PrioritÀ cliniche in sanitÀ: governare la domanda con il coinvolgimento dei professionisti

2009 ◽  
pp. 166-177
Author(s):  
Giuliano Mariotti
Keyword(s):  
Waiting Times ◽  
Family Doctor ◽  
Diagnostic Procedures ◽  
Healthcare Services ◽  
Public Healthcare ◽  
Management Technique ◽  
Specific Patient ◽  
Family Doctors ◽  
The Public

- Creating order: this is the first step needed to prevent the collapse of the public healthcare system. Clinical priority for the healthcare services is a model to create an explicit order based on patients' needs, to guarantee timely referrals. This supports the idea that, despite the general perception that health care is difficult to access, availability of out-patient diagnostic procedures may be sufficient to meet the requirements of patients with major diagnostic needs. In Italy, the Homogeneous Waiting Groups (Raggruppamenti di attesa omogenei, RAO) model is being applied. It involves all those who are part of the process of providing a referral: the family doctor, the booking service (Cup) and the specialist. The model is based on identifying categories for the access to referrals. These allow the prescribers to establish in advance the length of wait considered adequate for a specific patient. To manage a system as complex as this one, it may be useful the socalled "facilitation" management technique. The aim is to guarantee the ongoing improvement of the quality of services, to make waiting times adequate to the clinical needs of citizens and the patients themselves more satisfied. Our experience encourages us to organise educational initiatives and joint courses for family doctors and specialists to reinforce the former's ability to increase their knowledge of appropriateness. At the same time, the involvement of family doctors and specialists may increase the level of concordance regarding the attribution of priority levels and adherence to guidelines' keywords. This will need to be evaluated as such schemes are adopted more widely.Keywords: appropriateness; clinical priority; primary care; waiting lists; clinical needs.

scholarly journals The Problems and Needs of Patients Diagnosed with Cancer and Their Caregivers

2020 ◽  
Vol 18 (1) ◽  
pp. 87
Author(s):  
Anna Lewandowska ◽  
Grzegorz Rudzki ◽  
Tomasz Lewandowski ◽  
Sławomir Rudzki
Keyword(s):  
Cancer Patients ◽  
Medical Information ◽  
Unmet Needs ◽  
Public Healthcare ◽  
Literature Analysis ◽  
The Public ◽  
The Mean ◽  
High Level ◽  
Patients Experience

(1) Background: As the literature analysis shows, cancer patients experience a variety of different needs. Each patient reacts differently to the hardships of the illness. Assessment of needs allows providing more effective support, relevant to every person’s individual experience, and is necessary for setting priorities for resource allocation, for planning and conducting holistic care, i.e., care designed to improve a patient’s quality of life in a significant way. (2) Patients and Methods: A population survey was conducted between 2018 and 2020. Cancer patients, as well as their caregivers, received an invitation to take part in the research, so their problems and needs could be assessed. (3) Results: The study involved 800 patients, 78% women and 22% men. 66% of the subjects were village residents, while 34%—city residents. The mean age of patients was 62 years, SD = 11.8. The patients received proper treatment within the public healthcare. The surveyed group of caregivers was 88% women and 12% men, 36% village residents and 64% city residents. Subjects were averagely 57 years old, SD 7.8. At the time of diagnosis, the subjects most often felt anxiety, despair, depression, feelings of helplessness (46%, 95% CI: 40–48). During illness and treatment, the subjects most often felt fatigued (79%, 95% CI: 70–80). Analysis of needs showed that 93% (95% CI: 89–97) of patients experienced a certain level of need for help in one or more aspects. (4) Conclusions: Patients diagnosed with cancer have a high level of unmet needs, especially in terms of psychological support and medical information. Their caregivers also experience needs and concerns regarding the disease. Caregivers should be made aware of the health consequences of cancer and consider appropriate supportive care for their loved ones.

scholarly journals Intimate Labor at Biomedical Frontlines: Situated Knowledges of Female Community Health Workers in the Management of COVID-19 in India

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Sanghamitra Das ◽  
Samhita Das
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Medical Knowledge ◽  
Healthcare Services ◽  
Care Work ◽  
Professional Status ◽  
Public Healthcare ◽  
The Public ◽  
Female Community

Media reports of the COVID-19 pandemic in India have highlighted the important role that India’s female community health workers, the Accredited Social Health Activists (ASHAs), have played in managing COVID infections in India. This paper explores the epistemic basis of ASHA work to understand the significance of their role. Through a discourse analysis of textual media articles, we show that the ASHAs’ routine and COVID-related caregiving practices are a form of embodied, intimate labor rooted in their situated, community-oriented knowledge. This labor is devalued as emotional and feminized care work, which denies the ASHAs professional status in the public healthcare system of India and, in turn, reflects a hierarchy among health practitioners that stems from the status of objectivity/disembodiment in biomedicine. We find that, despite their low status in the public health system, ASHA workers develop a self-concept that enables them to self-identify as healthcare professionals, motivating them to continue providing essential healthcare services during the pandemic. We argue that an official recognition of the epistemic value of ASHA work would help to overcome the age-old nature/culture dichotomy that informs what counts as valuable, legitimate, formal medical knowledge. Furthermore, our analysis provides a critique of the gendered devaluation of care work within a political economy of health increasingly dictated by a neoliberal logic.

scholarly journals A comparison of the levels of satisfaction with the medical services provided by primary healthcare centers in selected communes in Lubelskie Voivodeship

2016 ◽  
Vol 126 (1) ◽  
pp. 8-12
Author(s):  
Daria Przybylska ◽  
Piotr Przybylski ◽  
Bartłomiej Drop ◽  
Krzysztof Czarnocki ◽  
Wojciech Przybylski ◽  
...  
Keyword(s):  
Family Medicine ◽  
Primary Healthcare ◽  
The Elderly ◽  
Healthcare Services ◽  
Medical Services ◽  
Public Healthcare ◽  
Healthcare Facilities ◽  
Primary Type ◽  
Primary Healthcare Centers

Abstract Introduction. Family medicine remains the primary type of medical services in Poland and it is supposed to treat both individual patients and the society as a whole. Due to the growing commercialization of the health service, most primary healthcare centers have transformed into non-public healthcare facilities. The public ones (called SPZOZ in Polish) account only for a small fraction of the whole number of primary healthcare facilities. The quality of medical services provided by such facilities, as patients see it, remains one of the key elements determining the development of family medicine centers. Aim. The aim of this paper was to assess patient satisfaction levels regarding the healthcare services they received in two primary healthcare institutions, both of the NZOZ and SPZOZ type, in a small town located close to Lublin. Material and methods. An anonymous survey was filled out by 30 patients of both a public and non-public healthcare center located in Niemce (Niemce Commune, Lublin District). The quality of services was assessed using an original questionnaire in the form of a poll. Results. The results obtained indicate a clear relationship between one’s trust to the physician, diagnosis accuracy and visiting the particular center again, in order to continue the treatment. For older subjects, it was nurses’ kindness and politeness that was the most important. The elderly appreciated the kindness and politeness of the nurses in particular. No significant differences were found between the institutions in respect of the overall perception of satisfaction with services. In terms of infrastructure assessment, the majority of positive feedback was provided for NZOZ. Conclusions. The findings above suggest that it is essential to conduct surveys on a regular basis, in order to check patients’ assessment of the service quality in various institutons.

scholarly journals Overpriced? Are Hospital Prices Associated with the Quality of Care?

Healthcare ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 135
Author(s):  
Brad Beauvais ◽  
Glen Gilson ◽  
Steve Schwab ◽  
Brittany Jaccaud ◽  
Taylor Pearce ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Clinical Care ◽  
Healthcare Services ◽  
Cost Ratio ◽  
Performance Score ◽  
Significant Positive Association ◽  
The Public ◽  
Total Performance

In most consumer markets, higher prices generally imply increased quality. For example, in the automobile, restaurant, hospitality, and airline industries, higher pricing generally conveys a signal of complexity and superiority of a service or product. However, in the healthcare industry, there is room to challenge the price-quality connection as both health prices and health quality can be difficult to interpret. In the best of circumstances, health care costs, prices, and quality can often be difficult to isolate and measure. Recent efforts by the Trump Administration and the Center for Medicare and Medicaid Services (CMS) have required the pricing of hospital services to be more transparent. Specifically, hospital chargemaster (retail) prices must now be available to the public. However, many continue to question if the pricing of health care services reflects the quality of service delivery. This research focuses on investigating the prices hospitals charge for their services in relation to the costs incurred and the association with the quality of care provided. By analyzing data from a nationwide sample of U.S. hospitals, this study considers the relationship between hospital pricing (as measured by the charge-to-cost ratio) and hospital quality performance as measured by the Value Based Purchasing Total Performance Score (TPS) and its associated sub-domains. Results of the study indicate that hospital prices, as measured by our primary independent variable of interest, the charge-to-cost ratio, are significantly and negatively associated with Total Performance Score, Patient Experience, and the Efficiency and Cost Reduction domains. A marginal statistically significant positive association is shown in the Clinical Care domain. The findings indicate that unlike most other industries, in medicine, higher pricing compared to cost does not necessarily associate with higher quality and, in fact, might indicate the opposite. The results of this study suggest that purchasers of healthcare, at all levels, have justification in challenging the pricing of healthcare services considering the quality scores available in the public domain.

scholarly journals Virtual care: Enhancing access or harming care?

2020 ◽  
Vol 33 (6) ◽  
pp. 288-292 ◽  
Author(s):  
Lorian Hardcastle ◽  
Ubaka Ogbogu
Keyword(s):  
Quality Care ◽  
Family Doctor ◽  
Healthcare Services ◽  
Policy Makers ◽  
Virtual Care ◽  
Established Relationship ◽  
Privacy Issues ◽  
Improve Access

COVID-19 has catalyzed the adoption of virtual medical care in Canada. Virtual care can improve access to healthcare services, particularly for those in remote locations or with health conditions that make seeing a doctor in person difficult or unsafe. However, virtual walk-in clinic models that do not connect patients with their own doctors can lead to fragmented, lower quality care. Although virtual walk-in clinics can be helpful for those who temporarily lack access to a family doctor, they should not be relied on as a long-term substitute to an established relationship with a primary care provider. Virtual care also raises significant privacy issues that policy-makers must address prior to implementing these models. Patients should be cautious of the artificial intelligence recommendations generated by some virtual care applications, which have been linked to quality of care concerns.

Delay in the oncology care. Role of patients and their family physicians

2011 ◽  
Vol 152 (34) ◽  
pp. 1368-1373 ◽  
Author(s):  
Éva Kovács ◽  
Judit Bardi ◽  
Imre Rurik
Keyword(s):  
Low Income ◽  
Economic Status ◽  
Family Doctor ◽  
Family Physicians ◽  
Diagnostic Procedures ◽  
Family Doctors ◽  
Oncology Care ◽  
University Degree ◽  
Oncologic Treatment

Delays between the onset of symptoms, consulting the doctor and the diagnosis are important periods for the success of oncologic treatment. They may depend on the patient’s socio-economic status, qualification, relationship with the doctor and the health care system. Aims and methods: Hundred and ten cancer patients were questioned about their age, social status, qualifications and experiences on delay in the diagnostic procedures and frequency of regular attendance by their family doctors. Results: It was found that 67% of the patients visited the family doctor only when they had symptoms. At the time of the onset of symptoms, 45% of the patients visited family doctors. In case of symptoms suggesting cancer, a longer delay was observed in men than in women; 44% of men while 50% of women were diagnosed within one month. The longest delay was observed in a small proportion of patients over 60 years of age with university degree, while the shortest periods were reported in those with secondary school and university degrees. Patients with low income were overrepresented in all delay categories. Conclusions: Family physicians may play an important role in the primary, secondary and tertiary prevention of tumors but these advantages are not exploited in the relationship between family doctors and their patients. Orv. Hetil., 2011, 152, 1368–1373.

Hierarchical Planning Models for Public Healthcare Supply Chains

2019 ◽  
pp. 86-122
Author(s):  
Hassan Yar Bareach ◽  
Wafa Malik ◽  
Rania Sohail ◽  
Areeb Javaid ◽  
Muhammad Naiman Jalil
Keyword(s):  
Supply Chain ◽  
Supply Chain Management ◽  
Supply Chains ◽  
Healthcare Services ◽  
Public Healthcare ◽  
Hierarchical Planning ◽  
Chain Management ◽  
The Public ◽  
Services Delivery ◽  
Planning Models

This chapter focuses on the hierarchical planning and execution for supply chain management in public healthcare services. The authors first introduce tiered organizational and services delivery structure of public healthcare services followed by various supply chain issues that public healthcare services encounters. They then review hierarchical planning and execution discussions for the strategic, tactical, and operational decisions in supply chain literature. They continue the discussion with public healthcare services cases on medicine and equipment maintenance supply chains. They compare hierarchical planning execution discussions in supply chain management literature vis-a-vis healthcare services cases. Their main argument is that much can be gained by the public healthcare services by striving for reduced information asymmetry and employing appropriate functional aggregation at various levels of the hierarchically organized public healthcare supply chains.

The Study of Public Reporting in Healthcare

2016 ◽  
pp. 115-136 ◽  
Author(s):  
Ubaldo Comite
Keyword(s):  
Quality Of Care ◽  
Healthcare Services ◽  
Considerable Change ◽  
Public Reporting ◽  
Healthcare Sector ◽  
The Public ◽  
Reporting Systems ◽  
Comparative Information ◽  
The Way

Public reporting, intended as the public disclosure of information on healthcare performance, is linked to the improvement of the quality of care through the incentives of selection and change, which are in turn determined by the availability of comparative information that is used by those outside the system (citizens) and those from within (organizations and professionals). In the last few decades, the healthcare sector, have undergone considerable change. This change is inevitably destined to modify the way in which citizens turn to healthcare services, and the way in which hospitals are called upon to be transparent and accountable in how they provide services. It is within this context that public reporting became widespread, as a strategy geared towards promoting informed choices to consumers and stimulating the improvement of quality of care. The aim of this paper is to highlight how public reporting systems have the potential to not only support healthcare users in making informed choices, but to also foster healthcare structures in the improvement of their services.

Sign in / Sign up

Export Citation Format

Share Document