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Cost efficiency of primary health care facilities in Ghana: stochastic frontier analysis 加纳初级卫生保健设施的成本效率:随机前沿分析
Pub Date : 2023-10-19 DOI: 10.1007/s44250-023-00044-8
Kwadwo Arhin, Eric Fosu Oteng-Abayie, Jacob Novignon
Abstract Primary health care (PHC) is a universally accepted key strategy to achieve universal health coverage (UHC) and Sustainable Development Goal 3 (SDG 3) due to its potential to produce a range of economic benefits through improved health outcomes, health quality, and health system efficiency. However, little evidence exists about the cost efficiency of primary health care facilities (PHCFs) in Sub-Saharan Africa. This study evaluates the cost efficiency of two main types of PHCFs in Ghana that are at the forefront of delivering PHC services to a greater proportion of the population: Community Health Centers (HCs) and Community-Based Health Planning Services (CHPS) compounds. The dataset we used for this study included 39 HCs and 55 CHPS facilities. Furthermore, it examines the factors that influence the cost efficiency of these facilities. The study applies the stochastic frontier analysis (SFA) technique to panel data. The estimated cost efficiency for HCs and CHPS is 61.6% and 85.8%, respectively. The study further revealed that facility size, medical staff density, and facility age are the main factors that explain the differences in the cost efficiency of PHCFs in Ghana. The study's policy recommendation is that the Ghana Health Service should consider utilizing modern technology such as telehealth and telemedicine to enhance access to PHC services for people living in hard-to-reach and densely populated communities. This strategic approach can significantly contribute to improving the cost-efficiency of PHCFs.
初级卫生保健(PHC)是一项被普遍接受的实现全民健康覆盖(UHC)和可持续发展目标3 (SDG 3)的关键战略,因为它有可能通过改善健康结果、卫生质量和卫生系统效率产生一系列经济效益。然而,关于撒哈拉以南非洲初级卫生保健设施(PHCFs)的成本效益的证据很少。本研究评估了加纳两种主要类型的初级保健中心的成本效益,这两种主要类型的初级保健中心在向更大比例的人口提供初级保健服务方面处于领先地位:社区卫生中心(HCs)和社区卫生计划服务中心(CHPS)。本研究使用的数据集包括39个hc和55个CHPS设施。此外,它还研究了影响这些设施成本效率的因素。本研究将随机前沿分析(SFA)技术应用于面板数据。卫生保健中心和CHPS的估计成本效率分别为61.6%和85.8%。该研究进一步表明,设施规模、医务人员密度和设施年龄是解释加纳初级保健中心成本效率差异的主要因素。该研究的政策建议是,加纳卫生服务局应考虑利用远程保健和远程医疗等现代技术,使生活在交通不便和人口稠密社区的人们更容易获得初级保健服务。这一战略方针可以大大有助于提高phcf的成本效益。
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引用次数: 0
Blood pressure measurement knowledge and counselling among hospital pharmacists - an interventional study 医院药师血压测量知识与咨询的介入性研究
Pub Date : 2023-10-19 DOI: 10.1007/s44250-023-00048-4
Akinniyi Akinbiyi Aje, Jumoke Oyeladun Adeyemo
Abstract Background Pharmacists occupy a vantage position to educate patients with hypertension on self-monitoring of blood pressure (BP). An update on their knowledge and counselling on BP measurement is needful to ascertain proper information dissemination to patients. Methods An interventional study was carried out for a six-month period among consecutively sampled pharmacists working at a tertiary healthcare facility, using a semi-structured questionnaire for data collection. Sequel to preintervention assessment of pharmacists’ knowledge and counselling on BP measurement, an educational intervention comprising didactic lecture, case studies, demonstrations, and interactive question and answer sessions was carried out to address the gaps observed. Knowledge and counselling were then reassessed one-month postintervention to find out the impact of the intervention. Data was summarized with descriptive and inferential statistics with significance level set at p < 0.05. Results One hundred and forty-four pharmacists completed the study. Preintervention knowledge and counselling on BP measurement among the pharmacists was poor. Median scores of pharmacists’ knowledge on BP measurement increased significantly from 13.00 preintervention to 25.00 postintervention (p < 0.001); while their counselling on BP measurement also increased significantly from 1.00 preintervention to 12.00 postintervention (p < 0.001). The knowledge category of the pharmacists’ improved as majority who were categorized as having either “poor” (67, 46.5%) or “fair” (68, 47.2%) knowledge preintervention advanced to “excellent” (99, 68.7%) knowledge postintervention. Similarly, the pharmacists’ counselling category was upgraded from the majority categorized as poor (141, 97.9%) preintervention to excellent (87, 60.4%) postintervention. Prior to the educational intervention, only 62 (43.1%) pharmacists knew that BP measurement had to be carried out in both arms for a first-time patient. Also, when asked the question “What BP reading will be recorded for a patient whose BP readings when taken thrice were 149/82 mmHg, 141/78 mmHg, and 139/78 mmHg?” only 38 (26.4%) provided the right answer. Similarly, majority of the pharmacists (51, 35.4%) could only state one out of five precautions during blood pressure measurement. In this study, pharmacists’ gender, additional educational qualification, and work experience did not significantly influence their knowledge and counselling on BP measurement. Conclusions The educational intervention significantly improved pharmacists’ knowledge and counselling on BP measurement.
背景药师在高血压患者自我监测血压教育中占有优势地位。更新他们的知识和咨询血压测量是必要的,以确定正确的信息传播给患者。方法采用半结构化问卷,对某三级医疗机构执业药师进行为期6个月的介入研究。继干预前评估药师的血压测量知识和咨询,教育干预包括教学讲座,案例研究,示范和互动问答环节进行,以解决所观察到的差距。然后在干预后一个月重新评估知识和咨询,以找出干预的影响。对数据进行描述性统计和推断性统计,显著性水平设为p <0.05. 结果144名药师完成研究。药师对血压测量的预防知识和咨询较差。药师血压测量知识得分中位数由干预前的13.00分显著提高至干预后的25.00分(p <0.001);而他们对血压测量的咨询也从干预前的1.00显著增加到干预后的12.00 (p <0.001)。药师的知识类别有所改善,干预前知识等级为“差”(67,46.5%)和“一般”(68,47.2%)的药师,干预后知识等级为“优”(99,68.7%)的药师居多。同样,药剂师的咨询类别从干预前较差(141.97.9%)的大多数类别升级为干预后优秀(87.60.4%)。在教育干预之前,只有62名(43.1%)药剂师知道首次患者必须在双臂中进行血压测量。此外,当被问及“如果患者三次测血压分别为149/ 82mmhg、141/ 78mmhg和139/ 78mmhg,该记录哪些血压读数?”只有38人(26.4%)给出了正确答案。同样,大多数药剂师(51名,35.4%)在测量血压时只能说明五项注意事项中的一项。在本研究中,药师的性别、学历和工作经验对其血压测量知识和咨询没有显著影响。结论教育干预可显著提高药师对血压测量的认知和咨询。
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引用次数: 0
Governance basics for the physician-scientist considering business ventures. Lessons from Theranos 考虑商业投资的医生科学家的治理基础。Theranos的经验教训
Pub Date : 2023-10-17 DOI: 10.1007/s44250-023-00045-7
Theodore J. Witek, David Klein
Abstract The prospect of an innovative laboratory device capable of an array of testing from a tiny amount of blood caught the intense attention of both the medical and investment community. The device, however, was never properly validated, with several false and misleading claims made by its founder. This venture in the business of science went very badly for the firm Theranos with ensuing criminal convictions. Using public domain reports from trial testimony provided a unique opportunity to distill facts for key learnings for future stakeholders in the business of science. Several lessons related to basic governance unfolded during the trial’s testimony and are the basis for this brief case study. These include (1) a board make-up that had a suboptimal understanding of the technology, (2) advisors that did not sufficiently engage, (3) management/employee trust was tarnished and (4) investors failing to perform optimal diligence prior to funding. These lessons are particularly important for the physician-scientist and health executive who may find themselves at the interface of health and commerce. Points to consider in such ventures are discussed toward fostering the avoidance of these breakdowns.
一种能够从少量血液中进行一系列测试的创新实验室设备的前景引起了医学界和投资界的强烈关注。然而,该设备从未得到适当的验证,其创始人提出了几项虚假和误导性的声明。Theranos公司在科学领域的这次冒险非常糟糕,随后被刑事定罪。利用审判证词中的公共领域报告,为科学事业中未来的利益相关者提炼关键知识提供了一个独特的机会。在审判的证词中揭示了与基本治理有关的几个教训,这些教训是本简短案例研究的基础。这些包括(1)董事会成员对技术的理解不够理想,(2)顾问没有充分参与,(3)管理层/员工信任受损,(4)投资者未能在融资前进行最佳尽职调查。这些经验教训对身兼医学家和卫生行政人员尤其重要,因为他们可能发现自己处于卫生和商业的交界。讨论了在此类冒险中应考虑的要点,以促进避免这些故障。
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引用次数: 0
Designing an online educational program to improve immunisation service delivery for migrants and refugees in Australia and New Zealand 设计一个在线教育项目,以改善澳大利亚和新西兰移民和难民的免疫服务提供
Pub Date : 2023-10-11 DOI: 10.1007/s44250-023-00043-9
Abela Mahimbo, Preeti Tiwari, Ikram Abdi, Holly Seale, Nadia Charania, Anita E. Heywood
Abstract Migrants and refugees are likely to be under-immunised according to the host country's national immunisation schedule and may remain under-immunised post-resettlement for various reasons. In Australia and Aotearoa New Zealand, primary health care professionals including general practitioners and nurses provide the majority of routine and catch-up immunisations for migrants and refugees. However, immunisation service delivery for migrants and refugees is complex, with evidence that unmet training needs for immunisation providers, particularly in the development of catch-up plans, is a significant barrier to immunisation service delivery for this group. Targeted professional development opportunities for immunisation providers are essential to improve their awareness, confidence, and capability to improve immunisation service delivery for migrants and refugees. We developed an educational program to support learning for immunisation providers and equip them with the requisite knowledge and confidence to improve immunisation service delivery for refugees and migrants. The development of the multi-module online educational program drew on evidence-based web design principles, adult learning theories, and its content aimed to complement general immunisation training and align with the continuing professional development standards of Australian and New Zealand general practice and nursing colleges. Input from experts and feedback from a few selected providers in Australia and New Zealand added to the robustness of the program. This program has the potential to improve the understanding and capacity of immunisation providers, to improve vaccination experiences and increase overall vaccine uptake among migrants and refugees.
根据东道国的国家免疫计划,移民和难民很可能免疫不足,并且由于各种原因在重新安置后可能仍然免疫不足。在澳大利亚和新西兰,包括全科医生和护士在内的初级卫生保健专业人员为移民和难民提供了大部分常规和补足免疫接种。然而,向移民和难民提供免疫接种服务是复杂的,有证据表明,免疫接种提供者的培训需求未得到满足,特别是在制定追赶计划方面,是向这一群体提供免疫接种服务的重大障碍。为免疫接种提供者提供有针对性的专业发展机会对于提高他们的意识、信心和能力以改善向移民和难民提供的免疫接种服务至关重要。我们制定了一项教育计划,以支持免疫接种提供者的学习,并使他们具备必要的知识和信心,以改善为难民和移民提供的免疫接种服务。多模块在线教育项目的开发借鉴了基于证据的网页设计原则、成人学习理论,其内容旨在补充普通免疫培训,并与澳大利亚和新西兰全科医生和护理学院的持续专业发展标准保持一致。来自专家的意见和来自澳大利亚和新西兰一些选定的供应商的反馈,增加了项目的稳健性。该规划有可能提高免疫接种提供者的理解和能力,改善疫苗接种经验,并增加移民和难民的总体疫苗接种率。
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引用次数: 0
Effectiveness of breast cancer campaigns in South Asia 南亚乳腺癌防治运动的有效性
Pub Date : 2023-10-09 DOI: 10.1007/s44250-023-00034-w
Huda Jaffar, Gaurav Kumar, Anfal Atif, Amna Iqbal
Abstract Despite the growing burden of cancer, it remains a low priority in healthcare planning and budgeting in South Asian low- and middle-income countries (LMICs). Mass public awareness about cancer signs and symptoms and encouragement to seek help is an important step towards early diagnosis. Due to scarcity of resources in South Asia, the scale of awareness campaigns is limited, and provision of drugs and curative services take precedence over preventative measures. Several misconceptions and superstitious beliefs regarding the treatment of breast cancer with homeopathic medicine and unconventional religious peers provide a challenge to awareness campaigns. Along with that, shortage of staff and transportation add to the difficulties of conducting these campaigns. Interventions such as role plays, weekly clinics providing counseling for the disease, and measures such as pamphlets and presentations have been considered useful. This review assesses the challenges faced by breast cancer awareness campaigns and the interventions that could help in bringing mortality rates lower.
尽管癌症负担日益加重,但在南亚低收入和中等收入国家(LMICs),它仍然是医疗保健计划和预算的低优先级。公众对癌症体征和症状的广泛认识以及鼓励寻求帮助是迈向早期诊断的重要一步。由于南亚资源匮乏,提高认识运动的规模有限,药物和治疗服务的提供优先于预防措施。关于顺势疗法治疗乳腺癌的一些误解和迷信观念以及非传统的宗教同伴对提高认识活动提出了挑战。除此之外,工作人员和交通的短缺也增加了开展这些运动的困难。角色扮演、每周提供疾病咨询的诊所等干预措施以及小册子和演讲等措施被认为是有用的。本审查报告评估了乳腺癌宣传运动和有助于降低死亡率的干预措施所面临的挑战。
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引用次数: 0
How deep learning influences workflows and roles in virtual surgical planning 深度学习如何影响虚拟手术计划中的工作流程和角色
Pub Date : 2023-09-26 DOI: 10.1007/s44250-023-00041-x
Beat Hofer, Markus Kittler, Kris Laukens
Abstract Background Deep learning (DL) has the potential to transform surgical practice, altering workflows and changing the roles of practitioners involved. However, studies have shown that introducing such change requires user acceptance. Following the development and presentation of a visual prototype for planning facial surgery interventions, the project aimed to understand the utility of DL, the implied workflow and role changes it would entail, and the potential barriers to its adoption in practice. Method This paper presents a multi-year case study providing insights from developing and introducing a visual prototype. The prototype was co-developed by facial surgeons, DL experts, and business process engineers. The study uses project data involving semi-structured interviews, workgroup results, and feedback from an external practitioner audience exposed to the prototype regarding their views on adopting DL tools in practice. Findings The surgeons attested a high utility to the application. However, the data also highlights a perceived need to remain in control, be able to intervene, and override surgical workflows in short intervals. Longer intervals without opportunities to intervene were seen with skepticism, suggesting that the practitioners’ acceptance of DL requires a carefully designed workflow in which humans can still take control of events. Conclusion Deep learning can improve and accelerate facial surgery intervention planning. Models from the business and management literature partially explain the acceptance of new technologies. Perceived ease of use seems less relevant than the perceived usefulness of new technology. Involving algorithms in clinical decision-making will change workflows and professional identities.
深度学习(DL)有可能改变外科实践,改变工作流程和从业人员的角色。然而,研究表明,引入这种变化需要用户接受。在开发和展示了规划面部手术干预的视觉原型之后,该项目旨在了解深度学习的实用性、它所隐含的工作流程和角色变化,以及在实践中采用它的潜在障碍。方法:本文介绍了一个多年的案例研究,提供了从开发和引入视觉原型的见解。原型是由面部外科医生、深度学习专家和业务流程工程师共同开发的。该研究使用了项目数据,包括半结构化访谈、工作组结果,以及外部从业者受众对原型的反馈,这些反馈涉及他们对在实践中采用深度学习工具的看法。结果外科医生证实该应用具有很高的实用性。然而,数据也强调了保持控制,能够在短时间间隔内干预和覆盖手术工作流程的感知需求。没有机会干预的较长时间间隔被认为是怀疑的,这表明从业者接受深度学习需要一个精心设计的工作流程,在这个工作流程中,人类仍然可以控制事件。结论深度学习可以改善和加快面部手术干预计划。商业和管理文献中的模型部分解释了对新技术的接受。感知到的易用性似乎不如感知到的新技术的有用性更重要。将算法纳入临床决策将改变工作流程和职业身份。
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引用次数: 0
Validation of gestational weight gain records on South Carolina birth certificate data 南卡罗来纳州出生证明数据中妊娠体重增加记录的验证
Pub Date : 2023-09-19 DOI: 10.1007/s44250-023-00040-y
Oluwatosin A. Momodu, Ronnie D. Horner, Jihong Liu, Elizabeth Crouch, Brian Chen
Abstract Objective To examine the accuracy of gestational weight gain (GWG) reported on birth certificates (BCs) in comparison with electronic medical records (EMRs), the gold standard. Methods BC data and EMR data were from a random sample of pregnant women who enrolled in CenteringPregnancy program, a type of group-based prenatal care, at three obstetric clinics in South Carolina between 2015 and 2019 (n = 206). Retrospective review of EMR data on patients’ prepregnancy BMI and GWG according to 2009 Institute of Medicine guidelines was conducted. Analyses involved summarizing the variables by their mean and mean differences per data source, and then calculating percent-weighted agreement and kappa statistics. Results The mean values of BMI, delivery weight and total weight gain were similar between BC and EMRs. Data correlation for variables was high for both data sources (height: r = 0.94, prepregnancy weight: r = 0.93, prepregnancy BMI: r = 0.92, delivery weight: r = 0.96, total weight gain: r = 0.60). The BCs slightly underestimated the proportion of women in the normal-weight BMI category but overestimated the proportion in the overweight BMI category. Additionally, BCs slightly overestimated women with inadequate GWG and underestimated those with excessive GWG. Overall, the BC and EMR data were in agreement regarding prepregnancy BMI (weighted-agreement = 90%, Kappa = 0.78) and GWG categories (weighted-agreement = 84%, Kappa = 0.63). Conclusion BC estimates of prepregnancy BMI and GWG categories were similar to those recorded in the EMRs. The South Carolina BC database is a valid database for gestational weight and can provide reasonable estimates for the state in the evaluation of the CenteringPregnancy program.
目的比较出生证明(bc)中妊娠体重增加(GWG)与电子病历(emr)的准确性。方法BC数据和EMR数据来自2015年至2019年期间在南卡罗来纳州三家产科诊所参加CenteringPregnancy计划(一种基于群体的产前护理)的孕妇随机样本(n = 206)。根据2009年医学研究所指南对患者孕前BMI和GWG的EMR数据进行回顾性分析。分析包括根据每个数据源的平均值和平均值差异汇总变量,然后计算百分比加权协议和kappa统计。结果BC组和EMRs组的BMI、分娩体重和总增重的平均值相似。两个数据源的变量数据相关性都很高(身高:r = 0.94,孕前体重:r = 0.93,孕前BMI: r = 0.92,分娩体重:r = 0.96,总体重增加:r = 0.60)。研究人员略微低估了体重指数正常的女性比例,但高估了体重指数超重的女性比例。此外,bc略微高估了GWG不足的女性,而低估了GWG过高的女性。总体而言,BC和EMR数据在孕前BMI(加权一致性= 90%,Kappa = 0.78)和GWG类别(加权一致性= 84%,Kappa = 0.63)方面是一致的。结论BC估计的孕前BMI和GWG分类与EMRs记录的相似。南卡罗来纳州BC数据库是一个有效的妊娠体重数据库,可以为该州评估CenteringPregnancy项目提供合理的估计。
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引用次数: 0
Customising hospitals for the future: a perspective focusing on infection prevention and control 为未来定制医院:关注感染预防和控制的视角
Pub Date : 2023-09-05 DOI: 10.1007/s44250-023-00039-5
Elisabeth Presterl, M. Diab-Elschahawi, Carolina Lohfert-Praetorius, Siegfried Gierlinger, Herwig Wetzlinger, Walter Zingg
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引用次数: 0
Impact of natural disasters on health disparities in low- to middle-income countries 自然灾害对中低收入国家健康差距的影响
Pub Date : 2023-09-04 DOI: 10.1007/s44250-023-00038-6
A. Nashwan, S. H. Ahmed, T. Shaikh, Summaiyya Waseem
{"title":"Impact of natural disasters on health disparities in low- to middle-income countries","authors":"A. Nashwan, S. H. Ahmed, T. Shaikh, Summaiyya Waseem","doi":"10.1007/s44250-023-00038-6","DOIUrl":"https://doi.org/10.1007/s44250-023-00038-6","url":null,"abstract":"","PeriodicalId":72826,"journal":{"name":"Discover health systems","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42044391","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}
引用次数: 0
Smart phone based medical record software for short term surgical missions 基于智能手机的医疗记录软件,用于短期手术任务
Pub Date : 2023-08-08 DOI: 10.1007/s44250-023-00035-9
P. Alfille, C. Bean, Gennadiy Fuzaylov
{"title":"Smart phone based medical record software for short term surgical missions","authors":"P. Alfille, C. Bean, Gennadiy Fuzaylov","doi":"10.1007/s44250-023-00035-9","DOIUrl":"https://doi.org/10.1007/s44250-023-00035-9","url":null,"abstract":"","PeriodicalId":72826,"journal":{"name":"Discover health systems","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42294277","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}
引用次数: 0
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