scholarly journals Perceived consequences of healthcare service decentralization on access, affordability and quality of care in Khartoum locality, Sudan

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bandar Noory ◽  
Sara Hassanain ◽  
Jeffrey Edwards ◽  
Benedikte V. Lindskog
Keyword(s):  
Quality Of Care ◽  
Healthcare Providers ◽  
Quality Of Healthcare ◽  
Healthcare Services ◽  
System Capacity ◽  
Cross Sectional ◽  
Study Results ◽  
Catchment Areas ◽  
The Impact

Abstract Background Decentralization of healthcare services has been widely utilized, especially in developing countries, to improve the performance of healthcare systems by increasing the access and efficiency of service delivery. Experiences have been variable secondary to disparities in financial and human resources, system capacity and community engagement. Sudan is no exception and understanding the perceived effect of decentralization on access, affordability, and quality of care among stakeholders is crucial. Methods This was a mixed method, cross-sectional, explorative study that involved 418 household members among catchment areas and 40 healthcare providers of Ibrahim Malik Hospital (IBMH) and Khartoum Teaching Hospital (KTH). Data was collected through a structured survey and in-depth interviews from July–December 2015. Results Access, affordability and quality of healthcare services were all perceived as worse, compared to before decentralization was implemented. Reported affordability was found to be 53 and 55% before decentralization compared to 24 to 16% after decentralization, within KTH and IBMH catchment areas respectively, (p = 0.01). The quality of healthcare services was reported to have declined from 47 and 38% before decentralization to 38 and 28% after, in KTH and IBMH respectively (p = 0.02). Accessibility was found to be more limited, with services being accessible before decentralization approximately 59 and 52% of the time, compared to 41 and 30% after, in KTH and IBMH catchment areas respectively, (p = 0.01). Accessibility to healthcare was reported to have decreased secondary to facility closures, reverse transference of services, and low capacity of devolved facilities. Lastly, privatized services were reported as strengthened in response to this decentralization of healthcare. Conclusions The deterioration of access, affordability and quality of health services was experienced as the predominant perception among stakeholders after decentralization implementation. Our study results suggest there is an urgent need for a review of the current healthcare policies, structure and management within Sudan in order to provide evidence and insights regarding the impact of decentralization.

scholarly journals Perceived Consequences of Healthcare Service Decentralization on Access, Affordability and Quality of Care in Khartoum Locality, Sudan

2020 ◽  
Author(s):  
Bandar Noory ◽  
Sara Hassanein ◽  
Jeffrey Edwards ◽  
Benedikte Victoria Lindskog
Keyword(s):  
Quality Of Care ◽  
Healthcare Providers ◽  
Quality Of Healthcare ◽  
Healthcare Services ◽  
System Capacity ◽  
Cross Sectional ◽  
Study Results ◽  
Catchment Areas ◽  
The Impact

Abstract Background: Decentralization of healthcare services have been widely utilized, especially in developing countries, to improve the performance of healthcare systems by increasing the access and efficiency of service delivery. Experiences have been variable secondary to disparities in financial and human resources, system capacity and community engagement. Sudan is no exception and understanding the perceived effect of decentralization on access, affordability, and quality of care among stakeholders is crucial.Methods: This was a mixed method, cross-sectional, explorative study that involved 418 household members among catchment areas and 40 healthcare providers of Ibrahim Malik Hospital (IBMH) and Khartoum Teaching Hospital (KTH). Data were collected through a structured survey and in-depth interviews from July-December 2015.Results: Access, affordability and quality of healthcare services were all perceived as worse, compared to before decentralization was implemented. Reported affordability was found to be 53% and 55% before decentralization compared to 24% to 16% after decentralization, within KTH and IBMH catchment areas respectively, (p= 0.01). The quality of healthcare services were reported to have declined from 47% and 38% before decentralization to 38% and 28% after, in KTH and IBMH respectively (p=0.02). Accessibility was found to be more limited, with services being accessible before decentralization approximately 59% and 52% of the time, compared to 41% and 30% after, in KTH and IBMH catchment areas respectively, (p=0.01).Accessibility to healthcare was reported to have decreased secondary to facility closures, reverse transference of services, and low capacity of devolved facilities. Lastly, privatized services were reported as strengthened in response to this decentralization of healthcare. Conclusions: The deterioration of access, affordability and quality of health services was experienced as the predominant perception among stakeholders after decentralization implementation. Our study results suggest there is an urgent need for a review of the current healthcare policies, structure and management within Sudan in order to provide evidence and insights regarding the impact of decentralization.

scholarly journals Observance of patients’ rights by physicians and nurses from the COVID-19 patients’ perspective

2021 ◽  
Author(s):  
Mohsen Kamali ◽  
Seyed Kazem Mousavi
Keyword(s):  
Healthcare Providers ◽  
Quality Of Healthcare ◽  
Healthcare Services ◽  
Validity And Reliability ◽  
Cross Sectional ◽  
Patients Rights ◽  
The Social ◽  
The Mean ◽  
Patients Perspective

Observance of patients' rights is a significant indicator in evaluating the quality of healthcare services. The COVID-19 pandemic has become a global crisis and affected the interactions between healthcare providers and patients. This study examined the COVID-19 patients’ viewpoint about the observance of their rights by physicians and nurses. This study is a descriptive cross-sectional work of research conducted on the COVID-19 patients in Zanjan Province, Iran, in September 2020. The subjects were selected through convenience sampling, and data was collected using a two-section questionnaire consisting of a demographic characteristics survey and a Likert-type scale for evaluating patients' rights observance. The validity and reliability of the questionnaire were found to be acceptable, and the collected data was analyzed in SPSS v.26 using descriptive statistics, independent t-test, and ANOVA test. The mean score of observance of patients' rights was 69.60±7.36, representing a moderate level. The highest and lowest scores for the observance of patients' rights were related to the dimensions of courteous communication and responsibility, respectively. A significant relationship was found between the observance of patients’ rights and their marital status, health insurance, and education level (P<0.05). This study showed that the observance of the COVID-19 patients' rights has not been affected by the social agitation caused by this disease.

scholarly journals Perceptions of Good-Quality Antenatal Care and Birthing Services among Postpartum Women in Nepal

2021 ◽  
Vol 18 (13) ◽  
pp. 6876
Author(s):  
Sushma Rajbanshi ◽  
Mohd Noor Norhayati ◽  
Nik Hussain Nik Hazlina
Keyword(s):  
Quality Of Care ◽  
Low Socioeconomic Status ◽  
Healthcare Providers ◽  
Healthcare Facility ◽  
Quality Of Healthcare ◽  
Healthcare Services ◽  
Interpersonal Behavior ◽  
Postpartum Women ◽  
Health Seeking

Patient complaints and dissatisfaction should be taken seriously and used as an opportunity to provide acceptable services. Mounting evidence shows that the perception of the quality of healthcare services impacts health-seeking behaviors. This study explores the perceptions of good-quality antenatal and birthing services among postpartum women. A qualitative study using phenomenological inquiry was conducted in the Morang district, Nepal. The study participants were postpartum women with at least one high-risk factor who refused the referral hospital’s birth advice. A total of 14 women were purposively selected and interviewed in-depth. NVivo 12 Plus software was used for systematic coding, and thematic analysis was performed manually. Three themes emerged: (i) women’s opinions and satisfactory factors of health services, (ii) expectations of the health facility and staff, and (iii) a lack of suggestions to improve the quality of care. Women did not have many expectations from the healthcare facility or the healthcare providers and could not express what good quality of care meant for them. Women from low socioeconomic status and marginalized ethnicities lack knowledge of their basic reproductive rights. These women judge the quality of care in terms of staff interpersonal behavior and personal experiences. Women will not demand quality services if they lack an understanding of their basic health rights.

scholarly journals Physician beliefs about the impact of meaningful use of the EHR

2014 ◽  
Vol 05 (03) ◽  
pp. 789-801 ◽  
Author(s):  
D.Y. Ting ◽  
M. Healey ◽  
S.R. Lipsitz ◽  
A.S. Karson ◽  
J. S. Einbinder ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Primary Care Physicians ◽  
Meaningful Use ◽  
The United States ◽  
Improve Quality ◽  
Cross Sectional ◽  
Incentive Program ◽  
Physician Beliefs ◽  
The Impact

SummaryBackground: As adoption and use of electronic health records (EHRs) grows in the United States, there is a growing need in the field of applied clinical informatics to evaluate physician perceptions and beliefs about the impact of EHRs. The meaningful use of EHR incentive program provides a suitable context to examine physician beliefs about the impact of EHRs.Objective: Contribute to the sparse literature on physician beliefs about the impact of EHRs in areas such as quality of care, effectiveness of care, and delivery of care.Methods: A cross-sectional online survey of physicians at two academic medical centers (AMCs) in the northeast who were preparing to qualify for the meaningful use of EHR incentive program.Results: Of the 1,797 physicians at both AMCs who were preparing to qualify for the incentive program, 967 completed the survey for an overall response rate of 54%. Only 23% and 27% of physicians agreed or strongly agreed that meaningful use of the EHR will help them improve the care they personally deliver and improve quality of care respectively. Physician specialty was significantly associated with beliefs; e.g., 35% of primary care physicians agreed or strongly agreed that meaningful use will improve quality of care compared to 26% of medical specialists and 21% of surgical specialists (p=0.009). Satisfaction with outpatient EHR was also significantly related to all belief items.Conclusions: Only about a quarter of physicians in our study responded positively that meaningful use of the EHR will improve quality of care and the care they personally provide. These findings are similar to and extend findings from qualitative studies about negative perceptions that physicians hold about the impact of EHRs. Factors outside of the regulatory context, such as physician beliefs, need to be considered in the implementation of the meaningful use of the EHR incentive program.Citation: Emani S, Ting DY, Healey M, Lipsitz SR, Karson AS, Einbinder JS, Leinen L, Suric V, Bates DW. Physician beliefs about the impact of meaningful use of the EHR: A cross-sectional study. Appl Clin Inf 2014; 5: 789–801http://dx.doi.org/10.4338/ACI-2014-05-RA-0050

scholarly journals Quality of care in the free maternal healthcare era in sub-Saharan Africa: a scoping review of providers’ and managers’ perceptions

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Monica Ansu-Mensah ◽  
Frederick Inkum Danquah ◽  
Vitalis Bawontuo ◽  
Peter Ansu-Mensah ◽  
Tahiru Mohammed ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Research Question ◽  
Healthcare Providers ◽  
Poor Quality ◽  
Sub Saharan Africa ◽  
Healthcare Financing ◽  
Maternal Healthcare ◽  
Sub Saharan ◽  
The Impact

Abstract Background Free maternal healthcare financing schemes play an essential role in the quality of services rendered to clients during antenatal care in sub-Saharan Africa (SSA). However, healthcare managers’ and providers’ perceptions of the healthcare financing scheme may influence the quality of care. This scoping review mapped evidence on managers’ and providers’ perspectives of free maternal healthcare and the quality of care in SSA. Methods We used Askey and O’Malley’s framework as a guide to conduct this review. To address the research question, we searched PubMed, CINAHL through EBSCOhost, ScienceDirect, Web of Science, and Google Scholar with no date limitation to May 2019 using keywords, Boolean terms, and Medical Subject Heading terms to retrieve relevant articles. Both abstract and full articles screening were conducted independently by two reviewers using the inclusion and exclusion criteria as a guide. All significant data were extracted, organized into themes, and a summary of the findings reported narratively. Results In all, 15 out of 390 articles met the inclusion criteria. These 15 studies were conducted in nine countries. That is, Ghana (4), Kenya (3), and Nigeria (2), Burkina Faso (1), Burundi (1), Niger (1), Sierra Leone (1), Tanzania (1), and Uganda (1). Of the 15 included studies, 14 reported poor quality of maternal healthcare from managers’ and providers’ perspectives. Factors contributing to the perception of poor maternal healthcare included: late reimbursement of funds, heavy workload of providers, lack of essential drugs and stock-out of medical supplies, lack of policy definition, out-of-pocket payment, and inequitable distribution of staff. Conclusion This study established evidence of existing literature on the quality of care based on healthcare providers’ and managers’ perspectives though very limited. This study indicates healthcare providers and managers perceive the quality of maternal healthcare under the free financing policy as poor. Nonetheless, the free maternal care policy is very much needed towards achieving universal health, and all efforts to sustain and improve the quality of care under it must be encouraged. Therefore, more research is needed to better understand the impact of their perceived poor quality of care on maternal health outcomes.

scholarly journals Quality of Care Delivered to Tuberculosis Patients among Public Hospitals in Central Northeast Ethiopia

2020 ◽  
Vol 30 (5) ◽  
Author(s):  
Balkew Asegidew Tegegn ◽  
Betregiorgis Zegeye Hailu ◽  
Birhanu Damtew Tsegaye ◽  
Gashaw Garedew Woldeamanuel ◽  
Wassie Negash
Keyword(s):  
Quality Of Service ◽  
Quality Of Care ◽  
Quality Of Healthcare ◽  
Cross Sectional Study ◽  
Public Hospitals ◽  
Binary Logistic Regression Analysis ◽  
Cross Sectional ◽  
The Mean ◽  
Process Dimension

BACKGROUND: Inappropriate Tuberculosis (TB) diagnosis and treatment contributes to unfavorable health outcome among TB patients. Improving quality of healthcare service helps to avert TB related morbidity. Despite these facts, the level of quality of service is not known in the hospitals. Hence, the present study was conducted to assess the quality of care delivered to TB patients among publichospitals.METHODS: A facility-based cross-sectional study was conducted from March 15 to April 30, 2019 in North Shewa Zone, Amhara region, Ethiopia. All TB patients who had follow-up in the hospitals were included. This resulted in the involvement of 82 TB patients. Data was collected by trained data collectors using facility audit, clinical observation checklists, structured questionnaire and in-depth interview. Data was analyzed using SPSS version 20. Binary logistic regression analysis was done to identify the predictors of patients’ satisfaction.RESULTS: In this study, 82 respondents with a mean age of 36.48 (±13.27) years were participated. The mean quality score for structural dimension was 59.5%, and 53.7% of participants were found to be satisfied in outcome dimension. The mean score for process dimension of quality of service were 67.9%. Having TB symptoms were significantly associated with the level of patientsatisfaction towards TB care [AOR = 0.217, p = 0.015].CONCLUSION:Quality of TB services from structural and outcome dimension were low and higher in process dimension. Thus, careful attention on the quality of services will help to reduce the burden of TB.

scholarly journals Impact of malocclusion on the quality of life of children aged 8 to 10 years

2018 ◽  
Vol 23 (2) ◽  
pp. 46-53 ◽  
Author(s):  
Sônia Rodrigues Dutra ◽  
Henrique Pretti ◽  
Milene Torres Martins ◽  
Cristiane Baccin Bendo ◽  
Miriam Pimenta Vale
Keyword(s):  
Quality Of Life ◽  
Negative Impact ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Significance Level ◽  
Normal Occlusion ◽  
Study Results ◽  
Belo Horizonte ◽  
The Impact

ABSTRACT Objective: The aim of the present cross-sectional study was to assess the impact of malocclusion on the quality of life of children aged 8 to 10 years attending public elementary schools in Belo Horizonte, State of Minas Gerais, Brazil. Methods: The Brazilian version of the Child Perceptions Questionnaire 8-10 (CPQ8-10) was used to evaluate oral health-related quality of life. The children were examined for the diagnosis of malocclusion using the Dental Aesthetic Index (DAI). The data were analyzed by bivariate and multivariate descriptive statistics using Poisson regression at a 5% significance level. A total of 270 children participated in the study. Results: Children with normal occlusion or mild malocclusion (DAI ≤ 25) were 56% less likely (95%CI: 0.258-0.758; p= 0.003) to have their quality of life affected compared with children diagnosed with extremely severe malocclusion (DAI ≥ 36). Children with a maxillary anterior overjet ≥ 3 mm had higher CPQ8-10 mean scores (19.4; SD = 17.1) than those with an overjet < 3 mm (13.6; SD = 11.7; p= 0.038). Conclusions: Extremely severe malocclusion and pronounced maxillary anterior overjet were associated with a negative impact on quality of life.

scholarly journals Impacts of common staff on indicators of sanitary evacuation: experience of the gynecology service of Treichville Teaching Hospital

2018 ◽  
Vol 7 (4) ◽  
pp. 1303
Author(s):  
Simplice Anongba ◽  
Jean-Marc Dia ◽  
Ignace Yao ◽  
Edouard N’guessan ◽  
Eric Bohoussou ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Good Practice ◽  
Cross Sectional Study ◽  
Fetal Mortality ◽  
Cross Sectional ◽  
Balance Sheets ◽  
Gynecology And Obstetrics ◽  
The Common ◽  
The Impact

Background: In order to improve the quality of care for patients discharged in our department, since 1996 we have initiated monthly meetings called "common staffs", with the heads of the peripheral maternities who evacuate patients, during which we analyse reference indicators and the SONUs. The objective of this study was to describe the impact of the common staff on the indicators of the reference.Methods: We carried out a retrospective cross-sectional study on the balance sheets of the common staff over the 20 years of practice.Results: In 20 years, 132 meetings were organized, during which 24,337 files were analyzed. In 1996 the indicators of evacuations were at alarming levels: the time taken between the diagnosis and the decision to evacuate was long (more than 1 hour in 83.4%), 73% of the evacuation records were poorly informed, the majority evacuations were by non-medical vehicle (54.8%), pre-discharge management was incorrect in several patients (47%), and maternal and fetal lethality were high (5% and 10%, respectively). Over time, these indicators have improved and have had a favourable impact on maternal and fetal mortality rates, which have gradually decreased. At the same time, the results of the last three years of the evacuees coming from the maternities who do not participate in our staffs, shows that the indicators are still alarming, at levels where we were at the beginning of common staffs.Conclusions: The joint staff proved to be a good practice to promote in the Gynecology and Obstetrics Departments. It helped to improve the quality of care for referred patients.

Haste or Waste? Peer Pressure and Productivity in the Emergency Department

2020 ◽  
Author(s):  
David Silver
Keyword(s):  
Quality Of Care ◽  
Peer Group ◽  
Healthcare Providers ◽  
Peer Groups ◽  
Peer Pressure ◽  
Cross Sectional ◽  
Discharge Data ◽  
Intensity Of Care ◽  
Group Environments

Abstract Motivated by wide cross-sectional variations in intensity of care that are unrelated to quality of care, researchers and policymakers commonly claim that healthcare providers waste considerable resources, engaging in so-called “flat-of-the-curve” medicine. A key yet elusive prediction of this hypothesis is that providers ought to be able to cut back on care without sacrificing quality. This article examines the effects of a particular form of provider cutbacks—those generated by physicians working in high-pressure peer group environments. Using expansive, time-stamped discharge data from 137 hospital-based emergency departments, I document that physicians systematically alter their pace and intensity of care across frequently shuffled peer groups. Peer groups that induce a physician to work faster also induce her to order fewer tests and spend less money. Contrary to the flat-of-the-curve hypothesis, these cutbacks lead to large reductions in quality of care. This evidence, paired with the fact that slower physicians do not produce better average outcomes, suggests that cross-physician differences in resource utilization reflect substantial differences in physician productivity within a hospital.

Impact of IT on Health Care Professionals: Changes in Work and the Productivity Paradox

1998 ◽  
Vol 11 (2) ◽  
pp. 69-79 ◽  
Author(s):  
M. A. Hebert
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Health Care Professionals ◽  
Roles And Responsibilities ◽  
Study Results ◽  
Interactive Relationship ◽  
Care Information ◽  
Manual Tasks ◽  
The Impact

Health care organizations are under increasing pressure to become more efficient while at the same time maintaining or improving the quality of care. Information technology (IT), with its potential to increase efficiency, accuracy and accessibility of information, has been expected to play an important role in supporting these changes. We report the impact of patient care information systems on health care professionals in five community hospitals. The study framework incorporated both quality of care in Donabedian's elements of structure–process–outcome and Grusec's three levels of IT impact: direct substitution, proceduralization and new capabilities. The study results suggest that, for specific tasks, IT increased efficiency and productivity—a single employee was able to complete more tasks. However, this produced other consequences not predicted. Participants noted this change did not ‘free up time’ to spend with patients, but meant there were potentially more opportunities to provide services and more tasks to complete. Other effects included: reduced job satisfaction as more time was spent on the computer; less frequent interactions with patients and for shorter duration; and an increasingly ‘visible’ accountability as performance was easily monitored. There were also changes in roles and responsibilities as the computer enabled tasks to be carried out from a number of locations and by a variety of personnel. When innovations are introduced into organizations there are both expected and unexpected consequences. Increased awareness of the interactive relationship between computer users and the technology helps organizations better understand why results do, or do not, occur. One must look beyond just simply increasing productivity by replacing manual tasks with automated ones, to examining how the changes influence the nature of work and relationships within the organization.

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