Qualitative Interviews Exploring the Views of Healthcare Professionals Working in a Mental Health Trust in England on Pharmacists as Future Approved Clinicians

BackgroundThe Mental Health Act 1983 was amended in 2007 introducing the role of the Approved Clinician (AC) which could be assumed by individuals from several professional groups. Although the role of mental health pharmacists have undergone significant transformation over the past few decades, pharmacists remain ineligible to train and practise as an AC. There is a paucity of research on non-medical ACs and there are currently no known studies exploring the potential of mental health pharmacists to be considered for the role of AC in future.AimThis qualitative research explored the views and attitudes of a range of healthcare professionals towards the role of the mental health pharmacist, and whether they could and/or should be enabled, via a legislative change, to become ACs in the future.MethodRecruitment based on systematic purposive sampling principles took place at one mental health trust in England. Six pharmacists, five medical ACs and two experienced mental health nurses participated in digitally audio-recorded semi-structured interviews between June-November 2020. The recordings were transcribed verbatim before being inductively coded and thematically analysed.ResultsNotwithstanding the wide recognition among participants of several key skills possessed by mental health pharmacists, various obstacles were also identified to their becoming ACs in future, including prevalent conventional models of pharmacy services delivery restricting adequate patient access, as well as insufficient training opportunities to acquire advanced clinical skills particularly in diagnosis and assessment. Participants also highlighted wider concerns with current uptake of the non-medical AC role which could influence the success of pharmacists’ involvement, including legislative restrictions and a lack of perceived training support.ConclusionChanges to the skill mix within multidisciplinary mental health teams as well as to the training of staff may be required to equip pharmacists with essential skills to be able to transition towards the AC role. Further research is required to gain a better understanding of the challenges facing the clinical development and enhanced utilisation of highly specialised mental health pharmacists across services.

The practice of integrated healthcare and the experiences of people in Ghana’s Ashanti region

Background The Ghanaian government has implemented interventions that integrate traditional medicine (TM) into its national health system in response to the high prevalence of TM use. However, empirical evidence of the experiences of service users and the practice of integrated health in Ghana is scanty. Therefore, this study explored the experiences of people with TM integration into the formal health system in Ashanti region using an adapted TM integration framework. Methods A sequential explanatory mixed methods study design comprising survey administration and in-depth interviews for data collection was utilised to address the research objective. Framework analysis was used in analysing the qualitative data and for triangulation of results. Results Participants were aware of licensing and training of TM practitioners in a science-based university in Ghana. However, knowledge of the existence of TM units in selected hospitals in the region was minimal. Integration knowledge was largely influenced by sex, marital status, household size and residential status, where males and urban dwellers were more familiar with the process than females and rural dwellers. Low patronage of integrated health services in the region was attributable to weak cross referrals. However, service users who had engaged with the integrated system recounted a satisfactory outcome. Conclusion Service users’ unfamiliarity with the presence of integrated facilities in Ghana could be an impediment to the practice of integrated healthcare. Sensitisation of the public about the practice of an integrated system could refine the Ghanaian integrated system. Regular evaluation of patient satisfaction and outcome measures might also serve as an effective strategy for improving health services delivery since evaluation is becoming an important component of health service design and implementation. There is the need for future studies to focus on exploring the perceptions and experiences of health practitioners and hospital administrators regarding the practice of integrated health in Ghana.

Impact of the COVID-19 pandemic on the utilisation of health services at public hospitals in Yemen: a retrospective comparative study

BackgroundThe COVID-19 pandemic has led to a global crisis, creating an unprecedented situation, which has taken the world by storm, overshadowing on all life’ aspects and having a significant impact on the health systems of most countries. In this study, the delivery of health services is investigated both before and during the outbreak of the COVID-19 pandemic at public hospitals in Yemen to assess the impact of COVID-19 on the utilisation of health services.MethodData collected from 127 hospitals in Yemen were reviewed using the DHIS2 system. The data represented 3 months before the outbreak of COVID-19 between January and March 2020 and during the outbreak of COVID-19 outbreak between April and June 2020. The results were then compared with the same period in 2019. The utilisation pattern of healthcare services during the period of investigation was compiled and analysed by applying a generalised estimating equation (GEE) to examine the effects of the COVID-19 outbreak in Yemen. The data collected from the targeted hospitals included information related to consultations, surgeries, deliveries, C-sections and penta-3rd dose immunisation.ResultsThe trendline of health services used during the pandemic showed a gradual decline beginning from April 2020 for consultations, surgeries and penta-3rd dose utilisation. The GEE model revealed a significant effect (p<0.05) during the outbreak compared with preoutbreak in the consultation services (B=−1,343.9; 95% CI −1,767.2 to −920.6; χ2=38.718), surgeries (B=−54.98; 95% CI −79.13 to −30.83, χ2=19.911) and penta-3rd dose (B=−24.47; 95% CI −30.56 to −18.38 and χ2=62.010). As for deliveries and C-sections, the results were shown to be statistically non-significant.ConclusionThe impact of COVID-19 on continuity of health services delivery in Yemen has been distinct and profound, where the study revealed that the number of the consultations, surgeries and number of vaccinated children have been declined during the COVID-19 pandemic, likely due to the partially lockdown measures taken and fear of being infected. However, the deliveries and C-section services remained nearly in the same level and did not affect by the COVID-19 pandemic.

New Innovations for Libraries in the Era of the COVID-19 Pandemic

This chapter explores new innovation for libraries in the era of the COVID-19 pandemic: SWOT. It highlights various areas in which the pandemic is stretching the thinking of libraries to embrace new innovations. Thereby, it creates a new environment for libraries to work. It also outlines the SWOT of COVID-19 for libraries, especially the intensive, drastic adoption and deployment of technological innovations that have been under-utilised over the years. It is no doubt that new innovation for services delivery were birthed in the lockdown globally by libraries and other organisations. Similarly, it evaluates the strengths, weaknesses, opportunities, and threats (SWOT) associated with the new innovation for libraries in era of the COVID-19 pandemic. Useful recommendations were made.

Fiscal Decentralization and Social Service Delivery: An empirical Analysis of Balochistan

Purpose: This study has been initiated to measure the impact of fiscal decentralization in case of Balochistan province by using both revenue decentralization and expenditure decentralization to measure the impact of fiscal decentralization on provision of health, education, employment and poverty reduction. Design/Methodology/Approach: In measure, we have applied ARDL approach on the data spanning from 1975 to 2016. Findings: Our results point out that fiscal decentralization improves the social services delivery in case of Balochistan province. Moreover, it improves the provision of health and education facilities in Balochistan. Further, our findings indicate that fiscal decentralization leads to reduction in the poverty and unemployment. In addition, we found that expenditure decentralization is relatively effective in the provision of social services as compared to the revenue decentralization in case of Balochistan. Implications/Originality/Value: Our study findings suggest that to improve the social services delivery; we may opt for fiscal decentralization particularly expenditure decentralization in case of Balochistan.

The circuits of healthcare: Understanding healthcare seeking behaviour—A qualitative study with tuberculosis patients in Lisbon, Portugal

Background Understanding health delivery service from a patient´s perspective, including factors influencing healthcare seeking behaviour, is crucial when treating diseases, particularly infectious ones, like tuberculosis. This study aims to trace and contextualise the trajectories patients pursued towards diagnosis and treatment, while discussing key factors associated with treatment delays. Tuberculosis patients’ pathways may serve as indicator of the difficulties the more vulnerable sections of society experience in obtaining adequate care. Methods We conducted 27 semi-structured interviews with tuberculosis patients attending a treatment centre in a suburban area of Lisbon. We invited nationals and migrant patients in active treatment to participate by sharing their illness experiences since the onset of symptoms until the present. The Health Belief Model was used as a reference framework to consolidate the qualitative findings. Results By inductive analysis of all interviews, we categorised participants’ healthcare seeking behaviour into 4 main types, related to the time participants took to actively search for healthcare (patient delay) and time the health system spent to diagnose and initiate treatment (health system delay). Each type of healthcare seeking behaviour identified (inhibited, timely, prolonged, and absent) expressed a mindset influencing the way participants sought healthcare. The emergency room was the main entry point where diagnostic care cascade was initiated. Primary Health Care was underused by participants. Conclusions The findings support that healthcare seeking behaviour is not homogeneous and influences diagnostic delays. If diagnostic delays are to be reduced, the identification of behavioural patterns should be considered when designing measures to improve health services’ delivery. Healthcare professionals should be sensitised and perform continuous capacity development training to deal with patients´ needs. Inhibited and prolonged healthcare seeking behaviour contributes significantly to diagnostic delays. These behaviours should be detected and reverted. Timely responses, from patients and the healthcare system, should be promoted.

Evaluation of Inpatient Surgical Wards' Performance at the Hospitals Affiliated with Tehran University of Medical Sciences in 2018

Background: Surgery wards account for a significant portion of hospital costs, followed by patient costs. Improving surgery wards' performance plays a major role in enhancing the accountability and efficiency of the hospital. This study aimed to evaluate the performance of inpatient surgical wards at the hospitals affiliated with Tehran University of Medical Sciences(TUMS). Methods: A descriptive, cross-sectional, retrospective study was performed at all hospitals affiliated with TUMS in 2018. To measure the efficiency of these wards, three indicators have been considered; bed occupancy rate, the average length of stay, and bed turnover. Data have been analyzed using Excel software based on the Pabon Lasso model . Results: Among the 15 active surgical departments, 5 (33.31 %) were categorized in quadrant three, including ophthalmology, obstetrics and gynecology, vascular and trauma surgery, plastic surgery, and infertility department. The oral and maxillofacial surgery and general surgery departments were the poorest in their performance and located in quadrant one. Ten surgical wards out of 38 (26.33 %) have reported a satisfactory performance. Conclusion: Understanding and comparing the performance of clinical departments is also useful in making decisions for standardizing the patterns of health services delivery, evidence-based management in health care centers, and enhancing accountability in the health system. It is suggested that managers revise the departments in the inefficient area to reduce the number of inefficient departments or attract more patients by marketing, diversifying services, and increasing the quality of services.