Delivering Rehabilitation Care Around the World: Voices From the Field.

OBJECTIVES: To identify the challenges and common issues that the rehabilitation health workforce experienced in delivering services in different practice settings across the world. These experiences could suggest approaches to improving rehabilitation care to people in need. DESIGN: A semi-structured interview protocol centering on 3 broad research questions was conducted to collect data. The data were analyzed to identify common themes across the cohort interviewed. SETTING: Interviews were conducted using Zoom. Interviewees not able to access Zoom provided written responses to the questions. PARTICIPANTS: Participants included 30 key rehabilitation opinion leaders from different disciplines from 24 countries, across world regions and income levels (N=30). INTERVENTIONS: NA. MAIN OUTCOME MEASURES: Although rehabilitation care deficiencies differ in severity, participants reported that the demand for services consistently outstrips available care, regardless of world region or income level. Access and social barriers, particularly in rural areas and remote regions, are common challenges for those delivering and receiving rehabilitation care. RESULTS: Individual voices from the field reported both challenges and hopeful changes in making rehabilitation services available and accessible. CONCLUSIONS: The descriptive approach undertaken has allowed individual voices, rarely included in studies, to be highlighted as meaningful data. Although the research findings are not generalizable beyond the convenience cohort included without further analysis and validation in specific local practice contexts, the authentic voices that spoke out on these issues demonstrated common themes of frustration with the current state of rehabilitation services delivery but also hopefulness that more solutions are on the horizon.

Framework to Guide Health Professions Faculty Towards Increased Scholarship: Recommendations from the ASAHP Research, Discovery & Innovation Committee.

The Research, Discovery, and Innovation Publications (RDI-P) Task Force met from October 2020 to March 2022 to discuss ways in which the Association of Schools Advancing Health Professions (ASAHP) can help to guide institutional leaders to assign faculty effort and resources to enable success with the scholarship mission. The purpose of this White Paper is to propose a guiding framework for institutional leaders to determine their faculty's individual or team scholarly goals, assign appropriate percent efforts (funded/unfunded), and guide an overall faculty mix that balances required teaching loads with scholarly activities. The Task Force identified seven modifiable factors that can influence workload allocation for scholarship: 1. Limited range of the spectrum for effort distribution; 2. Matching expectations with reality; 3. Clinical training undervalued as adequate prep for translational or implementation research; 4. Limited support for mentorship availability; 5. Richer collaborations needed; 6. Finding resources and matching them to individual faculty needs; and 7. Further time for training needed. We then provide a set of recommendations to address the seven issues described. Finally, we describe four foci of scholarly activity (evidence-based educator; evidence-based clinical application; evidence-based collaborator; and evidence-based principal leader) with which a leader can develop strategies to align faculty interests and growth opportunities towards advancing scholarship.

Global Rehabilitation Health Worker Certification: Global Agenda, Local Imperative.

Rehabilitation, seen as a disability-specific service needed only by few of the world's population, has not been prioritized in countries and is under-resourced. A rehabilitation-ready health workforce is potentially the most important resource for improving functioning and the quality of life for the 2.41 billion people worldwide needing this care. In April 2019, CGFNS International, Inc., and the Association of Schools Advancing Health Professions (ASAHP) partnered to respond to the World Health Organization's Rehab 2030, which emphasizes the need for global action by professional organizations, development agencies, and civil society to develop and maintain a sustainable workforce for rehabilitation under different healthcare models in different economies. The global certification framework presented in this article provides a mechanism to validate rehabilitation knowledge and practice competence of individual health workers. The impact of certification on upgrading rehabilitation education and upskilling the world's rehabilitation health workforce cannot be overstated.

Examining the association between educational attainment and life expectancy in MENA region: A panel data analysis.

BACKGROUND: The purpose of this study is to investigate the association between educational attainment and life expectancy in 18 countries in MENA region. METHODS: We used World Bank database for a panel of 18 MENA countries during the years 1995 to 2009. We used Life Expectancy at Birth, as the key health care output measure. Additionally, we used six health care input independent variables. All variables were transformed into natural logarithms. We estimated the production function using Cobb-Douglas function. RESULTS: Results indicate that 1% increase in educational attainment of males 25 to 34 years old, males 25 years and older, females 25 to 34 years old, females 25 years and older, and females aged 15 to 44 years old will increase life expectancy by 0.14%, 0.07%, 0.04%, 0.03%, and 0.04%, respectively, while everything else remains constant. CONCLUSION: Our results suggest that for MENA region countries investing in education to broaden access would improve health outcomes and life expectancy. Boosting educational attainment for both male and female population may close the life expectancy gaps between the MENA region and other developed countries, and males and females within the same country. Education attainment has the potential to be a social remedy for better health outcomes in MENA countries.

Measuring Efficiency of Health Systems of the Middle East and North Africa (MENA) Region Using Stochastic Frontier Analysis.

OBJECTIVE: The main purpose of this study is to measure the technical efficiency of twenty health systems in the Middle East and North Africa (MENA) region to inform evidence-based health policy decisions. In addition, the effects of alternative stochastic frontier model specification on the empirical results are examined. METHODS: We conducted a stochastic frontier analysis to estimate the country-level technical efficiencies using secondary panel data for 20 MENA countries for the period of 1995-2012 from the World Bank database. We also tested the effect of alternative frontier model specification using three random-effects approaches: a time-invariant model where efficiency effects are assumed to be static with regard to time, and a time-varying efficiency model where efficiency effects have temporal variation, and one model to account for heterogeneity. RESULTS: The average estimated technical inefficiency of health systems in the MENA region was 6.9 % with a range of 5.7-7.9 % across the three models. Among the top performers, Lebanon, Qatar, and Morocco are ranked consistently high according to the three different inefficiency model specifications. On the opposite side, Sudan, Yemen and Djibouti ranked among the worst performers. On average, the two most technically efficient countries were Qatar and Lebanon. We found that the estimated technical efficiency scores vary substantially across alternative parametric models. CONCLUSION: Based on the findings reported in this study, most MENA countries appear to be operating, on average, with a reasonably high degree of technical efficiency compared with other countries in the region. However, there is evidence to suggest that there are considerable efficiency gains yet to be made by some MENA countries. Additional empirical research is needed to inform future health policies aimed at improving both the efficiency and sustainability of the health systems in the MENA region.

Examining the health care payment reforms in Abu Dhabi.

OBJECTIVE: The purpose of this paper is to provide an overview of the current health care payment reforms in Abu Dhabi and discuss the potential impact of these reforms on health care consumers and providers as we all as long-term sustainability of the mandatory health care insurance system. METHODS: A focused literature review was conducted to systematically identify and summarize relevant literature published on the recent payments reforms in Abu Dhabi along with a secondary review and analysis of existing related government documents, technical reports, and press releases by the Health Authority-Abu Dhabi (HAAD) and other relevant research groups. RESULTS: The implementation of the mandatory health insurance system allowed all UAE nationals and foreign workings in Abu Dhabi to have access to medical care insurance and access to care. Prospective payment reforms represent critical sustainability interventions for health care funding in Abu Dhabi. The full impact of payment reforms on affordability, system efficiency, and patient outcomes is yet to be documented. CONCLUSION: Given the Government of Abu Dhabi has identified the sustainability of healthcare funding as a key governmental policy, more research is needed to systematically examine the impact of the current payment reforms on multiple stakeholders.

Quality improvement in healthcare delivery utilizing the patient-centered medical home model.

Despite the fact that the United States dedicates so much of its resources to healthcare, the current healthcare delivery system still faces significant quality challenges. The lack of effective communication and coordination of care services across the continuum of care poses disadvantages for those requiring long-term management of their chronic conditions. This is why the new transformation in healthcare known as the patient-centered medical home (PCMH) can help restore confidence in our population that the healthcare services they receive is of the utmost quality and will effectively enhance their quality of life. Healthcare using the PCMH model is delivered with the patient at the center of the transformation and by reinvigorating primary care. The PCMH model strives to deliver effective quality care while attempting to reduce costs. In order to relieve some of our healthcare system distresses, organizations can modify their delivery of care to be patient centered. Enhanced coordination of services, better provider access, self-management, and a team-based approach to care represent some of the key principles of the PCMH model. Patients that can most benefit are those that require long-term management of their conditions such as chronic disease and behavioral health patient populations. The PCMH is a feasible option for delivery reform as pilot studies have documented successful outcomes. Controversy about the lack of a medical neighborhood has created concern about the overall sustainability of the medical home. The medical home can stand independently and continuously provide enhanced care services as a movement toward higher quality care while organizations and government policy assess what types of incentives to put into place for the full collaboration and coordination of care in the healthcare system.

Assessment of the Turkish health care system reforms: a stakeholder analysis.

BACKGROUND: The Turkish health care system has been undergoing a significant transformation with the Health Transformation Program (HTP) since 2003. The HTP's overall objective is to improve governance, efficiency, user and provider satisfaction, and long-term fiscal sustainability of the health care system in Turkey. OBJECTIVES: To systematically evaluate the effects of the HTP Phase I reforms on various stakeholders, and to outline strategic options for the implementation of the second phase of health transformation in Turkey. METHODS: A total of 47 formal structured stakeholder interviews, representing 29 different institutions, are conducted between December 2008 and January 2009. Five main components of the HTP were examined: strengthening of the Ministry of Health (MoH) capacity for stewardship, universal health insurance, reorganizing health service delivery, human resources development, and national health information system. RESULTS AND CONCLUSIONS: There is a general agreement among stakeholders that the progress made thus far is the greatest in the national health information system and the slowest in strengthening the MoH capacity for stewardship. It appears that the HTP has the capacity to deliver cost-effective health care services and the implementation progress, so far, is in congruence with the overall economic development and growth in Turkey.

Healthcare financing: how does Turkey compare?

The authors provide an overview of Turkey's healthcare financing. After comparing financing data on Turkey and other Organization for Economic Cooperation and Development (OECD) member countries, they examine Turkey's performance on a wide range of healthcare input and outcome indicators using descriptive data drawn from the World Health Organization, World Bank, OECD, and Turkish Statistical Institute. The data analysis shows that Turkey ranks low by a number of key healthcare indicators across the OECD countries. Empirical analysis suggests that although many factors are associated with improvements in healthcare outcomes, a significant part of changes in life expectancy at birth are associated with higher spending on healthcare.

Assessing the accuracy of drug profiles in an electronic medical record system of a Washington state hospital.

OBJECTIVES: To determine the accuracy of patients' electronic medical record (EMR) drug profiles, to assess the relationship of copayment status with errors of commission and omission within drug profiles, and to evaluate the association between errors of commission in primary and secondary sections of the drug profiles. STUDY DESIGN: Cross-sectional analysis of patients' EMR drug profiles at a 46-bed hospital in Washington state. METHODS: Patients' drug profiles were compared against hospital staff interviews. Drug profiles listing each medication the patient was taking, without listing drugs the patient was not taking, exhibited perfect accuracy. We evaluated associations between errors of commission and omission, copayment status between errors of commission and omission, and associations between errors of commission in primary and secondary sections of the drug profiles. RESULTS: Demographics of study patients are similar to previously published research, and accuracy outcomes seem to be better than those of previously published studies. Fifty-six percent of drug profiles in our study hospital exhibited perfect accuracy. Errors of commission and omission were unassociated with copayment status; errors of commission in the primary section of the drug profile were unassociated with errors of commission in the secondary section of the drug profile. CONCLUSIONS: A medication reconciliation program may have led to a high rate of perfectly accurate drug profiles; while its purpose is to increase accuracy and to decrease errors, it may also assist in reducing adverse drug events. Results show that copayment amounts influence drug utilization; these may be associated with errors of commission and omission and not simply with copayment status.

Assessment of health-related quality of life (HRQoL) of patients with type 2 diabetes in Turkey.

We measured the health-related quality of life (HRQoL) in a sample of 376 type 2 diabetes patients in Turkey using the Diabetes Quality of Life (DQOL) instrument and examined which patient socio-demographic and diabetes-related clinical characteristics are associated with better quality of life (QoL). The influence of patient socio-demographic and clinical characteristics on QoL was examined using independent sample t-tests and one-way analysis of variance. Diabetes significantly affected the HRQoL of patients included in this study. The mean score of the total DQOL measure was higher among patients who were less than 40 years of age, male, married, had less than 8 years of education, lived with their family and had no family history of diabetes (p<0.05). Similarly, patients with less than 5 years of disease duration, no complications or prior hospitalization, receive insulin, and with HbA(1)c<7 reported significantly better overall HRQoL (p<0.05). Patients with BMI<24 had higher levels of satisfaction with diabetes than those with BMI>or=24 (p<0.05). Diabetes-related HRQoL information is clearly of supreme importance to family physicians and policy makers to identify and implement appropriate interventions for achieving better management of diabetes and ultimately improving the QoL of diabetes patients.

The relationship between guardian certification requirements and guardian sanctioning: a research issue in elder law and policy.

This study investigated the relationship between guardian certification requirements and guardian sanctioning in the state of Washington. A total of 377 files were examined. Findings show that 52.4% of guardians with an undergraduate degree or higher education are likely to be sanctioned compared with 42.2% with an Associate of Arts (AA) or Technical (Tech) degree, and 36.9% with a high school diploma (HS) or equivalency (GED). Guardians with an undergraduate or higher education are 1.88 times more likely to be sanctioned compared with GED or HS graduates (p < 0.05). However, 83.3% of GED or HS graduates are likely to have more severe sanctions compared with 76.4% undergraduate or higher education, and 47.7% with an AA or Tech degree, respectively. Guardians with an AA or Tech degree are 0.28 times less likely to have more severe sanctions than guardians with an undergraduate degree or higher education (p < 0.01). The results are discussed with respect to guardian registration, licensing, certification and quality; licensing and regulation of other professions; the limitations of the study; and the need for further research.

Translation, cultural adaptation, cross-validation of the Turkish diabetes quality-of-life (DQOL) measure.

OBJECTIVE: The aim of this study was to test the validity and reliability of the Turkish version of the diabetes quality of life (DQOL) questionnaire for use with patients with diabetes. METHODS: Turkish version of the generic quality of life (QoL) scale 15D and DQOL, socio-demographics and clinical parameter characteristics were administered to 150 patients with type 2 diabetes. Study participants were randomly sampled from the Endocrinology and Diabetes Outpatient Department of Dr. Lutfi Kirdar Kartal Education and Research Hospital in Istanbul, Turkey. RESULTS: The Cronbach alpha coefficient of the overall DQOL scale was 0.89; the Cronbach alpha coefficient ranged from 0.80 to 0.94 for subscales. Distress, discomfort and its symptoms, depression, mobility, usual activities, and vitality on the 15 D scale had statistically significant correlations with social/vocational worry and diabetes-related worry on the DQOL scale indicating good convergent validity. Factor analysis identified four subscales: satisfaction", impact", "diabetes-related worry", and "social/vocational worry". CONCLUSION: Statistical analyses showed that the Turkish version of the DQOL is a valid and reliable instrument to measure disease related QoL in patients with diabetes. It is a simple and quick screening tool with about 15 +/- 5.8 min administration time for measuring QoL in this population.

An evaluation of the opinions of hospital employees regarding the contribution of internal marketing to the application of total quality management in Turkey.

This research was conducted in a training-research hospital in Ankara, the capital of Turkey, in order to assess the contributions of internal marketing to the success of TQM applications by means of employee communication and participation. The key findings of this research indicate that the cultural changes needed to maintain the success of TQM applications in the organization were not achieved, there were problems in the internal communication system, effective participation of employees was not achieved, and public relations and internal marketing activities were not employed in a sufficient manner. Specific managerial recommendations are offered in regard to ensuring effective employee support and participation in TQM applications, improving internal communication, and effective application of modern internal marketing tools and methods.

Turkish version of the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration: a preliminary study.

BACKGROUND: The Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration is an established instrument to measure the perceived work relationship between physicians and nurses. The survey addresses areas of autonomy and decision making, interprofessional education and relations, psychosocial care, teamwork, and shared responsibility. The aim of this prelimiary study was to adapt the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration for use in Turkey and test its psychometric properties and utility in clinical and research practice. METHODS: The process of cross-cultural adaptation and validation followed the guidelines provided in the existing literature. First, three bilingual health professionals independently translated the original questionnaire into Turkish and a consensus version was generated. Then, three other translators, blind to the original questionnaire, performed a back translation into English to confirm the accuracy of the translation. This version was then compared with the original English questionnaire. Discrepancies were discussed and solved by a panel of two nurses and two physicians. The field-testing for face validity was done in a group of ten monolingual physicians and nurses. Reliability was assessed with test-retest reliability and construct validity was confirmed with factor analysis. RESULTS: The mean time of questionnaire administration was 3 minutes and 45 seconds. The test-retest reliability was 0.75, and Cronbach's coefficient alpha was 0.71 for the entire sample. The findings of the factor analysis indicated that the Turkish version of Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration was comprised of the following four factors: 'physician-nurse relationships', 'shared education', 'nursing role in patient care', and 'accountability and responsibility of nurses.' CONCLUSION: The overall findings of this study indicate that the Turkish version of the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration is a psychometrically sound tool with satisfactory measurement characteristics including construct validity and internal consistency reliability. This instrument may be useful in assessing the effectiveness of educational programs designed to enhance collaboration between physicians and nurses, whether these programs are aimed at residents and graduate nursing students or practicing physicians and nurses.

Nurse staffing levels and quality of care in Northeastern Pennsylvania nursing homes.

This study evaluated current nurse staffing levels in 90 licensed nursing homes in Northeastern Pennsylvania to determine whether they are significantly different from state and national averages. It further examined the association between nurse staffing and quality of patient care provided to nursing home residents. Findings indicate that although nurse staffing levels appear to be comparable with state and national averages, quality of care might be negatively affected when nurse staffing levels are reduced. Practical recommendations for solutions to the current nurse recruitment and retention crises are presented to ensure adequate nurse staffing and quality of care to elderly citizens.

Physician-nurse attitudes toward collaboration in Istanbul's public hospitals.

The need for greater collaboration between nurses and physicians in clinical practice is essential to improve patient care and worker satisfaction. This study used t-tests and logistic regression to test four research hypotheses concerning attitudes toward physician-nurse collaboration in Istanbul, Turkey. The study found that nurses express more positive attitudes toward collaboration than physicians. Noteworthy was the finding that male physicians expressed more positive attitudes toward collaboration than female physicians. Residents and those employed in secondary institutions were also more likely to express more positive attitudes toward collaboration than permanent physicians and those employed in tertiary hospitals.

Translation, cultural adaptation, initial reliability, and validation of Turkish 15D's version: a generic health-related quality of life (HRQoL) instrument.

This article describes the adaptation of the Finnish 15D standardized measure of health-related quality of life (HRQoL) instrument for use in Turkey and assesses its psychometric properties. The HRQoL is measured in a sample of 75 patients with Type 2 diabetes using both 15D and Nottingham Health Profile (NHP) instruments. The internal consistency within the domains of 15D was high, with Cronbach's alpha values 0.89 for 15D scale and 0.89 for NHP. Significant correlations were observed between the scores of similar domains of 15D and the NHP in general health perception supporting the construct validity of the new 15D Turkish version. Overall, the results indicated that the adaptation of the 15D for use in Turkey was successful. The Turkish version was found to be a reliable and valid instrument. It is suitable and applicable to both clinical and population-based studies for the measurement of HRQoL in Turkey.

The role of social marketing in understanding access to primary health care services: perceptions and experiences.

Using the concept of social marketing, this study examined the determinants of access to primary health care services in order to better understand the perceived access problems and unmet service needs of an entire city in Northeastern Pennsylvania. Consistent with previous research, lack of access to health insurance coverage represents an important financial barrier to access to health care services in this community. This study also highlights the role of perceived need in explaining the presence or absence of a physician consultation.While increased attention to access issues at the national level is important, there also needs to be more emphasis on collecting local data for local decision-making regarding access issues.

Managerial implications of medical sales representative perceptions of job duties, job qualifications, and other performance-related issues.

This study examined the perceptions of medical sales representatives of job related duties, job qualifications needed, and motivating factors and tested for differences based on gender, age, years of experience and education using prior research as a base. This study also explored issues that may arise between sales people and physicians. The authors surveyed 132 medical sales representatives from pharmaceutical firms located in Ankara, Turkey. The authors' findings highlight the need in Turkey for developing in-service training programs for medical sales representatives, especially in the areas related to technical aspects of the product, effective marketing and personal selling strategies, and consumer relations. Training in these areas will help salespeople to better manage the problems typically encountered in physician-sales representative relations. While the study was conducted in Turkey, the results are similar to findings in prior research conducted in other countries and therefore may be of interest to all sales managers.