Frontiers in health services最新文献

Patient-reported Outcome Measures (PROMs) are self-reported questionnaires that are used to deliver patient and family-centered care, but their use in routine pediatric clinical care remains limited. The American Institute of Medicine (IOM) recommends patient-centered care to achieve high quality health care delivery and PROMs can be used in routine pediatric clinical care to support six critical dimensions of patient-centered care endorsed by the IOM. The growing evidence including our systematic review of pediatric PROMs, shows that incorporating PROMs into routine pediatric clinical practice significantly enhances the quality of care and has a positive impact on Health-related Quality of Life (HRQL) among children and youth. Thus, we are sharing our perspectives on the current evidence, emphasizing the need for using PROMs in routine pediatric clinical care and proposing strategies for pediatric implementation.

A change is slowly occurring in the ways healthcare responds to patients after they experience harm. The imperative to be transparent with patients and families has been accepted as a key element of high quality, safe and patient-centered healthcare. The language used to describe the experience of the people impacted by harm events is also evolving, recognizing that certain words can help or hinder the experience of patients affected by harm. The language describing these efforts is shifting from legal and institutional terminology to more inclusive terms recognizing broader groups impacted by harm. We describe the evolution of language regarding harm response and make recommendations for the future of the field. While our observations on language are specific to the terminology used in the United States, the concept of moving to more patient-centered language is universal. Other countries should make similar reviews to use more patient-centered language when discussing patient harm.

Purpose: After a decade of post-Soviet decentralization of the healthcare in Russia the opposite trend has been dominating. This paper explores the impact of centralization of healthcare governance on the structure of the healthcare system in Russia, including shift in service delivery structure, the institutional organization of healthcare providers, and their interactions.

Methodology: We employ quantitative and qualitative analysis to study how centralization has contributed to restructuring service delivery with instruments of utilization planning, vertical health programs, and centrally determined pathways of patients flows in a multi-level health care system.

Findings: Centralization of healthcare governance has contributed to restructuring the Russian healthcare system, providing positive changes in structure of inpatient/outpatient care utilization, the organizational structure of service providers, and the structure of their activities. Inpatient care is increasingly replaced by outpatient care and day wards. Centralization contributed to creation of new types of medical organizations (perinatal centers, vascular centers, etc.), development of prevention, and strengthening of providers activity integration in a multi-level system of medical care. However, centralization has not been accompanied by the effective interaction of different levels of governance in developing structural reforms and their implementation in the regions. Uniform activities for the entire country do not take into account specific regional and local conditions. Some unified solutions are implemented in regions with negative consequences for the accessibility of care locally. The excessively centralized model of preventive measures does not provide an effective balance between detection of diseases and follow-up treatment. A so-called "new primary healthcare model", initiated from the top, limits the development of alternative models that are needed in many regions of the country. The analysis concludes with a set of conditions that should be followed in designing and implementing a centralized model of healthcare governance.

Background: Kenya has prioritized Primary Health Care as an indispensable foundation to realize UHC by 2022. Integral to this approach's operationalization is the adoption of the primary health care networks (PCNs) model to strengthen service delivery efficiency and coordination. The PCNs are coordinated by a Multidisciplinary Team (MDT). The MDT is dynamic and should comprise a care and support team that matches patient health needs and the catchment population. This scholarly article delineates the outcomes of an investigative assessment reviewing the current state and trajectory of PHC implementation, focusing on the PCN implementation, and analyzing PHC financing modalities in 7 counties in Kenya.

Methods: This study employed a mixed-methodological approach to gather data from seven counties; Garissa, Nyeri, Makueni, Vihiga, Kisumu, Nakuru, and Mombasa. Key informant interviews were conducted with county health officials and partners. Additionally, counties were supplied with templates for qualitative data. Data was subsequently analyzed using thematic analysis and descriptive statistics.

Results: Successful implementation of PCNs was positively correlated with robust county-level leadership, prioritization of PHC funding, intersectoral collaboration, and joint planning initiatives. Counties which had achieved high levels of community health unit (CHU) establishment and functionality were more adept at successfully mapping and operationalizing PCNs. All participating counties adopted Sub-County Health Management Teams (SCHMTs) as the MDTs due to staffing limitations at primary care facilities consequently inhibiting the capacity for effective MDT engagement. Fiscal commitments at the county level were imperative for facilitating the mobility of MDTs and orchestrating community outreach initiatives. Reimbursements from the National Hospital Insurance Fund (NHIF) served as a pivotal financial conduit for the sustenance of primary care facilities.

Conclusion: The study finds that robust leadership, funding, collaboration, and planning were crucial for the effective operationalization and financial structuring of PCNs. The study recommends that the county governments should invest more in PHC infrastructure, equipment, and supplies, as well as in strengthening the capacity and mobility of MDTs. The study also suggests that uptake of NHIF will enhance the sustainability of PCNs.

Introduction: It is well known that Germany's ambulance service (AS) suffers from a shortage of qualified personnel, which may increase in the following years. For this reason, this study aimed to determine the percentage of AS staff considering leaving their profession and to analyse the possible causes.

Methods: A self-developed questionnaire and the Employee Experience Questionnaire (EXQ) were used for this cross-sectional study.

Results: A total of 814 AS staff with a mean age of 35.71 [standard deviation (SD) 9.78] years were included in this study. Immediately leaving the AS was the intention of 17.27% of participants, with 2.86% having already resigned, 14.29% taking actions such as applying for a job, and another 14.04% specifically planning to leave the AS in the foreseeable future. Those who plan to leave the AS immediately [3.82 (SD 0.79)] showed significantly lower EXQ scores than the group who plan to stay in the EMS until retirement [4.92 (SD 0.87); p_Tukey ≤0.001]. At the same time, it is noticeable that EMS staff often suffer from unfavourable working conditions, such as not being granted breaks, work-related calls during free time, and over time, and significant correlations with the planned length of stay in the paramedic service and exit thoughts were identified here.

Conclusion: Unfavourable working conditions further aggravate the already existing shortage of qualified personnel in the ambulance service, so measures by various decision-makers are imperative.

Background: In some contexts, people living with HIV (PLWH) who are virally non-suppressed and participating in an intensive adherence counseling (IAC) program have demonstrated non-adherence to antiretroviral therapy (ART) even after IAC. There is limited literature on the facilitators and barriers to ART adherence following IAC.

Objective: This study aimed to explore the perspectives of healthcare workers (HCWs) on the facilitators and barriers to ART adherence following IAC among PLWH in Northern Uganda.

Methods: This was a descriptive qualitative study conducted among HCWs at the ART clinics of the two highest-volume public health facilities in Lira District. We purposively sampled 15 study participants and conducted face-to-face in-depth interviews using an interview guide formulated based on the components of the Capability, Opportunity, and Motivation framework for Behavior change (COM-B framework). Thematic analysis was used based on the COM-B framework. In this study, the desired behavior was ART adherence following IAC. Factors that were perceived to positively affect any component of the COM-B framework were classified as facilitators and those that were perceived to negatively affect were classified as barriers.

Results: The majority of the participants were females (53%), diploma holders (40%), and nurses (40%). The perceived facilitators and barriers to ART adherence following IAC emerged as six key themes under the subdivisions of the three domains of the COM-B framework: cognitive and emotional processes, physical and practical skills, accessibility and material resources, social relationships and cultural dynamics, cognitive beliefs and aspirations, and finally, emotional and subconscious drivers. These themes were identified as either facilitators or barriers to ART adherence following IAC depending on the lenses of interpretation.

Conclusions: This study offers a multidimensional insight into the facilitators and barriers to ART adherence following IAC and how the behavior influencing ART adherence can be optimized. The results suggest that optimizing cognitive and emotional processes, physical and practical skills, accessibility and material resources, social relationships and cultural dynamics, cognitive beliefs and aspirations, and emotional and subconscious drivers during IAC and any ART adherence-related intervention could yield the best level of ART adherence among the PLWH who are virally non-suppressed and on ART.

Access to UK general practice is complicated by the need to provide equitable and universal care within a system adapting to workforce challenges, digital innovation, and unprecedented demand. Despite the importance of accessing primary care in meeting the overall aim of delivering equitable care, this is the first time the direct and indirect influence of policies intended to facilitate access have been systematically explored. Further consideration by policymakers is needed to accommodate the difference between what patients need and what patients want when accessing primary care, and the differences in their ability to utilise digital options. The designation of care was hindered by long-standing issues of reliable data and variations in the interpretation of local and national protocols and guidelines.

[This corrects the article DOI: 10.3389/frhs.2024.1436375.].

Patients can experience serious harm from healthcare, the impacts can be prolonged, and events may also affect families and clinicians. Communication and Resolution Programs (CRPs) are designed to reduce these negative impacts, rebuild trust, and improve patient safety, but are not consistently implemented. To inform implementation efforts, enable accountability, and promote innovation, it is critical to develop standardized performance measures assessing CRPs' structure, process, and outcomes. To advance CRP measurement, an interdisciplinary workgroup from the Pathway to Accountability, Compassion, and Transparency (PACT) Leadership and Innovation Network-a group of leading healthcare organizations with CRPs-explores meaningful approaches to measurement and proposes a set of next steps. Interested parties in CRP measurement prioritize developing person-centered outcome and experience measures; assessing equity; addressing clinician and organization concerns about how CRP measurement may affect reputational and legal risk; reducing the burden of measurement; and improving mechanisms for sharing data across organizations to promote transparency, accountability, and broader patient safety improvements. Recommended next steps include: build a national coalition of interested parties to guide the work; overcome barriers to measurement and improve feasibility, especially through the engagement of patient safety and risk management software vendors; explore measure development processes that focus on patient, family, and clinician-centered outcome and experience measures; define nationally recognized standardized CRP measures; consider the role for regulatory and financial incentives to promote their use; and facilitate data sharing and comparative analysis. Ongoing engagement and strategy will be essential to move CRP measurement forward.