The subcontracting of specialized services or the execution of specialized works by socially responsible companies versus labor outsourcing

Socially responsible companies are economic entities that know their tax obligations, serving them correctly and in a timely manner. The prohibition of outsourcing as established in art. 12 of the LFT and the permission of specialized services or execution of specialized works of art. 13 of the LFT is the link by which a company that provides specialized services must act ethically against the third parties involved. The prohibition of outsourcing has been a step forward in the face of the relaxation in terms of contributions and contributions related to subordinate work relationships. However, it is necessary to thoroughly review if this intention is carried out in accordance with current legislation and procedures regarding the contracting of specialized services by the different regulatory bodies such as the Secretary of Labor and Social Security, among others. Objectives.- Identify the opportunity to be a socially responsible company in the face of specialization services or execution of specialized works versus the prohibition of outsourcing. Methodology. - Analysis of current legislation on outsourcingbjetivos

Developing an App to Screen for Dual Disorders: A Tool for Improving Treatment Services in Mexico

Background: Previous studies in Mexico undertaken at residential facilities for treating substance use disorders (SUDs) reported that the prevalence of Dual Disorders (DDs) is over 65%. DDs pose a major challenge for the Mexican health system, particularly for community-based residential care facilities for SUDs, due to the shortage of certified professionals to diagnose and treat these patients. Moreover, the lack of standardized algorithms for screening for and evaluating DDs to refer patients to specialized services (whether private or public) hinders timely care, delaying the start of integrated treatment. The use of new technologies provides a strategic opportunity for the timely detection of DDs through the development of standardized digital applications for the timely detection of DDs.Objective: To develop an app to screen for DDs, which will contribute to referral to specialized services in keeping with the level of severity of psychiatric and addictive symptomatology, and be suitable for use by community-based residential care facilities for SUDs.Method: The research project was implemented in two stages. Stage 1 involved obtaining the psychometric properties of the Dual Diagnosis Screening Interview (DDSI). Stage 2 consisted of two steps to test the Beta version of the app and the quality of version 1.0.Results: The DDS obtained sensitivity and specificity scores above 85%. The app and its algorithm to screen for and refer DDs proved to be efficient and easy to apply with satisfactory community acceptance.Conclusion: The app promises to be a useful screening tool at residential addiction treatment centers.

Primary care registration of the mental health needs of patients treated at outpatient specialized services: results from a medium-sized city in Brazil

Background Although matrix support seeks to promote integrating Primary Care with specialized mental health services in Brazil, little is known about the quantitative impact of this strategy on sharing cases between different levels of care. The aim of this study was to investigate the prevalence and factors associated with Primary Care registration of the mental health needs of patients treated at outpatient specialized services in a medium-sized city in Brazil with recent implementation of matrix support. Methods This is a document-based cross-sectional study conducted through an analysis of 1198 patients’ medical records. Crude and adjusted associations with the outcome were explored using logistic regression. Results The prevalence of cases registered in Primary Care was 40% (n = 479). Evidence was found for associations between the outcome and the patients being over 30 years old, and referral by emergency or hospital services. There was conversely an inverse association between the outcome and status as a patient from the Outpatient Clinic or from the Psychosocial Care Center for psychoactive substance misuse. Conclusions Even with the provision of mechanisms for network integration, such as matrix support, our results suggest that more groundwork is necessary to ensure that sharing cases between Primary Care and specialized services is effective.

Palliative Care Coverage across European National Health Systems: Proposal of a Synthetic Indicator

Background: The coverage of palliative care (PC) may be understood as a country’s capacity to offer prevention and relief from serious health-related suffering in relation to an existing need. The aim of this study is to estimate European countries´ coverage capacities. Method: Secondary analysis of three indicators, including the number of specialized services (SSPC), integration capacity scores (ICS) and the PC needs. By means of a K-medians clustering supervised algorithm, three coverage profiles were obtained: (1) Advanced: countries with high ICS and SSPC, and low PC needs; (2) Limited: countries with low ICS and SSPC, and low PC needs; and (3) Low: countries with low ICS and SSPC and high PC needs. Results: On average, the ratio of specialized services per population was 0.79 per 100,000 inhabitants, the average ICS was 19.62 and the average number of deceased patients with SHS per 100,000 inhabitants was 5.69. Twenty countries (41%) reached an advanced coverage profile. Nine countries (18%) demonstrated a limited coverage profile; and 20 countries (41%) fell under a low-coverage capacity. Conclusion: The level of palliative care coverage across Europe shows that 59% of European countries have either limited or very low availability of PC resources as regards their palliative care needs.

Commercialization of the activities of medical institutions — a steady trend

The features of the economic activity of budgetary institutions, including the restrictions and prohibitions established by the current legislation in relation to budgetary institutions, the interests of the state and medical institutions from the position of further improving the efficiency of their activities in the provision of paid medical services are considered. The analysis of the novelties of the legislation regulating paid services provided, including by budgetary medical institutions, is carried out; legislative initiatives to expand the independence of budgetary institutions, including in terms of the disposal of income received by them from income-generating activities; recent changes in the legal organization of medical activities, including clarification of the contractual mechanism for the provision of paid specialized services by medical institutions.

Barriers and facilitators to the access to specialized female genital cutting healthcare services: Experiences of Somali and Sudanese women in Norway

Background Girls and women subjected to female genital cutting (FGC) risk experiencing obstetrical, gynecological, sexual, and psychological health problems. Therefore, Norway has established low-threshold specialized healthcare services where girls and women with FGC-related health problems can directly seek medical attention. Nevertheless, we lack data about access to these services, especially for non-maternity-related purposes. In this article, we explore experiences of seeking medical attention for health problems that are potentially FGC-related, aiming to identify factors that hinder or facilitate access to FGC-specialized services. Methods We conducted a qualitative study in three Norwegian cities employing semi-structured repeat interviews with 26 girls and women subjected to FGC, participant observation, and three validation focus group discussions with 17 additional participants. We thematically analyzed the data and approached access as a dynamic process of interactions between individuals and the healthcare system that lasts from an initial perception of need until reception of healthcare appropriate to that need. Findings We identified several barriers to healthcare, including 1) uncertainty about FGC as a cause of experienced health problems, 2) unfamiliarity with FGC-specialized services, 3) lack of assessment by general practitioners of FGC as a potential cause of health problems, and 4) negative interactions with healthcare providers. In contrast, factors facilitating healthcare included: 1) receiving information on FGC-related health problems and FGC-specialized services from a non-profit immigrant organization, 2) referral to gynecologists with good knowledge of FGC, and 3) positive interactions with healthcare providers. Conclusion Assessing whether FGC is the cause for experienced health problems requires diagnostic competency and should not be left entirely to the patients. We recommend that Norwegian policymakers acknowledge the central role of GPs in the clinical management of patients with FGC-related health problems and provide them with comprehensive training on FGC.

Teleconsultation and the challenges for maintaining health care in times of pandemic

Telemedicine has proven to be an important tool for the assistance continuity facing the current COVID-19 pandemic. We discussed the role of tele-interconsultation and remote matrix support as resources, within the scope of the Unified Health System, in supporting primary care teams, aiming at maintaining quality and resolution, increasing demand for services, as well as the limitations to their implementation. There are difficulties in access by the population, the need for investment and resistance by professionals and managers. It is still necessary regulation of telemedicine activity in the country, given that the permission by the Federal Council of Medicine occured only during the pandemic. The ability to fill gaps and deficiencies left by specialized services and reference centers stands out, since there is an increase in demand in several areas. In addition, the opportunity for learning, safety in conduct and empowerment of primary care professionals is investigated.

Determinants of the access to remote specialised services provided by national sarcoma reference centres

Background Spatial inequalities in cancer management have been evidenced by studies reporting lower quality of care or/and lower survival for patients living in remote or socially deprived areas. NETSARC+ is a national reference network implemented to improve the outcome of sarcoma patients in France since 2010, providing remote access to specialized diagnosis and Multidisciplinary Tumour Board (MTB). The IGéAS research program aims to assess the potential of this innovative organization, with remote management of cancers including rare tumours, to go through geographical barriers usually impeding the optimal management of cancer patients. Methods Using the nationwide NETSARC+ databases, the individual, clinical and geographical determinants of the access to sarcoma-specialized diagnosis and MTB were analysed. The IGéAS cohort (n = 20,590) includes all patients living in France with first sarcoma diagnosis between 2011 and 2014. Early access was defined as specialised review performed before 30 days of sampling and as first sarcoma MTB discussion performed before the first surgery. Results Some clinical populations are at highest risk of initial management without access to sarcoma specialized services, such as patients with non-GIST visceral sarcoma for diagnosis [OR 1.96, 95% CI 1.78 to 2.15] and MTB discussion [OR 3.56, 95% CI 3.16 to 4.01]. Social deprivation of the municipality is not associated with early access on NETSARC+ remote services. The quintile of patients furthest away from reference centres have lower chances of early access to specialized diagnosis [OR 1.18, 95% CI 1.06 to 1.31] and MTB discussion [OR 1.24, 95% CI 1.10 to 1.40] but this influence of the distance is slight in comparison with clinical factors and previous studies on the access to cancer-specialized facilities. Conclusions In the context of national organization driven by reference network, distance to reference centres slightly alters the early access to sarcoma specialized services and social deprivation has no impact on it. The reference networks’ organization, designed to improve the access to specialized services and the quality of cancer management, can be considered as an interesting device to reduce social and spatial inequalities in cancer management. The potential of this organization must be confirmed by further studies, including survival analysis.