This commentary addresses methodological and interpretive limitations in Geremew et al.'s study on healthcare-seeking behaviour for obstetric complications in Ethiopia, emphasizing the need for clinically validated definitions, analytical exploration of variable interactions, inclusion of all obstetric events, and facility-level cross-validation to strengthen the policy relevance and accuracy of the findings.
Background: The utilisation of healthcare services is critical to maintaining and improving the health status of communities, however, numerous barriers and enablers can either hinder or facilitate an individual's ability to access and benefit from these services, and this is the case in South Africa.
Objective: This study aimed to identify and describe barriers to and enablers of healthcare service utilisation in a rural village of Mpumalanga province, South Africa.
Methods: A quantitative descriptive survey design was conducted with 415 adults who met the inclusion criteria, selected using a systematic sampling technique. Data were gathered through a researcher-administered questionnaire. Descriptive statistics were conducted, using the IBM SPSS version 29 software, to explain and summarise the data. The study was guided by Andersen and Newman's Behavioural Model, focusing on barriers and enabling factors to Health services utilisation.
Results: Key barriers identified in this study included cultural beliefs (58.7%), treatment shortages (54.4%), staff shortages (45.6%), negative staff attitudes (88%), long wait times (84.1%), lack of grievance mechanisms (77.8%), and poor interpersonal skills from nurses (88.5%), leading to low patient satisfaction. Men showed disengagement from chronic care (13%) compared to women (2.9%). A significant portion (20%) had no education, impacting health literacy. Enabling factors included a preference for the local clinic (98.8%) due to its proximity (69.3%) and confidence in nurses' abilities (88.7%).
Conclusion: The study highlighted that healthcare access is hindered by resource limitations, staff issues, attitude and communication problems, and cultural factors. Women, young adults, and less educated individuals underutilise services. This necessitates age and gender targeted programs, culturally sensitive strategies, and improved service delivery and quality assurance policies. Counselling for healthcare workers and accessible feedback mechanisms can enhance patient interactions and satisfaction. Further research is recommended to comprehensively address these barriers to healthcare access and utilisation.
Introduction: Telehealth is revolutionizing healthcare, particularly in post-operative care accessibility. However, technological limitations, costs, and communication barriers hinder its full implementation. This study examines healthcare providers' and patients' perception on telehealth services adoption for post-operative follow-ups at Korle Bu Teaching Hospital (KBTH), Ghana.
Methodology: A descriptive cross-sectional study design was employed to collect data involving 350 participants, (doctors (29), nurses (96), and patients (225)) at KBTH's surgical department using the priori power calculation method. Participants were selected via purposive and convenience sampling. There was a pilot-tested electronic and paper questionnaire administered by trained research assistants. The instrument captured multidimensional perception indices (eg, clinical efficacy, convenience, economic burden) on validated Likert scales alongside socio-demographic and telehealth utilization covariates. Data were managed in REDCap with mandatory fields to minimize missing responses and anonymized identifiers to reduce bias. Analyses comprised descriptive statistics and proportions in IBM SPSS v26 and R v4.2.1.
Results: A substantial 76.6% of stakeholders agree or strongly agree that telehealth reliably monitors minor postoperative conditions. Convenience and efficiency are paramount, with 82.9% of participants finding virtual follow-ups more convenient and 86.6% reporting significant time savings relative to in-person visits. Infection-control benefits are widely recognized (85.2%), and patient-provider rapport remains strong, with only 10.9% expressing discomfort. Major barriers include unstable broadband (83.4%), limited on-site technical support (66.0%), poor audiovisual quality (81.7%), and prohibitive data/device costs (61.4%). Key facilitators encompass robust security measures trusted by 73.8% of users, regulatory confidence (59.7%), perceived clinical equivalence (76.5%), and enhanced access for underserved populations (82.6%).
Conclusion: Telehealth improves accessibility and efficiency in minor post-operative care. However, addressing technological barriers, insurance issues, and communication challenges is crucial. A hybrid approach integrating telehealth with in-person visits is recommended to enhance care quality and patient satisfaction.
Background: Affiliations between community and academic hospitals are increasing. However, their impact on transfer practices remains under-characterized.
Objectives: To understand the impacts of hospital affiliation on transfer practices and hospital resource utilization.
Design: Retrospective cohort study.
Methods: We included patients ⩾18 years who were transferred from a 178-bed community hospital to a tertiary academic hospital between January 2015 to December 2019. Interrupted time series analysis was used to evaluate changes in outcomes after the affiliation in January 2017. Our primary outcome was the change in quarterly rate of early discharge (discharge within 48 hours post-transfer). Secondary outcomes included change in quarterly proportions of low-income patients, patients residing at a far distance from the hospital, and ICU admissions. We performed a sub-analysis in patients transferred to a surgical specialty that evaluated the tri-annual rate of operative management (surgical or interventional radiology procedure performed <72 hours after admission).
Results: Among 144 included patients, 93 (64.6%) were transferred post-affiliation and 63 (43.1%) were transferred to a surgical specialty. No significant trends were seen across outcomes in the pre-affiliation period. Relative to the former period, there was a quarterly decrease in early discharge rates (P = .027) and a quarterly increase in the percentage of patients residing at a long distance from the transferring hospital (P = .027) after affiliation. There was also a relative tri-annual decrease in the rate of operative management (P = .039).
Conclusion: Post-affiliation, the volume of transfers and utilization of resources at the receiving hospital increased. The percentage of transfer patients residing farther from the transferring hospital also increased.
Background: Exercise-based interventions, particularly dual-task training (DT), have been increasingly recognized as effective strategies for improving cognitive, motor, and functional capacities in individuals with Parkinson's disease (PD). This study presented a protocol for a randomized controlled trial (RCT) designed to evaluate and compare the effects of land and aquatic-based single-task (ST) and dual-task (DT) training on physical and cognitive outcomes in individuals with PD. The present study aims to describe the protocol of 4 different physical exercise programs, including single-task and dual-task exercises on land and in the aquatic environment, and their potential impact on the cognitive, motor, functional, and quality of life capacities of people with Parkinson's disease.
Methods: This randomized controlled trial (RCT) involved individuals with PD who were randomly assigned to 1 of 4 intervention groups: (i) Land Single-Task (LST), (ii) Land Dual-Task (LDT), (iii) Aquatic Single-Task (AST), and (iv) Aquatic Dual-Task (ADT). Participants in each group underwent a 12-week exercise program with standardized volume, frequency, and intensity. The interventions focused on improving cognitive and motor functions, balance, dynamic gait, fear of falling, and quality of life (QoL). A battery of validated assessments was used, including the MoCA, SCOPA-COG, TUG, FTSST, Mini-BEST, DGI, ABC, and PDQ-39, administered at baseline, post-intervention, and at a 12-week follow-up.
Objectives: This study aimed to investigate whether dual-task training, particularly in the aquatic environment, offered superior benefits over single-task training in improving cognitive, motor, and functional abilities in individuals with PD. Additionally, the study explored the potential of the aquatic environment to provide unique stimuli that enhance neuroplasticity, balance, and overall mobility.
Conclusions: This protocol outlined a structured approach to evaluating the effectiveness of land and aquatic-based exercise interventions in individuals with PD. The findings from this study will contribute to the development of evidence-based guidelines for exercise prescription in PD, emphasizing the role of aquatic environments in therapeutic interventions.
Background: The COVID-19 pandemic posed unprecedented challenges to healthcare systems worldwide, prompting governments to rapidly expand hospital bed capacity to meet the surge in demand for medical care. This study focuses on evaluating Colombia's healthcare system response by examining the expansion of hospital beds during the health crisis.
Methods: In an observational study, we used a national census of all healthcare facilities in Colombia, compiled by the Ministry of Health and Social Protection (MPSP), to analyze changes in hospital bed allocation from 2010 to 2022. Our analysis accounted for the size of each provider, its public or private ownership, and the types of services it was authorized to deliver. We applied interrupted time series models to assess changes at both the hospital and municipal levels over time.
Results: Findings reveal a significant reduction in hospital beds in 2020, with adult beds decreasing by 1049 units and pediatric beds by 0.709 units compared to 2019. However, there was an increase in ICU beds for adults across all years, which persisted after the end of the crisis. The expansion mainly targeted small hospitals and the public network of providers. Most of the expansion was restricted to areas of the country that already had a supply of ICU and hospitalization beds.
Conclusion: Colombia's healthcare system responded dynamically to the COVID-19 pandemic by reallocating resources and expanding hospital bed capacity, despite the complex command and control configuration of its health system. Yet, it shows that the country needs to modify its financial and organizational structures to ensure better preparedness for future health crises.
Background: Chronic pain is a complex condition affecting patients' health-related quality of life (HRQoL). Pharmacogenetic (PGx) testing offers an approach to personalize pain management by optimizing medication regimens. However, the impact of this approach on measurable patient reported outcomes (PROs) remains unexplored.
Objectives: This study evaluated the association of PGx testing on PROs in chronic pain patients and investigated differences between those who received PGx-guided therapy and those who did not, focusing on changes in HRQoL and pain intensity from pre-to-post PGx.
Design: An exploratory pre-post analysis was conducted as part of an observational case series assessing the influence of PGx testing and subsequent PGx-guided therapy on PROs in chronic pain patients with drug-related problems under their analgesic regimen.
Methods: PROs were assessed in 29 patients pre-PGx (baseline) and post-PGx (follow-up, 4-6 weeks later). HRQoL was measured using the EQ-5D-5L. The EQ index was calculated using the German value set. Pain intensity was determined with the Numeric Rating Scale (NRS). Minimal important difference (MID) threshold was applied for both outcomes. Statistical analyses included Wilcoxon signed-rank tests, chi-square tests, and effect size calculations.
Results: The mean EQ index score improved from pre-to-post PGx (0.379 ± 0.420-0.697 ± 0.307, P < .001, d = -0.84). Stratification revealed that the PGx-guided therapy group showed significantly greater improvements in HRQoL and NRS compared to the non-PGx guided therapy group (P < .01). Among 19 patients who met the MID for the EQ index, 18 had undergone PGx-guided therapy. For NRS, MID was reached in 3 pain intensity categories in the PGx-guided therapy group.
Conclusions: HRQoL and pain intensity significantly improved after PGx testing, with potentially clinically relevant results in the PGx-guided therapy group. Due to the observational nature of the study, further controlled studies are required to assess the clinical impact and economic feasibility of PGx-guided therapy.
Background: This exploratory study investigates the code of silence in healthcare, exploring its origins and outlining its negative impact on healthcare quality and patient safety. Drawing parallels with other professions where similar codes exist, the research delves into the reasons healthcare professionals may choose not to report inappropriate practices.
Objective: This article outlines the reasons for the existence of the code of silence in healthcare, assesses its prevalence, and suggests strategies to address it.
Design and methods: This is a qualitative study which uses in-depth interviews with 88 licensed healthcare providers (physicians, nurses, administrators, and pharmacists) to identify common types of inappropriate practices, the actions taken to address them, and the reasons why observers chose to remain silent.
Results: We find that the majority of healthcare providers in the sample (nearly 70%) either witnessed or were made aware of incidents of inappropriate practices. In a substantial proportion (about 40%) of the cases, no action was taken after reporting the inappropriate practice. The findings are discussed in the context of existing codes of professional ethics and the organizational cultures that either encourage or discourage transparency. The study highlights the tension healthcare professionals face between their personal values, institutional goals, and fear of retribution.
Conclusion: Breaking the code of silence is both a personal and organizational responsibility. The paper concludes with actionable recommendations to break the code of silence, such as fostering a supportive reporting culture, improving anonymous reporting mechanisms, and encouraging leadership to prioritize accountability.
Background: Scaling community-based health programs can contribute to efforts to achieve universal health coverage. Implementers of community-based health programs, such as community health workers (CHWs), hold valuable insights and experiences that can inform how these programs scale up and out.
Objectives: (1) To assess implementer experiences and perceptions of a community-based health program delivered by CHWs that underwent recent changes to broaden its programing and reach (ie, scaling up); and (2) to describe facilitators and barriers to the implementation of this community-based health program to inform subsequent scaling out.
Methods: In April 2023, an evaluation of an NGO-led CHW program was conducted with program implementers across 6 geographic regions in Negros Oriental, Philippines (n = 64 semi-structured interviews). Data were analyzed using a hybrid inductive-deductive analysis, informed by the Medical Research Council's framework for process evaluation of complex interventions. Ethics approval was provided by the University of Waterloo Research Ethics Board (Certificate #: 44828).
Results: CHWs perceived that the scaled up version of the program was more useful and impactful, given its expanded reach and provision of basic treatment; however, new program components also required significant time, effort, and strategy to implement which created new opportunity costs for CHWs. Implementation of the scaled up version of the program was facilitated via clear communication structures and supportive group training spaces. Pre-existing roles and social networks held by CHWs further facilitated the implementation of the scaled up version of the program. Overall, new individual-level and community-based strategies were leveraged by CHWs to implement the scaled up program, and participants described facilitators (eg, expanded reach) and barriers (eg, increased time and effort) that influenced program implementation.
Conclusion: This study contributes insights into how individuals involved in the scaling of a community-based health program may experience this process.
Aim: To provide a comprehensive scientometrics analysis of Six Sigma research in healthcare, a field gaining momentum due to its capacity to address missed improvement opportunities and inefficient cost-control strategies across global health systems.
Design: A cross-sectional mixed-methods study combining quantitative research and health metrics with thematic content analysis to explore trends and research patterns.
Methods: The study analyzed publications indexed in PubMed, Scopus, Web of Science, SciELO, and KCI, using thematic mapping techniques through term co-occurrence networks and cluster analysis. Also, correlation analysis with healthcare quality indicators and global health metrics were executed.
Results: A total of 883 publications were analyzed. (1) Geographical analysis showed 70.8% from high-income countries and 0.7% from low-income countries. (2) Thematic clusters were centered on hospital applications and patient safety. (3) Temporal trends revealed an increasing focus on "big data" and "health innovation." (4) Strong correlations were found between publication output and health/research expenditure (P < .01 for all cases); negative associations emerged with out-of-pocket expenditures and researcher density in low-income settings.
Conclusions: Findings provide a roadmap for aligning global research priorities and highlight the need for inclusive strategies that build research capacity and foster context-sensitive applications of Six Sigma in healthcare.
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