A community service doctor's experiences of mental healthcare provision in rural Eastern Cape.

BACKGROUND:  Literature shows that in South Africa there are insufficient resources to meet mental healthcare needs. At general or district hospital level, the non-specialist doctor is often responsible for the holistic assessment and management of mental health service users. Such situations inevitably increase doctors' care load as they are required to treat across disciplines. We highlight the particular challenges faced by a community service (CS) doctor in this context. METHODS:  The presented case study formed part of a larger project that investigated public mental healthcare provision in the Eastern Cape province. Data were collected through a once-off semi-structured interview with the participant. The interview was transcribed and data analysed by utilising thematic analysis to yield results. RESULTS:  The study suggests that the CS doctor experiences being overloaded with duties, and feels overwhelmed in a healthcare context that lacks resources needed for service provision, which may lead to inadequate mental healthcare provision to public health service users. CONCLUSION:  Healthcare facilities in rural parts of the Eastern Cape province are in need of assistance. This in-depth account highlighted the consequences of working on the front line of a disadvantaged and under-resourced health system. The presented account can be interpreted as a cry for help by CS doctors for relevant authorities to improve access and provision of mental healthcare in the area.Contribution: The paper provides an exploration of the circumstances wherein mental healthcare is provided in rural parts of South Africa.

Private equity investment in health care delivery, Australia, 2008-2022.

OBJECTIVES: To examine the scale of private equity investment in Australian health care delivery assets (clinics, hospitals, imaging facilities, other doctor-led health care services). STUDY DESIGN, SETTING: Extraction of information about private equity acquisitions of hospitals, clinics, imaging centres and in vitro fertilisation facilities in Australia, 2008-2022, from a commercial database (PitchBook), supplemented by information from publicly available online media sources. MAIN OUTCOME MEASURES: Number and value of private equity acquisitions of health care assets, 2008-2022; numbers of clinic parent company and clinic acquisitions, 2017-2022. RESULTS: A total of 75 private equity acquisitions of health care delivery assets in Australia during 2008-2022 were identified; the annual number rose from three acquisitions in 2008 to eighteen in 2022. During 2008-2010, five of seven acquisitions were of in vitro fertilisation providers; during 2020-2022, 22 of 39 acquisitions were of clinics or clinic groups, including eleven of eighteen in 2022. The total value of the 39 acquisitions for which purchase price could be ascertained (52%) was $24.1 billion. During 2017-2022, the clinic specialty with the greatest number of private equity acquisitions was general practice (256 of 446 clinics purchased within acquisitions). Seven companies owning ophthalmology clinics (24 clinics) were acquired by private equity. Four private equity acquisitions during 2017-2022 included 60 oncology clinics, all related to a single clinic group. CONCLUSIONS: The number of private equity acquisitions of Australian health care delivery assets increased during 2008-2022. Doctors should be aware of the motivations and dynamics of private equity companies, as they are increasingly likely to interact with these firms and assets owned by these firms.

The increasing costs of medicines and their implications for patients, physicians and the health system.

Most new medicines entering the market are high-cost speciality drugs. These drugs can cost tens to hundreds of thousands of dollars per course of treatment and in some cases millions of dollars per dose. Approximately half of all spending on medicines is projected to target only 2-3% of patients, raising important questions about resource allocation. While there is no doubt that breakthrough innovations have transformed clinical care in some disciplines, it is also true that cost is becoming one of the primary barriers to treatment access and that many new medicines do not provide value commensurate with their prices. This article examines pricing trends, the reasons for high prices and their implications for access and clinical practice.

Beliefs and practices of physicians in Lebanon regarding promotional gifts and interactions with pharmaceutical companies.

Background: Pharmaceutical companies invest greatly in promotional gifts to influence prescription of medications by physicians, yet there is limited published information evaluating its impact on healthcare. Aim: This study aimed to assess the beliefs and practices of physicians in Lebanon regarding promotional gifts and their interactions with representatives of pharmaceutical companies. Methods: This cross-sectional study was conducted between December 2019 and January 2020 through an email-based questionnaire sent to 5936 physicians of different specialties registered in the Lebanese Order of Physicians. Assessment was done using a validated tool and data analysis was conducted using SPSS version 26.0. Results: Of the 268 respondents, 188 (70.4%) reported that physicians in Lebanon accepted gifts from representatives of pharmaceutical companies. Most of the physicians (31.7%) interacted with company representatives more than once a week. Medication samples (251 respondents) and stationary items (222 respondents) were the most common gifts accepted by physicians who admitted accepting gifts. Overall, 225 (84.9%) respondents believed that prescriptions by physicians in Lebanon were influenced by the gifts. Only 74 (40.0%) of those who accepted gifts from pharmaceutical companies believed that it was unethical, and around half did not know if the Lebanese Code of Medical Ethics allowed them to accept gifts from pharmaceutical companies. Conclusion: Although physicians in Lebanon were aware of the effect that gifts from pharmaceutical companies could have on their prescription behaviours, many of them still accepted the gifts. This study provides evidence to policymakers for decision-making regarding ethical guidance on interactions between physicians and pharmaceutical companies in Lebanon.

Nurse practitioner low-value care ordering practices: an integrative review.

OBJECTIVES: Low-value care (LVC) health services are unsupported by current evidence, are associated with harmful patient outcomes, and equate to more than $100 billion in wasteful spending annually. Nurse practitioner (NP) LVC ordering practices among adult patients in outpatient settings are described and compared with those of other health care clinicians. Factors impacting NP ordering practices are also explored. STUDY DESIGN: Integrative review. METHODS: Electronic databases, including MEDLINE's PubMed, CINAHL, Web of Science, and Business Source Complete, and Google Scholar were searched for original studies published prior to April 2023. Search terms included relevant keywords pertaining to LVC and NPs. Results were supplemented by a search of the reference lists of included studies. RESULTS: Of the 20 included studies, 7 were of low quality, which limited findings. Results comparing NP LVC ordering practices with those of other health care clinicians were conflicting. When compared with physicians, NPs ordered equal rates of antibiotics in 4 studies and lumbar imaging in 6 studies; they ordered less imaging in 2 studies but more imaging in 1 study. In 1 study, NPs ordered fewer lumbar imaging studies than physician assistants. NPs reported following protocols for prescribing and found that patient education and reassurance were successful in minimizing LVC ordering when managing patient expectations. NP specialization appeared to influence LVC ordering, whereas scope of practice laws had no effect. CONCLUSIONS: The full extent to which NPs order LVC services, as well as a comprehensive understanding of the factors influencing their decisions, remains unknown. It is unclear whether NPs order fewer or equal LVC services compared with other health care clinicians. More research on NPs and LVC is indicated.

Interventions to support fellowship application success among predoctoral physician-scientists.

A critical element of physician-scientist training is the development and practice of core competencies that promote success in research careers. The ability to develop compelling training and research proposals is one such foundational skill. The NIH Ruth L. Kirschstein National Research Service Award (NRSA) individual fellowship for dual-degree students (F30, F31, or F31-Diversity) creates an ideal opportunity to provide formal instruction in grant-writing skills to physician-scientists early in training. In the guided process of preparing a predoctoral fellowship application, students learn to formulate clear short- and long-term research and training goals; construct a comprehensive, well-reasoned, and rigorous proposal; become familiar with funding agency priorities; and gain strategic insights into the peer review system. Beyond building scientific writing skills, the application process for an NRSA F30 or F31 is an opportunity for trainees to strengthen mentor-mentee relationships, identify learning opportunities key to their scientific development, and build effective research and mentoring teams. These skills also apply to developing future postdoctoral mentored K applications or faculty research program grants. Here, we outline key features of the structured proposal development training developed for students in the Yale MD-PhD Program and review outcomes associated with its implementation.

Interprofessional collaboration in the cardiovascular management of Marfan syndrome: A qualitative study based on interviews with professionals.

BACKGROUND AND AIM: Patients with Marfan syndrome, who present with a variety of symptoms and complex psychosocial problems, require interprofessional collaboration in their care. However, it is unclear how health care providers contribute to interprofessional collaboration for these patients. The purpose of this study was to determine the characteristics of interprofessional collaboration for patients with Marfan syndrome in the cardiovascular field. METHODS: Semi-structured interviews were conducted with health care specialists (5 physicians, 2 nurses, and 3 certified genetic counselors) were analyzed qualitatively. RESULTS: Based on the medical collaboration for the management of cardiovascular complications in patients and their relatives, interprofessional collaboration was identified, such as collaboration and cooperation between physicians and certified genetic counselors, and nursing practice to facilitate interprofessional collaboration. In addition, issues such as difficulties in dealing with and coordinating medical care for noncardiovascular complications, lack of specialist physicians, and lack of opportunities to collaborate with nurses were identified. CONCLUSIONS: Effective interprofessional collaboration requires the acquisition of Marfan syndrome and genetic knowledge by healthcare providers and the development of a healthcare delivery system based on departments that can provide leadership. In addition, the assignment of nurses to work across organizational boundaries and effective collaboration between genetic counselors and nurses should be considered.

Assessment of the Barriers and Enablers of the Use of mHealth Systems in Sub-Saharan Africa According to the Perceptions of Patients, Physicians, and Health Care Executives in Ethiopia: Qualitative Study.

BACKGROUND: Digital technologies are increasingly being used to deliver health care services and promote public health. Mobile wireless technologies or mobile health (mHealth) technologies are particularly relevant owing to their ease of use, broad reach, and wide acceptance. Unlike developed countries, Sub-Saharan Africa experiences more challenges and obstacles when it comes to deploying, using, and expanding mHealth systems. In addition to barriers, there are enabling factors that could be exploited for the design, implementation, and scaling up of mHealth systems. Sub-Saharan Africa may require tailored solutions that address the specific challenges facing the region. OBJECTIVE: The overall aim of this study was to identify the barriers and enablers for using mHealth systems in Sub-Saharan Africa from the perspectives of patients, physicians, and health care executives. METHODS: Multi-level and multi-actor in-depth semistructured interviews were employed to qualitatively explore the barriers and enablers of the use of mHealth systems. Data were collected from patients, physicians, and health care executives. The interviews were audio recorded, transcribed verbatim, translated, and coded. Thematic analysis methodology was adopted, and NVivo software was used for the data analysis. RESULTS: Through this rigorous study, a total of 137 determinants were identified. Of these determinants, 68 were identified as barriers and 69 were identified as enablers. Perceived barriers in patients included lack of awareness about mHealth systems and language barriers. Perceived enablers in patients included need for automated tools for health monitoring and an increasing literacy level of the society. According to physicians, barriers included lack of available digital health systems in the local context and concern about patients' mHealth capabilities, while enablers included the perceived usefulness in reducing workload and improving health care service quality, as well as the availability of mobile devices and the internet. As perceived by health care executives, barriers included competing priorities alongside digitalization in the health sector and lack of interoperability and complete digitalization of implemented digital health systems, while enablers included the perceived usefulness of digitalization for the survival of the highly overloaded health care system and the abundance of educated manpower specializing in technology. CONCLUSIONS: mHealth systems in Sub-Saharan Africa are hindered and facilitated by various factors. Common barriers and enablers were identified by patients, physicians, and health care executives. To promote uptake, all relevant stakeholders must actively mitigate the barriers. This study identified a promising outlook for mHealth in Sub-Saharan Africa, despite the present barriers. Opportunities exist for successful integration into health care systems, and a user-centered design is crucial for maximum uptake.

Design and Usability of an Open-Source, Low-Cost Flexible Laryngoscope for Resource-Limited Settings.

Importance: Endoscopes are paramount to the practice of otolaryngology. To provide physicians in low-middle-income countries with adequate tools to treat otolaryngologic problems, it is necessary to create a low-cost sustainable option. Objective: To describe the design and usability of an open-source, low-cost flexible laryngoscope that addresses the lack of affordable and accessible methods for otolaryngologic visualization in resource-limited settings. Design, Setting, and Participants: This quality improvement study used a mixed-methods approach, including a technical description of device design as well as quantitative and qualitative survey evaluation of device usability. Engineering involved device design, sourcing or manufacturing individual components, fabricating a prototype, and iterative testing. Key assumptions and needs for the device were identified in collaboration with otolaryngologists in Zimbabwe, and designed and simulated by biomedical engineers in a US university laboratory. Board-certified otolaryngologists at a single US university hospital trialed a completed prototype on simulated airways between May 2023 and June 2023. Main Outcomes and Measures: Technical details on the design of the device are provided. Otolaryngologist gave feedback on device characteristics, maneuverability, and visualization using the System Usability Scale, a customized Likert-scale questionnaire (5-point scale), and semistructured interviews. Results: A functional prototype meeting requirements was completed consisting of a distal-chip camera, spring bending tip, handle housing the control mechanism and electronics, and flexible polyether block amide-coated silicone sheath housing the camera and control wires; an external monitor provided real-time visualization and ability to store data. A total of 14 otolaryngologists participated in the device review. The mean (SD) System Usability Scale score was 88.93 (10.08), suggesting excellent usability. The device was rated highly for ease of set up, physical attributes, image quality, and functionality. Conclusions and Relevance: This quality improvement study described the design of a novel open-source low-cost flexible laryngoscope that external review with otolaryngologists suggests was usable and feasible in various resource-limited environments. Future work is needed to translate the model into a clinical setting.

Aspects that facilitate access to care for viral hepatitis: An evaluative research.

BACKGROUND: Viral hepatitis is a major public health concern worldwide. OBJECTIVES: This study aimed to analyze the factors that facilitate access to care for viral hepatitis. DESIGN AND SETTING: Using a sequential mixed method, this evaluation research was conducted in the state of Mato Grosso, Brazil. METHODS: Mapping of references and selection of regions were made based on the quantity and heterogeneity of services. The stakeholders, including the managers of the State Department of Health and professionals from reference services, were identified. Nine semi-structured interviews were conducted using content analysis and discussions guided by the dimensions of the analysis model of universal access to health services. RESULTS: In the political dimension, decentralizing services and adhering to the Intermunicipal Health Consortium are highly encouraged. In the economic-social dimension, a commitment exists to allocate public funds for the expansion of referral services and subsidies to support users in their travel for appointments, medications, and examinations. In the organizational dimension, the availability of inputs for testing, definition of user flow, ease of scheduling appointments, coordination by primary care in testing, collaboration following the guidelines and protocols, and engagement in extramural activities are guaranteed. In the technical dimension, professionals actively commit to the service and offer different opening hours, guarantee the presence of an infectious physician, expand training opportunities, and establish intersectoral partnerships. In the symbolic dimension, professionals actively listen to the experiences of users throughout their care trajectory and demonstrate empathy. CONCLUSIONS: The results are crucial for improving comprehensiveness, but necessitate managerial efforts to enhance regional governance.

A Competition Perspective on Physician Non-compete Agreements.

Physician non-compete agreements may have significant competitive implications, and effects on both providers and patients, but they are treated variously under the law on a state-by-state basis. Reviewing the relevant law and the economic literature cannot identify with confidence the net effects of such agreements on either physicians or health care delivery with any generality. In addition to identifying future research projects to inform policy, it is argued that the antitrust "rule of reason" provides a useful and established framework with which to evaluate such agreements in specific health care markets and, potentially, to address those agreements most likely to do significant damage to health care competition and consumers.

Improving Cultural Humility Among Pediatric Patients With Complex Medical Needs.

It is not possible for every physician and patient to originate from the exact same circumstances. Because of this impossibility, the dynamics between the patient, caregivers, and physician are extremely important to prevent mistrust, disputes, de-emphasizing the values of others, or miscommunication. Similar to how many diverse groups exist in society so, too, are there numerous factors for influencing how medical care is provided and received. Multiple studies demonstrate the inequalities of access and quality of health care in pediatric primary care as well as increased morbidity and mortality rates. This may be even more prevailing within racial and ethnic communities, which are often underserved populations. This article presents an evaluation of cultural humility and how the awareness of differing viewpoints, values, and norms can assist and improve the medical care of pediatric patients with chronic complex conditions. [Pediatr Ann. 2024;53(3):e88-e92.].

Rising Prices and Lower Medicare Reimbursement Rates Create Outrage Among Clinicians.

In a recent Hot Topics article, reimbursement rates for Medicare physicians are discussed, and how it will impact their practice.

Rising Prices and Lower Medicare Reimbursement Rates Create Outrage Among Clinicians.

In a recent Hot Topics article, reimbursement rates for Medicare physicians are discussed, and how it will impact their practice.

Assessment of physicians' career satisfaction in the Silesian Voivodeship, Poland.

OBJECTIVE: Aim: To assess the career satisfaction of physician's in the Silesian Voivodeship, Poland, in relation to selected factors. PATIENTS AND METHODS: Materials and Methods: The questionnaire survey was conducted among 701 physicians and dentists from the Silesian Voivodeship, Poland, in the period from January to December 2018, using the PAPI (Paper and Pencil Interview) method. Physicians' Career Satisfaction was measured and basic socio-demographic, economic and occupational data, concerning lifestyle and health, and also the level of life satisfaction according to the SWLS (Satisfaction with Life Scale) were collected. Moreover, the occurrence of anxiety and/or depressive symptoms according to the HADS (Hospital Anxiety and Depression Scale) were included in the analyses. RESULTS: Results: The career satisfaction of the surveyed Silesian physicians and dentists was moderate. Wages and combining personal life with work were rated the lowest, while interpersonal opportunities were rated the highest. The predictors: age, economic status and body mass index (BMI) were significant; in addition, in younger age group (25-49 years) - practicing sports and chronic fatigue, and in older age group (50-80 years) - the presence of a chronic disease. A moderate correlation between the level of career satisfaction and life satisfaction was revealed, as well as a lower score in people with the occurrence of anxiety and/or depression symptoms. CONCLUSION: Conclusions: The diversified level of career satisfaction of physicians in separated aspects makes it necessary to verify them both at the level of health care units and at higher levels.

Feasibility of quality indicators on prehospital advanced airway management in a physician-staffed emergency medical service: survey-based assessment of the provider point of view.

OBJECTIVE: We aimed to determine the feasibility of quality indicators (QIs) for prehospital advanced airway management (PAAM) from a provider point of view. DESIGN: The study is a survey based feasibility assessment following field testing of QIs for PAAM. SETTING: The study was performed in two physician staffed emergency medical services in Switzerland. PARTICIPANTS: 42 of the 44 emergency physicians who completed at least one case report form (CRF) dedicated to the collection of the QIs on PAAM between 1 January 2019 and 31 December 2021 participated in the study. INTERVENTION: The data required to calculate the 17 QIs was systematically collected through a dedicated electronic CRF. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes were provider-related feasibility criteria: relevance and acceptance of the QIs, as well as reliability of the data collection. Secondary outcomes were effort to collect specific data and to complete the CRF. RESULTS: Over the study period, 470 CRFs were completed, with a median of 11 per physician (IQR 4-17; range 1-48). The median time to complete the CRF was 7 min (IQR 3-16) and was considered reasonable by 95% of the physicians. Overall, 75% of the physicians assessed the set of QIs to be relevant, and 74% accepted that the set of QIs assessed the quality of PAAM. The reliability of data collection was rated as good or excellent for each of the 17 QIs, with the lowest rated for the following 3 QIs: duration of preoxygenation, duration of laryngoscopy and occurrence of desaturation during laryngoscopy. CONCLUSIONS: Collection of QIs on PAAM appears feasible. Electronic medical records and technological solutions facilitating automatic collection of vital parameters and timing during the procedure could improve the reliability of data collection for some QIs. Studies in other services are needed to determine the external validity of our results.

The role of human capital and stress for cost awareness in the healthcare system: a survey among German hospital physicians.

BACKGROUND: Germany has the highest per capita health care spending among EU member states, but its hospitals face pressure to generate profits independently due to the government's withdrawal of investment cost coverage. The diagnosis related groups (DRG) payment system was implemented to address the cost issue, challenging hospital physicians to provide services within predefined prices and an economic target corridor to reduce costs. This study examines the extent of cost awareness among medical personnel in German hospitals and its influencing factors. METHODS: We developed an online survey in which participants across all specialties in hospitals estimated the prices in euros of four common interventions and answered questions about their human capital and perceived stress on the workplace. As a measure of cost awareness, we used the probability of estimating the prices correctly within a reasonable margin. We employed logit logistic regression estimators to identify influencing factors in a sample of 86 participants. RESULTS: The results revealed that most of the respondents were unaware of the costs of common interventions. General human capital, acquired through prior education, and job-specific human capital had no influence on cost awareness, whereas domain-specific human capital, that is, gaining economic knowledge based on self-interest, had a positive nonlinear effect on cost awareness. Furthermore, an increased stress level negatively influenced cost awareness. CONCLUSIONS: This paper is the first of its kind for the German health care sector that contributes responses to the question whether health care professionals in German hospitals have cost awareness and if not, what reasons lie behind this lack of knowledge. Our findings show that the cost awareness desired by the introduction of the DRG system has yet to be achieved by medical personnel.

Initial Assessment and Management of Select Musculoskeletal Injuries: A Team Physician Consensus Statement.

ABSTRACT: Musculoskeletal injuries occur frequently in sport during practice, training, and competition. Injury assessment and management are common responsibilities for the team physician. Initial Assessment and Management of Musculoskeletal Injury-A Team Physician Consensus Statement is title 23 in a series of annual consensus documents written for the practicing team physician. This statement was developed by the Team Physician Consensus Conference, an annual project-based alliance of six major professional associations. The goal of this document is to help the team physician improve the care and treatment of the athlete by understanding the initial assessment and management of selected musculoskeletal injuries.