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1.
Notas enferm. (Córdoba) ; 25(43): 5-16, jun.2024.
Artigo em Espanhol | LILACS, BDENF, BINACIS, UNISALUD | ID: biblio-1561161

RESUMO

La presente investigación pretende evaluar el nivel de cumplimiento de las metas internacionales, que representan el foco principal para la mejora de calidad y seguridad de atención de los pacientes. La seguridad del paciente involucra a todos los estudios, prácticas y acciones promovidas por las instituciones sanitarias para disminuir y eliminar los riesgos de daños innecesarios relacionados con el cuidado de la salud. Metodología: Estudio descriptivo, observacional y transversal. De fuentes primaria y secundaria, Resultados: se abordaron las metas N° 1 la cual consiste en Identificar a los pacientes correctamente y la meta N° 6 la cual se refiere a Reducir el riesgo de lesiones en pacientes como resultado de caídas. En primer lugar, se destaca el cumplimiento en la identificación correcta del paciente y en segunda instancia la mejora del cumplimiento de medidas de prevención de caídas. Conclusión: Esta proximidad de los valores obtenidos genera un aspecto positivo para mejorar la seguridad de los pacientes y que, si bien el cumplimiento de las metas no es el deseado, es cercano al porcentaje planteado. Lo que en definitiva hace a este estudio un antecedente importante en la mejora continua con vista al futuro cercano[AU]


This research aims to evaluate the level of compliance with international goals, which represent the main focus for improving the quality and safety of patient care. Patient safety involves all studies, practices and actions promoted by health institutions to reduce and eliminate the risks of unnecessary harm related to health care. Methodology: Descriptive, observational and transversal study. From primary and secondary sources, Results: goals No. 1 were addressed, which consists of Identifying patients correctly and goal No. 6, which refers to Reducing the risk of injuries in patients as a result of falls. Firstly, compliance with correct patient identification stands out and secondly, improvement in compliance with fall prevention measures. Conclusion: This proximity of the values obtained generates a positive aspect to improve patient safety and that, although the fulfillment of the goals is not as desired, it is close to the proposed percentage. Which ultimately makes this study an important precedent in continuous improvement for the near future[AU]


Esta pesquisa tem como objetivo avaliar o nível de cumprimento das metas internacionais, que representam o foco principal para a melhoria da qualidade e segurança do atendimento ao paciente. A segurança do paciente envolve todos os estudos, e ações promovidas pelas instituições de saúde para reduzir e eliminar os riscos de danos desnecessários relacionados à assistência à saúde. Metodologia: Estudo descritivo, observacional e transversal. De fontes primárias e secundárias, dependendo do indicador e do objetivo para o qual a medição está sendo realizada. Resultados: Nesta pesquisa serão abordadas as metas nº1, que consiste em Identificar corretamente os pacientes e a meta nº 6, que es Reduzir o risco de lesões nos pacientes em decorrência de quedas. Foi realizado nos dois locais. Em primeiro lugar, destaca-se o cumprimento da correta identificação do paciente e, em segundo lugar, a melhoria no cumprimento das medidas de prevenção de quedas. Conclusão: Essa proximidade dos valores obtidos gera um aspecto positivo para melhorar a segurança do paciente e que, embora o cumprimento das metas não seja o desejado, está próximo do percentual proposto. O que acaba por tornar este estudo um precedente importante na melhoria contínua com vista ao futuro próximo.


Assuntos
Humanos , Sistemas de Identificação de Pacientes , Qualidade da Assistência à Saúde , Acidentes por Quedas/prevenção & controle
2.
Reprod Health ; 21(1): 114, 2024 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-39103920

RESUMO

BACKGROUND: Abortion-related complications remain a main cause of maternal mortality. There is little evidence on the availability and quality of post-abortion care (PAC) in humanitarian settings. We assessed the quality of PAC in two hospitals supported by an international organization in Jigawa State (Nigeria) and Bangui (Central African Republic, CAR). METHODS: We mapped indicators corresponding to the eleven domains of the WHO Maternal and Newborn Health quality-of-care framework to assess inputs, processes (provision and experience of care), and outcomes of PAC. We measured these indicators in four components of a cross-sectional multi-methods study: 1) an assessment of the hospitals' PAC signal functions, 2) a survey of the knowledge, attitudes, practices, and behavior of 140 Nigerian and 84 CAR clinicians providing PAC, 3) a prospective review of the medical records of 520 and 548 women presenting for abortion complications and, 4) a survey of 360 and 362 of these women who were hospitalized in the Nigerian and CAR hospitals, respectively. RESULTS: Among the total 27 PAC signal functions assessed, 25 were available in the Nigerian hospital and 26 in the CAR hospital. In both hospitals, less than 2.5% were treated with dilatation and sharp curettage. Over 80% of women received blood transfusion or curative antibiotics when indicated. However, antibiotics were given to about 30% of patients with no documented indication. Among discharged women in CAR, 99% received contraceptive counseling but only 39% did in Nigeria. Over 80% of women in Nigeria reported positive experiences of respect and preservation of dignity. Conversely, in CAR, 37% reported that their privacy was always respected during examination and 62% reported short or very short waiting time before seeing a health provider. In terms of communication, only 15% felt able to ask questions during treatment in both hospitals. The risk of abortion-near-miss happening ≥ 24h after presentation was 0.2% in Nigeria and 1.1% in CAR. Only 65% of women in the Nigerian hospital and 34% in the CAR hospital reported that the staff provided them best care all the time. CONCLUSION: Our comprehensive assessment identified that these two hospitals in humanitarian settings provided lifesaving PAC. However, hospitals need to strengthen the patient-centered approach engaging patients in their own care and ensuring privacy, short waiting times and quality provider-patient communication. Health professionals would benefit from instituting antibiotic stewardships to prevent antibiotic-resistance.


In humanitarian contexts, abortion complications are a leading cause of maternal mortality. Providing quality post-abortion care (PAC) is therefore an important part of needed services. We assessed the quality of PAC in two hospitals supported by an international organization in Jigawa State (Nigeria) and Bangui (Central African Republic). We measured quality indicators in four components: 1) an assessment of the equipment and human resources available in hospitals, 2) a survey of the knowledge, attitudes, practices, and behavior of clinicians providing PAC, 3) an assessment of the medical care provided by clinicians to women presenting with abortion complications and, 4) a survey of a subgroup of these women who were hospitalized. Both hospitals had almost all the equipment and human resources necessary to provide post-abortion care. Less than 2.5% of women received a non-recommended method to evacuate their uterus in both hospitals. More than 80% of women received a blood transfusion or antibiotics when they needed them. However, 30% of women received antibiotics without written justification and only 15% of women reported being able to ask questions about their treatment. Overall, only 65% of Nigerian women and 34% of Central African women said that the staff provided them with the best care all the time. The fact that less than 2% of women experienced a very severe complication 24 hours or more after their arrival at the two hospitals suggests that the care provided was lifesaving. But they urgently need to adopt a better patient-centered approach as well as to improve the rational management of antibiotics.


Assuntos
Aborto Induzido , Qualidade da Assistência à Saúde , Humanos , Feminino , Estudos Transversais , Gravidez , Aborto Induzido/normas , Recém-Nascido , Adulto , Nigéria , Organização Mundial da Saúde , Saúde do Lactente , Saúde Materna , Adulto Jovem
3.
Health Res Policy Syst ; 22(1): 94, 2024 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-39103922

RESUMO

BACKGROUND: While healthcare organizations in several countries are embracing Value-Based Health Care (VBHC), there are limited insights into how to achieve this paradigm shift. This study examines the decade-long (2012-2023) change towards VBHC in a pioneering Dutch university hospital. METHOD: Through retrospective, complexity-informed process research, we study how a Dutch university hospital's strategy to implement VBHC evolved, how implementation outcomes unfolded, and the underlying logic behind these developments. Data include the hospital's internal documents (n = 10,536), implementation outcome indicators (n = 4), a survey among clinicians (n = 47), and interviews with individuals contributing to VBHC at the hospital level (n = 20). RESULTS: The change towards VBHC is characterized by three sequential strategies. Initially, the focus was on deep change through local, tailored implementation of multiple VBHC elements. The strategy then transitioned to a hospital-wide program aimed at evolutionary change on a large scale, emphasizing the integration of VBHC into mainstream IT and policies. Recognizing the advantages and limitations of both strategies, the hospital currently adopts a "hybrid" strategy. This strategy delicately combines deep and broad change efforts. The strategy evolved based on accumulated insights, contextual developments and shifts in decision-makers. The complexity of change was downplayed in plans and stakeholder communication. By the end of 2023, 68 (sub)departments engaged in VBHC, enabled to discuss patients' responses to Patient Reported Outcomes Measures (PROMs) during outpatient care. However, clinicians' use of PROMs data showed limitations. While pioneers delved deeper into VBHC, laggards have yet to initiate it. CONCLUSIONS: VBHC does not lend itself to linear planning and is not easily scalable. While there appears to be no golden standard for implementation, blending local and larger-scale actions appears advantageous. Local, deep yet harmonized and system-integrated changes culminate in large scale transformation. Embracing complexity and focusing on the ultimate aims of (re)institutionalization and (re)professionalization are crucial.


Assuntos
Atenção à Saúde , Hospitais Universitários , Países Baixos , Humanos , Estudos Retrospectivos , Qualidade da Assistência à Saúde , Inquéritos e Questionários , Inovação Organizacional , Cuidados de Saúde Baseados em Valores
4.
Implement Sci ; 19(1): 56, 2024 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-39103927

RESUMO

BACKGROUND: Reducing low-value care (LVC) is crucial to improve the quality of patient care while increasing the efficient use of scarce healthcare resources. Recently, strategies to de-implement LVC have been mapped against the Expert Recommendation for Implementing Change (ERIC) compilation of strategies. However, such strategies' effectiveness across different healthcare practices has not been addressed. This overview of systematic reviews aimed to investigate the effectiveness of de-implementation initiatives and specific ERIC strategy clusters. METHODS: We searched MEDLINE (Ovid), Epistemonikos.org and Scopus (Elsevier) from 1 January 2010 to 17 April 2023 and used additional search strategies to identify relevant systematic reviews (SRs). Two reviewers independently screened abstracts and full texts against a priori-defined criteria, assessed the SR quality and extracted pre-specified data. We created harvest plots to display the results. RESULTS: Of 46 included SRs, 27 focused on drug treatments, such as antibiotics or opioids, twelve on laboratory tests or diagnostic imaging and seven on other healthcare practices. In categorising de-implementation strategies, SR authors applied different techniques: creating self-developed strategies (n = 12), focussing on specific de-implementation strategies (n = 14) and using published taxonomies (n = 12). Overall, 15 SRs provided evidence for the effectiveness of de-implementation interventions to reduce antibiotic and opioid utilisation. Reduced utilisation, albeit inconsistently significant, was documented in the use of antipsychotics and benzodiazepines, as well as in laboratory tests and diagnostic imaging. Strategies within the adapt and tailor to context, develop stakeholder interrelationships, and change infrastructure and workflow ERIC clusters led to a consistent reduction in LVC practices. CONCLUSION: De-implementation initiatives were effective in reducing medication usage, and inconsistent significant reductions were observed for LVC laboratory tests and imaging. Notably, de-implementation clusters such as change infrastructure and workflow and develop stakeholder interrelationships emerged as the most encouraging avenues. Additionally, we provided suggestions to enhance SR quality, emphasising adherence to guidelines for synthesising complex interventions, prioritising appropriateness of care outcomes, documenting the development process of de-implementation initiatives and ensuring consistent reporting of applied de-implementation strategies. REGISTRATION: OSF Open Science Framework 5ruzw.


Assuntos
Revisões Sistemáticas como Assunto , Humanos , Atenção à Saúde/normas , Atenção à Saúde/organização & administração , Ciência da Implementação , Melhoria de Qualidade/organização & administração , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/organização & administração
6.
Indian J Tuberc ; 71(3): 310-315, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-39111940

RESUMO

BACKGROUND: Community engagement is advocated to improve quality of services using community score card. Current study was done with the objective to formulate the TB-PSC and to carry out its feasibility assessment at three selected public healthcare facilities of Himachal Pradesh, India. METHODS: A mixed-method study design was adopted for the study and was carried out from April 2022 to March 2023. A total of 36 IDIs and four FGDs were carried out to conceptualize, and formulate the structure, components, and scoring mechanisms of TB-CSC. To assess the effect of TB-PSC at three primary health centres (PHCs), pre- and post-study design was used for change in level of satisfaction adapting patient satisfaction questionnaire (PSQ-18). RESULTS: Based on gathered information from IDIs and FGDs, TB-PSC was developed. It comprised of a total of 22 questions related to four domains of availability (9), accessibility (4), and quality (5) of services along with perceived stigma and discrimination (4). TB-PSC was implemented for five months in each PHC in interface-meetings. Mean PSQ score was observed to be significantly high (2.5 vs 2.6) after intervention. CONCLUSION: TB-PSC implementation is feasible in interface meetings and makes them more participatory and effective.


Assuntos
Satisfação do Paciente , Tuberculose , Humanos , Índia , Projetos Piloto , Tuberculose/diagnóstico , Feminino , Masculino , Inquéritos e Questionários , Adulto , Atenção Primária à Saúde , Acessibilidade aos Serviços de Saúde , Estigma Social , Qualidade da Assistência à Saúde , Estudos de Viabilidade
7.
Indian J Tuberc ; 71(3): 344-352, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-39111945

RESUMO

Tuberculosis (TB) is a major public health problem in Azerbaijan, with a high burden of multi-drug-resistant cases. In recent years, the country has made significant progress in TB care, reducing the incidence rate, and improving treatment outcomes. This paper explores the role of quality as a key driver of progress in TB care in Azerbaijan. Through a review of the literature, we identify the key factors that have contributed to the improvement in TB care quality in Azerbaijan, including the development of national guidelines, increased funding, and resource allocation, strengthened health systems and infrastructure, and the adoption of innovative technologies and practices. We also discuss the challenges and limitations of quality improvement efforts in TB care, such as the need for sustained political commitment, effective monitoring and evaluation systems, and the involvement of communities and civil society organizations. Overall, our findings suggest that quality improvement is a critical component of TB control efforts in Azerbaijan and other countries with high TB burden and should be prioritized in national and global health policies and strategies.


Assuntos
Melhoria de Qualidade , Tuberculose , Humanos , Azerbaijão/epidemiologia , Tuberculose/tratamento farmacológico , Tuberculose/terapia , Tuberculose/epidemiologia , Tuberculose/prevenção & controle , Qualidade da Assistência à Saúde , Política de Saúde , Atenção à Saúde/normas
8.
Afr J Prim Health Care Fam Med ; 16(1): e1-e8, 2024 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-39099273

RESUMO

BACKGROUND:  Type 2 diabetes mellitus (T2D) is a public health challenge, affecting 90% of all patients with diabetes, globally. Compliance to treatment guidelines among healthcare professionals (HCPs) is low, thus resulting in inadequate quality of patient care and poor health outcomes among patients. AIM:  To examine the availability of equipment, guidelines, screening and education offered to patients with T2D and compare between clinics and community health centres (CHCs). SETTING:  Tshwane Metropolitan Municipality, Gauteng Province, South Africa. METHODS:  A cross-sectional descriptive study utilised a self-administered questionnaire to collect data from nurses and doctors responsible for treating patients with T2D, from May to June 2022. About 250 eligible HCPs were recruited during routine morning meetings in 22 clinics and six CHCs. RESULTS:  More than 80% of HCPs reported having basic equipment except for ophthalmoscopes, Snellen charts (67%), tuning forks (64%), electrocardiograms (ECG) (46%) and monofilaments (12%). SEMDSA guidelines were reported by 16% of the participants, Diabetic Foot Care Guidelines were reported by 54% and Dietary Guidelines for Diabetic Patients by 55%. Furthermore, 91%, 71% and 69% of HCPs reported that ECG, microalbumin-creatinine and foot examinations were not always performed, respectively. About 66% and 17% always offered individual educational and group sessions, respectively. CONCLUSION:  Equipment availability and compliance with treatment guidelines, patient education and screening of chronic complications are inadequate.Contribution: The study highlights the poor adherence to treatment guidelines and inadequate equipment in health facilities. These shortcomings could lead to missed opportunities for early diagnosis of complications and ultimately poorer patient outcomes.


Assuntos
Diabetes Mellitus Tipo 2 , Qualidade da Assistência à Saúde , Humanos , Diabetes Mellitus Tipo 2/terapia , África do Sul , Estudos Transversais , Feminino , Masculino , Inquéritos e Questionários , Fidelidade a Diretrizes/estatística & dados numéricos , Centros Comunitários de Saúde , Pessoa de Meia-Idade , Adulto
9.
Health Res Policy Syst ; 22(1): 97, 2024 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-39107767

RESUMO

Patent and proprietary medicine vendors in Nigeria play a very integral role in providing primary health care services and are an important source of care for the poor. They are located close to communities and are often the first source of care for hygiene and family planning (FP) products and treatment of child illnesses. Since 2017, Pharmacy Council of Nigeria (PCN) has partnered with Society for Family Health through the IntegratE project to address the poor quality of services by patent and proprietary medicine vendors (PPMVs) and reposition them for better service delivery through piloting the three-tier accreditation system. The partnership has engendered innovation for human resource for health, and considering the peculiarity of their situation, new emerging methods and arrangements to deliver the training to PPMVs in diverse geographical locations within their catchment areas are developed. In this study, we aimed to discuss the role of patent and proprietary medicine vendors in the provision of quality health delivery and provide key lessons and recommendations which have been learned from the pilot scaling of training facilities for PPMVs in Nigeria through the IntegratE project. From the lessons learnt, we propose that, for a successful scale-up of implementation of the three-tier accreditation of PPMVs, PCN will have to establish a budget line for accreditation. In addition, the government should also consider supporting this training through the Basic Healthcare Provision Fund as a way of strengthening human resources at the primary healthcare level. Other alternative sources of funding include licensing and registration fees and other dues generated internally by PCN.


Assuntos
Acreditação , Comércio , Atenção à Saúde , Nigéria , Humanos , Atenção Primária à Saúde , Patentes como Assunto , Política de Saúde , Qualidade da Assistência à Saúde
10.
Ned Tijdschr Geneeskd ; 1682024 07 24.
Artigo em Holandês | MEDLINE | ID: mdl-39087464

RESUMO

This study researches the quality of care of the newly redesigned Department of Acute Care (AAZ), at the Noordwest Hospital in Den Helder. It is a multi-methodological study. Quality indicators were descriptively compared with a conventional Emergency Department (ED) at the location in Alkmaar. Moreover, focus groups were held among nurses employed in the AAZ and patient experiences were recorded by the Picker Institute with a validated questionnaire. The study shows that the quality of acute care in the harmonica model of the AAZ achieves comparable results compared to the conventional ED design at Alkmaar. These results imply that it is feasible to provide acute care near the patient, with efficient staffing through a redesign of the acute care chain.


Assuntos
Serviço Hospitalar de Emergência , Qualidade da Assistência à Saúde , Humanos , Países Baixos , Serviço Hospitalar de Emergência/organização & administração , Inquéritos e Questionários , Grupos Focais , Indicadores de Qualidade em Assistência à Saúde
11.
Health Expect ; 27(4): e14156, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39087726

RESUMO

INTRODUCTION: There have been some concerns about the impact of temporary doctors, otherwise known as locums, on patient safety and the quality of care. Despite these concerns, research has paid little attention to the implications of locum working on patient experience. METHODS: A qualitative semi-structured interview study was conducted with 130 participants including locums, people working with locums and patients with experience of being seen or treated by locums. Analysis was conducted using a reflexive thematic approach and abductive analysis to position themes against wider knowledge. RESULTS: Three main themes were constructed through analysis: (1) Awareness and disclosure; patients were not always aware if their doctor was a locum, and there was some debate about whether patients had a right to know, particularly if locum working presented quality and safety risks. (2) Continuity and accessibility of care; access was regarded as priority for acute conditions, but for long-term or serious conditions, patients preferred to see a permanent doctor who knew their history, although it was acknowledged that locums could provide fresh perspectives. (3) Communication and practice; locums and patients described how consultations were approached differently when doctors worked as locums. Patients evaluated their interactions based on how safe they felt with practitioners. CONCLUSION: Patients reported that they were unlikely to have continuity of care with any doctors delivering care, regardless of their contractual status. Locums sometimes provided new perspectives on care which could be beneficial for patient outcomes, but for patients with long-term, complex or serious conditions continuity of care was important, and these patients may avoid or delay seeking care when locums are the only available option. PATIENT OR PUBLIC CONTRIBUTION: Patients and carers were involved in our study from inception to dissemination. Our Patient and Public Involvement (PPI) forum was involved throughout project design and planning and gave us feedback and guidance on research materials and outputs (e.g., study protocol, participant information sheets, survey tools, interview schedules, emerging findings). Our PPI forum co-produced our patient interview schedule, two members of our PPI forum led the patient focus groups and all were involved in analysis of patient interviews. Our PPI Chair was involved in the preparation of this manuscript.


Assuntos
Entrevistas como Assunto , Relações Médico-Paciente , Pesquisa Qualitativa , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Satisfação do Paciente , Acessibilidade aos Serviços de Saúde , Continuidade da Assistência ao Paciente , Médicos/psicologia , Idoso , Qualidade da Assistência à Saúde , Comunicação , Segurança do Paciente
12.
JAMA Health Forum ; 5(8): e242173, 2024 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-39093589

RESUMO

Importance: Vertical relationships (ownership, affiliations, joint contracting) between physicians and health systems are increasing in the US. Many proponents of vertical relationships argue that increased spending associated with consolidation is accompanied by improvements in quality of care. Objective: To assess the association of vertical relationships between primary care physicians (PCPs) and large health systems and quality of care. Design, Setting, and Participants: This stacked difference-in-differences study compared outcomes for patients whose attributed PCP entered a vertical relationship with a large system in 2015 or 2017 to patients whose PCP was either never or always in a vertical relationship with a large system from 2013 to 2017. Models account for differences between PCPs, patient characteristics, market concentration, and secular trends. Data were derived from the 2013 to 2017 Massachusetts All-Payer Claims Database. The study population included commercially insured individuals attributed to a PCP in the Massachusetts Health Quality Partners' Massachusetts Provider Database in 2013, 2015, or 2017. Analyses were conducted between January 2021 and January 2024. Exposure: PCPs attributed to patients in the study entering a vertical relationship with a large health system in 2015 or 2017. Main Outcomes and Measures: Low-value care utilization, posthospitalization follow-up, utilization among patients with ambulatory care-sensitive conditions, practice site visit fragmentation, and timeliness of specialty care. Results: The study population included 4 603 172 patient-year observations from 2013 to 2017. Among all patients in the study, 53.5% were female, 35.3% had any chronic condition, and the mean (SD) age was 38.9 (20.3) years. There was no association between vertical relationships and low-value care or ambulatory care-sensitive conditions utilization. A patient's PCP entering a vertical relationship had no association with the probability of follow-up within 90 days of cancer diagnosis with any oncologist but was associated with a 7.34-percentage point (pp) (95% CI, 2.28-12.40; P = .01) increase in the probability of follow-up with an oncologist in the health system. Vertical relationships were associated with increased posthospitalization follow-up with a physician in the health system by 7.51 pp (95% CI, 2.96-12.06: P = .001) in the 2015 subgroup. PCP-health system vertical relationships were associated with a significant decrease in fragmentation of practice site visits of -1.05 pp (95% CI, -2.05 to 0.05; P = .04). Conclusions and Relevance: In this study, vertical relationships between PCPs and large health systems were associated with patient steering and changes in care delivery processes, but not necessarily improvements in patient outcomes.


Assuntos
Médicos de Atenção Primária , Qualidade da Assistência à Saúde , Humanos , Feminino , Masculino , Massachusetts , Adulto , Pessoa de Meia-Idade , Médicos de Atenção Primária/estatística & dados numéricos , Atenção à Saúde , Adolescente
13.
Obstet Gynecol Clin North Am ; 51(3): 453-461, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39098772

RESUMO

Obstetrics and gynecologic hospitalists play a pivotal role in the evolution of perinatal care. Hospitalists improve patient safety by providing on-site, reliable, high-quality care. Hospitalists help to reduce the rates of unnecessary cesarean deliveries and increase the rates of vaginal deliveries.


Assuntos
Ginecologia , Médicos Hospitalares , Obstetrícia , Segurança do Paciente , Humanos , Feminino , Gravidez , Obstetrícia/normas , Qualidade da Assistência à Saúde , Assistência Perinatal/normas , Parto Obstétrico/normas , Cesárea/estatística & dados numéricos
14.
Clin Ter ; 175(Suppl 2(4)): 213-218, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39101430

RESUMO

Background: In the healthcare system, in the last 30 years, the prognostically negative value of the so-called Weekend Effect (WE) has been internationally recognized. The WE is regarded as the increased risk a patient might incur when hospitalized during non-working days, of enduring severe complications in comparison to the same hospitalization that occur on working days. The aim of this study was to retrospectively verify whether, once a mistake was made during weekends or on holidays, in comparison to a mistake occurred on workdays, it subsequently implied a higher risk of complications, death included, in a statistical and medico-legal way. Methods: Three different evaluators independently examined a total of 378 medico-legal cases over a more than 20-year period. Eventual medical actions and omissions were labelled as 'mistake' when the AJ claimed that at least one occurred; 'alleged mistake' included the cases where the EW's report disagreed with the AJ's one; finally, 'no mistake' when both the AJ and the EW agreed in their evaluations. During weekends there is a higher risk that a mistake occurs (OR=3.3, 95% CI=1.6;7.4; p-value<0.001) compared to weekdays. When death occurs, delayed diagnosis is the main cause (p=0.02), whereas a damaging action is more frequently claimed in general. Conclusions: We verified as actual the impact of the WE on patients' outcome from a medico-legal point of view. The implications for an improvement of the several settings of the Italian NHS are various, and many are the consequences in the healthcare management.


Assuntos
Erros Médicos , Qualidade da Assistência à Saúde , Estudos Retrospectivos , Humanos , Erros Médicos/estatística & dados numéricos , Erros Médicos/legislação & jurisprudência , Masculino , Feminino , Fatores de Tempo , Pessoa de Meia-Idade , Idoso , Adulto , Itália , Plantão Médico/estatística & dados numéricos , Idoso de 80 Anos ou mais , Imperícia/estatística & dados numéricos , Imperícia/legislação & jurisprudência , Hospitalização/estatística & dados numéricos
15.
BMC Public Health ; 24(1): 2082, 2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-39090570

RESUMO

INTRODUCTION: Amidst the challenges posed by Covid-19, assessing healthcare quality in India is crucial, particularly through patient satisfaction levels. METHODOLOGY: A cross-sectional survey of 277 participants in Jammu and Kashmir was conducted, utilizing a semi-structured questionnaire and PSQ-18. Data analysis was performed using SPSS (v25) including Chi-Square tests and Descriptive analysis. RESULTS: Out of 277 participants, 70.8% expressed high satisfaction with medical care. Majority (70%) agreed that doctors explained medical tests well. Additionally, 70% strongly agreed that their doctor's office was well-equipped. Dissatisfaction factors were notably low. Significant associations were found between age and alcohol use (p = 0.041), gender and alcohol use (p = 0.007), gender and tobacco use (p = 0.032), and education level and vaccination (p = 0.001). CONCLUSION: The study highlights high patient satisfaction during the pandemic. Improving accessibility and quality of primary healthcare and community centres is essential to meet patient needs effectively.


Assuntos
COVID-19 , Satisfação do Paciente , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Índia/epidemiologia , Masculino , Satisfação do Paciente/estatística & dados numéricos , Feminino , Estudos Transversais , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Atenção à Saúde/organização & administração , Inquéritos e Questionários , Qualidade da Assistência à Saúde , Adolescente , Pandemias , Idoso
16.
Front Public Health ; 12: 1357688, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39145169

RESUMO

Introduction: Using digital health in primary health care (PHC) contributes to reducing costs and travel time, achieving global development goals, improving access, quality and longitudinality of care, and managing health crises. Its evaluation must go beyond the technical-operational aspects to include patient satisfaction, a key element in assessing the quality of care. Objective: To identify and map patient satisfaction (expectations, desires, cultural values) about the adoption of digital health strategies and assess their impact on the quality of care in PHC. Methods: The review will follow the recommendations proposed by the Joanna's Briggs Institute (JBI) manual, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) and the methodology proposed by Arksey and O'Malley and Levac et al. and will be conducted in nine stages. The search will be conducted in health studies databases (MEDLINE via PubMed, EMBASE, CINAHL, Web of Science, and BVS), gray literature, and preprint repositories (Google Scholar and MedRxiv). Two reviewers will select the studies, and the third will analyze possible conflicts. The inclusion criteria comprise studies that have been made available in their entirety, whether they are primary studies or short communications, as well as the following materials extracted from the gray literature: preprints, manuals, government documents, books, guidelines, theses and dissertations. Exclusion criteria include literature reviews, abstracts, books, conference archives, letters to the editor, duplicates and opinion articles. Data will be analyzed by content analysis and inferential statistics. This protocol is registered on the Open Science Framework (OSF) under DOI 10.17605/OSF.IO/PUJDB. Results: The study aims to understand aspects related to the expectations, desires, and cultural values of patients from different countries, as well as the strengths and critical nodes of the use of digital health on the quality of care in PHC.


Assuntos
Satisfação do Paciente , Atenção Primária à Saúde , Humanos , Telemedicina , Qualidade da Assistência à Saúde , Projetos de Pesquisa , Saúde Digital
17.
Glob Health Action ; 17(1): 2381878, 2024 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-39149932

RESUMO

There is a growing need to implement high quality chronic care to address the global burden of chronic conditions. However, to our knowledge, there have been no systematic attempts to define and specify aims for chronic care quality. To address this gap, we conducted a scoping review and Delphi survey to establish and validate comprehensive specifications. The Institute of Medicine's (IOM) quality of care definition and aims were used as the foundation. We purposively selected articles from the scientific (n=48) and grey literature (n=26). We sought papers that acknowledged and unpacked the plurality of quality in chronic care and proposed or utilised frameworks, studied their implementation, or investigated at least two IOM quality care aims and implementation. Articles were analysed both deductively and inductively. The findings were validated through a Delphi survey involving 49 international chronic care experts with varied knowledge of, and experience in, low-and-middle-income countries. Considering the natural history of chronic conditions and the journey of a person with a chronic condition, we defined and identified the aims of chronic care quality. The six IOM aims apply with specific meanings. We identified a seventh aim, continuity, which relates to the issue of chronicity. The group endorsed our specifications and several participants gave contextualised interpretations and concrete examples. Chronic conditions pose specific challenges underscoring the relevance of tailoring quality of care aims. The next steps require a tailored definition and specific aims to improve, measure and assure the quality of chronic care.


Main findings: While previously defined aims of good-quality care may also apply to chronic care quality, the nature of chronic conditions and ensuing healthcare needs warrant specifications for good-quality chronic care.Added knowledge: Our proposed definition and specific aims are tailored to the natural history of chronic conditions, and can serve as a guide on determining what can be deemed as good-quality chronic care.Global health impact for policy and action: This work, developed to guide further work on designing purchasing instruments to improve quality of chronic care, particularly in low- and middle-income countries, may also be a source of inspiration for other interventions aiming at improving quality of chronic care.


Assuntos
Técnica Delphi , Qualidade da Assistência à Saúde , Humanos , Doença Crônica/terapia , Qualidade da Assistência à Saúde/organização & administração , Qualidade da Assistência à Saúde/normas
19.
BMJ Open ; 14(8): e077124, 2024 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-39122397

RESUMO

OBJECTIVE: Intellectual disability liaison nurses in general hospitals could enhance access to high-quality, adapted healthcare and improve outcomes. We aimed to explore associations between the input of intellectual disability liaison nurses and the quality of care in people with intellectual disability who are admitted to hospital. DESIGN: Retrospective analysis of a national dataset of mortality reviews. SETTING: General hospitals in England. PARTICIPANTS: 4742 adults with intellectual disability who died in hospital between 2016 and 2021 and whose deaths were reviewed as part of the Learning from Lives and Deaths mortality review programme. OUTCOME MEASURES: We used logistic regression to compare the sociodemographic and clinical characteristics of those who did, and did not, receive input from an intellectual disability liaison nurse. We explored associations between liaison nurse input, care processes and overall quality of care. RESULTS: One-third of people with intellectual disability who died in hospital in England between 2016 and 2021 had input from an intellectual disability liaison nurse. Intellectual disability liaison nurse input was not evenly distributed across England and was more common in those who died of cancer. Having an intellectual disability liaison nurse involved in an individual's care was associated with increased likelihood of reasonable adjustments being made to care (adjusted OR (aOR) 1.95, 95% CI 1.63 to 2.32) and of best practice being identified (aOR 1.37, 95% CI 1.17 to 1.60) but was not associated with a rating of overall quality of care received (aOR 0.94, 95% CI 0.78 to 1.12). CONCLUSIONS: Intellectual disability liaison nurses see only a minority of people with intellectual disability who are admitted to hospital in England. Increasing the availability of intellectual disability liaison nurses could improve care for this disadvantaged group.


Assuntos
Hospitais Gerais , Deficiência Intelectual , Humanos , Inglaterra/epidemiologia , Deficiência Intelectual/enfermagem , Deficiência Intelectual/mortalidade , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto , Mortalidade Hospitalar , Idoso , Qualidade da Assistência à Saúde , Adulto Jovem , Modelos Logísticos
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