scholarly journals Exploring barriers and facilitators to integrated hypertension-HIV management in Ugandan HIV clinics using the Consolidated Framework for Implementation Research (CFIR)

2020 ◽  
Author(s):  
Martin Muddu ◽  
Andrew K. Tusubira ◽  
Brenda Nakirya ◽  
Rita Nalwoga ◽  
Fred C. Semitala ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Implementation Research ◽  
Health System Strengthening ◽  
Relative Advantage ◽  
Prior Work ◽  
Care Providers ◽  
Increased Risk ◽  
Inner Setting ◽  
Hiv Integration

Abstract BackgroundPersons Living with HIV (PLHIV) receiving antiretroviral therapy have increased risk of cardiovascular disease (CVD). Integration of services for hypertension (HTN), the primary CVD risk factor, into HIV clinics is recommended in Uganda. Our prior work demonstrated multiple gaps in implementation of integrated HTN care along the HIV treatment cascade. In this study, we sought to explore barriers to, and facilitators of, integrating HTN screening and treatment into HIV clinics in Eastern Uganda.MethodsWe conducted a qualitative study at three HIV clinics with low, intermediate, and high HTN care cascade performance, which we classified based on our prior work. Guided by the Consolidated Framework for Implementation Research (CFIR), we conducted semi-structured interviews with health services managers, health care providers and hypertensive PLHIV (n=83). Interviews were transcribed verbatim. Three qualitative researchers used both deductive (CFIR model-driven) and inductive (open coding) methods to develop relevant codes and themes. Ratings were performed to determine valence and strengths of each CFIR construct regarding influencing HTN/HIV integration. ResultsOf the 39 CFIR constructs assessed, 17 were relevant to either barriers or facilitators to HTN/HIV integration. Six constructs strongly distinguished performance and were barriers, three of which were in the Inner setting (Organizational Incentives & Rewards, Available Resources, Access to Knowledge & Information); two in Characteristics of individuals (Knowledge & Beliefs about the Intervention and Self-efficacy) and one in Intervention characteristics (Design Quality & Packaging). Four additional constructs were weakly distinguishing and negatively influenced HTN/HIV integration. There were four facilitators for HTN/HIV integration related to the intervention (Relative advantage, Adaptability, Complexity and Compatibility). The remaining three constructs negatively influenced HTN/HIV integration but were non-distinguishing. ConclusionUsing the CFIR, we have shown that while there are modifiable barriers to HTN/HIV integration in the Inner setting, Outer setting, Characteristics of individuals and implementation Process, HTN/HIV integration is of interest to patients, health care providers and managers. Improving access to HTN care among PLHIV will require overcoming barriers and capitalizing on the facilitators using a health system strengthening approach. These findings are a springboard for designing contextually appropriate interventions for HTN/HIV integration in low- and middle-income countries.

scholarly journals Exploring barriers and facilitators to integrated hypertension-HIV management in Ugandan HIV clinics using the Consolidated Framework for Implementation Research (CFIR)

2019 ◽  
Author(s):  
Martin Muddu ◽  
Andrew K. Tusubira ◽  
Brenda Nakirya ◽  
Rita Nalwoga ◽  
Fred C. Semitala ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Care Providers ◽  
Implementation Research ◽  
Barriers And Facilitators ◽  
Health System Strengthening ◽  
Prior Work ◽  
Care Providers ◽  
Inner Setting ◽  
Hiv Integration

AbstractBackgroundPersons Living with HIV (PLHIV) receiving antiretroviral therapy have increased risk of cardiovascular disease (CVD). Integration of services for hypertension (HTN), the primary CVD risk factor, into HIV clinics is recommended in Uganda. Our prior work demonstrated multiple gaps in implementation of integrated HTN care along the HIV treatment cascade. In this study, we sought to explore barriers to, and facilitators of, integrating HTN screening and treatment into HIV clinics in Eastern Uganda.MethodsWe conducted a qualitative study at three HIV clinics with low, intermediate, and high HTN care cascade performance, which we classified based on our prior work. Guided by the Consolidated Framework for Implementation Research (CFIR), we conducted semi-structured interviews with health services managers, health care providers and hypertensive PLHIV (n=83). Interviews were transcribed verbatim. Three qualitative researchers used both deductive (CFIR model-driven) and inductive (open coding) methods to develop relevant codes and themes. Ratings were performed to determine valence and strengths of each CFIR construct regarding influencing HTN/HIV integration.ResultsOf the 39 CFIR constructs assessed, 17 were relevant to either barriers or facilitators to HTN/HIV integration. Six constructs strongly distinguished performance and were barriers, three of which were in the Inner setting (Organizational Incentives & Rewards, Available Resources, Access to Knowledge & Information); two in Characteristics of individuals (Knowledge & Beliefs about the Intervention and Self-efficacy) and one in Intervention characteristics (Design Quality & Packaging). Four additional constructs were weakly distinguishing and negatively influenced HTN/HIV integration. There were four facilitators for HTN/HIV integration related to the intervention (Relative advantage, Adaptability, Complexity and Compatibility). The remaining four constructs negatively influenced HTN/HIV integration but were non-distinguishing.ConclusionUsing the CFIR, we have shown that while there are modifiable barriers to HTN/HIV integration in the Inner setting, Outer setting, Characteristics of individuals and implementation Process, HTN/HIV integration is of interest to patients, health care providers and managers. Improving access to HTN care among PLHIV will require overcoming barriers and capitalizing on the facilitators using a health system strengthening approach. These findings are a springboard for designing contextually appropriate interventions for HTN/HIV integration in low- and middle-income countries.Contribution to the literatureWe used the widely used and validated CFIR to assess the HIV program for HTN/HIV integration.To our knowledge, this is the first study to explore barriers and facilitators to integrating hypertension screening and treatment into HIV clinics using the CFIR.The barriers and facilitators identified are a basis for designing contextualized implementation interventions for HTN/HIV integration in Uganda and other LMIC using a health system strengthening approach.

scholarly journals Exploring barriers and facilitators to integrated hypertension-HIV management in Ugandan HIV clinics using the Consolidated Framework for Implementation Research (CFIR)

2020 ◽  
Author(s):  
Martin Muddu ◽  
Andrew K. Tusubira ◽  
Brenda Nakirya ◽  
Rita Nalwoga ◽  
Fred C. Semitala ◽  
...  
Keyword(s):  
Implementation Research ◽  
Self Efficacy ◽  
Healthcare Providers ◽  
Health System Strengthening ◽  
Relative Advantage ◽  
Prior Work ◽  
Care Providers ◽  
Hiv Services ◽  
Increased Risk ◽  
Hiv Integration

Abstract Background: Persons Living with HIV (PLHIV) receiving antiretroviral therapy have increased risk of cardiovascular disease (CVD). Integration of services for hypertension (HTN), the primary CVD risk factor, into HIV clinics is recommended in Uganda. Our prior work demonstrated multiple gaps in implementation of integrated HTN care along the HIV treatment cascade. In this study, we sought to explore barriers to and facilitators of integrating HTN screening and treatment into HIV clinics in Eastern Uganda. Methods: We conducted a qualitative study at three HIV clinics with low, intermediate, and high HTN care cascade performance, which we classified based on our prior work. Guided by the Consolidated Framework for Implementation Research (CFIR), we conducted semi-structured interviews and focus group discussions with health services managers, health care providers and hypertensive PLHIV (n=83). Interviews were transcribed verbatim. Three qualitative researchers used the deductive (CFIR-driven) method to develop relevant codes and themes. Ratings were performed to determine valence and strengths of each CFIR construct regarding influencing HTN/HIV integration. Results: Barriers to HTN/HIV integration arose from six CFIR constructs: organizational incentives & rewards, available resources, access to knowledge & information, knowledge & beliefs about the intervention, self-efficacy and planning. The barriers include: lack of functional BP machines, inadequate supply of anti-hypertensive medicines, additional workload to providers for HTN services, PLHIV’s inadequate knowledge about HTN care, sub-optimal knowledge, skills and self-efficacy of healthcare providers to screen and treat HTN and inadequate planning for integrated HTN/HIV services. Relative advantage of offering HTN and HIV services in a one-stop centre, simplicity (non-complex nature) of HTN/HIV integrated care, adaptability and compatibility of HTN care with existing HIV services are the facilitators for HTN/HIV integration. The remaining CFIR constructs were non-significant regarding influencing HTN/HIV integration. Conclusion: Using the CFIR, we have shown that while there are modifiable barriers to HTN/HIV integration, HTN/HIV integration is of interest to patients, healthcare providers and managers. Improving access to HTN care among PLHIV will require overcoming barriers and capitalizing on facilitators using a health system strengthening approach. These findings are a springboard for designing contextually appropriate interventions for HTN/HIV integration in low- and middle-income countries.

scholarly journals Are antiretrovirals prescribed according to the recommended prescribed daily doses in the private healthcare sector in South Africa

2011 ◽  
Vol 16 (1) ◽  
Author(s):  
Norah L. Katende-Kyenda ◽  
Martie Lubbe ◽  
Juan H.P. Serfontein ◽  
Ilse Truter
Keyword(s):  
South Africa ◽  
Health Care ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Health Care Sector ◽  
Hiv And Aids ◽  
Healthcare Sector ◽  
Private Health Care ◽  
Care Providers ◽  
Increased Risk

Current antiretroviral treatment (ART) guidelines recommend different combinations that have led to major improvements in the management of HIV and AIDS in the developed and developing world. With the rapid approval of many agents, health care providers may not be able to familiarise themselves with them all. This lack of knowledge leads to increased risk of dose- prescribing errors, especially by non-HIV and AIDS specialists. The purpose of this retrospective non-experimental, quantitative drug utilisation study was to evaluate if antiretrovirals (ARVs) are prescribed according to the recommended prescribed daily doses (PDDs) in a section of the private health care sector in South Africa (SA). Analysed ARV prescriptions (49995, 81096 and 88988) for HIV and AIDS patients were claimed from a national medicine claims database for the period 1 January 2005 through to 31 December 2007. ARV prescriptions prescribed by general practitioners (GPs) with PDDs not according to the recommended ARV dosing increased dramatically, from 12.33% in 2005 to 24.26% in 2007. Those prescribed by specialists (SPs) increased from 15.46% in 2005 to 35.20% in 2006 and decreased to 33.16% in 2007. The highest percentage of ARV prescriptions with PDDs not according to recommended ARV dosing guidelines was identified in ARV regimens with lopinavir−ritonavir at a PDD of 1066.4/264 mg and efavirenz at a PDD of 600 mg prescribed to patients in the age group of Group 3 (19 years > age ≤ 45 years). These regimens were mostly prescribed by GPs rather than SPs. There is a need for more education for all health care professionals and/or providers in the private health care sector in SA on recommended ARV doses, to avoid treatment failures, development of resistance, drug-related adverse effects and drug interactions.OpsommingHuidige riglyne vir behandeling met antiretrovirale middels beveel verskillende kombinasies aan wat tot groot verbetering in die beheer van MIV en VIGS in die ontwikkelde en ontwikkelende wêreld gelei het. Met die vinnige goedkeuring van talle nuwe middels kan dit gebeur dat verskaffers van gesondheidsorg nie kan bybly om hulle hiermee op hoogte te hou nie. Hierdie gebrek aan kennis lei tot ‘n hoër risiko vir foute in die voorgeskrewe dosis en veral deur persone wat nie spesialiste in MIV en VIGS is nie. Die doel van hierdie nie-eksperimentele, retrospektiewe, kwantitatiewe studie van die gebruik van geneesmiddels was om te bepaal of antiretrovirale middels in ‘n deel van die privaat gesondheidsorgsektor in Suid-Afrika (SA) volgens die aanbevole voorgeskrewe daaglikse dosisse (VDD) voorgeskryf word. Voorskrifte van antiretrovirale middels (49995, 81096 en 88988) aan pasiënte met MIV en VIGS wat in die periode van 1 Januarie 2005 tot 31 Desember 2007 van ‘n nasionale medisyne databasis geëis is, is ontleed. Voorskrifte van antiretrovirale middels deur algemene praktisyns (APs) met VDDs wat nie volgens die aanbevole dosisse vir antiretrovirale middels was nie, het dramaties van 12.33% in 2005 tot 24.26% in 2007 toegeneem. Die wat deur spesialiste (SPs) voorgeskryf is, het van 15.46% in 2005 tot 35.20% in 2006 toegeneem en in 2007 tot 33.16% gedaal. Die hoogste persentasie van voorskrifte vir antiretrovirale middels met VDDs wat nie volgens die riglyne was nie, was in die regimens met lopinavir−ritonavir met ‘n VDD van 1066.4/264 mg en efavirens met ‘n VDD van 600 mg wat aan pasiënte in die ouderdomsgroep van ouer as 19 tot en met 45 jaar voorgeskryf is. Hierdie regimens is meer deur APs as deur SPs voorgeskryf. Daar is ‘n behoefte aan nog opleiding van alle gesondheidsprofessies en/of voersieners in die privaat gesondheidsorgsektor in SA oor die aanbevole antiretrovirale middel-dosisse om mislukking van behandeling, ontwikkeling van weerstand, nadelige effekte vanweë geneesmiddels en geneesmiddel interaksies te voorkom.

scholarly journals Senior healt-hcare fraud under investigation

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Nicole F. Stowell ◽  
Carl Pacini ◽  
Martina K. Schmidt ◽  
Nathan Wadlinger
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Well Being ◽  
Care Providers ◽  
Prevention Strategies ◽  
Effective Prevention ◽  
Content Type ◽  
Health Care Fraud ◽  
Increased Risk ◽  
The Usa

Purpose This study aims to increase awareness and educate the reader about health-care fraud targeting seniors in the USA to help stakeholders better understand, recognize and prevent this type of fraud. Design/methodology/approach This paper collects statistics on the current state of health care frauds committed against seniors, and examines related cases and laws. Findings The authors find this type of fraud is highly prevalent and expected to increase. Current laws preventing this fraud from occurring are multifold and complex. While prevention strategies through law enforcement have been somewhat successful, a reduction in resources may put seniors at an increased risk in the years to come. Research limitations/implications Without additional prevention strategies, the problem will likely escalate with a growing population of older adults. This study encourages further research into effective prevention strategies and methods to fight health-care fraud against seniors. Practical implications Health-care fraud and its associated costs pose a significant threat to the society and economy of the USA. Reducing this fraud will not only reduce the costs to the US economy but also improve the physical and mental well-being of senior victims, reduce their mortality and hospitalization rates and improve the public trust placed to health-care providers. Originality/value This study highlights how health-care fraud is committed against seniors. With the projected trend of an aging US population, educating stakeholders, increasing awareness and applying tools to protect seniors will be important to reduce the absolute scope of this problem in the future.

scholarly journals ESGE and ESGENA Position Statement on gastrointestinal endoscopy and the COVID-19 pandemic

Endoscopy ◽  
2020 ◽  
Vol 52 (06) ◽  
pp. 483-490 ◽  
Author(s):  
Ian M. Gralnek ◽  
Cesare Hassan ◽  
Ulrike Beilenhoff ◽  
Giulio Antonelli ◽  
Alanna Ebigbo ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
European Society ◽  
Health Care Professionals ◽  
Gastrointestinal Endoscopy ◽  
Clinical Manifestations ◽  
Current Status ◽  
Infection Prevention And Control ◽  
Care Providers ◽  
Increased Risk

AbstractWe are currently living in the throes of the COVID-19 pandemic that imposes a significant stress on health care providers and facilities. Europe is severely affected with an exponential increase in incident infections and deaths. The clinical manifestations of COVID-19 can be subtle, encompassing a broad spectrum from asymptomatic mild disease to severe respiratory illness. Health care professionals in endoscopy units are at increased risk of infection from COVID-19. Infection prevention and control has been shown to be dramatically effective in assuring the safety of both health care professionals and patients. The European Society of Gastrointestinal Endoscopy (www.esge.com) and the European Society of Gastroenterology and Endoscopy Nurses and Associates (www.esgena.org) are joining forces to provide guidance during this pandemic to help assure the highest level of endoscopy care and protection against COVID-19 for both patients and endoscopy unit personnel. This guidance is based upon the best available evidence regarding assessment of risk during the current status of the pandemic and a consensus on which procedures to perform and the priorities on resumption. We appreciate the gaps in knowledge and evidence, especially on the proper strategy(ies) for the resumption of normal endoscopy practice during the upcoming phases and end of the pandemic and therefore a list of potential research questions is presented. New evidence may result in an updated statement.

scholarly journals Hiking

2016 ◽  
Vol 12 (4) ◽  
pp. 302-310 ◽  
Author(s):  
Denise Mitten ◽  
Jillisa R. Overholt ◽  
Francis I. Haynes ◽  
Chiara C. D’Amore ◽  
Janet C. Ady
Keyword(s):  
Physical Activity ◽  
Health Care ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Emotional Health ◽  
World Health ◽  
Health Care Practitioner ◽  
Federal State ◽  
Care Providers ◽  
Increased Risk

Research has connected sedentary lifestyles with numerous negative health outcomes, including a significant increased risk for mortality. Many health care professionals seek ways to help clients meet physical activity guidelines recommended by the Office of Disease Prevention and Health Promotion, the World Health Organization, and the American College of Sports Medicine in order to promote active lifestyles and improve overall wellness. Hiking is a cost-effective intervention that encourages people to be physically active while spending time in nature. Time in nature can lead to health benefits through contact with the natural elements, participation in physical activity, restoration of mental and emotional health, and time with social contacts. Benefits may be immediate, such as decreased blood pressure, decreased stress levels, enhanced immune system functioning, and restored attention, or transpire over time, such as weight loss, decreased depression, and overall wellness. Health care providers are ideally positioned to recommend and prescribe hiking to clients. Federal, state, and local natural resource agencies are beginning to partner with health care professionals to promote outdoor nature-related activities. Examples of successful doctor and other health care practitioner partnership programs are described, along with tips for getting started.

scholarly journals COVID-19 in pregnant women

2020 ◽  
Vol 11 (SPL1) ◽  
pp. 430-432
Author(s):  
Vaishnavi C. Ghate ◽  
Swapnil Borage ◽  
Priyanka Shelotkar
Keyword(s):  
Health Care ◽  
Pregnant Women ◽  
Health Care Providers ◽  
Virus Disease ◽  
Rna Virus ◽  
World Health ◽  
Care Providers ◽  
Corona Virus ◽  
Increased Risk ◽  
The World

Corona virus disease (COVID-19) is an emerging disease with rapid increases in cases. COVID-19 is a single-stranded RNA virus which can produce diseases in Humans and Animals also. As COVID-19 is a developing health issue in the World, Experts also remain unsure whether pregnant women are having a higher risk of COVID-19 or not. The emergency of acute health care, it is particularly deadly in large populations and communities in which health care providers are insufficiently prepared to manage the COVID-19 infection. And cases have increased in other countries around the world day by day. It has increased the possibility of vertical transmission of the virus from the mother to the fetus—the WHO the total confirmed cases as of 12th April as 1,836,041. Total death 113,233and pregnant women having positive corona cases is 38, as of 1st April 2020. Partial suppression of the immune system in pregnancy can increase the chances of a viral infection such as flu (influenza) in pregnant women. World Health Organization (WHO) suggests that there is no specific evidence exists that pregnant women are more prone to severe COVID-19 symptoms than other general people. Physiologic and immunologic changes in pregnant women have systemic effects which in an increased risk of respiratory infections, various other changes like cardiovascular system, Respiratory system, increased heart rate and decreased lung capacity. Pregnant women become infected with two pathogenic corona virus infections, one as a severe acute respiratory syndrome (SARS) and other one is Middle East respiratory syndrome (MERS).

Are health care providers who work with cancer drugs at an increased risk for toxic events? A systematic review and meta analysis of the literature

2005 ◽  
Vol 23 (16_suppl) ◽  
pp. 6082-6082 ◽  
Author(s):  
G. Dranitsaris ◽  
M. Johnston ◽  
S. Poirier ◽  
T. Trudi Schueller ◽  
T. Savage ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Health Care Providers ◽  
Meta Analysis ◽  
Care Providers ◽  
Cancer Drugs ◽  
Increased Risk

scholarly journals Prophylaxis of infective endocarditis

2011 ◽  
Vol 64 (5-6) ◽  
pp. 319-322 ◽  
Author(s):  
Dejan Sakac ◽  
Dragan Kovacevic ◽  
Slobodan Sekulic
Keyword(s):  
Health Care ◽  
At Risk ◽  
Infective Endocarditis ◽  
Antibiotic Prophylaxis ◽  
Health Care Providers ◽  
Heart Valves ◽  
Task Force ◽  
Care Providers ◽  
Increased Risk ◽  
European Society Of Cardiology

Introduction. Infective endocarditis is defined as an infection of the endothelial surface of the heart and heart valves, above all. It is a great challenge for doctors to diagnose infective endocarditis especially in primary health care, because this is a disease in evolution, bearing in mind changes in epidemiological and clinical characteristics, which developed in the last decades. Even today this is a very severe and insidious disease, with poor prognosis and high mortality. Prevention of Infective Endocarditis. Although previous guidelines proposed a limitation to prophylaxis in patients at increased risk of adverse outcome of infective endocarditis, new guidelines recommend the principles of antibiotic prophylaxis when performing procedures at risk of infective endocarditis in patients with predisposing cardiac conditions, and limit its indication to patients at the highest risk of infective endocarditis undergoing the highest risk procedures. Conclusion. Despite the fact that previous guidelines for diagnostics and treatment of infective endocarditis were published only several years ago, the Task Force on Prevention, Diagnosis and Treatment of Infective Endocarditis of the European Society of Cardiology identify infective endocarditis as a clearly evolving disease, with changes in its microbiological profile and higher incidence of health care associated cases which has brought about a need for new recommendations to help health care providers in making clinical decisions including preventive measures and antibiotic prophylaxis. As a novelty, a group of patients at the highest risk of infective endocarditis was defined as well as the type of procedures at risk divided into four categories.

scholarly journals Prevalence of Underlying Medical Conditions Associated with Severe COVID-19 Illness in Adult Cancer Survivors in the United States

2021 ◽  
Author(s):  
Changchuan Jiang ◽  
K Robin Yabroff ◽  
Lei Deng ◽  
Stuthi Perimbeti ◽  
Xuesong Han
Keyword(s):  
Health Care ◽  
Cancer Survivors ◽  
Health Care Providers ◽  
The United States ◽  
Health Care Facilities ◽  
Medical Conditions ◽  
Care Providers ◽  
Cancer History ◽  
Increased Risk ◽  
Adult Cancer Survivors

Abstract Cancer, and other underlying medical conditions, including chronic obstructive pulmonary disease, heart diseases, diabetes, chronic kidney disease, and obesity, are associated with increased risk of severe COVID-19 illness. We identified 6,411 cancer survivors and 77,748 adults without a cancer history from the 2016-2018 National Health Interview Survey and examined the prevalence and sociodemographic factors associated with these conditions in the US. Most survivors reported having ≥1 of the conditions (56.4% [95% CI = 54.8% to 57.9%] vs 41.6% [95% CI = 40.9% to 42.2%] in adults without a cancer history) and nearly one-quarter (22.9%, 95% CI = 21.6% to 24.3%) reported ≥2, representing 8.7 million and 3.5 million cancer survivors, respectively. These conditions were more prevalent in survivors of kidney, liver and uterine cancers as well as Black survivors, those with low socioeconomic status, and public insurance. Findings highlight the need to protect survivors against COVID-19 transmission in health-care facilities and prioritize cancer patients, survivors, caregivers, and their health-care providers in vaccine allocation.

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