scholarly journals Access-to-care: evidence from home-based postnatal coordinated care after hospital discharge

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Saad Zbiri ◽  
Patrick Rozenberg ◽  
Carine Milcent
Keyword(s):  
Hospital Discharge ◽  
Healthcare System ◽  
Health Professionals ◽  
Postnatal Care ◽  
Positive Impact ◽  
Coordinated Care ◽  
Prenatal Education ◽  
Related Factors ◽  
Home Based ◽  
Full Participation

Abstract Background Home-based postnatal care after hospital discharge has become an integral part of postnatal care. This study aimed to determine the factors relating either to individuals or the healthcare system that affect enrollment and full participation (adherence) in the French home-based postnatal coordinated care program (PRADO). Methods All admitted women for delivery in a French district over one year and eligible for this home-based midwifery support after hospital discharge were included (N = 4189). Both a simple probit model and a probit Heckman selection model were used. The control variables were the characteristics of the women, the municipalities, and the hospitals. Results Approximately 68% of the eligible women chose to enroll in the PRADO program, of who nearly 60% fully participated in this program. Enrollment in the program was influenced mostly by the family context, such as the woman’s age at the time of her pregnancy and the number of children in the household, the woman’s level of prenatal education and information about postnatal care, as well as some hospital variables such as the characteristics and organization of the maternity units. Full participation in the program was influenced by the accessibility to health professionals, particularly midwives. Furthermore, the women’s level of prenatal education and information about postnatal care, as well as their accessibility to health professionals, correlated with the socioeconomic environment. Conclusion While individual factors impacted enrollment in the PRADO program, only healthcare system-related factors influenced full participation in the program. A public health policy promoting home-based postnatal care could increase the women’s participation by improving their level of prenatal education and information about postnatal care. In addition, reducing regional inequality is likely to have a positive impact, as the availability of health professionals is a key factor for participation in home-based postnatal coordinated care.

scholarly journals Quality of care for people with multimorbidity: a focus group study with patients and their relatives

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e047025
Author(s):  
Nadine Janis Pohontsch ◽  
Josefine Schulze ◽  
Charlotte Hoeflich ◽  
Katharina Glassen ◽  
Amanda Breckner ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Focus Groups ◽  
Healthcare System ◽  
Qualitative Content Analysis ◽  
Coordinated Care ◽  
Treatment Standards ◽  
Focus Group Study ◽  
Treatment Regimens ◽  
Quality Aspects

BackgroundPrevalence of people with multimorbidity rises. Multimorbidity constitutes a challenge to the healthcare system, and treatment of patients with multimorbidity is prone to high-quality variations. Currently, no set of quality indicators (QIs) exists to assess quality of care, let alone incorporating the patient perspective. We therefore aim to identify aspects of quality of care relevant to the patients’ perspective and match them to a literature-based set of QIs.MethodsWe conducted eight focus groups with patients with multimorbidity and three focus groups with patients’ relatives using a semistructured guide. Data were analysed using Kuckartz’s qualitative content analysis. We derived deductive categories from the literature, added inductive categories (new quality aspects) and translated them into QI.ResultsWe created four new QIs based on the quality aspects relevant to patients/relatives. Two QIs (patient education/self-management, regular updates of medication plans) were consented by an expert panel, while two others were not (periodical check-ups, general practitioner-coordinated care). Half of the literature-based QIs, for example, assessment of biopsychosocial support needs, were supported by participants’ accounts, while more technical domains regarding assessment and treatment regimens were not addressed in the focus groups.ConclusionWe show that focus groups with patients and relatives adding relevant aspects in QI development should be incorporated by default in QI development processes and constitute a reasonable addition to traditional QI development. Our QI set constitutes a framework for assessing the quality of care in the German healthcare system. It will facilitate implementation of treatment standards and increase the use of existing guidelines, hereby helping to reduce overuse, underuse and misuse of healthcare resources in the treatment of patients with multimorbidity.Trial registration numberGerman clinical trials registry (DRKS00015718), Pre-Results.

scholarly journals Perception and Preference for Home-Based Telework in the COVID-19 Era: A Gender-Based Analysis in Hanoi, Vietnam

2021 ◽  
Vol 13 (6) ◽  
pp. 3179
Author(s):  
Minh Hieu Nguyen ◽  
Jimmy Armoogum
Keyword(s):  
Gender Inequality ◽  
Sustainable Development Goal ◽  
Related Factors ◽  
Social Distancing ◽  
Work Related ◽  
Home Based ◽  
The Social ◽  
The Government ◽  
Gender Based ◽  
Using Data

The rapid and widespread of COVID-19 has caused severe multifaceted effects on society but differently in women and men, thereby preventing the achievement of gender equality (the 5th sustainable development goal of the United Nations). This study, using data of 355 teleworkers collected in Hanoi (Vietnam) during the first social distancing period, aims at exploring how (dis)similar factors associated with the perception and the preference for more home-based telework (HBT) for male teleworkers versus female peers are. The findings show that 56% of female teleworkers compared to 45% of male counterparts had a positive perception of HBT within the social distancing period and 63% of women desired to telework more in comparison with 39% of men post-COVID-19. Work-related factors were associated with the male perception while family-related factors influenced the female perception. There is a difference in the effects of the same variables (age and children in the household) on the perception and the preference for HBT for females. For women, HBT would be considered a solution post-COVID-19 to solve the burden existing pre-COVID-19 and increasing in COVID-19. Considering gender inequality is necessary for the government and authorities to lessen the adverse effects of COVID-19 on the lives of citizens, especially female ones, in developing countries.

scholarly journals Home-based pulmonary rehabilitation for people with COPD: A qualitative study reporting the patient perspective

2017 ◽  
Vol 15 (2) ◽  
pp. 123-130 ◽  
Author(s):  
Aroub Lahham ◽  
Christine F McDonald ◽  
Ajay Mahal ◽  
Annemarie L Lee ◽  
Catherine J Hill ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Physical Fitness ◽  
Pulmonary Rehabilitation ◽  
Positive Impact ◽  
Chronic Obstructive ◽  
Structured Interviews ◽  
Obstructive Pulmonary Disease ◽  
Home Setting ◽  
Supervised Exercise ◽  
Home Based

This study aimed to document the perspective of patients with chronic obstructive pulmonary disease (COPD) who underwent home-based pulmonary rehabilitation (HBPR) in a clinical trial. In this qualitative study, open-ended questions explored participants’ views regarding HBPR. Thirteen semi-structured interviews were analysed using a thematic analysis approach. Major themes from interviews included the positive impact of HBPR on physical fitness, breathing and mood. Participants valued the flexibility and convenience of the programme. Participants also highlighted the importance of social support received, both from the physiotherapist over the phone and from family and friends who encouraged their participation. Reported challenges were difficulties in initiating exercise, lack of variety in training and physical incapability. While most participants supported the home setting, one participant would have preferred receiving supervised exercise training at the hospital. Participants also reported that HBPR had helped establish an exercise routine and improved their disease management. This study suggests that people with COPD valued the convenience of HBPR, experienced positive impacts on physical fitness and symptoms and felt supported by their community and programme staff. This highly structured HBPR model may be acceptable to some people with COPD as an alternative to centre-based pulmonary rehabilitation.

scholarly journals Remdesivir Use in Patients Requiring Mechanical Ventilation due to COVID-19

2020 ◽  
Vol 7 (11) ◽  
Author(s):  
Giuseppe Lapadula ◽  
Davide Paolo Bernasconi ◽  
Giacomo Bellani ◽  
Alessandro Soria ◽  
Roberto Rona ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Discharge ◽  
Multivariable Analysis ◽  
Competing Risk ◽  
Lower Mortality ◽  
Hospital Death ◽  
Related Factors ◽  
Cox Models ◽  
Treatment Groups ◽  
Reduction Of Mortality

Abstract Background Remdesivir has been associated with accelerated recovery of severe coronavirus disease 2019 (COVID-19). However, whether it is also beneficial in patients requiring mechanical ventilation is uncertain. Methods All consecutive intensive care unit (ICU) patients requiring mechanical ventilation due to COVID-19 were enrolled. Univariate and multivariable Cox models were used to explore the possible association between in-hospital death or hospital discharge, considered competing-risk events, and baseline or treatment-related factors, including the use of remdesivir. The rate of extubation and the number of ventilator-free days were also calculated and compared between treatment groups. Results One hundred thirteen patients requiring mechanical ventilation were observed for a median of 31 days of follow-up; 32% died, 69% were extubated, and 66% were discharged alive from the hospital. Among 33 treated with remdesivir (RDV), lower mortality (15.2% vs 38.8%) and higher rates of extubation (88% vs 60%), ventilator-free days (median [interquartile range], 11 [0–16] vs 5 [0–14.5]), and hospital discharge (85% vs 59%) were observed. Using multivariable analysis, RDV was significantly associated with hospital discharge (hazard ratio [HR], 2.25; 95% CI, 1.27–3.97; P = .005) and with a nonsignificantly lower mortality (HR, 0.73; 95% CI, 0.26–2.1; P = .560). RDV was also independently associated with extubation (HR, 2.10; 95% CI, 1.19–3.73; P = .011), which was considered a competing risk to death in the ICU in an additional survival model. Conclusions In our cohort of mechanically ventilated patients, RDV was not associated with a significant reduction of mortality, but it was consistently associated with shorter duration of mechanical ventilation and higher probability of hospital discharge, independent of other risk factors.

scholarly journals Eradicating Racism: An Endocrine Society Policy Perspective

2022 ◽  
Author(s):  
Ruban Dhaliwal ◽  
Rocio I Pereira ◽  
Alicia M Diaz-Thomas ◽  
Camille E Powe ◽  
Licy L Yanes Cardozo ◽  
...  
Keyword(s):  
Health Disparities ◽  
Ethnic Minority ◽  
Healthcare System ◽  
Health Professionals ◽  
Minority Groups ◽  
Ethnic Minority Groups ◽  
Minority Communities ◽  
Endocrine Society ◽  
Policy Perspective ◽  
Racial Ethnic

Abstract The Endocrine Society recognizes racism as a root cause of the health disparities that affect racial/ethnic minority communities in the United States and throughout the world. In this policy perspective, we review the sources and impact of racism on endocrine health disparities and propose interventions aimed at promoting an equitable, diverse, and just healthcare system. Racism in the healthcare system perpetuates health disparities through unequal access and quality of health services, inadequate representation of health professionals from racial/ethnic minority groups, and the propagation of the erroneous belief that socially constructed racial/ethnic groups constitute genetically and biologically distinct populations. Unequal care, particularly for common endocrine diseases such as diabetes, obesity, osteoporosis, and thyroid disease, results in high morbidity and mortality for individuals from racial/ethnic minority groups, leading to a high socioeconomic burden on minority communities and all members of our society. As health professionals, researchers, educators, and leaders, we have a responsibility to take action to eradicate racism from the healthcare system. Achieving this goal would result in high-quality health care services that are accessible to all, diverse workforces that are representative of the communities we serve, inclusive and equitable workplaces and educational settings that foster collaborative teamwork, and research systems that ensure that scientific advancements benefit all members of our society. The Endocrine Society will continue to prioritize and invest resources in a multifaceted approach to eradicate racism, focused on educating and engaging current and future health professionals, teachers, researchers, policy makers, and leaders.

scholarly journals Driving and Dementia: Workshop Module on Communicating Cessation to Drive

2017 ◽  
Vol 20 (4) ◽  
pp. 241-245
Author(s):  
Anna Byszewski ◽  
Barbara Power ◽  
Linda Lee ◽  
Glara Gaeun Rhee ◽  
Robert Parson ◽  
...  
Keyword(s):  
Health Professionals ◽  
Positive Impact ◽  
Communication Strategies ◽  
Emotional Reactions ◽  
Accurate Information ◽  
Driving Cessation ◽  
Ovid Medline ◽  
Online Tools ◽  
Background Material ◽  
The Subject

BackgroundFor persons with dementia (PWD), driving becomes very dangerous. Physicians in Canada are legally responsible to report unfit drivers and then must disclose that decision to their patients. That difficult discussion is fraught with challenges: physicians want to maintain a healthyrelationship; patients often lack insight into their cognitive loss and have very strong emotional reactions to the loss of their driving privileges. All of which may stifle the exchange of accurate information. The goal of this project was to develop a multimedia module that would provide strategies and support for health professionals having these difficult conversations.MethodsLiterature search was conducted of Embase and OVID MedLine on available driving and dementia tools, and on websites of online tools for communication strategies on driving cessation. A workshop module was developed with background material, communication strategies, links to resources and two videos demonstrating the “bad” then the “good” ways of managing this emotionally charged discussion.ResultsWhen the module was tested with internal medicine trainees, results demonstrated that confidence increased significantly (p < .001), and comfort and willingness in discussing the subject improved.ConclusionThis project demonstrated the positive impact of the module on improving health professionals’ attitude and readiness to communicate driving cessation to PWD.

Interprofessional Education

2020 ◽  
pp. 259-285
Author(s):  
Izhar Faisal ◽  
Saima Salam ◽  
Manisha Arora
Keyword(s):  
Developing Countries ◽  
Healthcare System ◽  
Health Professionals ◽  
Interprofessional Education ◽  
Institutional Support ◽  
Developed Countries ◽  
Collaborative Practice ◽  
Workplace Culture ◽  
Potential Barriers ◽  
Complete Overhaul

With an ever worsening shortage of healthcare workers, there has been a global shift towards strengthening of interprofessional education (IPE). IPE has existed as a powerful tool in developed countries, but in developing countries like India, it is still in its infancy. Several models of interprofessional education exist, yet India lags behind in implementing these models in academic curricula. Rudimentary curriculum, inefficient healthcare system, and maldistribution of health professionals are some of the potential barriers. A complete overhaul of the healthcare system along with progressive strategies of incorporation of IPE needs to be debated, and associated limitations need to be addressed. Adequate institutional support, well-constructed protocols, infrastructural revamp, and change of workplace culture are vital for IPE to succeed and be sustainable. This chapter provides an overview of IPE and collaborative practice in Indian settings and presents an account of an Indian institution utilizing IPP approach and highlights potential challenges in incorporating IPE in the academic curriculum.

Digital Governance and the NHS

2020 ◽  
pp. 192-216
Keyword(s):  
National Health Service ◽  
Health Service ◽  
Health Services ◽  
Healthcare System ◽  
Digital Health ◽  
Public Healthcare ◽  
Coordinated Care ◽  
Informal Networks ◽  
Technological Advances ◽  
Remote Health

The benefits of a fully-digitalised public healthcare system are significant. Digital health is an essential tool in order to improve efficiency, provide coordinated care, and make real health improvements. However, the National Health Service (NHS) has yet to provide a fully digitalised system to patients and providers despite technological advances in recent years. This chapter will thus describe the progress which has already been made in providing remote health services within the NHS. It will also explore problems arising from digitalising health services and the management of health both within the institution and through more informal networks beyond the NHS.

scholarly journals Stakeholders’ Views on Responsible Assessments of Assistive Technologies through an Ethical HTA Matrix

Societies ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. 51
Author(s):  
Thorstensen
Keyword(s):  
Health Professionals ◽  
Assistive Technologies ◽  
Decision Makers ◽  
Health Innovation ◽  
Health Technologies ◽  
Home Based ◽  
Care Workers ◽  
The Matrix ◽  
Gps Localization ◽  
Innovation Processes

Assessments of novel assistive technologies for use in home-based services has been documented to be performed in a variety of ways and often with a rather narrow focus on safety and effect or effectiveness. In order better to understand the place for wider forms of assessments of assistive technologies, the current study presents a combination of the Ethical Matrix and the Socratic approach for assessment of health technologies—the Ethical HTA Matrix. This matrix was filled with content based on a case of a GPS localization system, which was validated by stakeholders. In a next step, central decision-makers in assistive technologies and stakeholders were interviewed concerning their views on this methodology. Mainly, the matrix was seen as very comprehensive, but too detailed with an abundance of information. Nevertheless, some informants suggested concrete uses of the matrix in their organizations. Some understood the matrix more as an epistemic tool aiming at providing an overview of the state of knowledge, while others identified a normative potential in the matrix that could be implemented in health innovation processes for the home-based services, in particular when discussing novel solutions and working methods with health professionals and care workers.

Evaluating Elders' Bio-Psycho-Social Health Dimensions Using Their Smartphones

2020 ◽  
pp. 166-177
Author(s):  
Enrique Moguel ◽  
José García-Alonso ◽  
Javier Berrocal ◽  
Juan M. Murillo
Keyword(s):  
Health System ◽  
Functional Status ◽  
Chronic Diseases ◽  
Health Professionals ◽  
The Elderly ◽  
Developed Countries ◽  
Mobile Technologies ◽  
Social Health ◽  
Coordinated Care ◽  
Elder People

The percentage of elder people in developed countries is increasing rapidly. A high percentage of them usually present multiple and chronic diseases. A patient with several diseases requires specific and coordinated care that is difficult to configure. Different frameworks can evaluate their functional status and identify the required care, together with the associated cost to the health system. Nevertheless, these frameworks are usually questionnaires that have to be periodically performed by the patients with the assistance of already overloaded professionals. In this chapter, the authors make use of mobile technologies to build a system capable of monitoring the activities of the elderly and analysing these data to assess their bio-psycho-social status. The experiments carried out show us that it correctly evaluates these patients and reduces the effort required by health professionals.

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