarding the efficacy, safety and timing of vaccine administration in patients with MS were generated in April 2018 by a panel of experts based on a review of the published literature performed in October 2017. Results: Recommendations include the need for an ‘infectious diseases card’ of each patient’s infectious and immunisation history at diagnosis in order to exclude and eventually treat latent infections. We suggest the implementation of the locally recommended vaccinations, if possible at MS diagnosis, otherwise with vaccination timing tailored to the planned/current MS treatment, and yearly administration of the seasonal influenza vaccine regardless of the treatment received. Conclusion: Patients with MS should be vaccinated with careful consideration of risks and benefits. However, there is an urgent need for more research into vaccinations in patients with MS to guide evidence-based decision making.

The Future of Health Care in South Korea and the UK

2006 ◽  
Vol 5 (3) ◽  
pp. 375-385 ◽  
Author(s):  
Bob Matthews ◽  
Yoonsoon Jung
Keyword(s):  
Health Care ◽  
South Korea ◽  
Care Delivery ◽  
Health Care Systems ◽  
Public Provision ◽  
Capitalist System ◽  
Private Provision ◽  
Care Systems ◽  
Health Care Delivery Systems ◽  
The Uk

This paper discusses and compares the origin and development of the health care systems of South Korea and the UK from the end of WW2 and endeavours to compare outcomes. The paper emphasises the importance of war as a stimulus to the development of national health services in both countries and argues that there is convergence between the UK's nationalised NHS and South Korea's US-modelled capitalist system. Overall, we conclude that there is a possibility not only that the financing and nature of the Korean and UK health care delivery systems may show convergence, but it is not impossible that they will ‘change places’ with the UK system dominated by private provision and South Korea's by public provision.

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