scholarly journals Documenting Response To COVID-Individual and Systems Successes and Challenges: A Longitudinal Qualitative Study

2021 ◽  
Author(s):  
Natasha Shaukat ◽  
Daniyal Mansoor Ali ◽  
Butool Hisam ◽  
Sheza Hassan ◽  
Rubina Barolia ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Healthcare System ◽  
Healthcare Workers ◽  
Mobile App ◽  
System Level ◽  
Individual Level ◽  
The Future ◽  
Frontline Healthcare Workers ◽  
Prospective Longitudinal

Abstract Background This feasibility study aimed to assess the use of WhatsApp for qualitative data collection to document the evolution of perceptions of frontline healthcare workers (FHCW) regarding their wellbeing and the quality of health systems' response to the COVID-19 pandemic over four months. Methods This was a prospective longitudinal qualitative study conducted during the four months coinciding with the peak and trough of the first wave of the COVID-19 pandemic (June-September 2020). We approached frontline healthcare workers (physicians and nurses working in emergency departments) in two hospitals using the WhatsApp group of the Pakistan Society of Emergency Physicians (PSEM). We introduced the study and obtained consent using a google consent form. Each participant was asked to self-record their perception of their personal wellness and their level of satisfaction with the quality of their hospitals' response to the pandemic. Each participant sent their voice notes/audio-recording to a central WhatsApp number. We transcribed and analysed the recordings and identified themes and sub-themes, and the changes to these themes over six months. Results We invited approximately 200 FHCWs associated with PSEM to participate in the study. Of the 61 who agreed to participate, 27 completed the study. A total of 149 audio recordings were received and transcribed. Three themes and eight sub-themes have emerged from the data. The themes were individual-level challenges, health system-level challenges, and hope for the future. Sub-themes for individual-level challenges were: fear of getting or transmitting infection, financial stressors, stress due to turning away those patients who need care, anxiety due to the general public's lack of compliance with preventive measures, physical exhaustion, and fatigue. For the healthcare system, sub-themes were: issues with logistics and management of the hospital/healthcare system and lack of focus on providing air conditioning to address heat due to PPEs and sub-themes under hope for the future were the improved disease knowledge and vaccine development. Conclusion Despite a lower level of completion, our study identified possible use of a ubiquitously available mobile app to collect longitudinal real-time data from FHCWs during the initial period of the pandemic. The overall perceptions and experiences of FHCWs evolved from negative to positive as the curve of COVID-19 went down.

scholarly journals Documenting Response To COVID-Individual and Systems Successes and Challenges: A Longitudinal Qualitative Study

2021 ◽  
Author(s):  
Natasha Shaukat ◽  
Daniyal Mansoor Ali ◽  
Butool Hisam ◽  
Sheza Hassan ◽  
Rubina Barolia ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Healthcare System ◽  
Healthcare Workers ◽  
Mobile App ◽  
System Level ◽  
Individual Level ◽  
The Future ◽  
Frontline Healthcare Workers ◽  
Prospective Longitudinal

Abstract Background This feasibility study aimed to assess the use of WhatsApp for qualitative data collection to document the evolution of perceptions of frontline healthcare workers (FHCW) regarding their wellbeing and the quality of health systems' response to the COVID-19 pandemic over four months. Methods This was a prospective longitudinal qualitative study conducted during the four months coinciding with the peak and trough of the first wave of the COVID-19 pandemic (June-September 2020). We approached frontline healthcare workers (physicians and nurses working in emergency departments) in two hospitals using the WhatsApp group of the Pakistan Society of Emergency Physicians (PSEM). We introduced the study and obtained consent using a google consent form. Each participant was asked to self-record their perception of their personal wellness and their level of satisfaction with the quality of their hospitals' response to the pandemic. Each participant sent their voice notes/audio-recording to a central WhatsApp number. We transcribed and analysed the recordings and identified themes and sub-themes, and the changes to these themes over six months. Results We invited approximately 200 FHCWs associated with PSEM to participate in the study. Of the 61 who agreed to participate, 27 completed the study. A total of 149 audio recordings were received and transcribed. Three themes and eight sub-themes have emerged from the data. The themes were individual-level challenges, health system-level challenges, and hope for the future. Sub-themes for individual-level challenges were: fear of getting or transmitting infection, financial stressors, stress due to turning away those patients who need care, anxiety due to the general public's lack of compliance with preventive measures, physical exhaustion, and fatigue. For the healthcare system, sub-themes were: issues with logistics and management of the hospital/healthcare system and lack of focus on providing air conditioning to address heat due to PPEs and sub-themes under hope for the future were the improved disease knowledge and vaccine development. Conclusion Despite a lower level of completion, our study identified possible use of a ubiquitously available mobile app to collect longitudinal real-time data from FHCWs during the initial period of the pandemic. The overall perceptions and experiences of FHCWs evolved from negative to positive as the curve of COVID-19 went down.

scholarly journals Physicians’, Nurses’ and Pharmacists’ Perceptions of Determinants to Deprescribing in Nursing Homes Considering Three Levels of Action: A Qualitative Study

Pharmacy ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 17
Author(s):  
Rose-Anna Foley ◽  
Lucie Lechevalier Hurard ◽  
Damien Cateau ◽  
Daria Koutaissoff ◽  
Olivier Bugnon ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Healthcare System ◽  
Interprofessional Collaboration ◽  
Common Knowledge ◽  
System Level ◽  
Potentially Inappropriate Medications ◽  
Structured Interviews ◽  
Individual Level ◽  
Medication Costs ◽  
The Individual

Background: Polypharmacy and the use of potentially inappropriate medications are frequent safety issues among nursing home (NH) residents. Deprescribing can significantly reduce the number of drugs used, medication costs, and mortality. This qualitative study sought to understand and compare the perceptions and practices of nurses, pharmacists, and physicians regarding deprescribing in Swiss NHs, referring to an implementation approach on three levels of action: the individual, the institution, and the healthcare system. Methods: Two focus groups were held with 21 participants: one focus group with 11 pharmacists, another with 10 nurses and six semi-structured interviews with physicians were conducted and focused on their individual experience and practices. They were audiotaped and fully transcribed, and a content analysis was performed using to MAXQDA (Ver 12) software. Results: (1) At an individual level, physicians were concerned by consequences of deprescribing in terms of safety. Nurses were closest to residents and stressed the importance of finding the right time, creating a bond of trust before deprescribing and considering the purpose of the stay in the NH. Pharmacists relied on structured guides for deprescribing, which led their reflection and practice. All professionals saw the complexity of the clinical situations, as well as residents’ and relatives’ fears of interruption of care. (2) At an institutional level, the professionals stressed the lack of time to discuss patients’ health and treatment, while pre-existing interprofessional collaboration, specifically, quality circles, seemed useful tools to create common knowledge. In order to reduce prescriptions, better coordination between physicians, nurses, pharmacists and specialists seemed crucial. (3) At the health system level, funding still needs to be provided to consolidate the process, go beyond organisational constraints and ensure deprescribing serves the patient’s wellbeing above all. Conclusions: At the individual level of implementation, the different healthcare professionals expressed specific concerns about deprescribing, depending on their defined role in NHs. Their perspective about the different levers to promote deprescribing at institutional and healthcare system levels converge towards interprofessional collaboration supported by the healthcare system. Specific funding and incentives are therefore needed to support a sustainable interprofessional team.

scholarly journals System models for resilience in gerontology: application to the COVID-19 pandemic

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Katarzyna Klasa ◽  
Stephanie Galaitsi ◽  
Andrew Wister ◽  
Igor Linkov
Keyword(s):  
The Elderly ◽  
System Level ◽  
Improve Quality ◽  
Care Needs ◽  
Individual Level ◽  
Chronic Stressors ◽  
The World ◽  
Aging Adults ◽  
The Individual

AbstractThe care needs for aging adults are increasing burdens on health systems around the world. Efforts minimizing risk to improve quality of life and aging have proven moderately successful, but acute shocks and chronic stressors to an individual’s systemic physical and cognitive functions may accelerate their inevitable degradations. A framework for resilience to the challenges associated with aging is required to complement on-going risk reduction policies, programs and interventions. Studies measuring resilience among the elderly at the individual level have not produced a standard methodology. Moreover, resilience measurements need to incorporate external structural and system-level factors that determine the resources that adults can access while recovering from aging-related adversities. We use the National Academies of Science conceptualization of resilience for natural disasters to frame resilience for aging adults. This enables development of a generalized theory of resilience for different individual and structural contexts and populations, including a specific application to the COVID-19 pandemic.

The Second Shock: A Qualitative Study of Parents' Perspectives and Needs during Their Child's Transition from School to Adult Life

1995 ◽  
Vol 20 (1) ◽  
pp. 3-15 ◽  
Author(s):  
Cheryl Hanley-Maxwell ◽  
Jean Whitney-Thomas ◽  
Susan Mayfield Pogoloff
Keyword(s):  
Qualitative Research ◽  
Qualitative Study ◽  
Adult Life ◽  
Transition Process ◽  
Life Process ◽  
School Services ◽  
The Future

This paper describes a study in the tradition of qualitative research (Biklen & Moseley, 1988; Bogdan & Biklen, 1992; Taylor & Bogdan, 1984) and examines the transition from school to adult-life process. This study employed methodology similar to other investigations that have described the nature of relationships between families and professionals (Ferguson, Ferguson, Jeanchild, Olson, & Lucyshyn, 1993) and investigated the transition process from the perspective of those who experience it (Ferguson, Ferguson, & Jones, 1988; Zetlin & Hosseini, 1989; Zetlin & Turner, 1985). Results indicate that parents of students who are involved in the transition process have a vision for the future of their child. They measure the quality of school services, the potential for future happiness and their faith in the transition process by how their child is succeeding in moving toward that vision. Implications for practice and policy are discussed.

scholarly journals Improving the quality of anthropometric measures during medical consultations with children aged under five years old in Burkina Faso

2021 ◽  
Author(s):  
Aziza Merzouki ◽  
Wessel Valkenburg ◽  
Marc Bayala ◽  
Maroussia Roelens ◽  
Olivia Keiser ◽  
...  
Keyword(s):  
Probability Distribution ◽  
Burkina Faso ◽  
Healthcare Workers ◽  
Vital Signs ◽  
Data Entry ◽  
Anthropometric Measures ◽  
Medical Consultations ◽  
Time Specific ◽  
Frontline Healthcare Workers

Objective: Millions of medical consultations are conducted each year in Burkina Faso using the Electronic Register of Consultations (REC). Based on the consultation data collected, we present a method to quantify the quality of individual and ensembles of consultations conducted by frontline healthcare workers (FHWs). Methods: We focus on anthropometric measurements and vital signs (age, weight, height, mid-upper arm circumference and temperature) of children aged between two months and five years old. We compare individual and ensemble of consultations to a multivariate probability distribution defined by an external population-specific, gold standard consultation dataset. By comparing the distributions of consultations to the reference probability distribution, we define a score to rate the quality of measurements and data entry of each FHW. Findings: The defined scores allow us to detect which measurements are most problematic. They also allow us to detect potential biases in the consultation and treatment of different patient groups. No systematic gender-bias was found among FHWs. Height measurements were the most challenging; consultations with the lowest scores were associated with underestimated heights in children. Among these consultations, height was found to be even more underestimated among boys than girls. Conclusion: Our findings enable us to support capacity building of frontline healthcare workers. The REC can be enriched with real-time specific alert on errors, individual FHW can be proposed targeted trainings, and dynamic dashboards can support district managers to navigate the entire population of FHWs and understand which problems should be prioritised.

scholarly journals Battling the COVID-19 Pandemic: Is Bangladesh Prepared?

2020 ◽  
Author(s):  
Hasinur Rahaman Khan ◽  
Tamanna Howlader ◽  
Md. Mazharul Islam
Keyword(s):  
At Risk ◽  
Spatial Distribution ◽  
Healthcare System ◽  
Healthcare Workers ◽  
Polynomial Regression ◽  
Spatial Cluster ◽  
Short Term ◽  
Hospital Capacity ◽  
Order Polynomial ◽  
Frontline Healthcare Workers

Following detection of the first few COVID-19 cases in early March, Bangladesh has stepped up its efforts to strengthen capacity of the healthcare system to avert a crisis in the event of a surge in the number of cases. This paper sheds light on the preparedness of the healthcare system by examining the spatial distribution of isolation beds across districts and divisions, forecasting the number of ICU units that may be required in the short term and analyzing the availability of frontline healthcare workers to combat the pandemic. As of May 2, COVID-19 cases have been found in 61 of the 64 districts in Bangladesh with Dhaka District being the epicenter. Seventy-one percent of the cases have been identified in 6 neighboring districts, namely, Dhaka, Narayanganj, Gazipur, Narsingdi, Munsiganj and Kishoreganj, which appear to form a spatial cluster. However, if one takes into account the population at risk, the prevalence appears to be highest in Dhaka, followed by Narayanganj, Gazipur, Kishorganj, Narsingdi and Munshiganj. These regions may therefore be flagged as the COVID-19 hotspots in Bangladesh. Among the eight divisions, prevalence is highest in Dhaka Division followed by Mymensingh. The number of cases per million exceeds the number of available isolation beds per million in the major hotspots indicating that there is a risk of the healthcare system becoming overwhelmed should the number of cases rise. This is especially true for Dhaka Division, where the ratio of COVID-19 patients to doctors appears to be alarmingly high. Mymensingh Division also has a disproportionately small number of doctors relative to the number of COVID-19 patients. Using second order polynomial regression, the analysis predicts that even if all ICU beds are allocated to COVID-19 patients, Bangladesh may run out of ICU beds soon after May 15, 2020. We conclude that in spite of a significant increase in hospital capacity during 2005-15 and a 57 % rise in the number of doctors during the same period, the healthcare system in Bangladesh and Dhaka Division in particular, may not be fully prepared to handle the COVID-19 crisis. Thus, further steps need to be taken to flatten the curve and improve healthcare capacity.

Abstract 334: Impact of Sex, Gender and Healthcare System on the Quality of Care in Young Adults With Acute Myocardial Infarction

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Valeria Raparelli ◽  
Louise Pilote ◽  
Hassan Behlouli ◽  
Dziura D James ◽  
Hector Bueno ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Young Adults ◽  
Quality Of Care ◽  
Healthcare System ◽  
Quality Indicators ◽  
System Level ◽  
Post Discharge ◽  
Single Payer

Background: The quality of care among young adults with acute myocardial infarction (AMI) may be related to biological (sex) or psycho-socio-cultural (gender) determinants or healthcare system-level factors. Objectives: To examine whether sex, gender, and the type of healthcare system influence the quality of AMI care among young adults. Methods: A total of 4,564 AMI young adults (<55 years) (59% women, 47 years, 66% US) were analyzed from the VIRGO and GENESIS-PRAXY studies consisting of single-payer (Canada, Spain) versus multipayer (US) systems. For each patient treated in each system, we calculated a quality of care score (QCS) for pre-AMI (1-year pre-admission), in-hospital, and post-AMI (1-year post-discharge) phases of care (the number of quality indicators received divided by the total number [range=0-100%], with higher scores indicating better quality). The standard quality of care indicators were selected on the basis of being the standard of care to which young adults with AMI should have access to, based on European and North American Guidelines. Ordinal logistic or linear regression models and 2-way interactions between sex, gender and healthcare system were tested. Results: Women in the multipayer system had the highest risk factor burden. Across the phases of care for AMI, 20% of quality indicators were missed in both sexes. High stress, earner status, and social support were associated with a higher QCS in the pre-AMI phase, whereas only employment and earner status were associated with QCS in all other phases. In the pre-AMI phase, women had higher QCS than men, mainly in the single-payer system (adjusted-OR=1.85, 95%CI 1.46,2.35 vs. 1.07, 95%CI 0.84,1.36, P-interaction=0.002). Regardless of sex, only employment status had a greater effect in the multipayer system (adjusted-OR=0.59, 95%CI 0.44,0.78 vs 1.13, 95%CI 0.89,1.44, P-interaction<0.001). In the in-hospital phase, women had a lower QCS than men, especially in the multipayer system (adjusted-mean-difference: -2.48, 95%CI-3.87,-1.08). Employment was associated with a higher QCS (2.0, 95%CI 0.9-3.17, P interaction >0.05). Finally, in the post-AMI phase, men and women had a lower QCS, predominantly in the multipayer system. However, primary earners had higher QCS regardless of the healthcare system. Conclusion: Sex, gender, and the healthcare system affected the quality of care after AMI. Women had a poorer in-hospital than men and young adults had suboptimal post-discharge care. Being unemployed lowered the quality of care, more so in the multipayer healthcare system.

scholarly journals Perception of healthcare workers on mobile app-based clinical guideline for the detection and treatment of mental health problems in primary care: a qualitative study in Nepal

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
P. Pokhrel ◽  
R. Karmacharya ◽  
T. Taylor Salisbury ◽  
K. Carswell ◽  
B. A. Kohrt ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Disorders ◽  
Qualitative Study ◽  
Primary Healthcare ◽  
Healthcare Workers ◽  
Clinical Guideline ◽  
Health Workers ◽  
Mobile App

Abstract Background In recent years, a significant change has taken place in the health care delivery systems due to the availability of smartphones and mobile software applications. The use of mobile technology can help to reduce a number of barriers for mental health care such as providers’ workload, lack of qualified personnel, geographical and attitudinal barriers to seek treatment. This study assessed the perception of Nepali primary healthcare workers about the feasibility, acceptability, and benefits of using a mobile app-based clinical guideline for mental health care. Method A qualitative study was conducted in two districts Chitwan and Ramechhap of Nepal with purposively selected medical officers (n = 8) and prescribing primary healthcare workers (n = 35) who were trained in the World Health Organization mental health Gap Action Program Intervention Guide. Semi-structured interviews and focus group discussions were conducted in Nepali, audio recorded, transcribed and translated into English for data analysis. Data were analysed manually using a thematic analysis approach. Results The majority of the healthcare workers and medical officers reported a high level of interest, motivation and positive attitudes towards the mobile app-based clinical guidelines for detection and treatment of people with mental disorders in primary care. They respondents suggested that several features and functions should be included in the app: suggestive diagnosis and treatment options; clinical data recording system; sending messages to patients to promote follow-up visits; allow offline functions; minimal typing options and content to be available in Nepali language. The study participants reported that the app could help in bringing uniformity in diagnosis and management of mental disorders across all health facilities, enabling remote supervision, helping verification of health workers’ diagnosis and treatment; and increasing patients’ trust in the treatment. Lack of reliable internet connection in health facilities, possibility of distracting interaction between patient and provider, and confidentiality were the key factors potentially hindering the use of the app. Conclusion The suggested functions and features as well as the potential risk factors highlighted by the health workers, will be considered when further developing the mobile app-based clinical guidelines, training modality and materials, and the supervision system.

scholarly journals Implementation of patient-centred care: which system-level determinants matter from a decision maker’s perspective? Results from a qualitative interview study across various health and social care organisations

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e050054
Author(s):  
Carmen Leidner ◽  
Vera Vennedey ◽  
Hendrik Hillen ◽  
Lena Ansmann ◽  
Stephanie Stock ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Healthcare System ◽  
Information Exchange ◽  
Social Care ◽  
Qualitative Content Analysis ◽  
Decision Makers ◽  
System Level ◽  
Patient Centred Care ◽  
Qualitative Interview Study ◽  
Health And Social Care

ObjectivesThe healthcare system is characterised by a high degree of complexity and involves various actors at different institutional levels and in different care contexts. To implement patient-centred care (PCC) successfully, a multidimensional consideration of influencing factors is required. Our qualitative study aims to identify system-level determinants of PCC implementation from the perspective of different health and social care organisations (HSCOs).DesignA qualitative study using n=20 semistructured face-to-face interviews with n=24 participants was carried out between August 2017 and May 2018. Interview data were analysed based on concepts of qualitative content analysis using an inductive and deductive approach.Setting and participantsInterviews were conducted with clinical and managerial decision makers from multiple HSCOs in the model region of Cologne, Germany. Participants were recruited via networks of practice partners and cold calling.ResultsThis study identified various determinants on the system level that are associated with PCC implementation. Decision makers described external regulations as generating an economically controlled alignment of the healthcare system. The availability and qualification of staff resources and patient-related incentives of financial resources were identified as an eminent requirement for providers to deliver PCC. Participants considered the strict separation of financing and delivery of healthcare into inpatient and outpatient sectors to be a barrier to PCC. Interorganisational collaboration and information exchange were identified as facilitators of PCC, as they enable continuous patient care cycles.ConclusionThe results showed the necessity of enforcing paradigm changes at the system level from disease-centredness to patient-centredness while aligning policy and reimbursement decisions directly with patient needs and values. A systematic, long-term planned strategy that extends across all organisations is lacking, rather each organisation seeks its own possibilities to implement PCC activities under external restrictions.Trial registration numberDRKS00011925

scholarly journals Healthcare Workers′ Mental Health and Wellbeing During the COVID-19 Pandemic in the UK: Contrasting Guidelines with Experiences in Practice

2020 ◽  
Author(s):  
Norha Vera San Juan ◽  
David Aceituno ◽  
Nehla Djellouli ◽  
Kirsi Sumray ◽  
Nina Regenold ◽  
...  
Keyword(s):  
Mental Health ◽  
Qualitative Study ◽  
Healthcare Workers ◽  
Evidence Base ◽  
Rapid Review ◽  
Frontline Staff ◽  
Individual Level ◽  
Mental Health Support ◽  
Definition Of ◽  
The Uk

Background Substantial evidence has highlighted the importance of considering healthcare workers′ (HCW) mental health during the COVID-19 pandemic, and several organisations have issued guidelines with recommendations. However, the definition of wellbeing and the evidence-base behind such guidelines remains unclear. Objectives Assessing the applicability of wellbeing guidelines in practice; identify unaddressed HCWs′ needs; and provide recommendations for supporting frontline staff during the current and future pandemics. Methods and Design This paper discusses the findings of a qualitative study based on interviews with frontline healthcare staff in the UK and examines them in relation to a rapid review of wellbeing guidelines developed in response to the COVID-19 pandemic. Results 14 guidelines were included in the rapid review and 33 interviews with HCWs were conducted in the qualitative study. As a whole, the guidelines placed greater emphasis on wellbeing at an individual level, while HCWs placed greater emphasis on structural conditions at work, such as understaffing and the invaluable support of the community. This in turn had implications for the focus of wellbeing intervention strategies; staff reported an increased availability of formal mental health support, however, understaffing or clashing schedules prevented them from participating in these activities. Conclusion HCWs expressed wellbeing needs which align with social-ecological conceptualisations of wellbeing related to quality of life. This approach to wellbeing has been highlighted in literature about HCWs support in previous health emergencies, yet it has not been monitored during this pandemic. Wellbeing guidelines should explore staff′s needs and contextual characteristics affecting the implementation of recommendations.

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