scholarly journals Systematic review of experiences and perceptions of key actors and organisations at multiple levels within health systems internationally in responding to COVID-19

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Simon Turner ◽  
Natalia Botero-Tovar ◽  
Maria Alejandra Herrera ◽  
Juan Pablo Borda Kuhlmann ◽  
Francisco Ortiz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health System ◽  
Healthcare Workers ◽  
Healthcare Professionals ◽  
Qualitative Studies ◽  
System Level ◽  
Local Health ◽  
Multiple Levels ◽  
Local Health System ◽  
Organisational Level

Abstract Background COVID-19 has presented challenges to healthcare systems and healthcare professionals internationally. After one year of the pandemic, the initial evidence on health system responses begins to consolidate, and there is a need to identify and synthesise experiences of responding to COVID-19 among healthcare professionals and other health system stakeholders. This systematic review of primary qualitative studies depicts the experiences and perceptions of organisations and actors at multiple levels of health systems internationally in responding to COVID-19. Methods Six main databases of biomedical information, public health and health administration research were searched over the period October 1, 2019, to October 21, 2020. Information extracted from included studies was analysed thematically. Results Thirty-four studies were eligible for data extraction. Nine of those studies, of lower methodological quality, were removed from the thematic analysis of study results. Considering the professional level experiences, predominant themes of the studies consisted of the new roles and responsibilities of healthcare workers, burnout and distress, recognition of ´unseen´ healthcare workers, and positive changes and emergent solutions amid the crisis. Organisational level findings of the studies included provision of psychological support, COVID-19 as "catalyst" for change, and exercise of more "open" leadership by managers and health authorities. Continuous training, regulation of working conditions, providing supportive resources, coordinating a diversity of actors, and reviewing and updating regulations were roles identified  at the local health system level. Conclusions The experiences of frontline healthcare workers have been the focus of attention of the majority of primary qualitative studies as of October 2020. However, organisational and wider system level studies indicate that some responses to COVID-19 have been characterised by increased emphasis on coordination activities by local health system actors, making service adaptations at pace, and reliance on expanded roles of front-line workers. The need for theory-informed qualitative studies was identified at the organisational level. Trial registration CRD42020202875

Central COVID-19 Coordination Centers in Germany: Description, economic evaluation and systematic review (Preprint)

2021 ◽  
Author(s):  
Nikolas Schopow ◽  
Georg Osterhoff ◽  
Nikolaus von Dercks ◽  
Felix Girrbach ◽  
Christoph Josten ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health System ◽  
University Hospital ◽  
Local Health ◽  
The Public ◽  
Important Benefit ◽  
Economic Analyses ◽  
Management Institutions ◽  
Local Health System ◽  
Regional Hospitals

BACKGROUND During the COVID-19 pandemic, Central COVID-19 Coordination Centers (CCCC) have been established at several hospitals across Germany with the intention to assist local healthcare professionals in efficiently referring patients with suspected or confirmed SARS-CoV-2 infection to regional hospitals, and therefore to prevent the collapse of local health system structures. In addition, they coordinate interhospital transfers of COVID-19 patients and provide or arrange specialized telemedical consultations. OBJECTIVE This study describes the establishment and management of a CCCC at a German university hospital. METHODS We perform economic analyses (cost, cost-effectiveness, use and utility) according to the CHEERS criteria. Additionally, a systematic review was conducted to identify publications on similar institutions worldwide. RESULTS The two months with the highest local incidence (12/2020 and 01/2021) of COVID-19 cases were considered. During this time, 17.3 requests per day were made to CCCC regarding admission or transfer of COVID-19 patients. The majority of requests was made by emergency medical services (56.3%), patients with an average age of 71.8 years were involved and 69.0% of cases had already positive PCR detection. In 59.8% of the concerning patients, further treatment by the general practitioner or outpatient presentation in a hospital could be initiated after appropriate advice, 27.2% of patients were admitted to normal wards and 12.9% were directly transmitted to an intensive care unit. The operating costs of the CCCC amounted to more than €52,000 per month. 90.4% of all patients presented to the hospital were triaged and announced in advance by the CCCC. No other published economic analysis of COVID-19 coordination or management institutions at hospitals could be found. CONCLUSIONS Despite the high cost of the CCCC, we were able to show that it is a beneficial concept to both the providing hospital and the public health system. However, the most important benefit of the CCCC is that it prevents hospitals from being overrun by patients and that it avoids situations in which doctors have to weigh up one patient’s life against another´s.

scholarly journals Quality in crisis: a systematic review of the quality of health systems in humanitarian settings

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Keely Jordan ◽  
Todd P. Lewis ◽  
Bayard Roberts
Keyword(s):  
Systematic Review ◽  
Health System ◽  
Health Systems ◽  
Point Of Care ◽  
System Level ◽  
System Quality ◽  
High Quality ◽  
Humanitarian Settings ◽  
Quality Health

Abstract Background There is a growing concern that the quality of health systems in humanitarian crises and the care they provide has received little attention. To help better understand current practice and research on health system quality, this paper aimed to examine the evidence on the quality of health systems in humanitarian settings. Methods This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The context of interest was populations affected by humanitarian crisis in low- and middle- income countries (LMICs). We included studies where the intervention of interest, health services for populations affected by crisis, was provided by the formal health system. Our outcome of interest was the quality of the health system. We included primary research studies, from a combination of information sources, published in English between January 2000 and January 2019 using quantitative and qualitative methods. We used the High Quality Health Systems Framework to analyze the included studies by quality domain and sub-domain. Results We identified 2285 articles through our search, of which 163 were eligible for full-text review, and 55 articles were eligible for inclusion in our systematic review. Poor diagnosis, inadequate patient referrals, and inappropriate treatment of illness were commonly cited barriers to quality care. There was a strong focus placed on the foundations of a health system with emphasis on the workforce and tools, but a limited focus on the health impacts of health systems. The review also suggests some barriers to high quality health systems that are specific to humanitarian settings such as language barriers for refugees in their host country, discontinued care for migrant populations with chronic conditions, and fears around provider safety. Conclusion The review highlights a large gap in the measurement of quality both at the point of care and at the health system level. There is a need for further work particularly on health system measurement strategies, accountability mechanisms, and patient-centered approaches in humanitarian settings.

scholarly journals Barriers to and enablers of uptake of antiretroviral therapy in integrated HIV and tuberculosis treatment programmes in sub-Saharan Africa: a systematic review and meta-analysis

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Benjamin Momo Kadia ◽  
Christian Akem Dimala ◽  
Noah T. Fongwen ◽  
Adrian D. Smith
Keyword(s):  
Systematic Review ◽  
Antiretroviral Therapy ◽  
Health System ◽  
Sample Size ◽  
Meta Analysis ◽  
Sub Saharan Africa ◽  
System Level ◽  
Comprehensive Treatment ◽  
Barriers And Enablers ◽  
Sub Saharan

Abstract Introduction Programmes that merge management of Human Immunodeficiency Virus (HIV) and tuberculosis (TB) aim to improve HIV/TB co-infected patients’ access to comprehensive treatment. However, several reports from sub-Saharan Africa (SSA) indicate suboptimal uptake of antiretroviral therapy (ART) even after integration of HIV and TB treatment. This study assessed ART uptake, its barriers and enablers in programmes integrating TB and HIV treatment in SSA. Method A systematic review was performed. Seven databases were searched for eligible quantitative, qualitative and mixed-methods studies published from March 2004 through July 2019. Random-effects meta-analysis was used to obtain pooled estimates of ART uptake. A thematic approach was used to analyse and synthesise data on barriers and enablers. Results Of 5139 references identified, 27 were included in the review: 23/27 estimated ART uptake and 10/27 assessed barriers to and/or enablers of ART uptake. The pooled ART uptake was 53% (95% CI: 42, 63%) and between-study heterogeneity was high (I2 = 99.71%, p < 0.001). WHO guideline on collaborative TB/HIV activities and sample size were associated with heterogeneity. There were statistically significant subgroup effects with high heterogeneity after subgroup analyses by region, guideline on collaborative TB/HIV activities, study design, and sample size. The most frequently described socioeconomic and individual level barriers to ART uptake were stigma, low income, and younger age group. The most frequently reported health system-related barriers were limited staff capacity, shortages in medical supplies, lack of infrastructure, and poor adherence to or lack of treatment guidelines. Clinical barriers included intolerance to anti-TB drugs, fear of drug toxicity, and contraindications to antiretrovirals. Health system enablers included good management of the procurement, supply, and dispensation chain; convenience and accessibility of treatment services; and strong staff capacity. Availability of psychosocial support was the most frequently reported enabler of uptake at the community level. Conclusions In SSA, programmes integrating treatment of TB and HIV do not, in general, achieve high ART uptake but we observe a net improvement in uptake after WHO issued the 2012 guidelines on collaborative TB/HIV activities. The recurrence of specific modifiable system-level and patient-level factors in the literature reveals key intervention points to improve ART uptake in these programmes. Systematic review registration: CRD42019131933.

scholarly journals Self-management of patients with advanced cancer: A systematic review of experiences and attitudes

2020 ◽  
Vol 34 (2) ◽  
pp. 160-178 ◽  
Author(s):  
Sophie I van Dongen ◽  
Kim de Nooijer ◽  
Jane M Cramm ◽  
Anneke L Francke ◽  
Wendy H Oldenmenger ◽  
...  
Keyword(s):  
Systematic Review ◽  
Advanced Cancer ◽  
Healthcare Professionals ◽  
Management Strategies ◽  
Personal Characteristics ◽  
Qualitative Studies ◽  
Medical Decision ◽  
Self Management ◽  
Management Support ◽  
Quality Of Reporting

Background: Patients with advanced cancer are increasingly expected to self-manage. Thus far, this topic has received little systematic attention. Aim: To summarise studies describing self-management strategies of patients with advanced cancer and associated experiences and personal characteristics. Also, to summarise attitudes of relatives and healthcare professionals towards patient self-management. Design: A systematic review including non-experimental quantitative and qualitative studies. Data were analysed using critical interpretive synthesis. Included studies were appraised on methodological quality and quality of reporting. Data sources: MEDLINE, Embase, Cochrane Central, PsycINFO, CINAHL, Web of Science and Google Scholar (until 11 June 2019). Results: Of 1742 identified articles, 31 moderate-quality articles describing 8 quantitative and 23 qualitative studies were included. Patients with advanced cancer used self-management strategies in seven domains: medicine and pharmacology, lifestyle, mental health, social support, knowledge and information, navigation and coordination and medical decision-making (29 articles). Strategies were highly individual, sometimes ambivalent and dependent on social interactions. Older patients and patients with more depressive symptoms and lower levels of physical functioning, education and self-efficacy might have more difficulties with certain self-management strategies (six articles). Healthcare professionals perceived self-management as desirable and achievable if based on sufficient skills and knowledge and solid patient–professional partnerships (three articles). Conclusion: Self-management of patients with advanced cancer is highly personal and multifaceted. Strategies may be substitutional, additional or even conflicting compared to care provided by healthcare professionals. Self-management support can benefit from an individualised approach embedded in solid partnerships with relatives and healthcare professionals.

scholarly journals Individual-, Community-, and Health System–Level Barriers to Optimal Type 2 Diabetes Care for Inner-City African Americans: An Integrative Review and Model Development

2019 ◽  
Vol 46 (1) ◽  
pp. 11-27
Author(s):  
Jennifer A. Campbell ◽  
Leonard E. Egede
Keyword(s):  
Type 2 Diabetes ◽  
African Americans ◽  
Inner City ◽  
Health System ◽  
System Level ◽  
Self Management ◽  
Social Ecological ◽  
Multiple Levels ◽  
The Individual

Purpose The purpose of this integrative review is (1) to elucidate the unique barriers faced by inner-city African Americans for type 2 diabetes (T2DM) care; (2) to identify effective interventions/programs for optimal T2DM care at the individual, community, and health systems levels; and (3) to integrate 2 behavioral models and 1 social ecological model for framing interventions for inner-city African American to optimize T2DM care. Methods PRISMA guidelines were followed to systematically search PubMed, PsychInfo, and CINAHL. Integration of models was based on underlying principles of social ecological models. Results The search returned 1183 articles. Forty-six articles were synthesized after applying inclusion criteria. Multiple barriers for the individual level, community level, and health system level were identified. Major barriers include lack of knowledge, lack of social support, and self-management support. Interventions identified in this review show that among inner-city African Americans with T2DM, the focus is placed at the health systems level, with very limited focus toward addressing individual- and community-level barriers. Final synthesis includes development of a new integrated model that explains barriers to care across multiple levels. Conclusions These findings highlight the fragmentation that may be occurring between policy, research, and practice for achieving health equity and addressing health disparities for T2DM care among inner-city African Americans. The new model is an important step in the pursuit of equity in T2DM by specifying the complex barriers that occur across multiple levels. The application of this model using the 2017 National Standards for Diabetes–Self Management Education and Support are discussed.

scholarly journals A Comparative Study on Job Satisfaction between Registered Nurses and Other Qualified Healthcare Professionals

2016 ◽  
Vol 11 (7) ◽  
pp. 144
Author(s):  
Musrrat Parveen ◽  
Khalid Maimani ◽  
Norizan M. Kassim
Keyword(s):  
Job Satisfaction ◽  
Saudi Arabia ◽  
Personal Growth ◽  
Health Care Professionals ◽  
Healthcare Workers ◽  
Healthcare Professionals ◽  
Professional Support ◽  
Local Health ◽  
Public And Private ◽  
Overall Job Satisfaction

<p><em>Introduction </em>The concept of overall job satisfaction has recently received a lot of attention in the healthcare human resource management, particularly in Saudi Arabia. Saudi Arabia faces the biggest challenges in providing qualified healthcare workers and also local health care professionals, such as physicians, nurses and pharmacists. Job satisfaction/dissatisfaction in terms of salary package, personal growth and professional support may have resulted in high healthcare workers turnover rate within the healthcare system in Saudi Arabia.</p><p><em>Method </em>For this study, a total of 400 self-administered questionnaires were conveniently distributed among the RNs and QHPs in both public and private hospitals in Jeddah, one of the major cities of Saudi Arabia.</p><p><em>Analysis</em> Quantitative analysis was carried out on the data, which related to 400 healthcare professionals. This study used a-two way<em> </em>multivariate analysis of variance (MANOVA) to test the differences by using SPSS version 16.</p><p><em>Results</em> Results suggested that QHPs were more contented and satisfied with their salary package as compared to RNs. However, both professions were dissatisfied with the personal growth, and professional support they received from their employers. Some implications of the findings for managers/administrators to practice are discussed.</p><em>Conclusion </em>This study sheds some lights on the issues pertaining to the overall job satisfaction among the healthcare professionals in Saudi Arabia.

scholarly journals Measles Outbreak Among Healthcare Professionals: Operational Response and Remedial Measures

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Silvia Dari ◽  
Anna Maria Cassano ◽  
Sabrina Di Lorenzo ◽  
Raffaela Napoli ◽  
Elisabetta Manini ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Healthcare Professionals ◽  
Local Health ◽  
Close Monitoring ◽  
Health Unit ◽  
Mmr Vaccine ◽  
Information Campaign ◽  
Local Health Unit ◽  
Measles Outbreak ◽  
First Time

Given the numerous cases recorded in 2017, a descriptive epidemiological study was conducted in the Viterbo Local Health Unit (LHU) area, Italy. Hospital Discharge Sheets (HDSs) and the notifications of infectious diseases (NOIDs) were used.We were able to trace the distribution of the disease both in the general population and, in particular, among the staff of Belcolle Hospital in Viterbo. In 2017, 50 cases of measles were detected among the population in the area of Viterbo. Of these, 10 concerned healthcare professionals and 3 employees of the Viterbo LHU.Due to the education and information campaign on the measles, mumps, and rubella (MMR) vaccine and the close monitoring of the vaccination coverage among the employees of the hospital (performed for the first time), only 4 cases were registered from January 1, 2018 to December 31, 2018 in the same area, and no healthcare workers were involved.

scholarly journals The Case of Brazil

2021 ◽  
Vol 11 (1-2) ◽  
pp. 111-142
Keyword(s):  
Health System ◽  
The State ◽  
Local Health ◽  
Life Domains ◽  
Social Quality ◽  
The Social ◽  
Urban Rural ◽  
Local Health System ◽  
Quality Approach

This article analyzes the impacts of the COVID-19 pandemic on the lives of the Amazonian populations of Brazil. Following the social quality approach, it inquires into how COVID-19 intertwined with and reinforced underlying trends and inequalities in different life domains expressed in long-term societal complexities, urban–rural dynamics, and environmental transformations. The article finds that the pandemic, following coloniality of power patterns, has been instrumentalized as a necropolitical tool, and has disproportionately impacted certain peoples and territories based on ethnoracial bias. The collapse of the local health system in the State of Amazonas is a systemic burden, not serendipity. A dialogue is proposed between decolonial and social quality approaches to analyze, unveil, and denounce the interplay between the coloniality of power patterns in non-Western contexts.

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