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Estimating the Lifetime Cost of Managing Hypertension in Ghana: A Modelling Study. 估算加纳治疗高血压的终生成本:模型研究。
IF 2.8 Q2 Medicine Pub Date : 2024-03-29 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241241909
Fidelis Atibila, James Avoka Asamani, Emmanuel Timmy Donkoh, Rob Ruiter, Gerjo Kok, Gill Ten Hoor

Introduction: Over the last decade, hypertension (HPT) is among the leading causes of death and morbidity in Ghana. In recent past, most health policy research in Ghana and Africa focussed on communicable diseases. In recent times, Ghana and other developing nations have shifted their attention to non-communicable diseases because most of these countries are going through an epidemiologic transition where there is a surge in the prevalence of HPT. This paper was therefore set out to estimate the cost of treating HPT in Ghana from the patients' and health system's perspectives.

Method: We used a cost of illness framework to simulate the cost of HPT management in Ghana taking into account 4 of the common target organ complications with the most mortality implication. A decision analytic model (DAM) was developed in Microsoft® Excel to simulate the progression of HPT patients and the Markov model was employed in simulating the lifetime cost of illness.

Results: The results show that by 10 years from diagnosis, the probability of death from any of the 4 complications (ie, stroke, myocardial infarction, heart failure, and chronic kidney disease) is roughly 41.03%. By 20 years (or 243 months) from diagnosis, the probability of death is estimated to be 69.61%. However, by the 30th anniversary, the probability of death among the cohort is 82.3%. Also, the lifetime discounted cost of treating HPT is about GHS 869 106 which could range between GHS 570 239 and GHS 1.202 million if wide uncertainty is taken into account. This is equivalent to USD 119 056 (range: USD 78 115-164 723).

Conclusion: By highlighting the lifetime cost of treating HPT in Ghana, policies can be formulated regarding the cost of treating HPT by the non-communicable disease unit and National Health Insurance Authority (NHIA) of the Ministry of Health.

导言:在过去十年中,高血压(HPT)是加纳死亡和发病的主要原因之一。过去,加纳和非洲的大部分卫生政策研究都集中在传染性疾病上。近来,加纳和其他发展中国家已将注意力转移到非传染性疾病上,因为这些国家大多正处于流行病转型期,HPT 的发病率急剧上升。因此,本文旨在从患者和卫生系统的角度估算加纳治疗 HPT 的成本:我们采用疾病成本框架来模拟加纳 HPT 的治疗成本,其中考虑到了死亡率最高的 4 种常见目标器官并发症。我们在 Microsoft® Excel 中开发了一个决策分析模型 (DAM),用于模拟 HPT 患者的病情发展,并采用马尔可夫模型模拟疾病的终生成本:结果显示,确诊后 10 年,死于 4 种并发症(即中风、心肌梗死、心力衰竭和慢性肾病)中任何一种的概率约为 41.03%。到确诊后 20 年(或 243 个月)时,死亡概率估计为 69.61%。然而,到 30 周年时,队列中的死亡概率为 82.3%。此外,治疗 HPT 的终生贴现成本约为 869 106 戈比,如果考虑到广泛的不确定性,则可能在 570 239 至 120.2 万戈比之间。这相当于 119 056 美元(范围:78 115-164 723 美元):通过强调加纳治疗 HPT 的终生成本,卫生部的非传染性疾病部门和国家健康保险管理局 (NHIA) 可以制定有关治疗 HPT 成本的政策。
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引用次数: 0
ChatGPT Versus Medical Professionals: Comment. ChatGPT 与医疗专业人员:评论
IF 2.8 Q2 Medicine Pub Date : 2024-03-27 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241241904
Hinpetch Daungsupawong, Viroj Wiwanitkit
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引用次数: 0
Addressing the Challenges of Private Hospitals in the Philippines. 应对菲律宾私立医院的挑战。
IF 2.8 Q2 Medicine Pub Date : 2024-03-20 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241241905
Rowalt Alibudbud
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引用次数: 0
Inter-Establishment Complex Musculoskeletal Care Pathways in Montreal: Timeline of a Collaboration Involving a Research Team Within a Continuous Quality Improvement Initiative. 蒙特利尔机构间复杂肌肉骨骼护理路径:蒙特利尔复杂肌肉骨骼护理路径:持续质量改进计划中研究团队参与合作的时间轴。
IF 2.8 Q2 Medicine Pub Date : 2024-03-19 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241237709
Marie Beauséjour, Martin Sasseville, Aurélie Vigné, Sophie Riendeau, Stephanie Gould, Kelly Thorstad

Children and adolescents with complex musculoskeletal conditions may receive health care that requires at least 1 transfer between 4 specialized pediatric establishments in the Montreal region (Québec, Canada). This may result in challenges in navigating the system. A collaborative approach, aiming to make the inter-establishment care pathways seamless and to improve the integration of musculoskeletal health services, brought together key stakeholders including a research team. The aim of this paper is to describe the timeline of the collaborative approach's key milestones and activities and, more specifically, to describe the context, process, and outputs of the involvement of researchers in support of a continuous quality improvement project based on an integrated approach. The descriptive timeline was constructed from a qualitative document analysis of the project-related gray literature (n = 80 documents) and was validated and interpreted with key stakeholders. The results showed how the collaborative project was set up and operated, as well as what solutions were developed and implemented. The strategies on how the research team was involved in the integrated approach in addition to its research activities were also described. Conclusions suggest practice recommendations for creating change processes by integrating research, service evaluation and clinical audit into quality improvement projects.

患有复杂肌肉骨骼疾病的儿童和青少年在接受医疗服务时,可能需要在蒙特利尔地区(加拿大魁北克省)的 4 家儿科专科医院之间至少转院一次。这可能会导致在系统导航方面遇到困难。为了实现机构间医疗路径的无缝衔接并改善肌肉骨骼医疗服务的整合,包括研究团队在内的主要利益相关者共同采取了一种合作方法。本文旨在描述该合作方法的关键里程碑和活动时间表,更具体地说,是描述研究人员参与支持基于综合方法的持续质量改进项目的背景、过程和成果。描述性时间表是通过对与项目相关的灰色文献(n = 80 篇文献)进行定性文献分析后构建的,并与主要利益相关者进行了验证和解释。结果显示了合作项目是如何建立和运作的,以及开发和实施了哪些解决方案。此外,还介绍了研究团队在开展研究活动的同时如何参与综合方法的策略。结论提出了通过将研究、服务评估和临床审计整合到质量改进项目中来创建变革流程的实践建议。
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引用次数: 0
Service Allocators' Experiences of Ethical Dilemmas and Strategies in Long-Term Care: A Qualitative Study. 服务分配者在长期护理中的伦理困境和策略经验:定性研究。
IF 2.8 Q2 Medicine Pub Date : 2024-03-15 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241238883
Ann Katrin Blø Pedersen, Marianne Sundlisæter Skinner, Maren Sogstad

The provision of long-term care services for older adults is characterised by increasing needs and scarce resources, leading to ethical dilemmas. This qualitative study explored the ethical dilemmas experienced by healthcare professionals when allocating long-term care services to older adults and the strategies used to handle ethical dilemmas. Data from semi-structured individual interviews, focus group interviews, and observations of service allocators assessing needs and assigning long-term care services to older adults were analysed using content analysis. The overarching theme was the struggle for safe and equitable service allocation. The identified dilemmas were: (i) Struggles with A Just Allocation of Services due to Limited Time and Trust, (ii) Pressure on Professional Values Concerning Safety and Dignity, and (iii) Difficulties in Prioritising One Group Over Another. The strategies to deal with ethical dilemmas were: (i) Assessing Needs Across the Entire Municipality, (ii) Ensuring Distance to Service Recipients, (iii) Working as a Team, and (iv) Interprofessional Decision-Making. Scarce resources, organisational limitations, and political expectations drive the ethical dilemmas in long-term care service allocation. An open public discussion regarding the acceptable minimum standard of long-term care is needed to reduce the ethical pressure on service allocators.

为老年人提供长期护理服务的特点是需求不断增加和资源稀缺,这导致了伦理困境。这项定性研究探讨了医护人员在为老年人分配长期护理服务时遇到的伦理困境,以及处理伦理困境的策略。研究采用内容分析法,对来自半结构化个人访谈、焦点小组访谈以及对服务分配人员评估需求和为老年人分配长期护理服务的观察的数据进行了分析。总的主题是为安全和公平的服务分配而斗争。确定的困境包括(i) 因时间和信任有限而难以公正地分配服务,(ii) 安全和尊严方面的专业价值观压力,以及 (iii) 优先考虑一个群体而不是另一个群体的困难。应对伦理困境的策略有(i) 评估整个城市的需求,(ii) 确保与服务对象的距离,(iii) 团队合作,(iv) 跨专业决策。资源稀缺、组织限制和政治期望是长期护理服务分配中的道德难题。需要就可接受的最低长期护理标准进行公开讨论,以减轻服务分配者的伦理压力。
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引用次数: 0
Integrated Place-Based Primary Interventions: Levers and Tensions Related to Multilevel Governance for Community Integrated Pathways, A Multiple Case Study. 基于地方的综合初级干预:与社区综合路径多级治理相关的杠杆和张力,一项多重案例研究。
IF 2.8 Q2 Medicine Pub Date : 2024-03-11 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241234997
Anna Goudet, Chantal Doré, Shelley-Rose Hyppolite, Nancy Lévesque, Jean-Alex Joseph, Danielle Maltais, Denis Bourque, Lara Maillet

Integrated Place-Based Primary Interventions (IPPIs) are considered an innovative response to the challenges and complex issues faced in disadvantaged areas where traditional institutional services have difficulty reaching people in vulnerable situations. IPPIs are an innovative approach to the delivery of in services, conceived as an original community-based local care and service pathways. However, these intervention practices require adaptive modes of governance. In this article, we explore how and to what extent the mode of governance of IPPIs influences the performance of community-integrated pathways. To this end, using a qualitative exploratory multiple-case study design (observation and semi-structured interviews), we describe 4 IPPIs in 3 territories in Quebec. This includes an examination of the levers of action and tensions related to their governance and the performance levels of the community-integrated pathways. We conclude that collaborative and shared multilevel governance, despite its demanding nature, appears to contribute to the longevity of the actions and benefits of IPPIs and could prevent their relevance from being questioned.

以地方为基础的综合初级干预(IPPIs)被认为是一种创新的应对措施,可以解决贫困地区所面临的挑战和复杂问题,因为在这些地区,传统的机构服务很难惠及处于弱势地位的人们。IPPIs 是一种提供服务的创新方法,被视为一种独创的基于社区的地方护理和服务途径。然而,这些干预做法需要适应性的管理模式。在本文中,我们将探讨 IPPI 的管理模式如何以及在多大程度上影响社区综合路径的绩效。为此,我们采用定性探索性多案例研究设计(观察和半结构式访谈),描述了魁北克 3 个地区的 4 个 IPPI。这包括对行动杠杆、与其治理相关的紧张关系以及社区综合路径的绩效水平进行研究。我们得出的结论是,尽管多层次的合作与共享治理要求很高,但它似乎有助于提高综合社区参与计划的行动和效益的持久性,并可防止其相关性受到质疑。
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引用次数: 0
Magnitude and factors associated with delay in treatment-seeking among new pulmonary tuberculosis patients in public health facilities in Habro district, eastern Ethiopia. 埃塞俄比亚东部哈布罗区公共医疗机构中新肺结核患者延迟寻求治疗的程度和相关因素。
IF 2.8 Q2 Medicine Pub Date : 2024-02-23 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241232532
Assefa Getiye, Hamdi Fekredin Zakaria, Alemayehu Deressa, Galana Mamo, Mulugeta Gamachu, Abdi Birhanu, Addis Eyeberu, Adera Debela, Behailu Hawulte, Gezahegne Tesfaye, Ibsa Mussa

Background: In developing nations, almost two-thirds of people with active tuberculosis (TB) remain undetected and untreated. Delays in seeking treatment increase the severity of the illness, the likelihood of mortality, and the risk of the infection spreading to others in the community. Thus, this study aimed to assess the magnitude of delay in treatment-seeking and its associated factors among new adult pulmonary tuberculosis patients attending public health facilities in Habro District, West Harerge Zone, Oromia Region, Eastern Ethiopia.

Methods: A health facility-based cross-sectional study design was conducted among 420 randomly selected patients with pulmonary tuberculosis who visited public health facilities in Habro District from September 5 to October 5, 2022. Binary logistic regression analysis was used to determine the relationship between the dependent and independent variables, and a 95% confidence interval was used to select significant variables.

Result: Twenty-one days after the start of their illness, 62.38% (95% CI: 57.4%, 66.6%) of the patients sought an initial consultation. Being female (AOR = 2.14, 95% CI: 1.26, 3.65), having poor knowledge about TB (AOR = 3.10, 95% CI: 1.77, 5.43), having no contact history with TB patients (AOR = 3.52, 95% CI: 1.29, 9.58), having clinically diagnosed pulmonary tuberculosis (AOR = 2.16, 95% CI: 1.26, 3.67), and living a long distance from the nearest health facility (AOR = 2.87, 95% CI: 1.31, 6.23) were important predictors contributing to TB patient treatment delay.

Conclusion: In the current study, more than three-fifths of TB patients delayed seeking treatment. Thus, awareness of tuberculosis should be created, especially targeting females and communities found at a distance from the health facility. Additionally, health professionals should emphasise the importance of getting medical attention early and knowing how to suspect and identify tuberculosis symptoms.

背景:在发展中国家,近三分之二的活动性肺结核(TB)患者仍未被发现和治疗。延误就医会增加病情的严重性、死亡的可能性以及传染给社区其他人的风险。因此,本研究旨在评估在埃塞俄比亚东部奥罗莫地区西哈勒盖区哈布罗区公共医疗机构就诊的新发成人肺结核患者中,延误就医的程度及其相关因素:2022 年 9 月 5 日至 10 月 5 日,在哈布罗区公共医疗机构就诊的 420 名肺结核患者中随机抽取了 420 人,采用基于医疗机构的横断面研究设计。研究采用二元逻辑回归分析来确定因变量和自变量之间的关系,并采用95%的置信区间来选择显著变量:发病 21 天后,62.38%(95% 置信区间:57.4%,66.6%)的患者进行了初诊。女性(AOR = 2.14,95% CI:1.26, 3.65)、对肺结核知识缺乏了解(AOR = 3.10,95% CI:1.77, 5.43)、与肺结核患者无接触史(AOR = 3.52,95% CI:1.29, 9.58)、临床诊断为肺结核(AOR = 2.16,95% CI:1.26,3.67)和居住地距离最近的医疗机构较远(AOR = 2.87,95% CI:1.31,6.23)是导致肺结核患者治疗延迟的重要预测因素:在本次研究中,超过五分之三的肺结核患者延误了治疗。因此,应提高人们对结核病的认识,尤其是女性和远离医疗机构的社区。此外,医疗专业人员应强调及早就医的重要性,并了解如何怀疑和识别结核病症状。
{"title":"Magnitude and factors associated with delay in treatment-seeking among new pulmonary tuberculosis patients in public health facilities in Habro district, eastern Ethiopia.","authors":"Assefa Getiye, Hamdi Fekredin Zakaria, Alemayehu Deressa, Galana Mamo, Mulugeta Gamachu, Abdi Birhanu, Addis Eyeberu, Adera Debela, Behailu Hawulte, Gezahegne Tesfaye, Ibsa Mussa","doi":"10.1177/11786329241232532","DOIUrl":"https://doi.org/10.1177/11786329241232532","url":null,"abstract":"<p><strong>Background: </strong>In developing nations, almost two-thirds of people with active tuberculosis (TB) remain undetected and untreated. Delays in seeking treatment increase the severity of the illness, the likelihood of mortality, and the risk of the infection spreading to others in the community. Thus, this study aimed to assess the magnitude of delay in treatment-seeking and its associated factors among new adult pulmonary tuberculosis patients attending public health facilities in Habro District, West Harerge Zone, Oromia Region, Eastern Ethiopia.</p><p><strong>Methods: </strong>A health facility-based cross-sectional study design was conducted among 420 randomly selected patients with pulmonary tuberculosis who visited public health facilities in Habro District from September 5 to October 5, 2022. Binary logistic regression analysis was used to determine the relationship between the dependent and independent variables, and a 95% confidence interval was used to select significant variables.</p><p><strong>Result: </strong>Twenty-one days after the start of their illness, 62.38% (95% CI: 57.4%, 66.6%) of the patients sought an initial consultation. Being female (AOR = 2.14, 95% CI: 1.26, 3.65), having poor knowledge about TB (AOR = 3.10, 95% CI: 1.77, 5.43), having no contact history with TB patients (AOR = 3.52, 95% CI: 1.29, 9.58), having clinically diagnosed pulmonary tuberculosis (AOR = 2.16, 95% CI: 1.26, 3.67), and living a long distance from the nearest health facility (AOR = 2.87, 95% CI: 1.31, 6.23) were important predictors contributing to TB patient treatment delay.</p><p><strong>Conclusion: </strong>In the current study, more than three-fifths of TB patients delayed seeking treatment. Thus, awareness of tuberculosis should be created, especially targeting females and communities found at a distance from the health facility. Additionally, health professionals should emphasise the importance of getting medical attention early and knowing how to suspect and identify tuberculosis symptoms.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10893885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139971649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Epidemiological Aspects of Opioid Poisoning in Northern Iran: A Registry-Based Clinical Study. 伊朗北部阿片类药物中毒的流行病学方面:基于登记的临床研究
IF 2.8 Q2 Medicine Pub Date : 2024-02-22 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241232300
Hamed Ramezanzadeh, Navid Khosravi, Seyed Mohammad Hosseininejad, Mahboobe Mahmoodi, Zakaria Zakariaei, Mahdieh Sadeghi

Opioids are a class of drugs that are commonly used to manage pain due to their analgesic and sedative effects. However, the high consumption of opioids in the community has led to an increase in the incidence of overdoses and poisonings caused by various types of these drugs, whether intentional or unintentional. Therefore, comprehending the epidemiological features of patients experiencing opioid poisoning is crucial. We decided to investigate various epidemiological aspects of patients with opioid poisoning in the Mazandaran province, located in northern Iran, during the period of 2020 to 2021. The present investigation was conducted as a descriptive cross-sectional study, wherein we collected data on patients registered in the Mazandaran Registry Center of Opioid Poisoning (MRCOP) who had a history of using any kind of opioid. We collected information on various parameters, including patient demographics, the type of opioid consumed, the mode of consumption, and clinical outcomes. A total of 240 patients were initially registered at the registry center. However, 17 cases were excluded with personal consent, and eventually, a total of 223 patients were included in the investigation. The majority of the patients 70.9% (n = 158) were male, and the average age was 34.4 ± 16.55 years. The most common cause of poisoning reported in our study was intentional, which was mainly due to a suicide attempt. Furthermore, the most prevalent type of opioid consumed was methadone. The most frequently observed symptoms of poisoning among the patients were drowsiness, a decreased level of consciousness, and reduced arterial oxygen saturation levels. Based on the results of our study, several factors were found to be significant in methadone poisoning, including addiction, age, gender, suicide attempt, and a history of psychiatric disorder. These findings highlight the need for public education and awareness campaigns on the risks associated with opioid use, particularly methadone.

阿片类药物具有镇痛和镇静作用,是一类常用于控制疼痛的药物。然而,阿片类药物在社会中的高消费量导致了由各类此类药物引起的过量用药和中毒事件(无论是有意还是无意)的增加。因此,了解阿片类药物中毒患者的流行病学特征至关重要。我们决定在 2020 年至 2021 年期间调查伊朗北部马赞达兰省阿片类药物中毒患者的各种流行病学特征。本调查是一项描述性横断面研究,我们收集了在马赞达兰阿片类药物中毒登记中心(MRCOP)登记的、有使用任何种类阿片类药物史的患者的数据。我们收集了各种参数的信息,包括患者的人口统计学特征、服用的阿片类药物类型、服用方式和临床结果。登记中心最初共登记了 240 名患者。但经个人同意,有 17 例患者被排除在外,最终共有 223 例患者被纳入调查。大多数患者为男性,占 70.9%(n = 158),平均年龄为(34.4 ± 16.55)岁。在我们的研究中,最常见的中毒原因是蓄意中毒,主要是企图自杀。此外,最常见的阿片类药物是美沙酮。患者最常见的中毒症状是嗜睡、意识下降和动脉血氧饱和度降低。根据我们的研究结果,发现美沙酮中毒的几个重要因素包括成瘾、年龄、性别、自杀未遂和精神病史。这些研究结果突出表明,有必要就阿片类药物(尤其是美沙酮)使用的相关风险开展公众教育和宣传活动。
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引用次数: 0
Can Implementing New Services Organization Models to Better Meet the Needs of Young People Bring About Practice Changes? Analysis of an Experiment in Québec. 实施新的服务组织模式以更好地满足年轻人的需求能否带来实践上的改变?魁北克实验分析。
IF 2.8 Q2 Medicine Pub Date : 2024-02-15 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241232299
N Touati, I Ruelland, L Rodriguez d'El Barrio, M Bouchard, K Beaulieu, I Courcy

The research question addressed in this article is: Can implementing new services organization models to better meet the needs of young people bring about practice changes? More precisely, we examine the effects of a new model called Aire Ouverte (AO) which is implemented gradually across Quebec since 2019. This new model involves public sector and community organizations. To grasp practices' change, we use cultural historical activity theory (CHAT) and employ a qualitative approach. Beyond a precise description of work activities, we gained an inside view of how the actors involved represented their practice and context. Our results show that practice changes seen by actors are in line with the object of the intervention, that is, responding rapidly to the expressed needs of young people. The development of new tools, flexible functioning, strengthening of interprofessional and intersectoral collaboration, involvement of young people in decision-making, all should contribute to improving response to their needs. This being said, a critical look at practice changes reveals a challenge in aligning the design and objective of AO with the needs of some young people. We noted also a poor alignment of effective collaborative practices between levels of care and the practices sought from intersectoral collaboration.

本文探讨的研究问题是实施新的服务组织模式以更好地满足年轻人的需求,能否带来实践上的改变?更确切地说,我们研究了自 2019 年起在魁北克省逐步实施的名为 "Aire Ouverte"(AO)的新模式的效果。这种新模式涉及公共部门和社区组织。为了把握实践的变化,我们采用了文化历史活动理论(CHAT)和定性方法。除了对工作活动的精确描述外,我们还了解了相关参与者如何表述他们的实践和背景。我们的研究结果表明,行动者所看到的实践变化与干预的目标是一致的,即快速响应青 年人所表达的需求。开发新工具、灵活运作、加强跨专业和跨部门合作、让青年人参与决策,所有这些都应有助于更好地满足他们的需求。尽管如此,对实践变化的批判性审视揭示了在使活动设计和目标与一些青年人的需求相一致方面所面临的挑战。我们还注意到,各级护理之间的有效合作实践与跨部门合作所寻求的实践之间的一致性很差。
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引用次数: 0
Interorganisational collaboration to improve accessibility of diagnostic evaluations for children with a developmental disability. 组织间合作,提高发育障碍儿童诊断评估的可及性。
IF 2.8 Q2 Medicine Pub Date : 2024-02-13 eCollection Date: 2024-01-01 DOI: 10.1177/11786329241232531
Cloet Eva, Jansen Anna, Leys Mark

Introduction: A timely integrated diagnostic and care trajectory for children with a developmental disability may prevent severe problems in later life. In Flanders, Belgium, different types of governmental regulated and subsidised settings offer diagnostic evaluations, as (part of) their mission. However, they operate in a non-coordinated way inducing severe accessibility problems for the public. This article studies the factors impacting on interorganisational collaboration and proposes an interorganisational conceptual model improving accessibility.

Methods: Focus groups were performed per type of organisation. Qualitative data were categorised thematically in an iterative process of data- and researcher triangulation. A member check validation was organised.

Results: Fifty-nine individuals participated in 6 focus groups. Structural and agency-related barriers for interorganisational collaboration were identified at micro, meso and macro level. Participants provided suggestions for better interorganisational collaboration.

Discussion: To improve accessibility adapted to patients' needs, a patient-centred, integrated and interorganisational network model grounded in a stepped care logic is proposed to adapt the current organisation-centred model.

Conclusion: A timely, integrated, diagnostic and care trajectory for children with a developmental disability preventing severe problems in later life requires an integration of services during the overall care trajectory of children by means of interorganisational collaboration.

导言:对有发育障碍的儿童进行及时的综合诊断和护理,可以防止他们在以后的生活中出现严重问题。在比利时法兰德斯,不同类型的政府监管和补贴机构都提供诊断评估服务,这也是它们的使命之一。然而,这些机构的运作方式并不协调,给公众造成了严重的无障碍环境问题。本文研究了影响组织间合作的因素,并提出了一个改善无障碍环境的组织间概念模型:方法:按组织类型进行焦点小组讨论。在数据和研究人员三角测量的迭代过程中,对定性数据进行了主题分类。结果:59 人参加了 6 个焦点小组:59人参加了6个焦点小组。从微观、中观和宏观层面确定了组织间合作的结构性障碍和与机构相关的障碍。参与者为更好的组织间合作提出了建议:讨论:为了改善适应患者需求的可及性,我们提出了一个以患者为中心、以阶梯式护理逻辑为基础的综合组织间网络模式,以适应当前以组织为中心的模式:结论:要为发育障碍儿童提供及时、综合的诊断和护理服务,防止他们在今后的生活中出现严重问题,就必须通过组织间合作,在儿童的整体护理过程中整合各种服务。
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引用次数: 0
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Health Services Insights
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