Rural healthcare providers coping with clinical care delivery challenges: lessons from three health centres in Ghana

Abstract Background Rural settings in low- and middle-income countries are bedeviled with poverty and high disease burden, and lack adequate resources to deliver quality healthcare to the population. Drug shortage and inadequate number and skill-mix of healthcare providers is very common in rural health facilities. Hence, rural healthcare providers have no choice but to be innovative and introduce some strategies to cope with health delivery challenges at the health centre levels. This study explored how and why rural healthcare providers cope with clinical care delivery challenges at the health centre levels in Ghana. Methods This study was a multiple case studies involving three districts: Bongo, Kintampo North, and Juaboso districts. In each case study district, a cross-sectional design was used to explore the research question. Purposive sampling technique was used to select study sites and the study participants. The authors conducted 11 interviews, 9 focus group discussions (involving 61 participants), and 9-week participant observation (in 3 health centres). Transcription of the voice-recordings was done verbatim, cleaned and imported into the Nvivo version 11 platform for analysis. Data was analysed using the inductive content analysis approach. Ethical clearance was granted by the Ethics Review Committee of the Ghana Health Service. Results The study found three main coping strategies (borrowing, knowledge sharing and multi-tasking). First, borrowing arrangements among primary health care institutions help to address the periodic shortage of medical supplies at the health centres. Secondly, knowledge sharing among healthcare providers mitigates skills gap during service delivery; and finally, rural healthcare providers use multi-tasking to avert staff inadequacy challenges during service delivery at the health centre levels. Conclusion Borrowing, knowledge sharing, and multi-tasking are coping strategies that are sustaining and potentially improving health outcomes at the district levels in Ghana. We recommend that health facilities across all levels of care in Ghana and other settings with similar challenges could adopt and modify these strategies in order to ensure quality healthcare delivery amidst delivery challenges.

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Development of a Novel Clinician Decision Support Tool for the Management of Acute Diarrhea in Bangladesh: Formative Qualitative Research (Preprint)

10.2196/preprints.33325 ◽

2021 ◽

Author(s):

Rochelle K Rosen ◽

Stephanie C Garbern ◽

Monique Gainey ◽

Ryan Lantini ◽

Sabiha Nasrin ◽

...

Keyword(s):

Decision Support ◽

Focus Group ◽

Acute Diarrhea ◽

Clinical Utility ◽

Qualitative Data ◽

Care Delivery ◽

Clinical Care ◽

Healthcare Providers ◽

Final Analysis ◽

Support Tool

BACKGROUND The availability of mobile clinical decision-support (CDS) tools has grown substantially with the increased prevalence of smartphone devices and applications (apps). Though healthcare providers express interest in integrating mobile health (mHealth) technologies into their clinical settings, concerns raised include perceived disagreements between information provided by mobile CDS tools and standard guidelines. Despite their potential to transform health care delivery, there remains limited literature on the provider’s perspective of the clinical utility of mobile CDS tools for improving patient outcomes, especially in low- and middle- income countries. OBJECTIVE The aim of this study is to describe providers’ perceptions about the utility of a mobile CDS tool accessed via a smartphone app for diarrhea management in Bangladesh. In addition, feedback was collected on preliminary components of the mobile CDS tool to address clinicians’ concerns and incorporate their preferences. METHODS From November to December 2020, qualitative data were gathered through eight virtual focus group discussions with physicians and nurses from three Bangladeshi hospitals. Each discussion was conducted in the local language, Bangla, and audio recorded for transcription and translation by the local research team. Transcripts and codes were entered into NVivo12 and applied thematic analysis was used to identify themes that explore the clinical utility of a mHealth app to assess dehydration severity in patients with acute diarrhea. Summaries of concepts and themes were generated from reviews of the aggregated coded data, and thematic memos were written and used for the final analysis. RESULTS Of the 27 focus group participants, 14 were nurses and 13 doctors; 15 worked at a diarrhea specialty hospital and 12 worked in government district or subdistrict hospitals. The participants’ experience in their current position ranged from 2 to 14 years, with an average of 10.3 years. Key themes from the qualitative data analysis, including: current experience with CDS, overall perception of the app utility and its potential role in clinical care, barriers and facilitators to app use, considerations of overtreatment and undertreatment, and guidelines for the app’s clinical recommendations. CONCLUSIONS Participants were positive about the mHealth app and its potential to inform diarrhea management. They provided detailed feedback, which developers used to further the design and programming. Participants felt that the tool would initially take time to use, but once learned could be useful during epidemic cholera. Some felt that clinical experience remains an important part of treatment that can be supplemented, but not replaced, by a CDS tool. Additionally, diagnostic information, including mid-upper arm circumference and blood pressure, might not be available to directly inform programming decisions. These formative qualitative data provided timely and relevant feedback to improve the utility of a CDS tool for diarrhea treatment in Bangladesh.

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Client satisfaction and Competency of Healthcare Providers with the services of BRAC Maternity Centres – A Cross Sectional Study

10.21203/rs.2.21414/v1 ◽

2020 ◽

Author(s):

Nusrat Khan ◽

Saira Parveen Jolly ◽

Tridib Roy Chowdhury ◽

Ariful Alam ◽

Mahfuzar Rahman ◽

...

Keyword(s):

Service Delivery ◽

Antenatal Care ◽

Rural Areas ◽

Client Satisfaction ◽

Care Delivery ◽

Healthcare Providers ◽

Health Service Delivery ◽

Service Utilisation ◽

Cross Sectional ◽

Normal Delivery

Abstract Background Client satisfaction and competency of the healthcare providers are key areas to ensure good health service delivery anywhere. The objective of this study was to understand the competency of the healthcare providers of BRAC maternity centres (BMC) in rural areas of Bangladesh and acceptance of their services at client level. Methods It was a cross-sectional exploratory mixed method study. For exploring client satisfaction and expected services of the clients, 2810 married women, aged 15-44 years with a delivery outcome within one year of interview, were included in the survey. In addition, 12 observations, and19 in-depth interviews of patients and their attendants were used for collecting information on competency of the midwives and Community Skilled Birth Attendants (CSBAs) from four upazillas in Bangladesh. The BMC in Mithapukur was functioning for two years preceding the survey, whilst rest of the three were established before two months of the survey. For this reason client satisfaction information was collected only from BMC in MIthapukur. On the other hand, information on competency of midwives and CSBAs were collect from all BMCs. Results Mean age of the respondents was around 24 years and more than 96% were housewives. All facilities were well equipped to provide maternity services. We found that more than 92%, 91% and 87.5% of the beneficiaries of BMC in Mithapukur were satisfied with the antenatal care (ANC) check-up, normal delivery and episiotomy services. For all other centres, most of the clients expected caesarean section facilities, availability of doctors and financial support from the centres. In terms of competency, the midwives and CSBAs were satisfactorily competent to provide all required services. Conclusion Overall, the results suggest the BMC holds competent workforce and similar service delivery strategies can be replicated in poor resource settings and BMCs to ensure quality care and trust in the patients for healthcare service utilisation. Keywords: Antenatal care, delivery care, postnatal care, neonatal care, competency, midwife, community skilled birth attendant, client satisfaction

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Patient satisfaction and waiting times in the primary health centres of South Chennai

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20210832 ◽

2021 ◽

Vol 8 (3) ◽

pp. 1386

Author(s):

Vishnu Vardhan Yenuganti ◽

Srinivas Rao D. ◽

Sasi Kumar P. J. ◽

Narendranath R.

Keyword(s):

Health Care ◽

Patient Satisfaction ◽

Waiting Time ◽

Care Delivery ◽

Waiting Times ◽

Health Centre ◽

Primary Health ◽

Primary Health Centres ◽

Health Centres ◽

Physician Care

Background: Patient satisfaction and the out-patient waiting time denotes the extent to which general health care needs of the patients are met to their requirements. This study assesses the quality of health care delivery in three primary health care centres in south Chennai. The main aim was to assess the levels of patient satisfaction and its relation to various components and the waiting time among the patients visiting the primary health centres in south Chennai.Methods: This is a cross sectional study conducted in three primary health centres in the rural part of south Chennai. This study is conducted by face to face interview method using a structured questionnaire on 120 random patients visiting the OPDs of these health centres. The questionnaire included timing pattern associated with the patients visit in the health centre. The collected data is analysed using Chi-square test and is conducted to assess the relationship between different categorical variables.Results: Most of the respondents (66.6%) were highly satisfied with the service provided, treatment and physician care, facilities inside the hospital, and the care of paramedical staff. Hospital cleanliness and Physician care were found to be significant in terms of overall satisfaction, and large number of patients visiting the centre was the most quoted reason for long waiting times with a mean of 45.2 minutes.Conclusions: The longer waiting times can be effectively reduced by employing more doctors and paramedical staff wherever it is required. A proper feedback system by assessing the satisfaction and waiting time is needed in any tertiary health centre to improve the health care delivery.

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Expanding Access To Rural Healthcare Services And Benefits Through Secure, Interactive Video Links: A Case Study Of Video Claims Taking Implementation In The Great Plains

American Journal of Health Sciences (AJHS) ◽

10.19030/ajhs.v2i2.6624 ◽

2011 ◽

Vol 2 (2) ◽

pp. 19-28

Author(s):

Dana Michael Harsell ◽

Christine Carlascio Harsell ◽

Robert S. Wood

Keyword(s):

Native American ◽

Rural Communities ◽

Service Delivery ◽

Great Plains ◽

Interactive Video ◽

Healthcare Providers ◽

Healthcare Services ◽

Rural Healthcare ◽

Government Services

Context: Between 2003 and 2008, the University of North Dakota Center for Rural Service Delivery (RSD) increased access to a number of vital government services for citizens in rural communities and Native American reservations through the Video Claims Taking (VCT) program, which allowed claimants in rural healthcare settings to apply for benefits over secure interactive video networks to distant government offices. VCT helped increase healthcare reimbursement, social and related public service benefits to 31 underserved communities in six states and leveraged a significant increase in applications for government services and monetary benefits to these communities. Methods: A case-study examines the implementation, use and impact of the VCT technology over the RSD’s five year operation. Findings: The authors offer five principal findings which center on the relationships between government agencies and rural claimants, some cultural considerations posed by this electronic form of service delivery, the program’s potential to realize certain efficiencies, the technical challenges faced during implementation and overcoming a number of organizational and communications barriers. Conclusions: The foregoing analysis of the RSDs initiative and its VCT program contributes to a better understanding of how to leverage an interactive video platform to provide government healthcare reimbursement services to underrepresented groups in rural contexts for public agencies and private healthcare providers that are interested in adopting a similar model of service delivery to their stakeholders

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Acceptability of a Patient Portal (Opal) in HIV Clinical Care: A Feasibility Study

Journal of Personalized Medicine ◽

10.3390/jpm11020134 ◽

2021 ◽

Vol 11 (2) ◽

pp. 134

Author(s):

Dominic Chu ◽

Tibor Schuster ◽

David Lessard ◽

Kedar Mate ◽

Kim Engler ◽

...

Keyword(s):

Feasibility Study ◽

Clinical Care ◽

Health Centre ◽

Healthcare Providers ◽

Patient Reported Outcome Measures ◽

Hiv Care ◽

People Living With Hiv ◽

Patient Portal ◽

Cross Sectional ◽

Patient Reported

Opal (opalmedapps.com), a patient portal in use at the Cedars Cancer Centre of the McGill University Health Centre (MUHC) (Montreal, Canada), gives cancer patients access to their medical records, collects information on patient-reported outcome measures (PROMs), and has demonstrated patient satisfaction with care. This feasibility study aims to evaluate Opal’s potential acceptability in the context of HIV care. People living with HIV (PLWH) and their healthcare providers (HCPs) completed cross-sectional surveys from August 2019 to February 2020 at large HIV centers, including the Chronic Viral Illness Service of the MUHC, and other HIV clinical sites in Montreal and Paris, France. This study comprised 114 PLWH (mean age 48 years old, SD = 12.4), including 74% men, 24% women, and 2% transgender or other; and 31 HCPs (mean age 46.5 years old, SD = 11.4), including 32% men, 65% women, and 3% other. Ownership of smartphones and tablets was high (93% PLWH, 96% HCPs), and participants were willing to use Opal (74% PLWH, 68% HCPs). Participants were interested in most Opal functions and PROMs, particularly PROMs capturing quality of life (89% PLWH, 77% HCPs), experience of healthcare (86% PLWH, 97% HCPs), and HIV self-management (92% PLWH, 97% HCPs). This study suggests Opal has high acceptability and potential usefulness as perceived by PLWH and HCPs.

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Reimbursement and Telepractice

Perspectives on Telepractice ◽

10.1044/teles3.2.35 ◽

2013 ◽

Vol 3 (2) ◽

pp. 35-40

Author(s):

Carol Dudding

Keyword(s):

Service Delivery ◽

Healthcare Services ◽

Speech Language Pathology ◽

Delivery Method ◽

Quality Healthcare ◽

Service Delivery Models ◽

Private Lives ◽

Language Pathology ◽

Delivery Models

Whether in our professional or private lives, we are all aware of the system wide efforts to provide quality healthcare services while containing the costs. Telemedicine as a method of service delivery has expanded as a result of changes in reimbursement and service delivery models. The growth and sustainability of telehealth within speech-language pathology and audiology, like any other service, depends on the ability to be reimbursed for services provided. Currently, reimbursement for services delivered via telehealth is variable and depends on numerous factors. An understanding of these factors and a willingness to advocate for increased reimbursement can bolster the success of practitioners interested in the telehealth as a service delivery method.

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Exploration of Mothers’ Expectations of Care during Childbirth in Public Health Facilities in Kumasi, Ghana

Africa Journal of Nursing and Midwifery ◽

10.25159/2520-5293/3130 ◽

2018 ◽

Vol 20 (1) ◽

Author(s):

Veronica Dzomeku ◽

Brian Van Wyk ◽

Lucia Knight ◽

Jody R. Lori

Keyword(s):

Public Health ◽

Clinical Care ◽

Health Facilities ◽

Individual Interviews ◽

Midwifery Education ◽

Health Centres ◽

Adequate Communication ◽

Safe Care ◽

Respectful Care ◽

Childbirth Care

It is well established that clients’ past healthcare experiences influence their further use of that particular service, as well as their recommendations of that service. This also applies to the use of facility-based childbirth services which contribute to reducing maternal and infant mortality rates. This paper explores what mothers’ want from care in public health centres during childbirth. Knowing mothers’ expectations will contribute to improving their future childbirth care experiences. In this explorative qualitative study, 56 women were recruited from four public health centres. In-depth individual interviews were digitally recorded and transcribed in full, and subjected to content analysis. Themes emerged, revealing participants’ desire for both “respectful care” and “safe care”. From our findings, we posit that respectful care should be characterised by adequate communication between the healthcare provider and patient, and involvement of the patient in care decisions. Participants expected safe care, which results from health facilities with adequate resources. Health services generally concentrate on clinical care which aligns with mothers’ expectations of respectful and safe care. However, soft skills need much attention in nursing and midwifery education. There is also a need to orient midwives to a patient-centred approach to care that meets mothers’ expectations for childbirth care.

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Patient Experience in Home Respiratory Therapies: Where We Are and Where to Go

Journal of Clinical Medicine ◽

10.3390/jcm8040555 ◽

2019 ◽

Vol 8 (4) ◽

pp. 555 ◽

Cited By ~ 5

Author(s):

Cátia Caneiras ◽

Cristina Jácome ◽

Sagrario Mayoralas-Alises ◽

José Ramon Calvo ◽

João Almeida Fonseca ◽

...

Keyword(s):

Clinical Research ◽

Patient Experience ◽

Clinical Care ◽

Research Priorities ◽

Specific Patient ◽

Quality Healthcare ◽

Body Of Knowledge ◽

Number Of Patients ◽

Patient Reported ◽

System Sustainability

The increasing number of patients receiving home respiratory therapy (HRT) is imposing a major impact on routine clinical care and healthcare system sustainability. The current challenge is to continue to guarantee access to HRT while maintaining the quality of care. The patient experience is a cornerstone of high-quality healthcare and an emergent area of clinical research. This review approaches the assessment of the patient experience in the context of HRT while highlighting the European contribution to this body of knowledge. This review demonstrates that research in this area is still limited, with no example of a prescription model that incorporates the patient experience as an outcome and no specific patient-reported experience measures (PREMs) available. This work also shows that Europe is leading the research on HRT provision. The development of a specific PREM and the integration of PREMs into the assessment of prescription models should be clinical research priorities in the next several years.

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Knowledge and practices regarding malaria and the National Treatment Guidelines among public health workers in Equatorial Guinea

Malaria Journal ◽

10.1186/s12936-020-03528-7 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Marta Blanco ◽

Pablo Suárez-Sanchez ◽

Belén García ◽

Jesús Nzang ◽

Policarpo Ncogo ◽

...

Keyword(s):

Public Health ◽

Treatment Guidelines ◽

Health Workers ◽

Health Centre ◽

Regional Hospital ◽

Malaria Treatment ◽

Diagnosis And Treatment ◽

Equatorial Guinea ◽

Public Health Facilities ◽

Health Centres

Abstract Background In 2018, an estimated 228 million cases of malaria occurred worldwide. Countries are far from having achieved reasonable levels of national protocol compliance among health workers. Lack of awareness of treatment protocols and treatment resistance by prescribers threatens to undermine progress when it comes to reducing the prevalence of this disease. This study sought to evaluate the degree of knowledge and practices regarding malaria diagnosis and treatment amongst prescribers working at the public health facilities of Bata, Equatorial Guinea. Methods A cross-sectional survey was conducted in October-December 2017 amongst all public health professionals who attended patients under the age of 15 years, with suspected malaria in the Bata District of Equatorial Guinea. Practitioners were asked about their practices and knowledge of malaria and the National Malaria Treatment Guidelines. A bivariate analysis and a logistic regression model were used to determine factors associated with their knowledge. Results Among the 44 practitioners interviewed, 59.1% worked at a Health Centre and 40.9% at the District Hospital of Bata. Important differences in knowledge and practices between hospital and health centre workers were found. Clinical diagnosis was more frequently by practitioners at the health centres (p = 0.059), while microscopy confirmation was more frequent at regional hospital (100%). Intramuscular artemether was the anti-malarial most administrated at the health centres (50.0%), while artemether-lumefantrine was the treatment most used at the regional hospital (66.7%). Most practitioners working at public health facilities (63.6%) have a low level of knowledge regarding the National Malaria Treatment Guidelines. While knowledge regarding malaria, the National Malaria Treatment Guidelines and treatment resistances is low, it was higher amongst hospital workers than amongst practitioners at health centres. Conclusions It is essential to reinforce practitioners’ knowledge, treatment and diagnosis practices and use of the National Malaria Treatment Guidelines in order to improve malaria case management and disease control in the region. A specific malaria training programme ensuring ongoing updates training is necessary in order to ensure that greater experience does not entail obsolete knowledge and, consequently, inadequate diagnosis and treatment practices.

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Reducing time to differentiated service delivery for newly diagnosed people living with HIV in Kigali, Rwanda: study protocol for a pilot, unblinded, randomised controlled study

BMJ Open ◽

10.1136/bmjopen-2020-047443 ◽

2021 ◽

Vol 11 (4) ◽

pp. e047443

Author(s):

Jonathan Ross ◽

Gad Murenzi ◽

Sarah Hill ◽

Eric Remera ◽

Charles Ingabire ◽

...

Keyword(s):

Service Delivery ◽

Health Centre ◽

Albert Einstein College ◽

Secondary Outcome ◽

Controlled Study ◽

People Living With Hiv ◽

Newly Diagnosed ◽

Differentiated Service ◽

Viral Loads ◽

Living With Hiv

IntroductionCurrent HIV guidelines recommend differentiated service delivery (DSD) models that allow for fewer health centre visits for clinically stable people living with HIV (PLHIV). Newly diagnosed PLHIV may require more intensive care early in their treatment course, yet frequent appointments can be burdensome to patients and health systems. Determining the optimal parameters for defining clinical stability and transitioning to less frequent appointments could decrease patient burden and health system costs. The objectives of this pilot study are to explore the feasibility and acceptability of (1) reducing the time to DSD from 12 to 6 months after antiretroviral therapy (ART) initiation,and (2) reducing the number of suppressed viral loads required to enter DSD from two to one.Methods and analysesThe present study is a pilot, unblinded trial taking place in three health facilities in Kigali, Rwanda. Current Rwandan guidelines require PLHIV to be on ART for ≥12 months with two consecutive suppressed viral loads in order to transition to less frequent appointments. We will randomise 90 participants to one of three arms: entry into DSD at 6 months after one suppressed viral load (n=30), entry into DSD at 6 months after two suppressed viral loads (n=30) or current standard of care (n=30). We will measure feasibility and acceptability of this intervention; clinical outcomes include viral suppression at 12 months (primary outcome) and appointment attendance (secondary outcome).Ethics and disseminationThis clinical trial was approved by the institutional review board of Albert Einstein College of Medicine and by the Rwanda National Ethics Committee. Findings will be disseminated through conferences and peer-reviewed publications, as well as meetings with stakeholders.Trial registration numberNCT04567693.

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