Assessment of the quality of sexual and reproductive health services delivered to adolescents at Ujala clinics: A qualitative study in Rajasthan, India

The Adolescent Friendly Health Clinic (AFHCs), a key component of the Government of India’s National Adolescent Health Programme a.k.a. Rashtriya Kishor Swasthya Karyakram (RKSK), aims to increase the accessibility and utilization of sexual-reproductive health services by adolescents and youth. However, low quality of care provided at AFHCs by counsellors calls for attention. We, thus, explore both the clients’ and providers’ perspectives using the World Health Organization’s (WHO) global standards for quality health-care services for adolescents to assess the quality of the sexual reproductive health service delivery at AFHCs in Rajasthan, India. We conducted a qualitative study, comprising observation of the service delivery using mystery clients (MCs) (n = 12) and in-depth interviews with the counsellors (n = 4) in four AFHCs. Interviews were transcribed in local language and were translated in English. The transcripts were coded thematically. Our study, using five of the eight WHO global standards for quality health-care services for adolescents highlighted several gaps in the quality-of-service delivery at AFHCs. We unearth various intricacies related to the quality of the services provided at the AFHCs by referring to the relevant input, process, and the output criteria of WHO global standards I, III, IV, V and VI. Our study calls for efforts to improve- (i) the counsellors’ competencies to increase adolescents’ health literacy on sensitive topics, (ii) the facilities at the clinic to ensure privacy, comfort and confidentiality of the adolescents seeking services, (iii) the referrals to improve appropriate package of services, and (iv) an overall environment to ensure an equity and non-discrimination for all the adolescents. Our findings unearth the barriers that both the service providers and the adolescents face at the AFHCs and underscore the need for regular monitoring and evaluation of the AFHCs to strengthen the facility-based intervention of the RKSK programme.

Disparities in Utilization and Outcomes of Minimally Invasive Techniques for Gastric Cancer Surgery in the United States

Background This study investigated national implementation patterns and perioperative outcomes of minimally invasive gastrectomy (MIG) in gastric cancer surgery in the United States. Methods The National Inpatient Sample (NIS) was queried for patients who underwent elective gastrectomy for gastric cancer from 2008-2018. The MIG versus open gastrectomy approach was correlated with hospital factors, patient characteristics, and complications. Results There was more than a fivefold increase in MIG from 5.8% in 2008 to 32.9% in 2018 (nptrend < 0.001). Patients undergoing MIG had a lower Elixhauser Comorbidity Index (p = 0.001). On risk adjusted analysis, black patients (AOR = 0.77, p = 0.024) and patients with income below 25th percentile (AOR = 0.80, p = 0.018) were less likely to undergo MIG. When these analyses were limited to minimally invasive capable centers only, these differences were not observed. Hospitals in the upper tertile of gastrectomy case volume, Northeast, and urban teaching centers were more likely to perform MIG. Overall, MIG was associated with a 0.7-day decrease in length of stay, reduced risk adjusted mortality rates (AOR = 0.58, p = 0.05), and a $4,700 increase in total cost. Conclusions In this national retrospective study, we observe socioeconomic differences in patients undergoing MIG, which is explained by hospital level factors in MIG utilization. We demonstrate that MIG is associated with a lower mortality compared with open gastrectomy. Establishing MIG as a safe approach to gastric cancers and understanding regional differences in implementation patterns can inform delivery of equitable high-quality health care.

Caring for the Caregivers Through Healthy Human Resource Practices

India has a colossal shortage of human resources for health. The management of human resources in a healthcare institution is vital to enable the delivery of efficient and effective medical services and to achieve patient satisfaction. Everyone proclaims that the human asset is the most important asset. On the other side, health is declared to be one of the most important wealth. Hospitals and pharmaceutical companies constitute two arms of the “health management/ maintenance” effort of humanity. Human resource professionals face many hurdles in their attempt to deliver high-quality health care to citizens. Some of these constraints include budgets, lack of congruence between different stakeholders' values, absenteeism rates, high rates of turnover, and low morale of health personnel.

The public-private partnership (PPP) initiative in healthcare system: as the pathways to achieve the SDGs in Nepal

Globally, financing healthcare is one of the biggest challenges and it becomes a life or death issue in poor countries. Nepal is strongly committed to universal health coverage and Sustainable Development Goals. Existing public health services are inadequate to cater to the growing demands of quality health care and Public Private Partnership (PPP) evolved as newer arrangement for robust healthcare system, improved healthcare quality and enhance cost-effectiveness. Nepal has successfully utilized the PPP model in multiple sectors, however there is limited experience in healthcare. Strengthening PPP models in healthcare could be the pathway for Nepal toward SDG’s and UHC achievement.

BRIEF REVIEW OF THE ROLE OF TELEMEDICINE IN MANAGING POST COVID19 COMPLICATIONS

Telemedicine has been successful in proving its effectiveness and in overcoming the main barriers in managing long Covid-19 or post Covid-19 complications. Recognizing the necessity of Telemedicine, considering the current crisis both to address increased treatment needs and to prevent unnecessary in-person contact, Apollo Tele Health (ATH) has adopted an innovative way of Telemedicine in managing patients and helping them recover from post covid complications thus realizing the full potential of advancements in technology for high quality health care delivery. With the onset of Covid-19, ATH has proven to be an essential tool for prevention, diagnosis and treatment of COVID 19 and to mitigate the post covid complications. This has been possible by the use of information and communication technologies (ICT) for the exchange of valid health information. Burden on healthcare in India is eased by an integrated effort of the government and other private sector initiatives such as Apollo Tele Health. Telemedicine platform can be used effectively for managing post Covid-19 complications and health education on various risk factors of Covid-19.

Delay in Diagnosis of Cervical Cancer in Afghanistan: A Pilot Cross-Sectional Survey

Objectives: The present study aimed to investigate the potential delays in healthcare seeking and diagnosis of women with cervical cancer (CC) in Afghanistan.Methods: Clinical records of three hospitals in Kabul were searched for CC cases, and the women identified were interviewed by a trained physician using a semi-structured questionnaire. The main outcomes were the prevalence of potential delays over 90 days (1) from symptoms onset to healthcare seeking (patient delay), and (2) from first healthcare visit to CC diagnosis (healthcare delay). Information was also collected on: type and stage of CC, diagnostic test utilized, familiarity for CC, signs and symptoms, treatment type, and potential reasons for delaying healthcare seeking.Results: 31 women with CC were identified, however only 11 continued their treatment in the study hospitals or were reachable by telephone, and accepted the interview. The mean age was 51 ± 14 years, and only 18.2% had a previous history of seeking medical care. Patient delay was seen in 90.9% of the women (95% CI: 58.7–99.8), with a median of 304 ± 183 days. Instead, healthcare delay was found in 45.4% (95% CI: 16.7–76.6), with a median of 61 ± 152 days. The main reasons for patient delays were unawareness of the seriousness of the symptoms (70.0%) and unwillingness to consult a healthcare professional (30.0%). None of the women ever underwent cervical screening or heard of the HPV vaccination.Conclusions: Given the global effort to provide quality health care to all CC patients, Afghanistan needs interventions to reduce the delays in the diagnosis of this cancer, for instance by improving all women's awareness of gynecological signs and symptoms.

Patient-Centered Care for Patients with Cardiometabolic Diseases: An Integrative Review

Patient-centered care is essential in high-quality health care, as it leads to beneficial outcomes for patients. The objective of this review is to systematize indicators for the care of patients with cardiometabolic diseases based on patient-centered care, extending from the stages of diagnostic evaluation and care planning to intervention. An integrative literature review was conducted by searching seven scientific databases, and a narrative analysis was performed. A total of 15 articles were included, and indicators related to diagnosis and care planning/intervention were extracted. In the planning of care centered on the person with cardiometabolic diseases, the individuality, dynamics of the processes, flexibility and the participation of all stakeholders should be taken into account. The needs of the person must be addressed through the identification of problems; establishment of individual goals; shared decision making; information and education; systematic feedback; case management; meeting the patient’s preferences and satisfaction with care; engagement of the family; and therapeutic management. The indicators for intervention planning extracted were behavioral interventions, therapeutic management programs, lifestyle promotion, shared decision making, education patient and information, interventions with the use of technology, promotion of self-management, program using technology, therapeutic relationship, therapeutic adherence programs and specialized intervention.

Association Between Length of Residence in the U.S. and Insurance Coverage Within U.S. Chinese Older Adults

Barriers to affordable insurance may worsen disparities among underserved populations. Immigrants with &lt;5 years of residence are not eligible for Medicare and Medicaid and are potentially without affordable alternatives. This study aims to look at the relationship between length of residence in the U.S. and insurance coverage within U.S. Chinese older adults ages 65+.This study used data from a representative sample of 2,365 community-dwelling U.S. Chinese older adults age 65+. The association between length in the U.S. (&lt;5, 6-10, 10+) and insurance status was analyzed using chi squared test and logistic regressions. Within this sample, 58 (2.78%) participants had coverage outside Medicare and Medicaid, with 279 participants reporting no coverage. The vast majority of participants living in the U.S. &lt;5 years had no insurance (81.48%). In a fully adjusted model, participants who were older and female were positively associated with having insurance coverage (OR:1.11 [1.07,1.15] and OR:1.29 [0.88,1.90]). Conversely, both living in the U.S. &lt;5 years (OR:0.009 [0.006, 0.014]),and between 5-10 years (OR:1.20 [0.13,0.30]) were negatively associated with insurance coverage. When including coverage outside of Medicaid and Medicare, residence &lt;5 years and 5-10 years were still negatively associated with insurance coverage ((OR:0.13 [0.009,0.02]), and (OR:0.19 [0.13,0.30])). Vulnerable populations such as older immigrants may not have access to insurance outside of public options, making a 5-year waiting period an additional barrier to quality health care.

Male Prisoners’ Perspectives of Access to Quality Health Care at a Prison Infirmary in Ghana

This study assessed factors that influence access to quality health care among a prison population nearing its release in Ghana. A structured quantitative questionnaire was administered to 200 inmates using a total population sampling. Gap analysis was performed between inmate expectations and perceptions of health provider factors to determine quality. There was an overall negative gap due to expectations exceeding perceptions. This article recommends that a policy document on the health and welfare of inmates be developed and implemented to improve their access to quality health care.

Development of International Practice Recommendations for Persons With Hearing, Vision, and Cognitive Impairment

Many older adults being evaluated for dementia have unrecognized hearing and/or vision problems which can confound results of neuropsychological assessment(s) and can impact care recommendations. International care standards for detection, assessment, and management of people living with dementia (PwD) are rarely addressed yet are critical. We propose a set of recommendations crafted to foster the highest quality health care to enable PwD to live well with these combined impairments. The focus is detection, diagnosis, treatment, and support of PwD who have age-related hearing and/or vision impairments. The guiding principles underlying the recommendations was a focus on promotion of a person-centered approach, but to be pragmatic in considering all contextual levels including professional care pathways and socio-economic/policy factors internationally. The recommendations are inclusive of all stakeholders who work together to promote equity and mutual respect across the domains. The guidelines are designed to be pragmatic, implementable, resource sparing, and sustainable.