The Ethics of Health Care Delivery in a Pediatric Malaria Vaccine Trial: The Perspectives of Stakeholders From Ghana and Tanzania

2017 ◽  
Vol 13 (1) ◽  
pp. 26-41 ◽  
Author(s):  
Claire Leonie Ward ◽  
David Shaw ◽  
Evelyn Anane-Sarpong ◽  
Osman Sankoh ◽  
Marcel Tanner ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Malaria Vaccine ◽  
Ethical Issues ◽  
Care Delivery ◽  
Vaccine Trial ◽  
Standards Of Care ◽  
Care Services ◽  
Key Informant ◽  
Undue Inducement

This study explores ethical issues raised in providing medical care to participants and communities of low-resource settings involved in a Phase II/III pediatric malaria vaccine trial (PMVT). We conducted 52 key informant interviews with major stakeholders of an international multi-center PMVT (GSK/PATH-MVI RTS,S) (NCT00866619) in Ghana and Tanzania. Based on their stakeholder experiences, the responses fell into three main themes: (a) undue inducement, (b) community disparities, and (c) broad therapeutic misconceptions. The study identified the critical ethical aspects, from the perspectives of stakeholders, of delivering health care during a PMVT. The study showed that integrating research into health care services needs to be addressed in a manner that upholds the favorable risk–benefit ratio of research and attends to the health needs of local populations. The implementation of research should aim to improve local standards of care through building a collaborative agenda with local institutions and systems of health.

The Brave New World of Medical Standards of Care

2001 ◽  
Vol 29 (3-4) ◽  
pp. 323-334 ◽  
Author(s):  
Eleanor D. Kinney
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Care Delivery ◽  
Standards Of Care ◽  
Delivery Of Care ◽  
Care Plans ◽  
Care Services ◽  
Medical Standards ◽  
American Health Care ◽  
Integrated Delivery

There have always been medical standards of care in the American health-care sector. However, never before have they been so deeply incorporated in the delivery of health care as they are today. With the increased delivery of care through integrated delivery systems, as well as the development of the computerized patient record, medical standards of care are now used in innovative ways by providers and health plans in delivering health care to individual patients. There is great potential for even more innovative uses of medical standards of care in the future.This article first presents a taxonomy of the medical standards of care that are involved in health-care delivery today Next, the article traces the historical evolution of medical standards of care since the early 1980s. Included in this discussion are the origins of the standard-setting movement as well as the developments that led to the way standards of care are currently used by large institutional providers and managed care plans to improve the quality of their health-care services. The article concludes with a brief analysis of the key legal issues that affect how standards of care can be used to improve the health care of patients.

scholarly journals Analysis of Facilitators and Barriers to the Delivery of Routine Care during the COVID-19 Global Pandemic: A Systematic Review

Healthcare ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 528
Author(s):  
Cristian Lieneck ◽  
Brooke Herzog ◽  
Raven Krips
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Health Care Services ◽  
Care Delivery ◽  
Routine Care ◽  
Future Research ◽  
Healthcare Organizations ◽  
Care Services ◽  
Global Pandemic ◽  
Facilitators And Barriers

The delivery of routine health care during the COVID-19 global pandemic continues to be challenged as public health guidelines and other local/regional/state and other policies are enforced to help prevent the spread of the virus. The objective of this systematic review is to identify the facilitators and barriers affecting the delivery of routine health care services during the pandemic to provide a framework for future research. In total, 32 articles were identified for common themes surrounding facilitators of routine care during COVID-19. Identified constructed in the literature include enhanced education initiatives for parents/patients regarding routine vaccinations, an importance of routine vaccinations as compared to the risk of COVID-19 infection, an enhanced use of telehealth resources (including diagnostic imagery) and identified patient throughput/PPE initiatives. Reviewers identified the following barriers to the delivery of routine care: conservation of medical providers and PPE for non-routine (acute) care delivery needs, specific routine care services incongruent the telehealth care delivery methods, and job-loss/food insecurity. Review results can assist healthcare organizations with process-related challenges related to current and/or future delivery of routine care and support future research initiatives as the global pandemic continues.

Revising the ERDs for the 21st Century

2021 ◽  
Vol 46 (8) ◽  
pp. 1-2
Author(s):  
John F. Brehany ◽  
Keyword(s):  
United States ◽  
Health Care ◽  
21St Century ◽  
Health Care Services ◽  
Care Delivery ◽  
The United States ◽  
Care Services ◽  
Moral Tradition ◽  
Modern Health Care ◽  
Catholic Health Care

Since their inception in 1948, The Ethical and Religious Directives for Catholic Health Care Services (ERDs) have guided Catholic health care ministries in the United States, aiding in the application of Catholic moral tradition to modern health care delivery. The ERDs have undergone two major revisions in that time, with about twenty years separating each revision. The first came in 1971 and the second came twenty-six years ago, in 1995. As such, a third major revision is due and will likely be undertaken soon.

When Clock Time Governs Interaction: How Time Influences Health Professionals’ Intersectoral Collaboration

2018 ◽  
Vol 28 (13) ◽  
pp. 2059-2070 ◽  
Author(s):  
Anne Bendix Andersen ◽  
Kirsten Beedholm ◽  
Raymond Kolbæk ◽  
Kirsten Frederiksen
Keyword(s):  
Health Care ◽  
Elderly Patients ◽  
Health Care Delivery ◽  
Health Professionals ◽  
Health Care Services ◽  
Care Delivery ◽  
Intersectoral Collaboration ◽  
Clock Time ◽  
Care Services ◽  
Patient Pathways

When setting up patient pathways that cross health care sectors, professionals in emergency units strive to fulfill system requirements by creating efficient patient pathways that comply with standards for length of stay. We conducted an ethnographic field study, focusing on health professionals’ collaboration, of 10 elderly patients with chronic illnesses, following them from discharge to their home or other places where they received health care services. We found that clock time not only governed the professionals’ ways of collaborating, but acceleration of patient pathways also became an overall goal in health care delivery. Professionals’ efforts to save time came to represent a “monetary value,” leading to speedier planning of patient pathways and consequent risks of disregarding important issues when treating and caring for elderly patients. We suggest that such issues are significant to the future planning and improvement of patient pathways that involve elderly citizens who are in need of intersectoral health care delivery.

iKure Techsoft: Providing Technology Enabled Affordable Health Care in Rural India

2018 ◽  
Vol 22 (02) ◽  
pp. 385-411
Author(s):  
Atanu Chaudhuri ◽  
Venkatramanaiah Saddikutti ◽  
Thim Prætorius
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Health Workers ◽  
Care Delivery ◽  
Rural India ◽  
Medical Team ◽  
Hub And Spoke ◽  
Care Services ◽  
Primary Health ◽  
Care Delivery Model

iKure Techsoft was established in 2010 with the main objective to provide affordable and high quality primary health care to the rural population in India and to build a sustainable for-profit business model. To that end, iKure’s cloud based, and patent pending, Wireless Health Incident Monitoring System (WHIMS) technology along with their hub-and-spoke operating model are central, but also essential to exploit and explore further if iKure is to scale-up. iKure provides primary health care services through three hub clinics and 28 rural health centres (RHCs). Each hub clinic employs between one and up to six medical teams (each consisting of 1 doctor, 1 nurse, 1 paramedic and 2 health workers stationed at the hub) & 1 mobile medical team (1 doctor, 1 paramedic, 2 health workers) for catering to the RHCs). Each medical team manages six RHCs. Paramount in iKure’s health care delivery model is their self-developed software called WHIMS, which is a cloud-based award-winning application that runs on low internet bandwidths. WHIMS allow for (a) centralized monitoring of key metrics such as doctor’s attendance, treatment prescribed, patient record management, pharmacy stock management, and (b) supports effective communication, integration and contact that connects RHCs with hub clinics, but also city-based multi-specialty hospitals with whom iKure has formal tie-ups. iKure, moreover, also works extensively with Non-Governmental Organizations (NGOs). Collaboration with local NGOs in the target areas helps to build trust with the rural villagers and their local knowledge and access helps to assess service demand. NGOs also provide the necessary local logistical support and basic infrastructure in the rural areas where iKure works. Moreover, collaboration, for example, with corporate organizations are central as they contribute with part of their corporate social responsibility (CSR) funds to support iKure initiatives. At present, iKure is planning to add diagnostic services to its six hub clinics as well as expand its presence in other parts of West Bengal and other states across India. Expanding rural health care services even with the technology support of WHIMS is challenging because, for example, health is a very local issue (due to, among other things, local customs and languages) and it requires investing significant amount of time and resources to build relationship with the rural people as well as collaborators such as NGOs and corporates. The accompanying case describes iKure’s journey so far in terms of understanding: (a) the state of health care and government health care services provided in rural India, (b) the establishment and evolution of the iKure business and health care model, (c) iKure’s operations and health care delivery model including the WHIMS technology solution and hub-and-spoke set-up of operations, (d) the collaborative model which relies on NGOs and private corporates, and (e) finally iKure’s challenges related to scaling-up.

Light Still Shines in the Darkness

2010 ◽  
Vol 28 (4) ◽  
pp. 266-274 ◽  
Author(s):  
Ted Karpf ◽  
J. Todd Ferguson ◽  
Robin Y. Swift
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Care Delivery ◽  
Care Services ◽  
Care Giving ◽  
Basic Care ◽  
The People ◽  
British Military ◽  
Health Care Models ◽  
Care Models

Health care is in crisis at the global, national, and local levels, with hundreds of millions living without basic care, or with insufficient care. Current health care models seem to have ignored, muted, or excluded the voices of the people they were intended to serve, resulting in health systems and care delivery models that do not respond to the needs of the people. This article describes a values-based approach to health and health care services in which the voices of the people are heard and listened to, and in which individuals and communities are informed participants in their own care. We draw parallels between contemporary concerns for decency in care giving to Florence Nightingale’s path-breaking work, first with the British military medical system and then Great Britain as a whole.

scholarly journals Participative management in health care services

Curationis ◽  
1995 ◽  
Vol 18 (1) ◽  
Author(s):  
M. Muller
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Care Delivery ◽  
Inductive Reasoning ◽  
Participative Management ◽  
Management Approach ◽  
Health Care Organisation ◽  
Care Services ◽  
Care Organisation ◽  
Interactive Decision Making

The need and demand for the highest-quality management of all health care delivery activities requires a participative management approach. The purpose with this article is to explore the process of participative management, to generate and describe a model for such management, focusing mainly on the process of participative management, and to formulate guidelines for operationalisation of the procedure. An exploratory, descriptive and theory-generating research design is pursued. After a brief literature review, inductive reasoning is mainly employed to identify and define central concepts, followed by the formulation of a few applicable statements and guidelines. Participative management is viewed as a process of that constitutes the elements of dynamic interactive decision-making and problem-solving, shared governance, empowerment, organisational transformation, and dynamic communication within the health care organisation. The scientific method of assessment, planning, implementation and evaluation is utilised throughout the process of participative management.

Specialty Care Programme for Autism Spectrum Disorders in an Urban Population: A Case-Management Model for Health Care Delivery in an asd Population

2011 ◽  
Vol 28 (2) ◽  
pp. 102-109 ◽  
Author(s):  
M. Parellada ◽  
L. Boada ◽  
C. Moreno ◽  
C. Llorente ◽  
J. Romo ◽  
...  
Keyword(s):  
Health Care ◽  
Autism Spectrum Disorders ◽  
Case Management ◽  
Health Care Delivery ◽  
Health Care Services ◽  
Care Delivery ◽  
Autism Spectrum ◽  
Care Programme ◽  
Care Services ◽  
Spectrum Disorders

AbstractSubjects with autism spectrum disorders (ASD) have more medical needs and more difficulties accessing health care services than the general population. Their verbal and non-verbal communication difficulties and particular behaviors, along with lack of expertise on the part of physicians and failure of the services to make adjustments, make it difficult for them to obtain an appropriate health care.PurposeTo describe a model for health care delivery in an ASD population.MethodReview of relevant literature and a discussion process with stakeholders leading to the design of a service to meet the specialty health needs of subjects of all ages with ASD for a region with a population of 6,000,000.ResultsA service was designed centred around the concepts of case management, individualization, facilitation, accompaniment, continuous training and updating, and quality management. Five hundred and thirteen patients with ASD have been seen over a period of 18 months. The programme generated 1566 psychiatric visits and 1052 visits to other specialties (mainly Nutrition, Stomatology, Neurology, and Gastroenterology) in the same period.ConclusionPersons with ASD may benefit from adjustments of health care services in order to improve their access to adequate health care at the quality level of the rest of the population.

The Ethics of End-of-Trial Obligations in a Pediatric Malaria Vaccine Trial: The Perspectives of Stakeholders From Ghana and Tanzania

2018 ◽  
Vol 13 (3) ◽  
pp. 258-269 ◽  
Author(s):  
Claire Leonie Ward ◽  
David Shaw ◽  
Evelyn Anane-Sarpong ◽  
Osman Sankoh ◽  
Marcel Tanner ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Malaria Vaccine ◽  
Care Service ◽  
Health Care Service ◽  
Vaccine Trial ◽  
Health Indicators ◽  
Treatment Access ◽  
Post Trial ◽  
The Impact

This study explores stakeholder experiences and perspectives on end-of-trial obligations at the close of a phase II/III Pediatric Malaria Vaccine Trial (PMVT) [GSK/PATH-MVI RTS, S) (NCT00866619]. We conducted 52 key informant interviews with major stakeholders of an international multicentre PMVT in Ghana and Tanzania. The responses fell into four main themes: (a) Communicating End-of-Trial, (b) Maintaining Health Care Services, (c) Dissemination of Results, and (d) Post-Trial Access. Interviewee responses shared important practical experiences and insights that complement current thinking in the literature on research ethics guidance: (a) accompany end-of-trial communication with information on personal and family health care responsibilities, (b) establish public health indicators to measure the impact of research on a health care system, (c) design a gradual exit strategy with opportunities to address unplanned events, (d) endorse a principled approach of continuity of care when designing a health care service handover, and (e) devise an actionable post-trial treatment access pathway with diverse stakeholder representatives.

Social enterprises, health-care provision and ethical capital

2014 ◽  
Vol 10 (2) ◽  
pp. 105-120 ◽  
Author(s):  
Lucy Frith
Keyword(s):  
Health Care ◽  
Health Care Delivery ◽  
Health Care Services ◽  
Care Delivery ◽  
Social Enterprises ◽  
Ethical Perspective ◽  
Content Type ◽  
Care Services ◽  
The Relationship

Purpose – The aim of this paper is to advance a conceptual understanding of the role of social enterprises in health care by developing the concept of ethical capital. Social enterprises have been an important part of both the coalition and the previous government’s vision for improving health-care delivery. One of the central arguments for increasing the role of social enterprises in health care is they can provide the benefits of a public service ethos with the efficiencies and innovatory strategies of a business. Social enterprises are well placed to promote the type of values that should underpin health care delivery. Design/methodology/approach – This paper explores the conceptual issues raised by using social enterprises to provide health-care services that were previously provided by the National Health Service (NHS) from an ethical perspective. Findings – It will be argued that conceptualising social enterprises as organisations that can and should produce ethical capital could be a useful way of developing the debate over social enterprises in health care. Practical implications – The paper provides suggestions on how ethical capital might be produced and monitored in social enterprises. Originality/value – This paper advances the debate over the use of the concept of ethical capital in social enterprises and explores the relationship between ethical and social capital – both under researched areas. It also contributes to the emerging discussions of social enterprises in current health policy and their role in the radically reformed English NHS.

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