Strengthening implant provision and acceptance in South Africa with the 'Any woman, any place, any time' approach: An essential step towards reducing unintended pregnancies

Progress in reducing unintended pregnancies in South Africa is slow. The implant, introduced in 2014, expanded the range of available longacting reversible contraceptives (LARCs) and held much promise. Uptake, however, has declined precipitously, in spite of its 'unmatched effectiveness' and high levels of satisfaction for most users. We propose policy and provider interventions to raise implant use, underscored by a 'LARC-first' approach. Contraceptive counselling should focus on the particular benefits of LARCs and methods be presented in order of effectiveness. Moreover, implants hold particular advantages for certain groups, especially adolescents and young women, in whom it is considered first-line contraception. Provision of immediate postpartum and post-abortion implants is safe and highly acceptable, yet remains under-utilised. Implant services at HIV and tuberculosis clinics are a key priority, as is inclusion of LARC provision within school health services. Implants could also be delivered by existing mobile outreach services, for example in sex worker programmes. Services could be built around nurses dedicated solely to providing implants, with other health workers receiving brief refresher training. Women who experience side-effects, especially abnormal bleeding, require timely interventions, following a standardised protocol, including use of medications. Encouraging return for side-effects, follow-up phone calls and home visits would raise continuation rates. Removal services require doctor support or designated nurses at specific centres. Limited access to removal services, health workers' resistance or botched procedures will further undermine implant provision. Rapid implant demonstration projects in postpartum wards, schools, outreach services and by dedicated providers may rapidly advance the field. Together, the actions outlined here will ensure that the implant fulfils its potential and reinvigorates family planning services.

service line analytics in the new era.

To succeed under the value-based business model, hospitals and health systems require effective service line analytics that combine inpatient and outpatient data and that incorporate quality metrics for evaluating clinical operations. When developing a framework for collection, analysis, and dissemination of service line data, healthcare organizations should focus on five key aspects of effective service line analytics: Updated service line definitions. Ability to analyze and trend service line net patient revenues by payment source. Access to accurate service line cost information across multiple dimensions with drill-through capabilities. Ability to redesign key reports based on changing requirements. Clear assignment of accountability.

Hospital diversification strategy.

To determine the impact of health system restructuring on the levels of hospital diversification and operating ratio this article analyzed 94 teaching hospitals and 94 community hospitals during the period 2008-2013. The 47 teaching hospitals are matched with 47 other teaching hospitals experiencing the same financial market position in 2008, but with different levels of preference for risk and diversification in their strategic plan. Covariates in the analysis included levels of hospital competition and the degree of local government planning (for example, highly regulated in New York, in contrast to Texas). Moreover, 47 nonteaching community hospitals are matched with 47 other community hospitals in 2008, having varying manager preferences for service-line diversification and risk. Diversification and operating ratio are modeled in a two-stage least squares (TSLS) framework as jointly dependent. Institutional diversification is found to yield better financial position, and the better operating profits provide the firm the wherewithal to diversify. Some services are in a growth phase, like bariatric weight-loss surgery and sleep disorder clinics. Hospital managers' preferences for risk/return potential were considered. An institution life cycle hypothesis is advanced to explain hospital behavior: boom and bust, diversification, and divestiture, occasionally leading to closure or merger.

Sustainable competitive advantage for accountable care organizations.

In the current period of health industry reform, accountable care organizations (ACOs) have emerged as a new model for the delivery of high-quality and cost-effective healthcare. However, few ACOs operate in direct competition with one another, and the accountable care business model has yet to present a means of continually developing new marginal value for patients and network partners. With value-based purchasing and patient consumerism strengthening as market forces, ACOs must build organizational sustainability and competitive advantage to meet the value demands set by customers and competitors. This essay proposes a strategy, adapted from the disciplines of agile software development and Lean product development, through which ACOs can engage internal and external customers in the development of new products that will provide sustainability and competitive advantage to the organization by decreasing waste in development, promoting specialized knowledge, and closely targeting customer value.

Evaluación del proyecto de producción pública de fitomedicamentos en la provincia de Misiones durante el período 2006-2007 / Project evaluation phytomedicines public production in the province of Misiones in the period 2006-2007

En el presente trabajo nos proponemos estudiar el proyecto realizado por el Ministerio de Salud Pública de la Provincia de Misiones de elaboración de fitomedicamentos, utilizando la infraestructura del Laboratorio Provincial de Producción de Medicamentos, por el cual se ha abierto una línea de producción de fitomedicamentos (fitofármacos aprobados y distribuidos en efectores públicos) tales como: crema de caléndula officinalis.L. , comprimido de maytenus ilicifolia Mart. ex. Reiss. y jarabe de cecropia adenopus M, en reemplazo de ciertas drogas convencionales; y evaluar si la producción pública a mediano plazo de estos medicamentos fitoterápicos representará una disminución de costos del gasto público total en medicamentos.Los fitomedicamentos son medicamentos naturales que para su elaboración llevan una serie de pautas de tipo científico-tecnológico, controles de toxicología, respaldo de estudios clínicos, que garantizan la calidad y los controles necesarios para su elaboración. Este estudio nos permitirá la realización de recomendaciones económicas a decisores políticos en lo referente a la implementación de políticas de medicamentos, considerando la indicación de los fitomedicamentos como sustitución de drogas adquiridas en el mercado, válidos en términos de costo-efectividad. Además, estaremos en condiciones de evaluar el impacto de la producción de medicamentos fitoterápicos en la disminución de costos del gasto público provincial en esta materia.

SUMMARY: In this paper we propose to study the project developed by the Ministry of Public Health of Misiones Province of preparing phytomedicines, using the Public Laboratory of Drug Production infrastructure. It has opened a production line of phytomedicines (herbal medicines approved and distributed in public effectors) such as calendula cream officinalis.L, Compressed Maytenus ilicifolia Mart. former. Reiss. and M adenopus cecropia syrup, replacing some conventional drugs, and assess if public production of these herbal medicines represent a cost reduction of total public expenditure on drugs in the medium-term. Phytomedicines are natural medicines which required a series of scientific-technological controls, toxicology, clinical trial support, quality assurance and controls necessary for their processing. This study will allow the realization of economic advices to policy makers regarding the implementation of drug policies, considering the indication of phytomedicines as replacement drugs acquired on the market, valid in terms of cost-effectiveness. In addition, we will be able to assess the impact of the production of herbal medicines in reducing costs of provincial government in this area.

[Experience of Lucentis use in patients with wet age-related macular degeneration].

This article provides information about development and introduction of regional standard of specialized medical care for patients with neovascular age-related macular degeneration in medical practice in Tumen region. It discovered new opportunities for improvement of ophthalmologic care in the region.

Across the care continuum.

Using a service line strategy can help boards evaluate performance, improve physician integration and prioritize investment decisions.

Strategies for safe care of critical care perinatal patients.

In most inpatient settings, the complexity of care required by individual patients coupled with the wide range of services provided within a single institution mean patients are routinely cared for in highly specialized units. Service lines, such as surgical services; intensive care; emergency services; and maternity, typically operate cooperatively, but independently, within larger facilities. Units are distinguished from one another, not only by their mission, geographic location, and work processes, but by the expertise and specialty knowledge of clinicians who practice there. From a patient safety perspective, specialty care is advantageous because it promotes clinical benchmarking, standardization of practice norms, acquisition and maintenance of specialty knowledge and skills, and interdisciplinary teamwork.

Effective cost modeling for service line planning.

Healthcare executives have struggled to have accurate, timely information about cost and resources to model and monitor service line performance. Process-based cost modeling has been used successfully in other industries, but is relatively new in health care. Understanding costs and resources at process and patient levels can make the difference between a service line having a positive or negative margin.

UFE program: a service line opportunity for U.S. hospitals.

Uterine fibroid embolization (UFE) is a nonsurgical procedure performed by an interventional radiologist to treat uterine fibroids, the most common solid pelvic, benign tumors occurring in women and one of the most prevalent indications for hysterectomies. Most hospitals already have the resources in place to establish an effective UFE program in collaboration with interventional radiologists. Such collaborations, exploiting existing resources, hold the key to many attractive service-line opportunities that exist for hospitals in today's financially stressed healthcare marketplace.

Marketing strategies for vascular practitioners.

BACKGROUND: A common misconception is that marketing is synonymous with advertising. Marketing by physicians has undergone a transformation from the earlier unacceptable slick sales pitches to a more common sense, tasteful, comprehensive, and well thought out plan to reach potential patients. METHODS AND RESULTS: Marketing is a much broader concept comprising four aspects: product, price, promotion, and place. Marketing activities for a medical practice include not only external but internal tactics. Publicly available resources are available to assist physicians in developing and targeting the plan towards a narrow patient demographic. The marketing process includes: determining objectives, identifying resources, defining target population, honing a message, outlining a media plan, implementing the plan, and finally, evaluating the success or failure of the marketing campaign. CONCLUSION: A basic knowledge of marketing combined with a common sense approach can yield dividends for those practices that need the service. For surgical practices that exist in heavily populated urban areas with significant competition, a well thought out marketing plan can assist the practice in reaching out to new groups of patients and maintaining the existing patient base.

Seamless service line management.

Memorial Hermann Health System of Houston executed a systemwide service line management model in response to the competitive pace and intensity of the market. The steps the health system took to develop and implement this model include: Recognize the burning platform. Evaluate internal readiness. Invest in early wins. Build the management model. Create a service line mantra that guides all service line initiatives.

Designing the experience of health care.

New ideas and information services will be best served when they are examined from both the users' and the corporate perspective. It is imperative to identify what best serves the needs of the user while understanding the corporate context that would allow these products/services to be sustainable. The desired result is for users to feel included and become more active and involved in their lives and to be able to do so at a reasonable, sustainable price point. This collaboration is illustrated by several examples of health care product development including the development of a medication management system for patients and a diet assistance program for cardiac patients. In these examples, success is dependent on a solid relationship between people who have the methods to understand users and to develop products and people who have knowledge of the health care field and understand it in a business context.