Research in health services & regions最新文献

In the Netherlands, percentages of induction of labour (IOL) range from 14.3 to 41.1% in regional maternity care networks (MCNs). In this study, we focus on women's contribution in explaining this variation in range. We examine if different factors at the level of the individual woman (micro) and the level of the woman's social context (meso) are related to decision-making on IOL, and the variation. We used an online questionnaire inviting women counselled for IOL (n = 180, response rate 40%) from six different MCNs, three with a high and three with a low percentage of IOL. Factors included are, for example, attitude towards birth, reason for IOL, and social norms. Descriptive statistics and regression analyses were performed to examine the relation between the included factors and the intended decision on IOL. Our results show that only the factor women's attitude towards birth is related to the intended decision on IOL. The more women believe that birth is a medical process, the higher the odds that the intended decision is to induce labour. This may contribute to variation in IOL between individual women, but appears to contribute less to variation in IOL between MCNs. This is because the percentages of women with an intended decision for IOL do not differ within MCNs with a low or high percentage of IOL. A next step in explaining practice variation, is to examine mechanisms at the level of the individual healthcare provider (micro) and the MCN (meso).

Open conversations between patients and healthcare professionals (HCP) are required to evaluate which treatments are reasonable for the individual case, especially towards the end of life. Advance Care Planning (ACP), which often results in drafting an Advance Directive (AD), is a useful tool to help with decisions in these circumstances, but the rate of AD completion remains low. During the COVID-19 pandemic, ACP and AD gained popularity due to the alleged advantage that they could facilitate resource allocation, to the benefit of public health. In this article, which presents a theoretical reflection grounded in scientific evidence, we underline an even stronger ethical argument to support the implementation of AD in end-of-life care (eol-C) i.e. the instrumental value at the individual level. We show, with particular reference to lessons learned from the COVID-19 pandemic, that AD are instrumentally valuable in that they: (1) allow to thematise death; (2) ensure that overtreatment is avoided; (3) enable to better respect the wish of people to die at their preferred place; (4) help revive the "lost skill" of prognostication. We thus conclude that these arguments speak for promoting the territorially uniform implementation and accessibility of high-quality AD in care.

Background: Ghana adopted the policy on Intermittent Preventive Treatment of malaria in pregnancy using Sulfadoxine-Pyrimethamine (IPTp-SP) in 2004. Notwithstanding the government's and other stakeholders' efforts in Ghana, optimal uptake (three or more doses of IPTp-SP) has slightly declined since 2016. The study examined the individual and community-level correlates of pregnant women who take optimal or none/partial doses (less than three doses) of IPTp-SP using the Ghana Malaria Indicator Survey (GMIS) 2019.

Methods: We conducted a secondary analysis of the GMIS 2019 data. Our analytical sample included 1,151 women aged 15-49 with their most recent birth in the last two years before the survey.

Results: The overall uptake among participants was approximately 8.2% for none, 30.15% for 1-2 (partial), and 61.6% for 3 or more (optimal) doses of IPTp-SP. The level of uptake differs depending on the individual rather than community-level characteristics of pregnant women. Individual-level demographic factors- residents in Upper East (OR 3.0, 95% CI; 1.2-7.3) and Upper West (OR 5.3, 95% CI; 1.9-14.7) -and health-related factors-the four or more antenatal (ANC) visits (OR 3.3, 95% CI; 1.8-6.0) were associated with optimal IPTp-SP uptake among pregnant women in Ghana. However, late scheduling of the first ANC visit in the second trimester (OR 0.7, 95% CI; 0.5-1.0)- predicted less IPTp-SP uptake.

Conclusions: Few regions (Upper East and West) are doing better than the capital, Greater Accra Region, in terms of optimal uptake. Also, early scheduling of ANC in the first trimester and increased ANC attendance are key for increased uptake. There is a need for policy, interventions, and research on malaria prevention in pregnancy to improve the decline in uptake.

Mapping, identifying and reducing unwarranted healthcare variation is integral to improving the appropriateness of care - minimising wasteful or unnecessary care and redirecting care to those who could benefit most (J Eval Clin Pract 26: 687-696, 2020). The Australian Atlas of Healthcare Variation series has examined variation in healthcare use since 2015. The findings reported in the Atlas series have led to important system changes. National safety and quality standards, mandatory for all hospitals and day procedure services, now require health service organisations to monitor and investigate variation and address unwarranted variation. Clinical care standards have been developed for clinical conditions in which the Atlas series has identified considerable variation. But the overuse of low-value care and underuse of high-value care persists, as suggested by the marked variation the Atlas series continues to uncover. We must now develop an approach that systematically links reporting of data and investigation of variation with a suite of responses to address unwarranted variation. This paper focuses on efforts to reduce low value-care, so that resources can be redirected to supporting high-value care as well as reducing waste and cutting carbon emissions from health care (Med J Aust 216: 67-68, 2022).

Background: About half of the patients diagnosed with colon cancer are 70 years or older. Standard treatment for stage III colon cancer is major surgical resection followed by adjuvant chemotherapy (ACT). Norwegian guidelines recommend initiation of ACT within 6 weeks after resection.

Objective: This study investigated socioeconomic and geographic variation in the recommended provision of ACT to elderly patients with stage III colon cancer in Norway.

Methods: This population-based retrospective cohort study included patients aged 70 years or older diagnosed with stage III colon cancer between 2011 and 2021 who underwent major surgical resection. Individual data were obtained from national registries. Multilevel logistic regression analysis was used to model variation in provision of ACT.

Results: Of 4 501 included patients, 603 (13%) and 1 182 (26%) received ACT within 6 and 8 weeks after resection, respectively. The provision of ACT decreased with increasing age and frailty. Odds of ACT within 6 weeks decreased for patients with low socioeconomic status (SES) compared to high SES (odds ratio (OR) 0.67 (95% confidence interval (CI) 0.50-0.91)), and decreased for patients living alone compared to those living with a cohabitant (OR 0.72 (95% CI 0.58-0.91)). Geographic variation was found between hospital referral areas (OR 0.41-2.58).

Conclusions: Our study found that ACT provision to elderly stage III colon cancer patients is associated with SES and geography, indicating variation in guidelines adherence. Further research is needed to explore the impact of ACT timing among elderly patients with stage III colon cancer in Norway.

Across the U.S, it is a documented fact that rural areas have longer ambulance response times and tend to have lower median income. The objective of this study was to test if the rural-urban emergency medical service (EMS) response time disparity was related to wealth disparity in the state of Connecticut. All mean EMS response times were sourced from the 2016 Office of Emergency Medical Services Data Report. Rural definitions were sourced from the Connecticut Office of Rural Health. Median income data was drawn from the Connecticut Office of Policy and Management. A Mann-Whitney U test determined if the average rural EMS response time was greater than the non-rural EMS response time. Pearson coefficients quantified the relationship between median income and EMS response time. A t-test ascertained if the average median income differed between the two datasets. The mean EMS response time was 12.98 min (SD = 3.36) rural and 8.26 min (SD = 2.12) non-rural. Rural mean response time and median income were not significantly correlated (r = -.148, p=.247); non-rural mean response time and median income were also not significantly related. No significant disparity was detected (t=0.478, p=.633) between the mean rural household income ($98,258) and mean non-rural household income ($95,706). Significant disparities in EMS response times can exist between rural and non-rural towns separate from median income trends, as is the case in Connecticut. These findings may have limited generalizability because of Connecticut's relatively high median income as compared to other states yet may be relevant to states with similar economic metrics.

Introduction: In Brazil, a country of continental dimensions, the lack of services in the different regions is a major barrier that prevents patients from accessing Pediatric Palliative Care (PPC). If accessing PPC is already challenging, end-of-life care for these patients may also be difficult. Therefore, this study is based on a recent mapping effort, aimed at reflecting on the end-of-life care for children in Palliative Care in Brazil.

Method: Descriptive, cross-sectional study, and online survey research, based on a larger study of Palliative Care Network.

Results: The final sample comprised 90 Pediatric Palliative Care services, which proved to be unevenly distributed across the country. Many services lack a minimum team, 40% face difficulties accessing opioids, and one-third do not provide bereavement care.

Discussion: There should be more services with better distribution across the country, and a minimum team should be required to provide adequate care for children and adolescents. Strategies to improve symptom control and grief support should be introduced.

Conclusions: It is concluded that continuing education and the inclusion of relevant topics in health courses are necessary. Additionally, health service managers must expand their focus to address these issues effectively.

Background: Cervical cancer, albeit preventable, is the second-most deadly gynecological cancer in developing nations. Little is known about cervical cancer among Bangladeshi women. This study aims to estimate the prevalence of cervical cancer screening and demographic correlates to identify potential variabilities in screening rates among different demographic groups and regions.

Methods: This study used secondary data from the WHO STEPS 2018 Survey. We used Bayesian regression to perform the bivariate analyses between the outcome and each explanatory factor, as it generates more acceptable results and improves parameter estimates. The top-ranked socio-demographic factors were identified using a two-step cluster analysis. This method determines the relevance of predictor variables and automatically establishes the number of clusters.

Results: The prevalence of Bangladeshi women who had ever been screened for cervical cancer was 6.2%. In the adjusted model, women with the following socio-demographic factors had a higher likelihood of developing cervical cancer: being 18-29 years old (AOR = 3.3, 95% CI: 0.24, 15.27) or 45-59 years old (AOR = 2.8, 95% CI: 1.22, 6.0), currently married (AOR = 2.3, 95% CI: 1.36, 3.70), and employed (AOR = 2.4, 95% CI: 1.40, 4.06). Women in the Barisal division were found to have higher odds of being screened for cervical cancer (AOR = 21, 95% CI: 0.66, 121.97). Cluster analysis found residence status predisposes women to cervical cancer screening.

Conclusion: There is a significant potential for substantial reductions in the burden of cervical cancer in Bangladesh by strengthening the application of cervical cancer screening. Future studies should examine how socioeconomic status, culture, and healthcare access affect cervical cancer screening trends for different divisions in Bangladesh. An independent national cancer registry is urgently needed to evaluate screening trends and outcomes.

Background: The research centers on an underrated type of mediator organization namely facilitator organizations (FO) that work in the health care setting. These organizations are mediators that bridge the gap between patients (healthcare customers) and medical services. The facilitator organizations considered for the study are non-governmental organizations situated in Assam that works in align to chronic diseases, particularly cancer.

Methods: The data collection was done through organizational referrals for the study making it a snowball sampling, progressively incorporating additional contemporary entities. The study's respondents were facilitator organizations (i.e.Non-Government Organizations) actively involved in addressing chronic disease. Data were gathered from these facilitator organizations situated in Assam, India, supporting healthcare customers specifically those with cancer. Key informant interviews and semi-structured questionnaires were used for data collection, the responses were documented using a field diary and the Lovelock service model was used as a reference for the construction of the questionnaire and developing the research framework.

Results: The analysis of data shows that facilitator organisations maintain continuity in relationships, which enhances health management and outcomes for customers. The shift in cancer care towards a patient-centred approach and the crucial role of FOs in providing comprehensive and individualized care, addressing diverse patient needs thereby addressing the holistic development of the health care customer is vital. In addition, effective patient-centred communication, incorporating trust, compassion, respect and comprehensive support including mental health therapy, occupational therapy, and rehabilitation plays a crucial role in leading a normal life. ` CONCLUSION: The facilitator organizations dealing with Cancer have to meet a broad range of services outside the core medical service providers for their healthcare customers. These efforts contribute to the overall recovery of both the healthcare customer with cancer and their family.

Providing timely and satisficing End-of-Life care (EOLC) is a priority for healthcare systems since aging population and chronic diseases are boosting the global demand for care at end-of-life (EOL). In OECD countries the access to EOLC is insufficient. In Italy, the average rate of cancer patients assisted by the palliative care (PC) network at EOL was 28% in 2021, with high variability in the country. Among the Italian regions offering the best coverages, Tuscany has a rate of about 40%, but intraregional variation is marked as well. The study aims to explore the delivery of EOLC to adult cancer patients in public facilities in the Tuscany region through survey data collection among professionals. Two online surveys were delivered to Directors of community-based PC Functional-Units (FUs) and Directors of hospital-based medical-oncology units. All FU Directors responded to the survey (n = 14), and a response rate of 96% was achieved from hospital-unit Directors (n = 27). The results highlight the availability of numerous dedicated services, but reveal heterogeneity among and within organisations, including variations in the professionals involved, pathways, and tools adopted. Care continuity is supported by institutionalized collaboration between hospital and community settings, but hindered by fragmented care processes and heterogeneous transition pathways. Late referral to PC is perceived as a major constraint to EOLC. Developing structured pathways for patient transition to end-stage PC is crucial, and practices/processes should be uniformly implemented to ensure equity. Multi-professional care should be facilitated through tailored supporting tools. Both hospital-unit and FU Directors suggest developing shared pathways between organisations/professionals (82% and 80% respectively) and digital information sharing (61% and 80% respectively). Hospital and community-based professionals have similar perceptions about the concerns and challenges to EOLC provision in the region, but community-based professionals are more sensitive to the importance of improving communication on PC to the public and early discussing EOLC with caregivers. This finding suggests the need of enhancing hospital personnel's awareness about these issues. Professional training and the capacity to assess patients' needs and preferences should be improved. The identified needs can inform future research and interventions to improve the quality and outcomes of EOLC for cancer patients.