scholarly journals Provider perspectives on demand creation for maternal vaccines in Kenya

2018 ◽  
Vol 2 ◽  
pp. 34 ◽  
Author(s):  
Irina Bergenfeld ◽  
Stacy W. Nganga ◽  
Courtni A. Andrews ◽  
Vincent L. Fenimore ◽  
Nancy A. Otieno ◽  
...  
Keyword(s):  
Patient Education ◽  
Healthcare Providers ◽  
Immunization Coverage ◽  
Provider Education ◽  
Structured Interviews ◽  
Maternal Immunization ◽  
Provider Perspectives ◽  
Demand Creation ◽  
Print Materials ◽  
Cultural Leaders

Background. Expansion of maternal immunization, which offers some of the most effective protection against morbidity and mortality in pregnant women and neonates, requires broad acceptance by healthcare providers and their patients. We aimed to describe issues surrounding acceptance and demand creation for maternal vaccines in Kenya from a provider perspective. Methods. Nurses and clinical officers were recruited for semi-structured interviews covering resources for vaccine delivery, patient education, knowledge and attitudes surrounding maternal vaccines, and opportunities for demand creation for new vaccines. Interviews were conducted in English and Swahili, transcribed verbatim from audio recordings, and analyzed using codes developed from interview guide questions and emergent themes. Results. Providers expressed favorable attitudes about currently available maternal immunizations and introduction of additional vaccines, viewing themselves as primarily responsible for vaccine promotion and patient education.  The importance of educational resources for both patients and providers to maintain high levels of maternal immunization coverage was a common theme. Most identified barriers to vaccine acceptance and delivery were cultural and systematic in nature. Suggestions for improvement included improved patient and provider education, including material resources, and community engagement through religious and cultural leaders. Conclusions. The distribution of standardized, evidence-based print materials for patient education may reduce provider overwork and facilitate in-clinic efforts to inform women about maternal vaccines. Continuing education for providers should address communication surrounding current vaccines and those under consideration for introduction into routine schedules. Engagement of religious and community leaders, as well as male decision-makers in the household, will enhance future acceptance of maternal vaccines.

scholarly journals Connected diagnostics to improve accurate diagnosis, treatment, and conditional payment of malaria services in Kenya

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shannen M. C. van Duijn ◽  
Angela K. Siteyi ◽  
Sherzel Smith ◽  
Emmanuel Milimo ◽  
Leon Stijvers ◽  
...  
Keyword(s):  
Clinical Performance ◽  
Healthcare Providers ◽  
Malaria Treatment ◽  
Sub Saharan Africa ◽  
Structured Interviews ◽  
National Guidelines ◽  
Private Providers ◽  
Provider Perspectives ◽  
Treatment Data ◽  
Sub Saharan

Abstract Background In sub-Saharan Africa, the material and human capacity to diagnose patients reporting with fever to healthcare providers is largely insufficient. Febrile patients are typically treated presumptively with antimalarials and/or antibiotics. Such over-prescription can lead to drug resistance and involves unnecessary costs to the health system. International funding for malaria is currently not sufficient to control malaria. Transition to domestic funding is challenged by UHC efforts and recent COVID-19 outbreak. Herewith we present a digital approach to improve efficiencies in diagnosis and treatment of malaria in endemic Kisumu, Kenya: Connected Diagnostics. The objective of this study is to evaluate the feasibility, user experience and clinical performance of this approach in Kisumu. Methods Our intervention was performed Oct 2017–Dec 2018 across five private providers in Kisumu. Patients were enrolled on M-TIBA platform, diagnostic test results digitized, and only positive patients were digitally entitled to malaria treatment. Data on socio-demographics, healthcare transactions and medical outcomes were analysed using standard descriptive quantitative statistics. Provider perspectives were gathered by 19 semi-structured interviews. Results In total 11,689 febrile patients were digitally tested through five private providers. Malaria positivity ranged from 7.4 to 30.2% between providers, significantly more amongst the poor (p < 0.05). Prescription of antimalarials was substantially aberrant from National Guidelines, with 28% over-prescription (4.6–63.3% per provider) and prescription of branded versus generic antimalarials differing amongst facilities and correlating with the socioeconomic status of clients. Challenges were encountered transitioning from microscopy to RDT. Conclusion We provide full proof-of-concept of innovative Connected Diagnostics to use digitized malaria diagnostics to earmark digital entitlements for correct malaria treatment of patients. This approach has large cost-saving and quality improvement potential.

scholarly journals Connected Diagnostics to Improve Accurate Diagnosis, Treatment, and Conditional Payment of Malaria Services in Kenya.

2020 ◽  
Author(s):  
Shannen Van Duijn ◽  
Angela Siteyi ◽  
Sherzel Smith ◽  
Emmanuel Milimo ◽  
Leon Stijvers ◽  
...  
Keyword(s):  
Clinical Performance ◽  
Healthcare Providers ◽  
Malaria Treatment ◽  
Sub Saharan Africa ◽  
Structured Interviews ◽  
Medical Outcomes ◽  
Provider Perspectives ◽  
Treatment Data ◽  
Sub Saharan ◽  
Quantitative Statistics

Abstract Background: In sub-Saharan Africa, the material and human capacity to diagnose patients reporting with fever to healthcare providers is largely insufficient. Febrile patients are typically treated presumptively with antimalarials and/or antibiotics. Such over-prescription can lead to drug resistance and involves unnecessary costs to the health system. International funding for malaria is decreasing and transition to domestic funding is challenged by UHC efforts and recent COVID-19 outbreak. Herewith we present a digital approach to markedly improve efficiencies in diagnosis and treatment of malaria in endemic Kisumu, Kenya. The objective of this study is to evaluate feasibility, user experience, clinical performance and of Connected Diagnostics in Kisumu and to assess over-prescription of antimalarials. Methods: Our intervention was performed Oct 2017 – Dec 2018 across seven providers in Kisumu. Patients were enrolled on M-TIBA platform, diagnostic test results digitized, and only positive patients were digitally entitled for malaria treatment. Data on socio-demographics, healthcare transactions and medical outcomes were analysed using standard descriptive quantitative statistics. Provider perspectives were gathered by 19 semi-structured interviews. Results: In total 11,689 febrile patients were tested. Malaria positivity rates ranged from 7.4% to 30.2% between providers, with significantly more positive cases amongst the poor (p< 0.05). Over-prescription of antimalarials was 28%, fluctuating between 4.6% to 63.3% per provider. Prescription of branded versus generic antimalarials was dichotomous. Challenges were encountered transitioning from microscopy to RDT. Conclusion: We provide full proof-of-concept of innovative Connected Diagnostics to use digitized malaria diagnostics to earmark digital entitlements for correct malaria treatment of patients. This approach has large cost-saving and quality improving potential.

Survey analysis: Assessing the needs of immunotherapy patients, caregivers, and health care providers.

2018 ◽  
Vol 36 (5_suppl) ◽  
pp. 135-135 ◽  
Author(s):  
Anabella Aspiras ◽  
Nicholas James Power ◽  
Maria Belen Gonzalo
Keyword(s):  
Side Effects ◽  
Patient Education ◽  
Health Care Providers ◽  
Clinical Care ◽  
Healthcare Providers ◽  
Care Providers ◽  
Survey Analysis ◽  
Needs Assessments ◽  
Provider Perspectives ◽  
Cancer Support

135 Background: As the use of cancer immunotherapy increases, unique challenges emerge for both patients undergoing immunotherapy and the clinical staff who care for them. To better understand these challenges, the Cancer Support Community (CSC) conducted surveys of patients, caregivers, and healthcare staff (e.g. oncologists, nurses, social workers) at nine oncology centers across the country. Methods: Needs assessments were conducted through paper and online surveys between August and September, 2017. The analysis is based upon a cross-sectional survey of adult (18 years old and older) cancer patients, caregivers, and healthcare providers. 93 healthcare providers, 65 patients, and 21 caregivers completed the survey. Descriptive statistics and statistical analyses were performed using SPSS Version 24; analyses of association used a significance level of .05. Results: Findings from this analysis yielded important provider perspectives and illustrated targeted areas of patient and caregiver concern. Of note, while only about one-third of patients and caregivers (31% and 38%, respectively) indicated that it was important to understand the science of immunotherapy, nearly half of healthcare providers (46%) reported that educational resources should go “quite a bit” in-depth into immunotherapy science. Also, although caregivers reported greater difficulty finding information about immunotherapy, the majority of both patients (55%) and caregivers (85%) identified managing treatment-related side effects as their foremost education need. Conclusions: CSC’s analysis revealed valuable insights in both clinical care and patient education. Needs assessment results will inform the development and implementation of Immunotherapy & Me, a CSC pilot program to determine whether layering in patient education and care-management tools leads to improved patient and clinical outcomes. CSC’s needs assessments conclude that for both patients and providers, treatment-related side effects are top-of-mind. This underscores the importance of developing turnkey resources to help patients and healthcare providers manage immunotherapy-related side effects – an express goal of the Immunotherapy & Me pilot.

scholarly journals Connected Diagnostics to improve accurate diagnosis, treatment, and conditional payment of malaria services in Kenya.

2020 ◽  
Author(s):  
Shannen Van Duijn ◽  
Angela Siteyi ◽  
Sherzel Smith ◽  
Emmanuel Milimo ◽  
Leon Stijvers ◽  
...  
Keyword(s):  
Clinical Performance ◽  
Healthcare Providers ◽  
Malaria Treatment ◽  
Sub Saharan Africa ◽  
Structured Interviews ◽  
National Guidelines ◽  
Private Providers ◽  
Provider Perspectives ◽  
Treatment Data ◽  
Sub Saharan

Abstract Background: In sub-Saharan Africa, the material and human capacity to diagnose patients reporting with fever to healthcare providers is largely insufficient. Febrile patients are typically treated presumptively with antimalarials and/or antibiotics. Such over-prescription can lead to drug resistance and involves unnecessary costs to the health system. International funding for malaria is currently not sufficient to control malaria. Transition to domestic funding is challenged by UHC efforts and recent COVID-19 outbreak. Herewith we present a digital approach to improve efficiencies in diagnosis and treatment of malaria in endemic Kisumu, Kenya: Connected Diagnostics. The objective of this study is to evaluate the feasibility, user experience and clinical performance of this approach in Kisumu.Methods: Our intervention was performed Oct 2017 – Dec 2018 across five private providers in Kisumu. Patients were enrolled on M-TIBA platform, diagnostic test results digitized, and only positive patients were digitally entitled to malaria treatment. Data on socio-demographics, healthcare transactions and medical outcomes were analysed using standard descriptive quantitative statistics. Provider perspectives were gathered by 19 semi-structured interviews.Results: In total 11,689 febrile patients were digitally tested through five private providers. Malaria positivity ranged from 7.4% to 30.2% between providers, significantly more amongst the poor (p< 0.05). Prescription of antimalarials was substantially aberrant from National Guidelines, with 28% over-prescription (4.6%-63.3% per provider) and prescription of branded versus generic antimalarials differing amongst facilities and correlating with the socioeconomic status of clients. Challenges were encountered transitioning from microscopy to RDT.Conclusion: We provide full proof-of-concept of innovative Connected Diagnostics to use digitized malaria diagnostics to earmark digital entitlements for correct malaria treatment of patients. This approach has large cost-saving and quality improvement potential.

scholarly journals Exploring provider perspectives on patients with atrial fibrillation who are not prescribed anticoagulation therapy

2021 ◽  
Author(s):  
Catherine Yao ◽  
Aubrey E. Jones ◽  
Stacey Slager ◽  
Angela Fagerlin ◽  
Daniel M. Witt
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Shared Decision Making ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Shared Decision ◽  
Provider Education ◽  
Prescribing Practices ◽  
Structured Interviews ◽  
Provider Perspectives

AbstractBackgroundEvidence-based guidelines strongly recommend oral anticoagulants to prevent stroke in patients with non-valvular atrial fibrillation (AF). However, many patients are not prescribed guideline recommended anticoagulant therapy.ObjectivesTo explore themes underlying anticoagulant prescribing or discontinuation in patients with AF and compare and contrast prescribing preferences between cardiologists and general practitioners.MethodsProviders at the University of Utah Health system were recruited to participate in semi-structured interviews. An interview guide directed the 15-minute interviews with focus on anticoagulant prescribing practices for patients with AF. Interviews were transcribed verbatim. Two reviewers independently read transcripts and labeled passages of text corresponding with key concepts and themes.ResultsOf the eleven practitioners interviewed, seven practiced in cardiology, two in internal medicine and two in family medicine. The most prominent reasons cited for not prescribing anticoagulation for stroke prevention in AF patients were concerns about intracranial bleeding, followed by gastrointestinal bleeding. Other common reasons were increased age, thrombocytopenia, chemotherapy, previous or concerns of noncompliance, and comorbidities. Providers believed patient refusal of anticoagulants was related to fear of bleeding, medication burden, or warfarin’s negative reputation. All prescribers reported similar prescribing strategies, including using risk stratification, shared decision making, and utilizing specialized anticoagulation clinics and pharmacists as resources.ConclusionFear of bleeding was a common theme underlying anticoagulant underutilization in patients with AF. Identifying major reasons directly from providers can be utilized to develop patient education addressing common fears and misconceptions, promote shared decision making, and provide provider education and resources to achieve appropriate anticoagulant prescribing.

scholarly journals Antenatal Doppler ultrasound implementation in a rural sub-Saharan African setting: exploring the perspectives of women and healthcare providers

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Sam Ali ◽  
Olive Kabajaasi ◽  
Michael G. Kawooya ◽  
Josaphat Byamugisha ◽  
David Zakus ◽  
...  
Keyword(s):  
Doppler Ultrasound ◽  
Qualitative Content Analysis ◽  
Healthcare Providers ◽  
World Health ◽  
Structured Interviews ◽  
Long Distance ◽  
Local Staff ◽  
Provider Perspectives ◽  
Ultrasound Technology ◽  
Western Uganda

Abstract Background The World Health Organization recommends research to evaluate the effects of a single third trimester Doppler ultrasound examination on preventable deaths in unselected-risk pregnancies, particularly in low- and middle-income countries (LMICs) where the evidence base is scarce. While evaluating such technologies, researchers often ignore women and health care provider perspectives. This study explored the views and experiences of women and healthcare providers regarding the use of advanced ultrasound technology to optimize the health of mothers and their babies in a rural community in mid-western Uganda. Methods We enrolled 53 mothers and 10 healthcare providers, and captured data on their perceptions, barriers, and facilitators to the use of Doppler ultrasound technology using focus group discussions, semi-structured interviews and observations. Using qualitative content analysis, we inductively coded the transcripts in ATLAS.ti 8.0, detecting emerging themes. Results Women were afraid that ultrasound would harm them or their fetuses and many of them had never seen an ultrasound scan. The majority of the women found their partners supportive to attend antenatal care and use ultrasound services. Healthcare providers in Kagadi Hospital were unfamiliar with Doppler technology and using it to guide clinical decisions. Other barriers to the implementation of Doppler ultrasound included shortage of trained local staff, insufficient equipment, long distance to and from the hospital, and frequent power cuts. Conclusions We found limited exposure to Doppler ultrasound technology among women and healthcare providers in mid-western Uganda. Engaging male partners may potentially influence the likelihood of accepting and using it to improve the health of women and their fetuses while wide spread myths and misconceptions about it may be changed by community engagement. Healthcare workers experienced difficulties in offering follow-up care to mothers detected with complications and Doppler ultrasound required a high level of training. While introducing advanced ultrasound machines to weak health systems, it is important to adequately train healthcare providers to avoid inappropriate interventions based on misinterpretation of the findings, consider where it is likely to be most beneficial, and embed it with realistic clinical practice guidelines.

scholarly journals Patient and provider perspectives on the development and resolution of prescribing cascades: a qualitative study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Barbara J. Farrell ◽  
Lianne Jeffs ◽  
Hannah Irving ◽  
Lisa M. McCarthy
Keyword(s):  
Qualitative Study ◽  
Team Member ◽  
Healthcare Providers ◽  
Social Supports ◽  
Relevant Information ◽  
Patient Specific ◽  
Day Hospital ◽  
Structured Interviews ◽  
Provider Perspectives ◽  
Patient And Provider Perspectives

Abstract Background Prescribing cascades occur when the side effect of a medication is treated with a second medication. The aim of the study was to understand how prescribing cascades develop and persist and to identify strategies for their identification, prevention and management. Method This qualitative study employed semi-structured interviews to explore the existence of prescribing cascades and to gather patients', caregivers' and clinicians’ perspectives about how prescribing cascades start, persist and how they might be resolved. Participants were older adults (over age 65) at an outpatient Geriatric Day Hospital (GDH) with possible prescribing cascades (identified by a GDH team member), their caregivers, and healthcare providers. Data were analyzed using an inductive content analysis approach. Results Fourteen participants were interviewed (eight patients, one family caregiver, one GDH pharmacist, three GDH physicians and one family physician) providing a total of 22 interviews about patient-specific cases. The complexity and contextually situated nature of prescribing cascades created challenges for all of those involved with their identification. Three themes impacted how prescribing cascades developed and persisted: varying awareness of medications and cascades; varying feelings of accountability for making decisions about medication-related care; and accessibility to an ideal environment and relevant information. Actions to prevent, identify or resolve cascades were suggested. Conclusion Patients and healthcare providers struggled to recognize prescribing cascades and identify when they had occurred; knowledge gaps contributed to this challenge and led to inaction. Strategies that equip patients and clinicians with resources to recognize prescribing cascades and environmental and social supports that would help with their identification are needed. Current conceptualizations of cascades warrant additional refinement by considering the nuances our work raises regarding their appropriateness and directionality.

scholarly journals Understanding patient outcomes to develop a multimorbidity adapted patient-reported outcomes measure: a qualitative description of patient and provider perspectives

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Maxime Sasseville ◽  
Maud-Christine Chouinard ◽  
Martin Fortin
Keyword(s):  
Health Management ◽  
Healthcare Providers ◽  
Psychosocial Health ◽  
Research Process ◽  
Qualitative Description ◽  
Valuable Insight ◽  
Structured Interviews ◽  
Provider Perspectives ◽  
Wide Range ◽  
Patient Reported

Abstract Background Multimorbidity is a complex health situation that requires interventions tailored to patient needs; the outcomes of such interventions are difficult to evaluate. The purpose of this study was to describe the outcomes of patient-centred interventions for people with multimorbidity from the patients’ and healthcare providers’ perspectives. Methods This study followed a qualitative descriptive design. Nine patients with multimorbidity and 18 healthcare professionals (nurses, general practitioners, nutritionists, and physical and respiratory therapists), participating in a multimorbidity-adapted intervention in primary care were recruited. Data were collected using semi-structured interviews with 12 open-ended questions. Triangulation of disciplines among interviewers, research team debriefing, data saturation assessment and iterative data collection and analysis ensured a rigorous research process. Results Outcome constructs described by participants covered a wide range of themes and were grouped into seven outcome domains: Health Management, Physical Health, Functional Status, Psychosocial Health, Health-related Behaviours, General Health and Health Services. The description of constructs by stakeholders provides valuable insight on how outcomes are experienced and worded by patients. Conclusion Participants described a wide range of outcome constructs, which were relevant to and observable by patients and were in line with the clinical reality. The description provides a portrait of multimorbidity-adapted intervention outcomes that are significant for the selection and development of clinical research outcome measures.

scholarly journals Reluctance to Accept Palliative Care and Recommendations for Improvement: Findings From Semi-Structured Interviews With Patients and Caregivers

2021 ◽  
pp. 104990912110126
Author(s):  
Valeria Cardenas ◽  
Anna Rahman ◽  
Yujun Zhu ◽  
Susan Enguidanos
Keyword(s):  
Palliative Care ◽  
Controlled Trial ◽  
Insurance Coverage ◽  
Healthcare Providers ◽  
Health Condition ◽  
Insurance Companies ◽  
Structured Interviews ◽  
Care Services ◽  
Home Based ◽  
Palliative Care Services

Background: Despite some insurance plans now paying for home-based palliative care, recent reports have suggested that insurance coverage for palliative care may be insufficient in expanding patient access to home-based palliative care. Aim: To identify patients’ and caregivers’ perceived barriers to home-based palliative care and their recommendations for overcoming these barriers. Design: We conducted a qualitative study using semi-structured individual interviews. Our interview protocol elicited participants’ perspectives on home-based palliative care services; positive and negative aspects of the palliative program explanation; and suggestions for improving messaging around home-based palliative care. Setting/Participants: Twenty-five participants (patients, proxies, and their caregivers) who were eligible for a randomized controlled trial of home-based palliative care were interviewed by telephone. Results: Themes related to home-based palliative care referral barriers included reluctance to have home visits, enrollment timing, lack of palliative care knowledge, misconceptions about palliative care, and patients’ self-perceived health condition. Themes related to recommendations for overcoming these obstacles included ensuring that palliative care referrals come from healthcare providers or insurance companies and presenting palliative care services more clearly. Conclusion: Findings reinforce the need for additional palliative care education among patients with serious illness (and their caregivers) and the importance of delivering palliative care information and referrals from trusted sources.

scholarly journals Exploring the experiences related to postpartum changes: perspectives of mothers and healthcare providers in Iran

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mahboobeh Asadi ◽  
Mahnaz Noroozi ◽  
Mousa Alavi
Keyword(s):  
Postpartum Period ◽  
Qualitative Content Analysis ◽  
Healthcare Providers ◽  
Educational Interventions ◽  
Psychological State ◽  
Structured Interviews ◽  
Childbearing Age ◽  
New Period ◽  
Women's Lives ◽  
Field Notes

Abstract Background Numerous changes occur in different aspects of women’s lives in the postpartum period. Women’s adjusting with problems and taking advantage of this opportunity can develop their personality. In this regard, accurate knowledge of their experiences and feelings is necessary to help them to benefit from this period. Therefore, the present study aimed to explore the experiences related to postpartum changes in women. Methods In the present qualitative study, 23 participants, including women of childbearing age who gave birth and healthcare providers (midwives and obstetricians) in Isfahan, Iran were selected using purposive sampling with a maximum variation strategy. Data were collected through in-depth semi structured interviews, field notes, and daily notes, and simultaneously analyzed using the conventional qualitative content analysis. Results The data analysis results led to the extraction of three main categories including “feeling of decreased female attractiveness” (with two sub-categories of “ feeling of decreased beauty” and “feeling of decreased sexual function”), “feeling of insolvency and helplessness” (with two sub-categories of “physical burnout”, and “mental preoccupations”) and “beginning a new period in life” (with three sub-categories of “changing the meaning of life”, “feeling of maturity” and “deepening the communication”). Conclusions Findings of this study can provide a good context for designing interventions to improve the women’s quality of life by explaining and highlighting their experiences in the postpartum period. In this regard, providing sufficient empathy, social and psychological support from family members (especially husband), performing appropriate educational interventions and also regular assessment of women’s psychological state by healthcare providers in postpartum period can reduce their concerns and help to improve their health.

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