scholarly journals Reducing inequality in avoidable emergency admissions: Case studies of local health care systems in England using a realist approach

2021 ◽  
pp. 135581962110216
Author(s):  
John Ford ◽  
Julia Knight ◽  
John Brittain ◽  
Chris Bentley ◽  
Sarah Sowden ◽  
...  
Keyword(s):  
Health Care ◽  
Case Studies ◽  
Health Care Systems ◽  
Decision Makers ◽  
Local Health ◽  
Emergency Admissions ◽  
Local Health Care ◽  
Local Decision ◽  
Care Systems ◽  
Local Decision Makers

Objective People in disadvantaged areas are more likely to have an avoidable emergency hospital admission. Socio-economic inequality in avoidable emergency hospital admissions is monitored in England. Our aim was to inform local health care purchasing and planning by identifying recent health care system changes (or other factors), as reported by local health system leaders, that might explain narrowing or widening trends. Methods Case studies were undertaken in one pilot and at five geographically distinct local health care systems (Clinical Commissioning Groups, CCGs), identified as having consistently increasing or decreasing inequality. Local settings were explored through discussions with CCG officials and stakeholders to identify potential local determinants. Data were analysed using a realist evaluation approach to generate context-mechanism-outcome (CMO) configurations. Results Of the five geographically distinct CCGs, two had narrowing inequality, two widening, and one narrowing inequality, which widened during the project. None of the CCGs had designed a large-scale package of service changes with the explicit aim of reducing socio-economic inequality in avoidable emergency admissions, and local decision makers were unfamiliar with their own trends. Potential primary and community care determinants included: workforce, case finding and exclusion, proactive care co-ordination for patients with complex needs, and access and quality. Potential commissioning determinants included: data use and incentives, and targeting of services. Other potential determinants included changes in care home services, national A&E targets, and wider issues - such as public services financial constraints, residential gentrification, and health care expectations. Conclusions We did not find any bespoke initiatives that explained the inequality trends. The trends were more likely due to an interplay of multiple health care and wider system factors. Local decision makers need greater awareness, understanding and support to interpret, use and act upon inequality indicators. They are unlikely to find simple, cheap interventions to reduce inequalities in avoidable emergency admissions. Rather, long-term multifaceted interventions are required that embed inequality considerations into mainstream decision making.

scholarly journals Involving citizens in disinvestment decisions: what do health professionals think? Findings from a multi-method study in the English NHS

2017 ◽  
Vol 13 (2) ◽  
pp. 162-188 ◽  
Author(s):  
Tom Daniels ◽  
Iestyn Williams ◽  
Stirling Bryan ◽  
Craig Mitton ◽  
Suzanne Robinson
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Public Involvement ◽  
Health Care Systems ◽  
Future Research ◽  
Local Health ◽  
The Public ◽  
Health Care Leaders ◽  
Local Health Care ◽  
Care Systems

AbstractPublic involvement in disinvestment decision making in health care is widely advocated, and in some cases legally mandated. However, attempts to involve the public in other areas of health policy have been accused of tokenism and manipulation. This paper presents research into the views of local health care leaders in the English National Health Service (NHS) with regards to the involvement of citizens and local communities in disinvestment decision making. The research includes a Q study and follow-up interviews with a sample of health care clinicians and managers in senior roles in the English NHS. It finds that whilst initial responses suggest high levels of support for public involvement, further probing of attitudes and experiences shows higher levels of ambivalence and risk aversion and a far more cautious overall stance. This study has implications for the future of disinvestment activities and public involvement in health care systems faced with increased resource constraint. Recommendations are made for future research and practice.

Social science perspectives on schistosomiasis control in Africa: past trends and future directions

Parasitology ◽  
2009 ◽  
Vol 136 (13) ◽  
pp. 1747-1758 ◽  
Author(s):  
J. AAGAARD-HANSEN ◽  
J. R. MWANGA ◽  
B. BRUUN
Keyword(s):  
Health Care ◽  
Social Science ◽  
Community Involvement ◽  
Neglected Tropical Diseases ◽  
Health Care Systems ◽  
Local Health ◽  
Access To Health Services ◽  
Schistosomiasis Control ◽  
Local Health Care ◽  
Care Systems

SUMMARYNew ways of integrating and scaling up control of neglected tropical diseases (including schistosomiasis) are presently underway. In this context consideration of social science perspectives is essential. In this article, we review social science publications of relevance to sustained control of schistosomiasis in Africa including diagnosis and screening, treatment, supply of clean water and improved sanitation, as well as health communication. Studies of community involvement and links between schistosomiasis control programmes and broader health care systems are also explored. Directions for future social science of relevance to sustainable schistosomiasis control are outlined, including ways of ensuring equitable access to health services as well as involvement of endemic communities and local health care systems based on equal partnership.

Impact Of Purchasing Strategies On Local Health Care Systems

1996 ◽  
Vol 15 (2) ◽  
pp. 62-76 ◽  
Author(s):  
Debra J. Lipson ◽  
Jeanne M. De Sa
Keyword(s):  
Health Care ◽  
Health Care Systems ◽  
Local Health ◽  
Local Health Care ◽  
Care Systems

Market access – An essential investment before drug launch

1969 ◽  
Vol 16 (3) ◽  
Author(s):  
Sean McGrath
Keyword(s):  
Market Access ◽  
New Product ◽  
Decision Makers ◽  
Good Time ◽  
Local Health ◽  
Local Health Care ◽  
Local Decision ◽  
Advance Information ◽  
The Impact ◽  
Local Decision Makers

Before introducing a new pharmaceutical/biopharmaceutical agent into clinical practice, local decision makers need to consider not only the costs and benefits of the product, but also the impact that it will have on local health-care priorities and on the manner in which services are delivered. Its use is likely to require updated protocols, new patient information, staff training and changes to the manner in which clinics are organised – all of which can take many months to develop and implement. Hence, timely introduction of a new product relies on the delivery of advance information via a carefully planned market access strategy. Ideally, local decision makers need to receive initial notification of the likely impact of a product at least 18 months before its launch date, with follow-up communications at intervals thereafter. Failure to devise and fund a market access strategy in good time can reduce the company's return on its product. More important, patients may have to wait for access to the new product, and there is a potential for inequality of care when the introduction of a drug is delayed in some areas and not in others.

scholarly journals Thirty-day hospital re-admission for Medicaid enrollees with schizophrenia: the role of patient comorbidity and local health-care systems

2015 ◽  
Vol 10 (S1) ◽  
Author(s):  
Alisa B Busch ◽  
Arnold M Epstein ◽  
Thomas G McGuire ◽  
Sharon-Lise T Normand ◽  
Richard G Frank
Keyword(s):  
Health Care ◽  
Health Care Systems ◽  
Local Health ◽  
Day Hospital ◽  
Local Health Care ◽  
Care Systems

A Brief History of Quality Improvement

2014 ◽  
Vol 10 (3) ◽  
pp. 196-199 ◽  
Author(s):  
Gareth J. Parry
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Intrinsic Motivation ◽  
Health Care Systems ◽  
Local Health ◽  
Local Health Care ◽  
Care Systems ◽  
History Of

Intrinsic motivation can fuel people to activate improvement initiatives in their local health care systems.

scholarly journals Incidence and Death Rates from COVID-19 Are Not Always Coupled: An Analysis of Temporal Data on Local, Federal, and National Levels

Healthcare ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 338
Author(s):  
Stefan Borgmann ◽  
David Meintrup ◽  
Kerstin Reimer ◽  
Helmut Schels ◽  
Martina Nowak-Machen
Keyword(s):  
Health Care ◽  
Local Community ◽  
Health Care Systems ◽  
Case Fatality ◽  
Local Health ◽  
Infection Rates ◽  
Death Rates ◽  
Local Health Care ◽  
Care Systems ◽  
The Individual

SARS-CoV-2 has caused a deadly pandemic worldwide, placing a burden on local health care systems and economies. Infection rates with SARS-CoV-2 and the related mortality of COVID-19 are not equal among countries or even neighboring regions. Based on data from official German health authorities since the beginning of the pandemic, we developed a case-fatality prediction model that correctly predicts COVID-19-related death rates based on local geographical developments of infection rates in Germany, Bavaria, and a local community district city within Upper Bavaria. Our data point towards the proposal that local individual infection thresholds, when reached, could lead to increasing mortality. Restrictive measures to minimize the spread of the virus could be applied locally based on the risk of reaching the individual threshold. Being able to predict the necessity for increasing hospitalization of COVID-19 patients could help local health care authorities to prepare for increasing patient numbers.

Staying in the middle

Interpreting ◽  
2012 ◽  
Vol 14 (1) ◽  
pp. 1-22 ◽  
Author(s):  
Alexander Bischoff ◽  
Elisabeth Kurth ◽  
Alix Henley
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Health Care Systems ◽  
Public Institutions ◽  
Local Health ◽  
Host Society ◽  
Care Services ◽  
Integration Of Immigrants ◽  
Care Systems ◽  
Local Health System

In this age of migration, many societies are characterized by linguistic and cultural diversity. Public institutions, such as health care systems, face the challenge of integrating new arrivals, immigrants, refugees or asylum seekers, into the host society. The purpose of this study was to examine how interpreters see their work within the context of the integration of immigrants into the host society (Switzerland) in general, and into the local health system in particular. We investigated the roles that interpreters working in a Women’s Hospital in Switzerland take on and are aware of in their work. The interpreters described four main roles: word-for-word interpreting, intercultural explanation, building patient–provider relationships, and accompanying immigrant patients. An additional cross-cutting theme emerged: interpreters facilitating the integration of immigration. Only the first of these is generally regarded as their “official” role. The interpreters take on the additional roles as necessary during a consultation, in response to the needs of the patient and the health professionals. Further discussion is needed about whether these additional roles should be recognized and promoted as part of their work since they are important and there is no one else to take them on. Interpreters who take on the additional roles related to integration have the potential to be important actors in health care services whose patient populations that are increasingly linguistically and culturally diverse.

scholarly journals Impact of the COVID-19 Pandemic on Patients With Idiopathic Subglottic Stenosis

2020 ◽  
pp. 014556132097746
Author(s):  
Catherine Anderson ◽  
Guri Sandhu ◽  
Chadwan Al Yaghchi
Keyword(s):  
High Risk ◽  
Psychological Health ◽  
Clinical Pathways ◽  
Health Care Systems ◽  
Subglottic Stenosis ◽  
Local Health ◽  
Number Of Patients ◽  
Local Health Care ◽  
Care Systems ◽  
The Impact

Objectives: To determine the number of patients with idiopathic subglottic stenosis (iSGS) who have contracted coronavirus disease 2019 (COVID-19), the impact of the pandemic on patients’ attitudes on seeking help and attending hospitals, as well as the delays in the offer of treatment from the local health care systems. Methods: A 29-question survey was distributed to an international mailing list of patients with subglottic stenosis to assess the patient experience during the COVID-19 pandemic. Results: A total of 543 patients with iSGS participated. Fewer than 1 in 10 patients with iSGS have experienced COVID-19 symptoms, which were predominantly mild to moderate, with only 2 hospitalizations. Most patients with iSGS (80.0%) have not been advised they are high risk for COVID-19, despite 36.5% of patients with iSGS being obese (body mass index of 30+). Delays to surgeries and in-office procedures have impacted 40.1% of patients currently receiving treatment, with 38.8% of patients increasingly struggling to breathe as a result. Anxiety and stress are increasing among patients, with 3 in 4 (75.2%) reporting they are anxious about travelling by public transport, contracting the virus in hospital and infecting loved ones (69.0% and 71.9%, respectively). Of greater concern is that 23.1% with increasing dyspnea state they are staying away from hospital despite their deteriorating health. Conclusions: The COVID-19 pandemic has had an impact on the physical and psychological health of patients with iSGS. Surgeons managing cases of laryngotracheal stenosis need to offer appropriate support and communication to these high risk patients. During the pandemic, this should include self-isolation if they are dyspneic or on treatments that may have reduced their immunity. In addition, they should offer safe clinical pathways to airway assessment and treatments, if they become necessary. To minimize unnecessary travel, much of the clinical monitoring can be carried out remotely, using telephone or video-based consultations, in conjunction with local health professionals.

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