Pub Date : 2024-03-15DOI: 10.1101/2024.03.13.24304156
Luke Allen, Sarah Karanja, Michael Gichangi, Cosmas Bunywera, Emmaculate Muturi, Dickson Gachobi, Purity Kathure, Elizabeth Mutile Muasa, Lorna Mutwiri, Lorna Kajuju, Faith Kagwiria, Benjamin Ntabathia, Hillary Rono, David Macleod, Min Jung Kim, Malebogo Tlhajoane, Matthew J Burton, Jacqueline Ramke, Nigel M Bolster, Andrew Bastawrous
Background: Recent research has found that less than half of people identified with an eye problem in Meru countys screening programme were able to access care, with younger adults being the least likely to receive the care they needed. We aimed to interview and survey members of this "left-behind" group to explore barriers and identify potential solutions using a rapid mixed-methods approach. Methods: First, we conducted interviews to explore perceptions of barriers and potential solutions. Next, we asked a representative sample to rank the suggested solutions by likely impact. Finally, we held a multistakeholder meeting to identify which of the top-ranked interventions offered the best balance of impact, feasibility, cost, and potential risks. We used a deductive matrix and thematic analysis to rapidly analyse the interview data. Results: We conducted 67 interviews. Barriers to access included long queues, conflicting work engagements, and lack of clear information. Proposed solutions focused on reducing queue lengths, providing better counselling and clinic information, holding mop-up clinics, and maintaining adequate stocks & supplies. We conducted ranking surveys with 401 additional people from the left-behind group. All proposed solutions were ranked at moderately-to-highly likely to improve equitable access. Fifteen people attended the multistakeholder meeting, including community representatives. Workshop participants unanimously selected enhanced counselling and SMS reminders as the interventions that offered the best balance of impact, risk, cost, and feasibility. The other proposed solutions were deemed impractical or unaffordable. Conclusion: Rapid mixed-methods and multistakeholder collaboration were used to identify a range of potential service modifications that will be implemented within the ongoing programme. Our approach was centred on the experiences and perceptions of those who face the highest barriers to care.
{"title":"Identifying barriers and potential solutions to improve equitable access to community eye services in central Kenya: a rapid exploratory sequential mixed methods study","authors":"Luke Allen, Sarah Karanja, Michael Gichangi, Cosmas Bunywera, Emmaculate Muturi, Dickson Gachobi, Purity Kathure, Elizabeth Mutile Muasa, Lorna Mutwiri, Lorna Kajuju, Faith Kagwiria, Benjamin Ntabathia, Hillary Rono, David Macleod, Min Jung Kim, Malebogo Tlhajoane, Matthew J Burton, Jacqueline Ramke, Nigel M Bolster, Andrew Bastawrous","doi":"10.1101/2024.03.13.24304156","DOIUrl":"https://doi.org/10.1101/2024.03.13.24304156","url":null,"abstract":"Background: Recent research has found that less than half of people identified with an eye problem in Meru countys screening programme were able to access care, with younger adults being the least likely to receive the care they needed. We aimed to interview and survey members of this \"left-behind\" group to explore barriers and identify potential solutions using a rapid mixed-methods approach. Methods: First, we conducted interviews to explore perceptions of barriers and potential solutions. Next, we asked a representative sample to rank the suggested solutions by likely impact. Finally, we held a multistakeholder meeting to identify which of the top-ranked interventions offered the best balance of impact, feasibility, cost, and potential risks. We used a deductive matrix and thematic analysis to rapidly analyse the interview data. Results: We conducted 67 interviews. Barriers to access included long queues, conflicting work engagements, and lack of clear information. Proposed solutions focused on reducing queue lengths, providing better counselling and clinic information, holding mop-up clinics, and maintaining adequate stocks & supplies. We conducted ranking surveys with 401 additional people from the left-behind group. All proposed solutions were ranked at moderately-to-highly likely to improve equitable access. Fifteen people attended the multistakeholder meeting, including community representatives. Workshop participants unanimously selected enhanced counselling and SMS reminders as the interventions that offered the best balance of impact, risk, cost, and feasibility. The other proposed solutions were deemed impractical or unaffordable. Conclusion: Rapid mixed-methods and multistakeholder collaboration were used to identify a range of potential service modifications that will be implemented within the ongoing programme. Our approach was centred on the experiences and perceptions of those who face the highest barriers to care.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"148 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140153085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-14DOI: 10.1101/2024.03.11.24304131
Nega Assefa, Anthony Scott, Lola Madrid, Merga Dheresa, Gezahegn Mengesha, Shabir Mahdi, Sana Mahtab, Ziyaad Dangor, Nellie Myburgh, Lesego Kamogelo Mothibi, Samba O. Sow, Karen L. Kotloff, Milagritos D. Tapia, Uma U. Onwuchekwa, Mahamane Djiteye, Rosauro Varo, Inacio Mandomando, Ariel Nhacolo, Charfudin Sacoor, Elisio Xerinda, Ikechukwu Ogbuanu, Solomon Samura, Babatunde Duduyemi, Alim Swaray-Deen, Abdulai Bah, Shams El Arifeen, Emily S Gurley, Mohammed Zahid Hossain, Afruna Rahman, Atique Iqbal Chowdhury, Bassat Quique, Portia Mutevedzi, Argeseanu Solveig, Dianna Blau, Cyndy Whitney
Background: In resource-limited settings where vital registration and medical death certificates are unavailable or incomplete, verbal autopsy (VA) is often used to attribute causes of death (CoD), identify the distribution and trends of diseases, and prioritize resource allocation and interventions. However, VA findings can be non-specific, as this tool is based on family members’ recall of symptoms rather than objective diagnostic testing. We aimed to compare the CoD diagnoses obtained in stillbirths and children below five years of age (<5s) through two very different approaches; namely: 1) VA; and 2) the results obtained through the use of Minimally Invasive Tissue Sampling (MITS) and rigorous diagnostic testing, as part of the approach proposed by the Child Health and Mortality Prevention Surveillance (CHAMPS). Methods: CHAMPS identified stillbirths and deceased children <5s in real time between 2017 and 2021 in catchment areas in seven low- and middle-income countries (LMICs): Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa. Deaths were eligible for MITS if identified <24 hours after death, legal concerns were not present, burial had not occurred, and parents consented. CHAMPS teams utilized information from MITS and VA to determine the causes of death (CoDs); if not eligible for MITS, the InterVA software utilized only VA information to determine the CoDs. CHAMPS attributed CoD using expert panels that reviewed clinical evidence microbiological, and histopathological results from MITS to derive the CoDs (Determination of Cause of Death [DeCoDe]). The InterVA4 package of OpenVA software automatically assigned the underlying CoDs using the Bayesian probabilistic modeling technique. These automatically assigned CoDs from OpenVA were compared to the gold-standard of the CHAMPS-attributed CoDs to evaluate both systems’ agreement, weaknesses, and strengths using Lin’s concordance correlation coefficient. Results: Data from 2852 deaths that underwent MITS were analysed. The most common age categories were stillbirths (n=1075, 37.7%) and neonatal deaths (n=1077, 37.8%). Overall concordance of InterVA4 and DeCoDe in assigning causes of death across surveillance sites, age groups, and causes of death was poor (0.75 with 95% CI: 0.73 – 0.76) and lacked precision. We found substantial differences in agreement among surveillance sites, with Mali showing the lowest and Mozambique and Ethiopia the highest concordance. Lin’s concordance correlation coefficient for children aged < 1 year was 0.69 (95%CI: 0.65 – 0.71), and for children aged 1-4 years was 0.28 (95%CI: 0.19 – 0.37) Conclusion: The InterVA4 assigned CoD agrees poorly in assigning causes of death for under-fives and stillbirths. Because VA methods are relatively easy to implement, such systems could be more useful if algorithms were improved to more accurately reflect causes of death, for example, by calibrating algorithms to information from programs t
{"title":"Comparison of causes of stillbirth and child deaths as determined by verbal autopsy and minimally invasive tissue sampling","authors":"Nega Assefa, Anthony Scott, Lola Madrid, Merga Dheresa, Gezahegn Mengesha, Shabir Mahdi, Sana Mahtab, Ziyaad Dangor, Nellie Myburgh, Lesego Kamogelo Mothibi, Samba O. Sow, Karen L. Kotloff, Milagritos D. Tapia, Uma U. Onwuchekwa, Mahamane Djiteye, Rosauro Varo, Inacio Mandomando, Ariel Nhacolo, Charfudin Sacoor, Elisio Xerinda, Ikechukwu Ogbuanu, Solomon Samura, Babatunde Duduyemi, Alim Swaray-Deen, Abdulai Bah, Shams El Arifeen, Emily S Gurley, Mohammed Zahid Hossain, Afruna Rahman, Atique Iqbal Chowdhury, Bassat Quique, Portia Mutevedzi, Argeseanu Solveig, Dianna Blau, Cyndy Whitney","doi":"10.1101/2024.03.11.24304131","DOIUrl":"https://doi.org/10.1101/2024.03.11.24304131","url":null,"abstract":"Background: In resource-limited settings where vital registration and medical death certificates are unavailable or incomplete, verbal autopsy (VA) is often used to attribute causes of death (CoD), identify the distribution and trends of diseases, and prioritize resource allocation and interventions. However, VA findings can be non-specific, as this tool is based on family members’ recall of symptoms rather than objective diagnostic testing. We aimed to compare the CoD diagnoses obtained in stillbirths and children below five years of age (<5s) through two very different approaches; namely: 1) VA; and 2) the results obtained through the use of Minimally Invasive Tissue Sampling (MITS) and rigorous diagnostic testing, as part of the approach proposed by the Child Health and Mortality Prevention Surveillance (CHAMPS).\u0000Methods: CHAMPS identified stillbirths and deceased children <5s in real time between 2017 and 2021 in catchment areas in seven low- and middle-income countries (LMICs): Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa. Deaths were eligible for MITS if identified <24 hours after death, legal concerns were not present, burial had not occurred, and parents consented. CHAMPS teams utilized information from MITS and VA to determine the causes of death (CoDs); if not eligible for MITS, the InterVA software utilized only VA information to determine the CoDs. CHAMPS attributed CoD using expert panels that reviewed clinical evidence microbiological, and histopathological results from MITS to derive the CoDs (Determination of Cause of Death [DeCoDe]). The InterVA4 package of OpenVA software automatically assigned the underlying CoDs using the Bayesian probabilistic modeling technique. These automatically assigned CoDs from OpenVA were compared to the gold-standard of the CHAMPS-attributed CoDs to evaluate both systems’ agreement, weaknesses, and strengths using Lin’s concordance correlation coefficient.\u0000Results: Data from 2852 deaths that underwent MITS were analysed. The most common age categories were stillbirths (n=1075, 37.7%) and neonatal deaths (n=1077, 37.8%). Overall concordance of InterVA4 and DeCoDe in assigning causes of death across surveillance sites, age groups, and causes of death was poor (0.75 with 95% CI: 0.73 – 0.76) and lacked precision. We found substantial differences in agreement among surveillance sites, with Mali showing the lowest and Mozambique and Ethiopia the highest concordance. Lin’s concordance correlation coefficient for children aged < 1 year was 0.69 (95%CI: 0.65 – 0.71), and for children aged 1-4 years was 0.28 (95%CI: 0.19 – 0.37)\u0000Conclusion: The InterVA4 assigned CoD agrees poorly in assigning causes of death for under-fives and stillbirths. Because VA methods are relatively easy to implement, such systems could be more useful if algorithms were improved to more accurately reflect causes of death, for example, by calibrating algorithms to information from programs t","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140124308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-13DOI: 10.1101/2024.03.11.24304097
Bart R. Maas, Robin van den Bergh, Sanne W. van den Berg, Eveline Hulstein, Niek Stadhouders, Patrick P.T. Jeurissen, Nienke M. de Vries, Bastiaan R. Bloem, Marten Munneke, Yoav Ben-Shlomo, Sirwan K.L. Darweesh
Background: An innovative, integrative care model for people with Parkinson (PRIME Parkinson) has gradually been implemented in a selected region of the Netherlands since 2021. A prospective evaluation of this model (PRIME-NL study) was initiated in parallel, spanning the year prior to implementation (baseline) and the implementation period. Following publication of the original study protocol, the COVID-19 crisis delayed implementation of the full PRIME Parkinson care model by two years and hampered the recruitment of study participants. Objective: To describe which methodological adjustments were made to the study protocol because of these developments. Methods: We compare various outcomes between a region where PRIME Parkinson care was implemented (innovation region) versus the rest of the Netherlands (usual care region). We use healthcare claims data of virtually all people with Parkinson in the Netherlands and annual questionnaires in a representative subsample of 984 people with Parkinson, 566 caregivers and 192 healthcare professionals. Four major methodological adjustments had to be made since publication of the original protocol. First, we extended the evaluation period by two years. Second, we incorporated annual process measures of the stage of implementation of the new care model. Third, we introduced a real-time iterative feedback loop of interim results to relevant stakeholders. Fourth, we updated the statistical analysis plan. Discussion: This manuscript provides transparency in how the design and analyses of the evaluation study had to be adapted to control for external influences in a dynamic environment, including eruption of the COVID-19 crisis. Our solutions could serve as a template for evaluating other complex healthcare interventions in a dynamic environment.
背景：自 2021 年起，一种针对帕金森患者的创新型综合护理模式（PRIME 帕金森）在荷兰的部分地区逐步实施。与此同时，还启动了对该模式的前瞻性评估（PRIME-NL 研究），横跨实施前一年（基线）和实施期间。最初的研究方案公布后，COVID-19 危机将 PRIME 帕金森病护理模式的全面实施推迟了两年，并阻碍了研究参与者的招募。目的：描述因上述情况而对研究方案进行的方法学调整。方法：我们比较了实施 PRIME 帕金森病护理的地区（创新地区）与荷兰其他地区（常规护理地区）的各种结果。我们使用了荷兰几乎所有帕金森患者的医疗报销数据，以及对 984 名帕金森患者、566 名护理人员和 192 名医疗专业人员的代表性子样本进行的年度问卷调查。自原始方案发布以来，我们不得不对方法进行了四项重大调整。首先，我们将评估期延长了两年。其次，我们纳入了新护理模式实施阶段的年度过程测量。第三，我们将中期结果实时迭代反馈给相关利益方。第四，我们更新了统计分析计划。讨论：这篇手稿提供了在动态环境中（包括 COVID-19 危机的爆发）如何调整评估研究的设计和分析以控制外部影响的透明度。我们的解决方案可作为在动态环境中评估其他复杂医疗干预措施的模板。
{"title":"The PRIME-NL study: evaluating a complex healthcare intervention for people with Parkinson's disease in a dynamic environment","authors":"Bart R. Maas, Robin van den Bergh, Sanne W. van den Berg, Eveline Hulstein, Niek Stadhouders, Patrick P.T. Jeurissen, Nienke M. de Vries, Bastiaan R. Bloem, Marten Munneke, Yoav Ben-Shlomo, Sirwan K.L. Darweesh","doi":"10.1101/2024.03.11.24304097","DOIUrl":"https://doi.org/10.1101/2024.03.11.24304097","url":null,"abstract":"Background: An innovative, integrative care model for people with Parkinson (PRIME Parkinson) has gradually been implemented in a selected region of the Netherlands since 2021. A prospective evaluation of this model (PRIME-NL study) was initiated in parallel, spanning the year prior to implementation (baseline) and the implementation period. Following publication of the original study protocol, the COVID-19 crisis delayed implementation of the full PRIME Parkinson care model by two years and hampered the recruitment of study participants. Objective: To describe which methodological adjustments were made to the study protocol because of these developments. Methods: We compare various outcomes between a region where PRIME Parkinson care was implemented (innovation region) versus the rest of the Netherlands (usual care region). We use healthcare claims data of virtually all people with Parkinson in the Netherlands and annual questionnaires in a representative subsample of 984 people with Parkinson, 566 caregivers and 192 healthcare professionals. Four major methodological adjustments had to be made since publication of the original protocol. First, we extended the evaluation period by two years. Second, we incorporated annual process measures of the stage of implementation of the new care model. Third, we introduced a real-time iterative feedback loop of interim results to relevant stakeholders. Fourth, we updated the statistical analysis plan. Discussion: This manuscript provides transparency in how the design and analyses of the evaluation study had to be adapted to control for external influences in a dynamic environment, including eruption of the COVID-19 crisis. Our solutions could serve as a template for evaluating other complex healthcare interventions in a dynamic environment.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140116322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-07DOI: 10.1101/2024.03.04.24303754
Tracey H Taveira, Lisa B. Cohen, Sharon LaForest, Karen Oliver, Melanie Parent, Renee Hearns, Sherry Ball, sandesh dev, Wen-Chih Wu
Background: Shared medical appointments (SMAs) in heart failure (HF) are medical visits where several patients with HF meet with multidisciplinary providers at the same time for efficient and comprehensive care. It is unknown whether HF-SMAs can improve overall and cardiac health status for high-risk patients discharged with HF. Methods: A 3-site, open-label, randomized-controlled-trial was conducted. Participants within 12 weeks of HF hospitalization were randomized to receive either HF-SMA or usual HF clinical care (usual-care) on a 1:1 ratio. The HF-SMA team, which consisted of a nurse, nutritionist, psychologist, nurse practitioner and/or a clinical pharmacist, provided four 2-hour session HF-SMAs that met every other week for 8 weeks. Primary outcomes were the overall health status measured by EQ5D-VAS and cardiac health status by KCCQ, 180 days post-randomization. Results: Of the 242 patients enrolled (HF-SMA n=117, usual-care n=125, mean age 69.3±9.4 years, 71.5% white, 94.6% male), 84% of participants completed the study (n=8 HF-SMA and n=9 usual-care patients died). After 180 days, both HF-SMA and usual-care participants had similar and significant improvements from baseline in KCCQ, but only HF-SMA participants had significant improvements in EQ5D-VAS (mean change = 7.2 +/- 15.8 in HF-SMA versus -0.4 +/- 19.0 points in usual-care, p<0.001). Conclusion: Both HF-SMA and usual care in HF participants achieved significant improvements in cardiac health status, but only a team approach through HF-SMA achieved significant improvements in overall health status. A larger population and a longer follow-up time are needed in future studies to evaluate re-hospitalization and death outcomes.
{"title":"Shared Medical Appointments in Heart Failure For Post-hospitalization Follow-up: A Randomized Controlled Trial","authors":"Tracey H Taveira, Lisa B. Cohen, Sharon LaForest, Karen Oliver, Melanie Parent, Renee Hearns, Sherry Ball, sandesh dev, Wen-Chih Wu","doi":"10.1101/2024.03.04.24303754","DOIUrl":"https://doi.org/10.1101/2024.03.04.24303754","url":null,"abstract":"Background: Shared medical appointments (SMAs) in heart failure (HF) are medical visits where several patients with HF meet with multidisciplinary providers at the same time for efficient and comprehensive care. It is unknown whether HF-SMAs can improve overall and cardiac health status for high-risk patients discharged with HF.\u0000Methods: A 3-site, open-label, randomized-controlled-trial was conducted. Participants within 12 weeks of HF hospitalization were randomized to receive either HF-SMA or usual HF clinical care (usual-care) on a 1:1 ratio. The HF-SMA team, which consisted of a nurse, nutritionist, psychologist, nurse practitioner and/or a clinical pharmacist, provided four 2-hour session HF-SMAs that met every other week for 8 weeks. Primary outcomes were the overall health status measured by EQ5D-VAS and cardiac health status by KCCQ, 180 days post-randomization.\u0000Results: Of the 242 patients enrolled (HF-SMA n=117, usual-care n=125, mean age 69.3±9.4 years, 71.5% white, 94.6% male), 84% of participants completed the study (n=8 HF-SMA and n=9 usual-care patients died). After 180 days, both HF-SMA and usual-care participants had similar and significant improvements from baseline in KCCQ, but only HF-SMA participants had significant improvements in EQ5D-VAS (mean change = 7.2 +/- 15.8 in HF-SMA versus -0.4 +/- 19.0 points in usual-care, p<0.001). Conclusion: Both HF-SMA and usual care in HF participants achieved significant improvements in cardiac health status, but only a team approach through HF-SMA achieved significant improvements in overall health status. A larger population and a longer follow-up time are needed in future studies to evaluate re-hospitalization and death outcomes.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"298 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140072073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-06DOI: 10.1101/2024.03.04.24303744
Abel Chukwuemeka, Folahanmi Akinsolu, Marylyn Adekola, Mobolaji Olagunju, Olunike Abodunrin, Ifeoluwa Adewole, Oluwabukola Ola, Oliver Ezechi
Introduction Patient satisfaction plays a critical role in healthcare service delivery. Despite growing studies, patient satisfaction levels are still widely under-reported in Nigeria. This study assessed patient satisfaction among patients in primary and secondary healthcare facilities in Ibadan Southwest local government area of Oyo State, Nigeria. Method and Materials In this cross-sectional study, investigators collected data using the Short-form Patient Satisfaction Questionnaire (PSQ-18). The data was analyzed using the Statistical Package for the Social Sciences (SPSS) software with descriptive statistics and One-way analysis of variance (ANOVA). Results A total of 387 patients participated in the study, and results showed that overall satisfaction among patients was 67.9%, where Communication (84.5%) and Financial Aspect (54.9%) recorded the highest and lowest percentage of positive responses respectively. Conclusion Patient satisfaction is a growing subject in Nigeria. It has a significant influence on healthcare service delivery. Stakeholders, policymakers, and managers should employ policies, strategies, and programs to improve the quality of healthcare service delivery across Nigeria.
{"title":"Assessing Patient Satisfaction in Ibadan South-west Region of Oyo State, Nigeria","authors":"Abel Chukwuemeka, Folahanmi Akinsolu, Marylyn Adekola, Mobolaji Olagunju, Olunike Abodunrin, Ifeoluwa Adewole, Oluwabukola Ola, Oliver Ezechi","doi":"10.1101/2024.03.04.24303744","DOIUrl":"https://doi.org/10.1101/2024.03.04.24303744","url":null,"abstract":"Introduction\u0000Patient satisfaction plays a critical role in healthcare service delivery. Despite growing studies, patient satisfaction levels are still widely under-reported in Nigeria. This study assessed patient satisfaction among patients in primary and secondary healthcare facilities in Ibadan Southwest local government area of Oyo State, Nigeria. Method and Materials\u0000In this cross-sectional study, investigators collected data using the Short-form Patient Satisfaction Questionnaire (PSQ-18). The data was analyzed using the Statistical Package for the Social Sciences (SPSS) software with descriptive statistics and One-way analysis of variance (ANOVA). Results\u0000A total of 387 patients participated in the study, and results showed that overall satisfaction among patients was 67.9%, where Communication (84.5%) and Financial Aspect (54.9%) recorded the highest and lowest percentage of positive responses respectively.\u0000Conclusion\u0000Patient satisfaction is a growing subject in Nigeria. It has a significant influence on healthcare service delivery. Stakeholders, policymakers, and managers should employ policies, strategies, and programs to improve the quality of healthcare service delivery across Nigeria.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140045817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-04DOI: 10.1101/2024.03.04.24303701
Luke N Allen, Sarah Karanja, Malebogo Tlhajoane, John Tlhakanelo, David Macleod, Andrew Bastawrous
Background: Our research team is conducting phenomenological interviews with people who have not been able to access health services in Meru County, Kenya, aiming to explore the barriers they face and their perceptions of how we could modify our community outreach services to improve accessibility. We plan to conduct an embedded study that compares in-person and telephone interview modalities in terms of the richness of the data and the resources required for each modality. Methods/Design: This is a qualitative mode comparison study, embedded within a broader project to understand and address the issues that lead to inequitable access to local outreach clinics in Kenya. We will recruit at least 40 people who have been referred to local services but who have not been able to attend. We will conduct in-person interviews with half of these people, and telephone interviews with the other half. We will use random numbers to determine the modality that is used for each participant. All interviews will be conducted in the same month by a team of six research assistants who will use the same topic guide and analytic matrix for each interview. For all interviews conducted in each mode we will record and compare the mean duration; mean number of themes reported by each participant; total number of themes reported; interviewer rating of perceived richness; interviewer rating of perceived ease of building rapport; number of days taken by the team to complete all interviews; and all costs associated with conducting the interviews. Discussion: The findings will help us to weigh up the relative strengths and weaknesses of each modality for our research context. Given that we are exploring a focused research question in a fairly homogenous population, we anticipate that there may not be a meaningful difference in the number of themes reported.
{"title":"A protocol for the comparison of telephone and in-person interview modalities: duration, richness, and costs in the context of exploring determinants of equitable access to community health services in Meru, Kenya","authors":"Luke N Allen, Sarah Karanja, Malebogo Tlhajoane, John Tlhakanelo, David Macleod, Andrew Bastawrous","doi":"10.1101/2024.03.04.24303701","DOIUrl":"https://doi.org/10.1101/2024.03.04.24303701","url":null,"abstract":"Background: Our research team is conducting phenomenological interviews with people who have not been able to access health services in Meru County, Kenya, aiming to explore the barriers they face and their perceptions of how we could modify our community outreach services to improve accessibility. We plan to conduct an embedded study that compares in-person and telephone interview modalities in terms of the richness of the data and the resources required for each modality. Methods/Design: This is a qualitative mode comparison study, embedded within a broader project to understand and address the issues that lead to inequitable access to local outreach clinics in Kenya. We will recruit at least 40 people who have been referred to local services but who have not been able to attend. We will conduct in-person interviews with half of these people, and telephone interviews with the other half. We will use random numbers to determine the modality that is used for each participant. All interviews will be conducted in the same month by a team of six research assistants who will use the same topic guide and analytic matrix for each interview. For all interviews conducted in each mode we will record and compare the mean duration; mean number of themes reported by each participant; total number of themes reported; interviewer rating of perceived richness; interviewer rating of perceived ease of building rapport; number of days taken by the team to complete all interviews; and all costs associated with conducting the interviews. Discussion: The findings will help us to weigh up the relative strengths and weaknesses of each modality for our research context. Given that we are exploring a focused research question in a fairly homogenous population, we anticipate that there may not be a meaningful difference in the number of themes reported.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140032546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-29DOI: 10.1101/2024.02.22.24303214
Er-Rays Youssef, M’dioud Meriem
Background The public hospital network in Morocco plays a crucial role in providing healthcare services. However, this network faces challenges in terms of technical efficiency in healthcare management.
{"title":"Assessment of Technical Efficiency in the Moroccan Public Hospital Network: Using the DEA Method","authors":"Er-Rays Youssef, M’dioud Meriem","doi":"10.1101/2024.02.22.24303214","DOIUrl":"https://doi.org/10.1101/2024.02.22.24303214","url":null,"abstract":"<strong>Background</strong> The public hospital network in Morocco plays a crucial role in providing healthcare services. However, this network faces challenges in terms of technical efficiency in healthcare management.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"223 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140032395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-29DOI: 10.1101/2024.02.28.24303254
Luke Allen, Min Kim, Michael Gichangi, David Macleod, James Carpenter, Malebogo Tlhajoane, Sarah Karanja, Nigel Bolster, Matthew Burton, Andrew Bastawrous
Background The Vision Impact Project (VIP) is a major community-based eye screening programme running in Kenya with the aim of promoting eye health for all. Previous studies embedded within the programme in Meru County have found that a third of people who are screened require care for an eye problem, however only half of these people manage to access outreach treatment clinics. Access varies between sociodemographic groups, and only 30% of young adults (18-44 years old) were able to access care. In previous mixed-methods work our team conducted interviews and surveys with non-attenders from this ‘left-behind’ group to explore what could be done to improve access.
{"title":"Protocol for an individual-level, two arm, superiority RCT within an adaptive platform trial: Enhanced patient counselling and SMS reminder messages to improve access to community-based eye care services in Meru, Kenya","authors":"Luke Allen, Min Kim, Michael Gichangi, David Macleod, James Carpenter, Malebogo Tlhajoane, Sarah Karanja, Nigel Bolster, Matthew Burton, Andrew Bastawrous","doi":"10.1101/2024.02.28.24303254","DOIUrl":"https://doi.org/10.1101/2024.02.28.24303254","url":null,"abstract":"<strong>Background</strong> The Vision Impact Project (VIP) is a major community-based eye screening programme running in Kenya with the aim of promoting eye health for all. Previous studies embedded within the programme in Meru County have found that a third of people who are screened require care for an eye problem, however only half of these people manage to access outreach treatment clinics. Access varies between sociodemographic groups, and only 30% of young adults (18-44 years old) were able to access care. In previous mixed-methods work our team conducted interviews and surveys with non-attenders from this ‘left-behind’ group to explore what could be done to improve access.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140033069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-28DOI: 10.1101/2024.02.26.24303386
Yan-Wei Su, Chia-Cheng Hao, Gi-Ren Liu, Yuan-Chung Sheu, Hau-Tieng Wu
Background: Assessing signal quality is crucial for biomedical signal processing, yet a precise mathematical model for defining signal quality is often lacking, posing challenges for experts in labeling signal qualities. The situation is even worse in the free living environment. Method: We advocate a reconsideration of the concept of signal quality. Result: We demonstrate the necessity of this reconsideration and highlight the relationship between signal quality and signal decomposition with examples recorded from the free living environment. Conclusion: A new method, distinct from visually inspecting the raw PPG signal to assess its quality, is needed. Our proposed ANHM model, combined with advanced signal processing tools, shows potential for establishing a systematic signal decomposition based SQA model.
{"title":"Reconsider photoplethysmogram signal quality assessment in the free living environment","authors":"Yan-Wei Su, Chia-Cheng Hao, Gi-Ren Liu, Yuan-Chung Sheu, Hau-Tieng Wu","doi":"10.1101/2024.02.26.24303386","DOIUrl":"https://doi.org/10.1101/2024.02.26.24303386","url":null,"abstract":"Background: Assessing signal quality is crucial for biomedical signal processing, yet a precise mathematical model for defining signal quality is often lacking, posing challenges for experts in labeling signal qualities. The situation is even worse in the free living environment.\u0000Method: We advocate a reconsideration of the concept of signal quality.\u0000Result: We demonstrate the necessity of this reconsideration and highlight the relationship between signal quality and signal decomposition with examples recorded from the free living environment. Conclusion: A new method, distinct from visually inspecting the raw PPG signal to assess its quality, is needed. Our proposed ANHM model, combined with advanced signal processing tools, shows potential for establishing a systematic signal decomposition based SQA model.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140004004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-28DOI: 10.1101/2024.02.27.24303447
Muhammad Naveed Noor, Haider Safdar Abbasi, Nina Van Der Mark, Zahida Azizullah, Janice Linton, Afifah Rahman-Shepherd, Amna Rehana Siddiqui, Mishal S. Khan, Rumina Hasan, Sadia Shakoor
Incentive-linked prescribing (ILP) is considered a controversial practice universally. If incentivised, physicians may prioritise meeting pharmaceutical sales targets through prescriptions, rather than considering patients' health and wellbeing. Despite the potential harms of ILP to patients and important stakeholders in the healthcare system, healthcare consumers (HCCs) which include patients and the general public often have far less awareness about the practice of pharmaceutical incentivisation of physicians. We conducted a scoping review to explore what existing research says about HCCs’ perceptions of the financial relationship between physicians and pharmaceutical companies. To conduct this scoping review, we followed Arksey and O'Malley’s five-stage framework: identifying research questions, identifying relevant studies, selecting eligible studies, data charting, and collating, summarising, and reporting results. We also used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses’ extension for scoping reviews (PRISMA-ScR), as a guide to organise the information in this review. Quantitative and qualitative studies with patients and the general public, published in the English language were identified through searches of Scopus, Medline (OVID), EMBASE (OVID), and Google Scholar. Three themes emerged through the analysis of the 13 eligible studies: understanding of incentivisation, perceptions of hazards linked to ILP, and HCCs’ suggestions to address it. We found documentation that HCCs exhibited a range of knowledge from good to insufficient about the pharmaceutical incentivisation of physicians. HCCs perceived several hazards linked to ILP such as a lack of trust in physicians and the healthcare system, the prescribing of unnecessary medications, and the negative effect on physicians’ reputations in society. In addition to strong regulatory controls, it is critical that physicians self-regulate their behaviour, and publicly disclose if they have any financial ties with pharmaceutical companies. Doing so can contribute to trust between patients and physicians, an important part of patient-focused care and a contributor to user confidence in the wider health system.
与激励挂钩的处方（ILP）被普遍认为是一种有争议的做法。如果受到激励，医生可能会优先考虑通过处方达到药品销售目标，而不是考虑病人的健康和福祉。尽管ILP对患者和医疗保健系统中的重要利益相关者有潜在危害，但包括患者和公众在内的医疗保健消费者（HCCs）往往对医生的药品激励行为知之甚少。我们进行了一次范围界定审查，以探索现有研究对 HCCs 对医生与制药公司之间财务关系的看法的描述。为了进行此次范围界定综述，我们遵循了 Arksey 和 O'Malley 的五阶段框架：确定研究问题、确定相关研究、选择符合条件的研究、绘制数据图表以及整理、总结和报告结果。我们还使用了《系统性综述和荟萃分析首选报告项目》（Preferred Reporting Items for Systematic Reviews and Meta-Analyses）的扩展版（PRISMA-ScR）作为本综述的信息组织指南。通过搜索 Scopus、Medline (OVID)、EMBASE (OVID) 和 Google Scholar，确定了以患者和公众为对象的定量和定性研究。通过对 13 项符合条件的研究进行分析，我们发现了三个主题：对激励机制的理解、对与 ILP 相关的危害的看法，以及保健中心对解决这一问题的建议。我们发现有文献表明，HCCs 对医生的药物激励表现出了从了解到不了解的不同程度。医疗保健理事会认为，ILP存在若干危害，如对医生和医疗保健系统缺乏信任、开具不必要的药物处方以及对医生的社会声誉造成负面影响。除了强有力的监管措施外，至关重要的是，医生应自我约束其行为，并公开披露他们是否与制药公司有任何财务关系。这样做可以促进病人与医生之间的信任，是以病人为中心的医疗服务的重要组成部分，也有助于增强用户对更广泛的医疗系统的信心。
{"title":"Healthcare Consumers’ Perceptions of Incentive-Linked Prescribing: A Scoping Review of Research","authors":"Muhammad Naveed Noor, Haider Safdar Abbasi, Nina Van Der Mark, Zahida Azizullah, Janice Linton, Afifah Rahman-Shepherd, Amna Rehana Siddiqui, Mishal S. Khan, Rumina Hasan, Sadia Shakoor","doi":"10.1101/2024.02.27.24303447","DOIUrl":"https://doi.org/10.1101/2024.02.27.24303447","url":null,"abstract":"Incentive-linked prescribing (ILP) is considered a controversial practice universally. If incentivised, physicians may prioritise meeting pharmaceutical sales targets through prescriptions, rather than considering patients' health and wellbeing. Despite the potential harms of ILP to patients and important stakeholders in the healthcare system, healthcare consumers (HCCs) which include patients and the general public often have far less awareness about the practice of pharmaceutical incentivisation of physicians. We conducted a scoping review to explore what existing research says about HCCs’ perceptions of the financial relationship between physicians and pharmaceutical companies. To conduct this scoping review, we followed Arksey and O'Malley’s five-stage framework: identifying research questions, identifying relevant studies, selecting eligible studies, data charting, and collating, summarising, and reporting results. We also used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses’ extension for scoping reviews (PRISMA-ScR), as a guide to organise the information in this review. Quantitative and qualitative studies with patients and the general public, published in the English language were identified through searches of Scopus, Medline (OVID), EMBASE (OVID), and Google Scholar. Three themes emerged through the analysis of the 13 eligible studies: understanding of incentivisation, perceptions of hazards linked to ILP, and HCCs’ suggestions to address it. We found documentation that HCCs exhibited a range of knowledge from good to insufficient about the pharmaceutical incentivisation of physicians. HCCs perceived several hazards linked to ILP such as a lack of trust in physicians and the healthcare system, the prescribing of unnecessary medications, and the negative effect on physicians’ reputations in society. In addition to strong regulatory controls, it is critical that physicians self-regulate their behaviour, and publicly disclose if they have any financial ties with pharmaceutical companies. Doing so can contribute to trust between patients and physicians, an important part of patient-focused care and a contributor to user confidence in the wider health system.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"73 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140004256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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