Perinatal and newborn care in a two years retrospective study in a first level peripheral hospital in Sicily (Italy)

Abstract Background Two hundred seventy-five thousand maternal deaths, 2.7 million neonatal deaths, and 2.6 million stillbirths have been estimated in 2015 worldwide, almost all in low-income countries (LICs). Moreover, more than 20 million severe disabilities result from the complications of pregnancy, childbirth or its management each year. A significant decrease of mortality/morbidity rates could be achieved by providing effective perinatal and newborn care also in high-income countries (HICs), especially in peripheral hospitals and/or rural areas, where the number of childbirths per year is often under the minimal threshold recognized by the reference legislation. We report on a 2 years retrospective cohort study, conducted in a first level peripheral hospital in Cefalù, a small city in Sicily (Italy), to evaluate care provided and mortality/morbidity rates. The proposed goal is to improve the quality of care, and the services that peripheral centers can offer. Methods We collected data from maternity and neonatal records, over a 2-year period from January 2017 to December 2018. The informations analyzed were related to demographic features (age, ethnicity/origin area, residence, educational level, marital status), diagnosis at admission (attendance of birth training courses, parity, type of pregnancy, gestational age, fetal presentation), mode of delivery, obstetric complications, the weight of the newborns, their feeding and eventual transfer to II level hospitals, also through the Neonatal Emergency Transport Service, if the established criteria were present. Results Eight hundred sixteen women were included (age 18–48 years). 179 (22%) attended birth training courses. 763 (93%) were Italian, 53 foreign (7%). 175 (21%) came from outside the province of Palermo. Eight hundred ten were single pregnancies, 6 bigeminal; 783 were at term (96%), 33 preterm (4%, GA 30–41 WG); 434 vaginal deliveries (53%), 382 caesarean sections (47%). One maternal death and 28 (3%) obstetric complications occurred during the study period. The total number of children born to these women was 822, 3 of which stillbirths (3.6‰). 787 (96%) were born at term (>37WG), 35 preterm (4%), 31 of which late preterm. Twenty-one newborns (2.5%) were transferred to II level hospitals. Among them, 3 for moderate/severe prematurity, 18 for mild prematurity/other pathology. The outcome was favorable for all women (except 1 hysterectomy) and the newborns transferred, and no neonatal deaths occurred in the biennium under investigation. Of the remaining 798 newborns, 440 were breastfed at discharge (55%), 337 had a mixed feeding (breastfed/formula fed, 42%) and 21 were formula fed (3%). Conclusions Although the minimal standard of adequate perinatal care in Italy is >500 childbirths/year, the aims of the Italian legislation concern the rationalization of birth centers as well as the structural, technological and organizational improvement of health facilities. Therefore, specific contexts and critical areas need to be identified and managed. Adequate resources and intervention strategies should be addressed not only to perinatal emergencies, but also to the management of mild prematurity/pathology, especially in vulnerable populations for social or orographic reasons. The increasing availability and spread of health care offers, even in HICs, cannot be separated from the goal of quality of care, which is an ethic and public health imperative.

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Care-seeking and managing diabetes in rural Bangladesh: a mixed methods study

BMC Public Health ◽

10.1186/s12889-021-11395-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hannah Maria Jennings ◽

Joanna Morrison ◽

Kohenour Akter ◽

Hassan Haghparast-Bidgoli ◽

Carina King ◽

...

Keyword(s):

Quality Of Care ◽

Health Care Providers ◽

Low Income ◽

Diabetes Management ◽

Local Health ◽

Care Seeking ◽

Care Providers ◽

Structured Interviews ◽

Rural Bangladesh

Abstract Background Type 2 diabetes mellitus poses a major health challenge worldwide and in low-income countries such as Bangladesh, however little is known about the care-seeking of people with diabetes. We sought to understand the factors that affect care-seeking and diabetes management in rural Bangladesh in order to make recommendations as to how care could be better delivered. Methods Survey data from a community-based random sample of 12,047 adults aged 30 years and above identified 292 individuals with a self-reported prior diagnosis of diabetes. Data on health seeking practices regarding testing, medical advice, medication and use of non-allopathic medicine were gathered from these 292 individuals. Qualitative semi-structured interviews and focus group discussions with people with diabetes and semi-structured interviews with health workers explored care-seeking behaviour, management of diabetes and perceptions on quality of care. We explore quality of care using the WHO model with the following domains: safe, effective, patient-centred, timely, equitable and efficient. Results People with diabetes who are aware of their diabetic status do seek care but access, particularly to specialist diabetes services, is hindered by costs, time, crowded conditions and distance. Locally available services, while more accessible, lack infrastructure and expertise. Women are less likely to be diagnosed with diabetes and attend specialist services. Furthermore costs of care and dissatisfaction with health care providers affect medication adherence. Conclusion People with diabetes often make a trade-off between seeking locally available accessible care and specialised care which is more difficult to access. It is vital that health services respond to the needs of patients by building the capacity of local health providers and consider practical ways of supporting diabetes care. Trial registration ISRCTN41083256. Registered on 30/03/2016.

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Implementing Technology That Disrupts Health Systems but not Quality of Care: The Pocket Colposcope in Lima, Peru

JCO Global Oncology ◽

10.1200/go.20.29000 ◽

2020 ◽

Vol 6 (Supplement_1) ◽

pp. 34-34

Author(s):

Marlee Krieger ◽

Nimmi Ramanujam ◽

Mary Elizabeth Dotson Libby

Keyword(s):

Quality Of Care ◽

Low Income ◽

Value Chain ◽

Ease Of Use ◽

Patient Acceptance ◽

Disruptive Technology ◽

Global Value Chain ◽

High Quality ◽

Iron Triangle

PURPOSE Innovative devices are often targeted at increasing access, improving quality, or reducing costs—the three axes of the infamous Iron Triangle of Health Care, which are notoriously difficult to simultaneously optimize. The main aim of this study was to demonstrate that disruptive technologies, if high quality and appropriately implemented, can result in improved access, cost, and quality of care, overcoming the conventional constraints of the Iron Triangle framework. METHODS Our team conducted a global value chain analysis of the Pocket Colposcope in Lima, Peru, and developed surveys and conducted in-depth interviews to evaluate Pocket Colposcope stakeholders. All surveys were developed with consultations from the Duke Evidence Lab and had institutional review board approval. RESULTS The global value chain identified 5 leverage points: regulatory approval, task shifting, collaboration, telemedicine, and patient acceptance. We also identified stakeholders and processes that affect the degree to which the Pocket Colposcope is successfully implemented. Of women surveyed, 39.4% answered that they had previously wanted a cervical cancer screening test, but had been unable to receive one as a result of some barrier. The most common responses were distance to clinics (31.0%), participants could not leave work (27.6%), and patients were afraid of receiving a cancer diagnosis (20.7%). All 4 midwives who participated in the focus group identified the portability of the Pocket Colposcope as the device’s most appealing feature. Providers identified the quality of the image, cost to patient, and ease of use as the 3 most important aspects of the Pocket Colposcope. CONCLUSION The Pocket Colposcope provides an opportunity to make high-quality diagnostic technology more accessible at a cheaper price for more people. Often, disruptive technology in low-income settings is expected to increase access at the cost of reducing quality. In the case of the Pocket Colposcope, the disruptive technology is significantly cheaper than existing technology, but quality is still high enough to succeed.

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‘It makes you someone who changes with the times’: health worker and client perspectives on a smartphone-based counselling application deployed in rural Tanzania

Health Policy and Planning ◽

10.1093/heapol/czz036 ◽

2019 ◽

Vol 34 (4) ◽

pp. 307-315 ◽

Cited By ~ 2

Author(s):

Kristy Hackett ◽

Mina Kazemi ◽

Curtis Lafleur ◽

Peter Nyella ◽

Lawelu Godfrey ◽

...

Keyword(s):

Quality Of Care ◽

Health System ◽

Data Management ◽

Low Income ◽

Community Intervention ◽

Health Workers ◽

Low Income Countries ◽

Maternal And Newborn Health ◽

Pregnancy And Childbirth

AbstractMobile health (mHealth) applications have been developed for community health workers (CHW) to help simplify tasks, enhance service delivery and promote healthy behaviours. These strategies hold promise, particularly for support of pregnancy and childbirth in low-income countries (LIC), but their design and implementation must incorporate CHW clients’ perspectives to be effective and sustainable. Few studies examine how mHealth influences client and supervisor perceptions of CHW performance and quality of care in LIC. This study was embedded within a larger cluster-randomized, community intervention trial in Singida, Tanzania. CHW in intervention areas were trained to use a smartphone application designed to improve data management, patient tracking and delivery of health messages during prenatal counselling visits with women clients. Qualitative data collected through focus groups and in-depth interviews illustrated mostly positive perceptions of smartphone-assisted counselling among clients and supervisors including: increased quality of care; and improved communication, efficiency and data management. Clients also associated smartphone-assisted counselling with overall health system improvements even though the functions of the smartphones were not well understood. Smartphones were thought to signify modern, up-to-date biomedical information deemed highly desirable during pregnancy and childbirth in this context. In this rural Tanzanian setting, mHealth tools positively influenced community perceptions of health system services and client expectations of health workers; policymakers and implementers must ensure these expectations are met. Such interventions must be deeply embedded into health systems to have long-term impacts on maternal and newborn health outcomes.

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Essential basic and emergency obstetric and newborn care: From education and training to service delivery and quality of care

International Journal of Gynecology & Obstetrics ◽

10.1016/j.ijgo.2015.03.007 ◽

2015 ◽

Vol 130 ◽

pp. S46-S53 ◽

Cited By ~ 27

Author(s):

Emmanuel Otolorin ◽

Patricia Gomez ◽

Sheena Currie ◽

Kusum Thapa ◽

Blami Dao

Keyword(s):

Quality Of Care ◽

Service Delivery ◽

Newborn Care ◽

Education And Training ◽

And Training

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PACK Child: the development of a practical guide to extend the scope of integrated primary care for children and young adolescents

BMJ Global Health ◽

10.1136/bmjgh-2018-000957 ◽

2018 ◽

Vol 3 (Suppl 5) ◽

pp. e000957 ◽

Cited By ~ 7

Author(s):

Sandy Picken ◽

Juliet Hannington ◽

Lara Fairall ◽

Tanya Doherty ◽

Eric Bateman ◽

...

Keyword(s):

Primary Care ◽

Quality Of Care ◽

Low Income ◽

Integrated Management ◽

Decision Support Tool ◽

Clinical Decision ◽

Childhood Mortality ◽

Middle Income ◽

Support Tool

Pioneering strategies like WHO’s Integrated Management of Childhood Illness (IMCI) have resulted in substantial progress in addressing infant and child mortality. However, large inequalities exist in access to and the quality of care provided in different regions of the world. In many low-income and middle-income countries, childhood mortality remains a major concern, and the needs of children present a large burden upon primary care services. The capacity of services and quality of care offered require greater support to address these needs and extend integrated curative and preventive care, specifically, for the well child, the child with a long-term health need and the child older than 5 years, not currently included in IMCI. In response to these needs, we have developed an innovative method, based on experience with a similar approach in adults, that expands the scope and reach of integrated management and training programmes for paediatric primary care. This paper describes the development and key features of the PACK Child clinical decision support tool for the care of children up to 13 years, and lessons learnt during its development.

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Analysis of the Implementation of Telehealth Visits for Care of Patients With Cancer in Houston During the COVID-19 Pandemic

JCO Oncology Practice ◽

10.1200/op.20.00572 ◽

2020 ◽

pp. OP.20.00572

Author(s):

Jorge G. Darcourt ◽

Kalia Aparicio ◽

Phillip M. Dorsey ◽

Joe E. Ensor ◽

Eva M. Zsigmond ◽

...

Keyword(s):

Quality Of Care ◽

Low Income ◽

Clinical Findings ◽

Medical Data ◽

Medical Liability ◽

Lower Income ◽

Demographic Information ◽

Patients With Cancer ◽

Patient Interactions

PURPOSE: The purpose of this study was to evaluate the use of telemedicine amid the SARS-CoV-2 pandemic in patients with cancer and assess barriers to its implementation. PATIENTS AND METHODS: Telehealth video visits, using the Houston Methodist MyChart platform, were offered to patients with cancer as an alternative to in-person visits. Reasons given by patients who declined to use video visits were documented, and demographic information was collected from all patients. Surveys were used to assess the levels of satisfaction of treating physicians and patients who agreed to video visits. RESULTS: Of 1,762 patients with cancer who were offered telehealth video visits, 1,477 (83.8%) participated. The patients who declined participation were older (67.7 v 60.2 years; P < .0001), lived in significantly lower-income areas ( P = .0021), and were less likely to have commercial insurance ( P < .0001) than patients who participated. Most participating patients (92.6%) were satisfied with telehealth video visits. A majority of physicians (65.2%) were also satisfied with its use, and 74% indicated that they would likely use telemedicine in the future. Primary concerns that physicians had in using this technology were inadequate patient interactions and acquisition of medical data, increased potential for missing significant clinical findings, decreased quality of care, and potential medical liability. CONCLUSION: Oncology/hematology patients and their physicians expressed high levels of satisfaction with the use of telehealth video visits. Despite recent advances in technology, there are still opportunities to improve the equal implementation of telemedicine for the medical care of vulnerable older, low-income, and underinsured patient populations.

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Neoliberal Reforms in Swedish Primary Health Care: For Whom and for What Purpose?

International Journal of Health Services ◽

10.2190/hs.38.4.g ◽

2008 ◽

Vol 38 (4) ◽

pp. 697-715 ◽

Cited By ~ 15

Author(s):

Göran Dahlgren

Keyword(s):

Health Care ◽

Quality Of Care ◽

Primary Health Care ◽

Low Income ◽

Health Sector ◽

High Income ◽

Public Hospitals ◽

Primary Health ◽

Access And Quality

The conservative government that came to power in Sweden in 2006 has initiated major market-oriented reforms in the health sector. Its first health care policy bill changed the health legislation to make it possible to sell/transfer public hospitals to commercial providers while maintaining public funding. Far-reaching market-oriented primary health care reforms are also initiated, for example in Stockholm County. They are typically presented as “free choice models” in which “the money follows the patient.” The actual and likely effects of these reforms in terms of access and quality of care are discussed in this article. One main finding is that existing social inequities in geographic access to care not only are reinforced but also become very difficult to change by democratic political decisions. Furthermore, dynamic market forces will gradually reduce the quality of care in low-income areas while both access and quality of care will be even better in high-income areas. Public funds are thus transferred from people living in low-income areas to people living in high-income areas, even though the need for good health services is much greater in the low-income areas. Certain policy options for reversing the inverse law of care are also presented.

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