scholarly journals Health system challenges to hypertension and related non-communicable diseases prevention and treatment: perspectives from Ghanaian stakeholders

2019 ◽  
Author(s):  
Amos K. Laar ◽  
Alma J. Adler ◽  
Agnes M. Kotoh ◽  
Helena Legido-Quigley ◽  
Isabelle L. Lange ◽  
...  
Keyword(s):  
Health System ◽  
National Level ◽  
Healthcare Providers ◽  
Significant Risk ◽  
System Level ◽  
Task Sharing ◽  
Improvement Program ◽  
Community Based ◽  
Prevention And Treatment ◽  
Policy Level

Abstract Background Hypertension, itself a cardiovascular condition, is a significant risk factor for other cardiovascular diseases. Hypertension is recognised as a major public health challenge in Ghana. Beginning in 2014, a collaborative team launched the community-based hypertension improvement program (ComHIP) in one health district in Ghana. The ComHIP project, a public-private partnership, tests a community-based model that engages the private sector and utilizes information and communication technology (ICT) to control hypertension. This paper, however, focuses on the various challenges associated with managing hypertension in Ghana, as reported by ComHIP stakeholders. Methods A total of 55 informants – comprising patients, health care professionals, licensed chemical sellers (LCS), national and sub-national policy makers – were purposively selected for interview and focus group discussions (FGDs). Interviews were audio-recorded and transcribed verbatim. Where applicable, transcriptions were translated directly from local language to English. The data were then analysed using two-step thematic analysis. The protocol was approved by the two ethics review committees based in Ghana and the third, based in the United Kingdom. All participants were interviewed after informed consent. Results Our data have implications for the on-going implementation of ComHIP, especially the importance of policy maker buy-in, the benefits, as well as drawbacks of the program to different stakeholders. While our data show that the ComHIP initiative is acceptable to patients and healthcare providers – increasing providers’ knowledge on hypertension and patients’ awareness of same, there were implementation challenges identified by both patients and providers. Policy level challenges relate to task-sharing bottlenecks, which precluded nurses from prescribing or dispensing antihypertensives, and LCS from stocking same. Medication adherence, and the phenomenon of medical pluralism in Ghana, were identified challenges. The perspectives from the national level stakeholders enable elucidation of whole of health system challenges to ComHIP and therefore similarly designed future programmes. Conclusions This paper sheds important light on the patient/individual, and system level challenges to hypertension and related non-communicable disease prevention and treatment in Ghana. The data show that although the ComHIP initiative is acceptable to patients and healthcare providers, policy level task-sharing bottlenecks preclude optimal implementation of ComHIP.

scholarly journals Health system challenges to hypertension and related non-communicable diseases prevention and treatment: perspectives from Ghanaian stakeholders

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Amos K. Laar ◽  
Alma J. Adler ◽  
Agnes M. Kotoh ◽  
Helena Legido-Quigley ◽  
Isabelle L. Lange ◽  
...  
Keyword(s):  
Health System ◽  
National Level ◽  
Healthcare Providers ◽  
Significant Risk ◽  
System Level ◽  
Task Sharing ◽  
Improvement Program ◽  
Community Based ◽  
Prevention And Treatment ◽  
Policy Level

Abstract Background Hypertension, itself a cardiovascular condition, is a significant risk factor for other cardiovascular diseases. Hypertension is recognized as a major public health challenge in Ghana. Beginning in 2014, a collaborative team launched the community-based hypertension improvement program (ComHIP) in one health district in Ghana. The ComHIP project, a public-private partnership, tests a community-based model that engages the private sector and utilizes information and communication technology (ICT) to control hypertension. This paper, focuses on the various challenges associated with managing hypertension in Ghana, as reported by ComHIP stakeholders. Methods A total of 55 informants – comprising patients, health care professionals, licensed chemical sellers (LCS), national and sub-national policymakers – were purposively selected for interview and focus group discussions (FGDs). Interviews were audio-recorded and transcribed verbatim. Where applicable, transcriptions were translated directly from local language to English. The data were then analysed using two-step thematic analysis. The protocol was approved by the two ethics review committees based in Ghana and the third, based in the United Kingdom. All participants were interviewed after giving informed consent. Results Our data have implications for the on-going implementation of ComHIP, especially the importance of policy maker buy-in, and the benefits, as well as drawbacks, of the program to different stakeholders. While our data show that the ComHIP initiative is acceptable to patients and healthcare providers – increasing providers’ knowledge on hypertension and patients’ awareness of same- there were implementation challenges identified by both patients and providers. Policy level challenges relate to task-sharing bottlenecks, which precluded nurses from prescribing or dispensing antihypertensives, and LCS from stocking same. Medication adherence and the phenomenon of medical pluralism in Ghana were identified challenges. The perspectives from the national level stakeholders enable elucidation of whole of health system challenges to ComHIP and similarly designed programmes. Conclusions This paper sheds important light on the patient/individual, and system level challenges to hypertension and related non-communicable disease prevention and treatment in Ghana. The data show that although the ComHIP initiative is acceptable to patients and healthcare providers, policy level task-sharing bottlenecks preclude optimal implementation of ComHIP.

scholarly journals Health system challenges to hypertension and related non-communicable diseases prevention and treatment: perspectives from Ghanaian stakeholders

2019 ◽  
Author(s):  
Amos K. Laar ◽  
Alma J. Adler ◽  
Agnes M. Kotoh ◽  
Helena Legido-Quigley ◽  
Isabelle L. Lange ◽  
...  
Keyword(s):  
Health System ◽  
National Level ◽  
Healthcare Providers ◽  
Significant Risk ◽  
System Level ◽  
Task Sharing ◽  
Improvement Program ◽  
Community Based ◽  
Prevention And Treatment ◽  
Policy Level

Abstract Background Hypertension, itself a cardiovascular condition, is a significant risk factor for other cardiovascular diseases. Hypertension is recognised as a major public health challenge in Ghana. Beginning in 2014, a collaborative team launched the community-based hypertension improvement program (ComHIP) in one health district in Ghana. The ComHIP project, a public-private partnership, tests a community-based model that engages the private sector and utilizes information and communication technology (ICT) to control hypertension. This paper, however, focuses on the various challenges associated with managing hypertension in Ghana, as reported by ComHIP stakeholders. Methods A total of 55 informants – comprising patients, health care professionals, licensed chemical sellers (LCS), national and sub-national policy makers – were purposively selected for interview and focus group discussions (FGDs). Interviews were audio-recorded and transcribed verbatim. Where applicable, transcriptions were translated directly from local language to English. The data were then analysed using two-step thematic analysis. The protocol was approved by the two ethics review committees based in Ghana and the third, based in the United Kingdom. All participants were interviewed after informed consent. Results Our data have implications for the on-going implementation of ComHIP, especially the importance of policy maker buy-in, the benefits, as well as drawbacks of the program to different stakeholders. While our data show that the ComHIP initiative is acceptable to patients and healthcare providers – increasing providers’ knowledge on hypertension and patients’ awareness of same, there were implementation challenges identified by both patients and providers. Policy level challenges relate to task-sharing bottlenecks, which precluded nurses from prescribing or dispensing antihypertensives, and LCS from stocking same. Medication adherence, and the phenomenon of medical pluralism in Ghana, were identified challenges. The perspectives from the national level stakeholders enable elucidation of whole of health system challenges to ComHIP and therefore similarly designed future programmes. Conclusions This paper sheds important light on the patient/individual, and system level challenges to hypertension and related non-communicable disease prevention and treatment in Ghana. The data show that although the ComHIP initiative is acceptable to patients and healthcare providers, policy level task-sharing bottlenecks preclude optimal implementation of ComHIP.

Advocacy for patients with neuropathic pain

2019 ◽  
pp. 347-360
Author(s):  
Ligia Onofrei ◽  
A. Gordon Smith
Keyword(s):  
Health System ◽  
Coping Styles ◽  
Belief Systems ◽  
Healthcare Providers ◽  
Behavioural Therapy ◽  
System Level ◽  
Treatment Modalities ◽  
Educational Materials ◽  
Cognitive Behavioural ◽  
Key Issues

Pain is a nearly universal yet highly individual experience, with broad determinants including genetic factors, mechanism of injury, medical comorbidities, social aspects, and variations in coping styles and belief systems. In this chapter we examine how pain impacts individuals, healthcare providers who care for individuals with pain, and the overall health system with an emphasis on the importance of advocacy at each level. Key issues include the importance of continuing research in developing effective treatments with minimal side effects, improving access to and understanding of complementary and alternative treatment modalities such as cognitive behavioural therapy, developing continuing medical education programmes that empower physicians in the management of complex pain disorders, developing educational materials for patients that enable them to participate in the prevention and/or treatment of pain disorders, and integrating efforts within and across institutions and at a health system level.

scholarly journals Physician Attitudes and Confidence Toward Dementia Capability: Screening, Diagnoses, and Referrals

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 202-202
Author(s):  
Tamara Herrick ◽  
Michelle Ward
Keyword(s):  
Focus Group ◽  
Healthcare Providers ◽  
Memory Loss ◽  
Primary Care Providers ◽  
Physician Attitudes ◽  
System Level ◽  
Cognitive Screening ◽  
Care Providers ◽  
Community Based ◽  
Community Based Organizations

Abstract The MaineHealth Alzheimer’s Disease Partnership is working to improve integration between the healthcare system and community partners through training and a referral network. Primary care providers are often the first to assess cognitively impaired patients, so it is important to understand their attitudes and confidence in dealing with dementia. The objective of this study is to determine barriers to care and evaluate healthcare providers’ attitudes towards their dementia capability, which includes screening for cognitive impairment, disclosing diagnoses, and making referrals to community-based organizations or specialists. A 27-item survey was developed and sent to 474 providers from MaineHealth practices via email. Fifty-three providers responded to the survey. Five healthcare professionals also took part in a focus group; looking more specifically at challenges encountered throughout the dementia care system. This poster will present the findings from the survey and focus group. There was strong agreement that much can be done to improve the quality of life for patients with dementia (86% agreed/strongly agreed) and that screening all patients over age 65 is important (85% agreed/strongly agreed). Confidence levels in ability to diagnose dementia, provide memory loss information, and refer patients to specialists were significantly associated with training (p<.05). The majority of providers identified barriers to cognitive screening and referring patients to community-based organizations, showing that improvements are needed at the system level to remove these barriers. Overall, the results suggest that dementia specific training can improve confidence in care and allow physicians to provide more information about memory loss to patients.

scholarly journals A Systematic Review of Health System Level Initiatives Promoting the Earlier Diagnosis of Cancer Among the Adult Population in High-Income Countries

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 38s-38s ◽  
Author(s):  
N. Calanzani ◽  
L. Nijenhuis ◽  
O. Shahaj ◽  
D. Weller ◽  
C. Campbell
Keyword(s):  
Early Diagnosis ◽  
Health System ◽  
Adult Population ◽  
National Level ◽  
High Income ◽  
Barriers And Facilitators ◽  
System Level ◽  
Health Seeking ◽  
Awareness Campaigns ◽  
The Impact

Background: The increased burden of cancer has driven the development of health system level initiatives worldwide promoting early diagnosis. Although it is challenging to synthesize results of such complex, diverse initiatives, it is crucial to review the evidence to inform future programs and enhance transparency and accountability. Aim: We aimed to systematically review the literature on health system level initiatives promoting early diagnosis among the adult population, describing and categorizing their components, stakeholders, target populations, and outcomes. Methods: We have searched databases (including Embase, PsycInfo, Medline and ASSIA), Web sites (including charities, governmental and nongovernmental agencies) and reference lists of included studies and relevant systematic reviews for peer-reviewed publications and gray literature. We included quantitative, qualitative, mixed-methods studies and reviews/overviews about a single initiative in high-income countries as defined by the World Bank. We included initiatives: 1) targeting adults aged 18 or older; 2) aiming to promote early diagnosis; 3) addressing the patient/public and at least two more levels of contextual influence (according to a model of multilevel influences on cancer care); 4) implemented at a national level or equivalent. Study selection, quality assessment and data extraction were carried out independently by two reviewers. Narrative synthesis was used to analyze the findings. The review protocol has been published by BMJ Open and registered at PROSPERO (CRD42016047233). Results: Twenty initiatives from 10 countries were identified in 263 publications. Data were extracted from 104 core publications about 19 initiatives. It was possible to assess the quality of 35 core publications. Initiatives focused on fast-track for patients with alarm symptoms or other referral pathways for those with other symptoms or abnormal test results (n=11), national awareness campaigns for the public (n=4), and strategies with multiple components (n=4). Tools developed for professionals included referral guidelines and online referral systems. Initiatives focusing on referral pathways showed some improvements in diagnostic intervals, and limited evidence on the impact on staging. Performance targets were often not met. Results from awareness campaigns indicated improvement in awareness, but evidence about changes in health-seeking behavior was limited. Barriers and facilitators were described, including availability of specialist staff. Conclusion: Robustness of methods/outcomes could not always be assessed as several publications were reports or government documents. Evidence on the impact of initiatives regarding longer-term outcomes is limited. Described barriers and facilitators may help to inform future initiatives. Findings may be useful to researchers, policy makers, and governments developing early diagnosis programs and assessing cancer outcomes.

scholarly journals How do inner and outer settings affect implementation of a community-based innovation for older adults with a serious illness: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Grace Warner ◽  
Emily Kervin ◽  
Barb Pesut ◽  
Robin Urquhart ◽  
Wendy Duggleby ◽  
...  
Keyword(s):  
Older Adults ◽  
Palliative Care ◽  
National Level ◽  
Community Context ◽  
System Level ◽  
Successful Implementation ◽  
Community Based ◽  
Serious Illness ◽  
Provider Perceptions ◽  
Outer Setting

Abstract Background Implementing community-based innovations for older adults with serious illness, who are appropriate for a palliative approach to care, requires developing partnerships between health and community. Nav-CARE is an evidence-based innovation wherein trained volunteer navigators advocate, facilitate community connections, coordinate access to resources, and promote active engagement of older adults within their communities. Acknowledging the importance of partnerships between organizations, the aim of our study was to use the Consolidated Framework for Implementation Research (CFIR) to explore organizational (Inner Setting) and community or health system level (Outer Setting) barriers and facilitators to Nav-CARE implementation. Methods Guided by CFIR, qualitative individual and group interviews were conducted to examine the implementation of Nav-CARE in a Canadian community. Participants were individuals who delivered or managed Nav-CARE research, and stakeholders who provided services in the community. The Framework Method was used to analyse the data. Particular attention was paid to the host organization’s external network and community context. Results Implementation was affected by several inter-related CFIR domains, making it difficult to meaningfully separate key findings by only inner and outer settings. Thus, findings were organized into themes informed by CFIR, that cut across other domains and incorporated inductive findings: intraorganizational perceptions of Nav-CARE; public and healthcare professionals’ perceptions of palliative care; interorganizational partnerships and relationships; community and national-level factors that should have facilitated Nav-CARE implementation; and suggested changes to Nav-CARE. Themes demonstrated barriers to implementing Nav-CARE, such as poor organizational readiness for implementation, and public and health provider perceptions palliative care was synonymous with fast-approaching death. Conclusions Implementation science frameworks and theories commonly focus on assessing implementation of innovations within facilities and changing behaviours of individuals within that organizational structure. Implementation frameworks need to be adapted to better assess Outer Setting factors that affect implementation of community-based programs. Although applying the CFIR helped uncover critical elements in the Inner and Outer Settings that affected implementation of Nav-CARE. Our study suggests that the CFIR could expand the Outer Setting to acknowledge and assess organizational structures and beliefs of individuals within organizations external to the host organization who impact successful implementation of community-based innovations.

scholarly journals Dispensing antiretrovirals during Covid-19 lockdown: re-discovering community-based ART delivery models in Uganda

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Henry Zakumumpa ◽  
Christopher Tumwine ◽  
Kiconco Milliam ◽  
Neil Spicer
Keyword(s):  
Health System ◽  
National Level ◽  
Hiv Care ◽  
District Health ◽  
Community Based ◽  
Community Based Art ◽  
System Resilience ◽  
Delivery Models ◽  
Art Delivery

Abstract Background The notion of health-system resilience has received little empirical attention in the current literature on the Covid-19 response. We set out to explore health-system resilience at the sub-national level in Uganda with regard to strategies for dispensing antiretrovirals during Covid-19 lockdown. Methods We conducted a qualitative case-study of eight districts purposively selected from Eastern and Western Uganda. Between June and September 2020, we conducted qualitative interviews with district health team leaders (n = 9), ART clinic managers (n = 36), representatives of PEPFAR implementing organizations (n = 6).In addition, six focus group discussions were held with recipients of HIV care (48 participants). Qualitative data were analyzed using thematic approach. Results Five broad strategies for distributing antiretrovirals during ‘lockdown’ emerged in our analysis: accelerating home-based delivery of antiretrovirals,; extending multi-month dispensing from three to six months for stable patients; leveraging the Community Drug Distribution Points (CDDPs) model for ART refill pick-ups at outreach sites in the community; increasing reliance on health information systems, including geospatial technologies, to support ART refill distribution in unmapped rural settings. District health teams reported leveraging Covid-19 outbreak response funding to deliver ART refills to homesteads in rural communities. Conclusion While Covid-19 ‘lockdown’ restrictions undoubtedly impeded access to facility-based HIV services, they revived interest by providers and demand by patients for community-based ART delivery models in case-study districts in Uganda.

scholarly journals Factors affecting healthcare pathways for chronic lung disease management in Vietnam: a qualitative study on patients’ perspectives

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Thu-Anh Nguyen ◽  
Yen Ngoc Pham ◽  
Nhung Phuong Doan ◽  
Thao Huong Nguyen ◽  
Toan Thanh Do ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Health System ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
National Level ◽  
Healthcare Providers ◽  
Chronic Respiratory Disease ◽  
Health Facilities ◽  
Respiratory Morbidity ◽  
Chronic Obstructive

Abstract Background Chronic obstructive pulmonary disease (COPD) and asthma rank among the leading causes of respiratory morbidity, particularly in low- and middle-income countries. This qualitative study aimed to explore the healthcare pathways of patients with chronic respiratory disease, and factors influencing their ability to access healthcare in Vietnam, where COPD and asthma are prevalent. Methods We conducted 41 in-depth interviews among patients, including 31 people with COPD, eight with asthma and two with asthma-COPD overlap syndrome. Participants were recruited at provincial- or national-level health facilities in two urban and two rural provinces in Vietnam. The interviews were audio-recorded, transcribed, and analysed using thematic analysis. Results Patients’ healthcare pathways were complex and involved visits to multiple health facilities before finally obtaining a definitive diagnosis at a provincial- or national-level hospital. Access to healthcare was affected considerably by participants’ limited knowledge of their respiratory conditions, the availability of social support, especially from family members, the costs of healthcare as well as health system factors (including the coverage of public health insurance, the distance to health facilities, and attitude of healthcare providers). Conclusion The study demonstrated the need for improved access to timely diagnosis and treatment of chronic lung disease within the lower level of the health system. This can be achieved by enhancing the communication skills and diagnostic capacity of local healthcare workers. Health education programmes for patients and caregivers will contribute to improved control of lung disease.

Multi-level Barriers for Utilization of Youth Friendly Reproductive Health Services (YFRHS) among Youths

2020 ◽  
Vol 8 ◽  
pp. 95-108
Author(s):  
Shanti Prasad Khanal
Keyword(s):  
Reproductive Health ◽  
Health Services ◽  
Health System ◽  
System Level ◽  
Mixed Method Research ◽  
Reproductive Health Services ◽  
Group Discussions ◽  
Personal Level ◽  
Multi Level ◽  
Youth Friendly

 The present study aims to examine the multi-level barriers to utilize by the youth-friendly reproductive health services (YFRHS) among the school-going youths of the Surkhet valley of Nepal. This study is based on the sequential explanatory research design under mixed-method research. The quantitative data were collected using the self- administered questionnaire from the 249 youths, aged between the 15-24 years, those selected by using random sampling. The qualitative data were collected using the Focus Group Discussions (FGDs) from the 12 participants who were selected purposively. The study confirmed that school-going youths do not have appropriate utilization of YFHS due to multi-layered barriers. However, the utilization of the service was higher among females, those the older age group, studying in the upper classes, the upper castes, and married youths. The key findings and themes are recognized as multi-layered barriers including personal-level, health system-level, community-level, and policy-level on the entire socio-ecological field. Among them, the existing health system is the foremost barrier. Multi-level interventions are, therefore, required to increase the YFRHS utilization and improve concerns for school-going-youths.  

scholarly journals 139. Impact of Pharmacist Driven Outpatient Fluoroquinolone Stewardship Initiative in Community Based Setting

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S81-S81
Author(s):  
Sarah Norman ◽  
Sara Jones ◽  
Cara Acklin ◽  
Christian Cheatham
Keyword(s):  
Antimicrobial Stewardship ◽  
Healthcare Providers ◽  
Hospital Setting ◽  
Secondary Outcome ◽  
Quality Improvement Initiative ◽  
Oral Antibiotic ◽  
Ambulatory Care Setting ◽  
Community Based ◽  
Before And After ◽  
Physician Network

Abstract Background Antimicrobial stewardship initiatives and efforts have historically had a greater emphasis in the inpatient hospital setting. There is a need for outpatient stewardship, and additionally, accreditation standards are starting to require antimicrobial stewardship efforts in the ambulatory care setting. Fluoroquinolones are a target for antimicrobial stewardship based on their broad-spectrum activity, pharmacokinetics/pharmacodynamics, safety profile, downstream resistance, and risk of super infections. The objective of this study was to compare outpatient fluoroquinolone prescribing rates before and after pharmacist led initiative. Methods This was a prospective, quality improvement initiative between October 1, 2019 to June 1, 2020 at a community-based physician network across Indiana. The pharmacist initiative incorporated a live, educational presentation with intervention 1 and an informational letter to healthcare providers across the outpatient physician network with intervention 2. Data was collected from a computer-generated, prescription report. The primary outcome was fluoroquinolone prescribing rates at Central Indiana (CI) sites before and after pharmacist led interventions. Rate of fluoroquinolone prescribing was defined as total number of fluoroquinolone prescriptions per month. The secondary outcome included percentage of fluoroquinolone use at CI sites. Percentage of fluoroquinolone use was defined as monthly number of fluoroquinolones prescriptions compared to monthly number of all oral antibiotic prescriptions. Results There was a 29.8% decrease (382 vs 268 prescriptions) in outpatient fluoroquinolone prescriptions at CI sites after intervention 1 compared to same month of previous year. There was a 43.7% decrease (428 vs 241 prescriptions) in outpatient fluoroquinolone prescriptions at CI sites after intervention 2. There was an overall 2.4% decrease (4.9% vs 2.5%) in percentage of fluoroquinolone use compared to all oral antibiotics at CI sites after intervention 2 compared to same month of previous year. Conclusion These findings suggest the pharmacist led outpatient antimicrobial stewardship initiative successfully decreased fluoroquinolone prescribing rates across the network. Disclosures Christian Cheatham, PharmD, BCIDP, Antimicrobial Resistance Solutions (Shareholder)

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