Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 65.466
Filtrar
4.
Ig Sanita Pubbl ; 76(3): 173-186, 2020.
Artículo en Italiano | MEDLINE | ID: mdl-33142309

RESUMEN

INTRODUCTION: Missed Nursing Care is widely recognized as affecting patient safety and healthcare outcomes. Theoretical frameworks, antecedents and consequences have been extensively studied while interventions aimed at preventing the Missed Nursing Care remain little investigated to date. Nurse Managers and Nurse Directors play a main role in promoting interventions at the unit, hospital and at the policy levels. However, few evidences are available to date, thus limiting an evidence-based approach. The aim of this study was to emerge interventions used on a daily basis by Nurse Managers and Directors to prevent and/or minimize Missed Nursing Care. METHODS: A qualitative descriptive study design based upon a positive deviance approach was adopted. Twelve Nurse Managers and Nurse Directors were purposefully selected, working at Hospital, Healthcare Trust or Nursing Home levels, in Italy. Participants were interviewed in two focus group sessions. A thematic analysis of the audio-recorded interviews was performed by two researchers. RESULTS: The following interventions have been reported as effective in preventing and/or minimizing the Missed Nursing Care: (a) Expanding the nursing care capacity; (b) Ensuring the standard of care and an early detection of failures; (c) Monitoring the processes of care; (d) Promoting a shared decision-making; (e) Redesigning the layout of the hospital systems; (f) Promoting a culture towards the Missed Nursing Care prevention, and (g) Realigning the nurse management to the care of patients. DISCUSSION: Several interventions based mainly on process dimension and with preventive intents are daily enacted by Nurse Managers and Directors to prevent and/or minimize Missed Nursing Care. Measuring the effect of these interventions through rigorous studies could help in expanding the evidence available to contrast a phenomenon that threatens patient safety.


Asunto(s)
Enfermeras Administradoras/psicología , Supervisión de Enfermería/organización & administración , Flujo de Trabajo , Humanos , Entrevistas como Asunto , Italia , Investigación Cualitativa
6.
PLoS One ; 15(10): e0230849, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33031399

RESUMEN

INTRODUCTION: In South Africa, in 2013-2014, provision of antiretroviral treatment (ART) shifted in some areas from NGOs to public facilities. Tuberculosis (TB) management has also been integrated into public services. We aimed to explore the opinions and experiences of service managers and healthcare providers regarding integration of HIV and TB services into primary healthcare services. METHODS: The study sites included three clinics in one peri-urban/urban administrative region of Johannesburg. From March 2015 to August 2016, trained interviewers conducted semi-structured interviews with purposively selected participants. Participants were eligible if they were city/regional managers, clinic managers, or healthcare providers responsible for HIV, TB, non-communicable diseases, or sexual and reproductive health at the three study sites. We used a grounded theory approach for iterative, qualitative analysis, and produced descriptive statistics for quantitative data. RESULTS: We interviewed 19 individuals (nine city/regional managers, three clinic managers, and seven nurses). Theoretical definitions of integration varied, as did actual practice. Integration of HIV treatment had been anticipated, but only occurred when required due to shifts in funding for ART. The change was rapid, and some clinics felt unprepared. That said, nearly all respondents were in favor of integrated care. Perceived benefits included comprehensive case management, better client-nurse interactions, and reduced stigma. Barriers to integration included staff shortages, insufficient training and experience, and outdated clinic infrastructure. There were also concerns about the impact of integration on staff workloads and waiting times. Finally, there were concerns about TB integration due to infection control issues. DISCUSSION: Integration is multi-faceted and often contingent on local, if not site-specific, factors. In the future in South Africa and in other settings contending with health service reorganization, staff consultations prior to and throughout phase-in of services changes could contribute to improved understanding of operational requirements, including staff needs, and improved patient outcomes.


Asunto(s)
Antivirales/uso terapéutico , Prestación Integrada de Atención de Salud/estadística & datos numéricos , Infecciones por VIH/tratamiento farmacológico , Tuberculosis/tratamiento farmacológico , Actitud del Personal de Salud , Femenino , Humanos , Entrevistas como Asunto , Masculino , Médicos de Atención Primaria , Atención Primaria de Salud , Investigación Cualitativa , Salud Reproductiva , Sudáfrica
7.
PLoS One ; 15(10): e0239400, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33035216

RESUMEN

BACKGROUND: After a COVID-19 diagnosis, vulnerable populations face considerable logistical and financial challenges to isolate and quarantine. We developed and evaluated a novel, community-based approach ('Test-to-Care' Model) designed to address these barriers for socioeconomically vulnerable Latinx individuals with newly diagnosed COVID-19 and their households. METHODS: This three-week demonstration project was nested within an epidemiologic surveillance study in a primarily Latinx neighborhood in the Mission district of San Francisco, California. The Test-to-Care model was developed with input from community members and public health leaders. Key components included: (1) provision of COVID-19-related education and information about available community resources, (2) home deliveries of material goods to facilitate safe isolation and quarantine (groceries, personal protective equipment and cleaning supplies), and (3) longitudinal clinical and social support. Newly SARS-CoV-2 PCR-positive participants were eligible to participate. Components of the model were delivered by the Test-to-Care team, which was comprised of healthcare providers and community health workers (CHWs) who provided longitudinal clinic- and community-based support for the duration of the isolation period to augment existing services from the Department of Public Health (DPH). We evaluated the Test-to-Care Model using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) Framework and drew upon multiple data sources including: programmatic data, informal interviews with participants and providers/CHWs and structured surveys among providers/CHWs. RESULTS: Overall, 83 participants in the surveillance study were diagnosed with COVID-19, of whom 95% (79/83) were Latinx and 88% (65/74) had an annual household income <$50,000. Ninety-six percent (80/83) of participants were reached for results disclosure, needs assessment and DPH linkage for contact tracing. Among those who underwent an initial needs assessment, 45% (36/80) were uninsured and 55% (44/80) were not connected to primary care. Sixty-seven percent (56/83) of participants requested community-based CHW support to safely isolate at their current address and 65% (54/83) of all COVID-19 participants received ongoing community support via CHWs for the entire self-isolation period. Participants reported that the intervention was highly acceptable and that their trust increased over time-this resulted in 9 individuals who disclosed a larger number of household members than first reported, and 6 persons who requested temporary relocation to a hotel room for isolation despite initially declining this service; no unintended harms were identified. The Test-to-Care Model was found to be both acceptable and feasible to providers and CHWs. Challenges identified included a low proportion of participants linked to primary care despite support (approximately 10% after one month), and insufficient access to financial support for wage replacement. CONCLUSIONS: The Test-to-Care Model is a feasible and acceptable intervention for supporting self-isolation and quarantine among newly diagnosed COVID-19 patients and their households by directly addressing key barriers faced by socioeconomically vulnerable populations.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Modelos Teóricos , Neumonía Viral/diagnóstico , Pobreza , Adolescente , Adulto , Anciano , Betacoronavirus/genética , Betacoronavirus/aislamiento & purificación , Niño , Preescolar , Agentes Comunitarios de Salud/educación , Agentes Comunitarios de Salud/psicología , Infecciones por Coronavirus/economía , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/virología , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Pandemias/economía , Neumonía Viral/economía , Neumonía Viral/terapia , Neumonía Viral/virología , Atención Primaria de Salud , Cuarentena , Apoyo Social , Encuestas y Cuestionarios , Adulto Joven
8.
Harm Reduct J ; 17(1): 77, 2020 10 19.
Artículo en Inglés | MEDLINE | ID: mdl-33076911

RESUMEN

BACKGROUND: Technology can enable syringe service programs (SSPs) and other community-based organizations (CBOs) operating under a harm reduction framework to work with an increased number of clients and can also enable organizations to offer services more effectively (e.g., offering HIV testing in ways participants may be more likely to accept). In the current time of COVID-19 social distancing, technology can also help organizations more safely provide services to people with compromised immune systems and to clients who might otherwise not be reached. However, technology projects implemented in harm reduction settings are frequently conceptualized and developed by researchers or technology specialists rather than by SSP staff or clients. METHODS: To more effectively meet the needs of SSPs and other CBOs across the USA, our team conducted qualitative interviews with 16 individuals who have extensive backgrounds working in the field of harm reduction. Interviews were digitally recorded and professionally transcribed, and the transcripts were checked for accuracy by the interviewers. The resulting transcripts were coded and analyzed to determine emerging themes. RESULTS: Interviewees mentioned the ability of technology to deliver consistent quality messaging to multiple clients at the same time and the potential to customize or tailor technology-based messaging to specific client populations as positive benefits. Clear barriers to technology use also emerged, in particular regarding privacy, data security, and the need to maintain client trust when discussing sensitive issues (e.g., illicit drug use). CONCLUSIONS: Technology offers the potential to deliver consistently high-quality health communication and maintain contact with clients who may have no other access to care. If designed and managed effectively, technology can also address issues related to providing services during times when physical contact is limited due to COVID-19 social distancing measures.


Asunto(s)
Betacoronavirus , Servicios de Salud Comunitaria/métodos , Infecciones por Coronavirus/prevención & control , Reducción del Daño , Educación en Salud/métodos , Programas de Intercambio de Agujas/métodos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Grabación de Cinta de Video/métodos , Adulto , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Medios de Comunicación Sociales , Estados Unidos , Adulto Joven
9.
BMC Med Educ ; 20(1): 377, 2020 Oct 22.
Artículo en Inglés | MEDLINE | ID: mdl-33092586

RESUMEN

BACKGROUND: The coronavirus pandemic has exerted significant impacts on primary care, causing rapid digital transformation, exacerbating social isolation, and disrupting medical student and General Practice [GP] trainee education. Here we report on a medical student telephone initiative set-up by a final year GP trainee (the equivalent of a family medicine resident), which aimed to support patients at high risk and vulnerable to the Coronavirus Disease of 2019 [Covid-19]. In addition, it was hoped the project would mitigate a digital divide, enable proactive anticipatory planning, and provide an active learning environment to compensate for the pandemic's impact on medical education. METHODS: Thirty-three medical students conducted daily telephone conversations with high risk and vulnerable patients as specified by the initial NHSE published lists. They confirmed public health messages, offered details for voluntary support groups, established need for medication delivery, explored levels of digital connectivity, and prompted discussions around end-of-life choices. Students had access to online reflective resources and daily remote debriefing sessions with the GP trainee. A convergent mixed-methods evaluation was subsequently undertaken, using quantitative process and descriptive data and individual qualitative interviews were conducted according to a maximal variation sampling strategy with students, General Practitioners [GPs], and the GP trainee. Inductive thematic analysis was then applied with cross-validation, respondent validation, and rich evidential illustration aiding integrity. RESULTS: Ninety-seven 'high risk' and 781 'vulnerable' calls were made. Individuals were generally aware of public heath information, but some struggled to interpret and apply it within their own lives. Therefore respondents felt students provided additional practical and psychological benefits, particularly with regard to strengthening the links with the community voluntary groups. The project was widely liked by students who reported high levels of skill development and widened awareness, particularly valuing the active learning environment and reflective feedback sessions. CONCLUSION: This study demonstrates utilization of medical students as wider assets within the primary health care team, with an initiative that enables support for vulnerable patients whilst promoting active medical education. Ongoing integration of students within 'normal' primary health care roles, such as chronic disease or mental health reviews, could provide similar opportunities for supported active and reflective learning.


Asunto(s)
Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Estudiantes de Medicina , Brecha Digital , Educación Médica/métodos , Humanos , Entrevistas como Asunto , Pandemias , Educación del Paciente como Asunto , Teléfono , Cuidado Terminal , Reino Unido , Poblaciones Vulnerables
10.
PLoS One ; 15(10): e0239279, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33027276

RESUMEN

BACKGROUND: Funding bodies are placing increased emphasis on patient and public involvement in research, but the research priorities of individuals and caregivers living with dementia with Lewy bodies (DLB) are unknown. METHOD: Investigators conducted telephone interviews with individuals living with DLB and caregivers. Participants were recruited from a Lewy Body Dementia Association Research Center of Excellence. Interviews employed a semi-structured questionnaire querying research needs in different categories and then asking participants to select their top priorities. Investigators used a qualitative descriptive approach to analyze transcripts and identify themes. RESULTS: Twenty individuals with DLB and 25 caregivers participated. Seventeen from each group participated as part of a patient-caregiver dyad. Twenty-three of the caregivers were spouses, two were daughters. Individuals with DLB and caregivers identified research needs relating to focusing on awareness, determining the cause of DLB, improving diagnosis, and investigating what to expect/disease stages. Participants also highlighted DLB symptoms needing additional research, therapies to prevent, cure, or slow the progression of DLB, and research targeting daily function and quality of life, caregiving, and improving education. CONCLUSIONS: These findings support the research priorities defined in the National Institutes of Health dementia care summits in addition to ADRD priority-setting summits. Research is needed across all domains of DLB. Funding should be informed by the priorities of all relevant stakeholders and support research investigating causes, natural history, biomarkers, and treatment in addition to research targeting themes regarding living with disease (e.g. independence, quality of life, caregiving, and education).


Asunto(s)
Cuidadores/psicología , Enfermedad por Cuerpos de Lewy/psicología , Anciano , Anciano de 80 o más Años , Concienciación , Femenino , Humanos , Entrevistas como Asunto , Enfermedad por Cuerpos de Lewy/diagnóstico , Enfermedad por Cuerpos de Lewy/patología , Masculino , Persona de Mediana Edad , Calidad de Vida , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Teléfono
11.
PLoS One ; 15(10): e0239345, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33031437

RESUMEN

Human subsistence societies have thrived in environmental extremes while maintaining biodiversity through social learning of ecological knowledge, such as techniques to prepare food and medicine from local resources. However, there is limited understanding of which processes shape social learning patterns and configuration in ecological knowledge networks, or how these processes apply to resource management and biological conservation. In this study, we test the hypothesis that the prestige (rarity or exclusivity) of knowledge shapes social learning networks. In addition, we test whether people tend to select who to learn from based on prestige (knowledge or reputation), and homophily (e.g., people of the same age or gender). We used interviews to assess five types of medicinal plant knowledge and how 303 people share this knowledge across four villages in Solomon Islands. We developed exponential random graph models (ERGMs) to test whether hypothesized patterns of knowledge sharing based on prestige and homophily are more common in the observed network than in randomly simulated networks of the same size. We found that prestige predicts five hypothesized network configurations and all three hypothesized learning patterns, while homophily predicts one of three hypothesized network configurations and five of the seven hypothesized learning patterns. These results compare the strength of different prestige and homophily effects on social learning and show how cultural practices such as intermarriage can affect certain aspects of prestige and homophily. By advancing our understanding of how prestige and homophily affect ecological knowledge networks, we identify which social learning patterns have the largest effects on biocultural conservation of ecological knowledge.


Asunto(s)
Conocimiento , Plantas Medicinales , Aprendizaje Social , Biodiversidad , Humanos , Entrevistas como Asunto , Melanesia , Plantas Medicinales/crecimiento & desarrollo , Red Social
12.
PLoS One ; 15(10): e0239336, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33052905

RESUMEN

All across the globe politically initiated research evaluations are based on "informed peer review" procedures. Scholars are appointed as evaluators and can apply self-defined quality standards in order to overcome shortcomings of standardized measures. Even though there are no binding criteria in these procedures and the quality standards of the scholars' disciplines vary, studies suggest that scholars, in their role as government-appointed research evaluators, assess research uniformly.By drawing on a small-N investigation, this study compares the quality standards scholars apply as government-appointed research evaluators with quality standards they follow as researchers. The study points to a paradox: Criteria scholars refer to while describing the excellence of their own research and criteria they use as evaluators differ and contradict each other. The results are discussed from different angles.


Asunto(s)
Evaluación de Programas y Proyectos de Salud/normas , Investigadores/psicología , Humanos , Entrevistas como Asunto , Desarrollo de Programa , Proyectos de Investigación
13.
PLoS One ; 15(10): e0239310, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33064737

RESUMEN

Infants born to HIV-infected mothers are more likely to be low birthweight (LBW) than other infants, a condition that is stigmatized in many settings worldwide, including sub-Saharan Africa. Few studies have characterized the social-cultural context and response to LBW stigma among mothers in sub-Saharan Africa or explored the views of women living with HIV (WLHIV) on the causes of LBW. We purposively sampled thirty postpartum WLHIV, who had given birth to either LBW or normal birthweight infants, from two tertiary hospitals in Accra, Ghana. Using semi-structured interviews, we explored women's understanding of the etiology of LBW, and their experiences of caring for a LBW infant. Interviews were analyzed using interpretive phenomenology. Mothers assessed their babies' smallness based on the baby's size, not hospital-recorded birthweight. Several participants explained that severe depression and a loss of appetite, linked to stigma following an HIV diagnosis during pregnancy, contributed to infants being born LBW. Women with small babies also experienced stigma due to the newborns' "undesirable" physical features and other people's unfamiliarity with their size. Consequently, mothers experienced blame, reluctance showing the baby to others, and social gossip. As a result of this stigma, women reported self-isolation and depressive symptoms. These experiences were layered on the burden of healthcare and infant feeding costs for LBW infants. LBW stigma appeared to attenuate with increased infant weight gain. A few of the women also did not breastfeed because they thought their baby's small size indicated pediatric HIV infection. Among WLHIV in urban areas in Ghana, mother and LBW infants may experience LBW-related stigma. A multi-component intervention that includes reducing LBW incidence, treating antenatal depression, providing psychosocial support after a LBW birth, and increasing LBW infants' weight gain are critically needed.


Asunto(s)
Infecciones por VIH/psicología , Madres/psicología , Periodo Posparto/psicología , Estereotipo , Adolescente , Adulto , Depresión/etiología , Femenino , Ghana , Infecciones por VIH/patología , Humanos , Lactante , Recién Nacido de Bajo Peso , Entrevistas como Asunto , Aislamiento Social , Aumento de Peso , Adulto Joven
14.
Sex Reprod Health Matters ; 28(3): 1831717, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33073725

RESUMEN

In recent decades, bold steps taken by the government of Nepal to liberalise its abortion law and increase the affordability and accessibility of safe abortion and family planning have contributed to significant improvements in maternal mortality and other sexual and reproductive health (SRH) outcomes. The Trump administration's Global Gag Rule (GGR) - which prohibits foreign non-governmental organisations (NGOs) from receiving US global health assistance unless they certify that they will not use funding from any source to engage in service delivery, counselling, referral, or advocacy related to abortion - threatens this progress. This paper examines the impact of the GGR on civil society, NGOs, and SRH service delivery in Nepal. We conducted 205 semi-structured in-depth interviews in 2 phases (August-September 2018, and June-September 2019), and across 22 districts. Interview participants included NGO programme managers, government employees, facility managers and service providers in the NGO and private sectors, and service providers in public sector facilities. This large, two-phased study complements existing anecdotal research by capturing impacts of the GGR as they evolved over the course of a year, and by surfacing pathways through which this policy affects SRH outcomes. We found that low policy awareness and a considerable chilling effect cut across levels of the Nepali health system and exacerbated impacts caused by routine implementation of the GGR, undermining the ecology of SRH service delivery in Nepal as well as national sovereignty.


Asunto(s)
Aborto Inducido/economía , Aborto Inducido/legislación & jurisprudencia , Servicios de Planificación Familiar/economía , Servicios de Planificación Familiar/legislación & jurisprudencia , Salud Global , Política , Desarrollo Económico , Femenino , Regulación Gubernamental , Derechos Humanos , Humanos , Internacionalidad , Entrevistas como Asunto , Nepal , Estados Unidos
15.
BMC Psychiatry ; 20(1): 489, 2020 10 06.
Artículo en Inglés | MEDLINE | ID: mdl-33023535

RESUMEN

BACKGROUND: COVID-19 infection is a new disease that infects a large number of people, killing a ratio of whom every day in the world. Healthcare staff, especially nurses, experience a great deal of psychological distress during care of COVID-19 patients. Detecting factors that disturb nurses' mental health during care of these patients can help to reduce their psychological distress. Therefore, this study aimed to explore nurses' experiences of psychological distress during care of patients with COVID-19. METHODS: The present qualitative research was performed using the conventional content analysis method in Iran from March to May 2020. Participants in this study included the nurses caring for patients with COVID-19, and they were selected based on the purposeful sampling method. The data was collected through 20 phone call interviews and analyzed based on the method proposed by Lundman and Graneheim. RESULTS: Qualitative data analysis revealed 11 categories including death anxiety, anxiety due to the nature of the disease, anxiety caused by corpse burial, fear of infecting the family, distress about time wasting, emotional distress of delivering bad news, fear of being contaminated, the emergence of obsessive thoughts, the bad feeling of wearing personal protective equipment, conflict between fear and conscience, and the public ignorance of preventive measures. CONCLUSION: The data showed that the nurses experienced a variety of psychological distress during care of patients with COVID-19. Through proper planning by authorities, it is possible to manage the risk factors of mental health distress in nurses and improve their mental health status.


Asunto(s)
Betacoronavirus , Agotamiento Profesional , Infecciones por Coronavirus , Personal de Enfermería en Hospital/psicología , Pandemias , Neumonía Viral , Distrés Psicológico , Adulto , Femenino , Humanos , Entrevistas como Asunto , Irán , Masculino
17.
BMC Infect Dis ; 20(1): 737, 2020 Oct 07.
Artículo en Inglés | MEDLINE | ID: mdl-33028228

RESUMEN

BACKGROUND: Chronic hepatitis C virus (HCV), which is a concern in many countries, is the leading cause of liver cancer around the world. Since Taiwan launched its national health insurance system in 1995, it has managed to extend health coverage to 99% of the Taiwanese population, providing free but limited antiviral treatment each year since 2017. However, many people in rural areas are unaware that they have chronic HCV; nor do they realize that new drugs with high cure rates could drastically reduce their health burden. The aim of this study is to explore the implementation facilitators of and barriers to inviting potentially infected patients in rural areas to be transferred for HCV ribonucleic acid (RNA) confirmation and new drug treatment. METHODS: A descriptive and prospective study design with an interdisciplinary collaboration approach was implemented. After five elements of referral were developed, telephone counseling was conducted between August 2018 and May 2019 in Yunlin, Taiwan. The elements of referral developed by the research team were: (1) forming and coordinating physicians' schedules, (2) recruiting and training volunteers, (3) training the nursing staff, (4) raising funds or resources, and (5) connecting with village leaders. Thereafter, we collaborated with two district health centers, a private local hospital, and health clinics. Based on the medical records provided by these agencies, community adults that were HCV antibody (anti-HCV) positive were invited to join the program. RESULTS: Of the 1795 adults who were serum anti-HCV positive, 1149 (64%) accepted transfer to a qualified hospital; of these, 623 (54.2%) had an HCV infection. 552 (88.6%) of those infected started receiving direct-acting antivirals (DAAs) treatment. The top four barriers to accepting transfer were: (1) they perceived themselves to be healthy (n = 98, 32.3%); (2) mistrust of treatment/healthcare (n = 60, 20.2%); (3) limited transportation to the hospital (n = 52, 17.5%); and (4) work conflict (n = 30, 10.1%). CONCLUSION: An interdisciplinary collaboration approach significantly contributed to the invitation of CHC patients, as well as their acceptance of HCV RNA confirmation and free DAAs treatment. Using anti-HCV data from previous medical records for case-finding and collaborating with a hospital and health clinics proved to be an efficient strategy.


Asunto(s)
Antivirales/uso terapéutico , Hepacivirus/genética , Hepatitis C Crónica/tratamiento farmacológico , ARN Viral/metabolismo , Adulto , Femenino , Hepacivirus/aislamiento & purificación , Anticuerpos contra la Hepatitis C/sangre , Hepatitis C Crónica/diagnóstico , Hepatitis C Crónica/psicología , Humanos , Comunicación Interdisciplinaria , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Derivación y Consulta , Población Rural , Taiwán
18.
PLoS One ; 15(10): e0241017, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33104705

RESUMEN

BACKGROUND: Economic recessions carry an impact on population health and access to care; less is known on how health systems adapt to the conditions brought by a downturn. This particularly matters now that the COVID-19 epidemic is putting health systems under stress. Brazil is one of the world's most affected countries, and its health system was already experiencing the aftermath of the 2015 recession. METHODS: Between 2018 and 2019 we conducted 46 semi-structured interviews with health practitioners, managers and policy-makers to explore the impact of the 2015 recession on public and private providers in prosperous (São Paulo) and impoverished (Maranhão) states in Brazil. Thematic analysis was employed to identify drivers and consequences of system adaptation and coping strategies. Nvivo software was used to aid data collection and analysis. We followed the Standards for Reporting Qualitative Research to provide an account of the findings. RESULTS: We found the concept of 'health sector crisis' to be politically charged among healthcare providers in São Paulo and Maranhão. Contrary to expectations, the public sector was reported to have found ways to compensate for diminishing federal funding, having outsourced services and adopted flexible-if insecure-working arrangements. Following a drop in employment and health plans, private health insurance companies have streamlined their offer, at times at the expenses of coverage. Low-cost walk-in clinics were hit hard by the recession, but were also credited for having moved to cater for higher-income customers in Maranhão. CONCLUSIONS: The 'plates' of a health system may shift and adjust in unexpected ways in response to recessions, and some of these changes might outlast the crisis. As low-income countries enter post-COVID economic recessions, it will be important to monitor the adjustments taking place in health systems, to ensure that past gains in access to care and job security are not eroded.


Asunto(s)
Personal Administrativo/psicología , Betacoronavirus , Infecciones por Coronavirus , Recesión Económica , Sector de Atención de Salud/economía , Administradores de Instituciones de Salud/psicología , Personal de Salud/psicología , Pandemias , Neumonía Viral , Sector Privado/economía , Sector Público/economía , Instituciones de Atención Ambulatoria/economía , Actitud del Personal de Salud , Brasil , Servicios de Salud Comunitaria/economía , Países en Desarrollo , Humanos , Reembolso de Seguro de Salud , Entrevistas como Asunto , Médicos/psicología , Investigación Cualitativa , Telemedicina , Desempleo
19.
BMC Med Inform Decis Mak ; 20(1): 216, 2020 09 10.
Artículo en Inglés | MEDLINE | ID: mdl-32912224

RESUMEN

BACKGROUND: Telehealth (TH) was introduced as a promising tool to support integrated care for the management of chronic obstructive pulmonary disease (COPD). It aims at improving self-management and providing remote support for continuous disease management. However, it is often not clear how TH-supported services fit into existing pathways for COPD management. The objective of this study is to uncover where TH can successfully contribute to providing care for COPD patients exemplified in a Greek care pathway. The secondary objective is to identify what conditions need to be considered for successful implementation of TH services. METHODS: Building on a single case study, we used a two-phase approach to identify areas in a Greek COPD care pathway where care services that are recommended in clinical guidelines are currently not implemented (challenges) and areas that are not explicitly recommended in the guidelines but that would benefit from TH services (opportunities). In phase I, we used the care delivery value chain framework to identify the divergence between the clinical guidelines and the actual practice captured by a survey with COPD healthcare professionals. In phase II, we conducted in-depth interviews with the same healthcare professionals based on the discovered divergences. The responses were analyzed with respect to identified opportunities for TH and care pathway challenges. RESULTS: Our results reveal insights in two areas. First, several areas with challenges were identified: patient education, self-management, medication adherence, physical activity, and comorbidity management. TH opportunities were perceived as offering better bi-directional communication and a tool for reassuring patients. Second, considering the identified challenges and opportunities together with other case context details a set of conditions was extracted that should be fulfilled to implement TH successfully. CONCLUSIONS: The results of this case study provide detailed insights into a care pathway for COPD in Greece. Addressing the identified challenges and opportunities in this pathway is crucial for adopting and implementing service innovations. Therefore, this study contributes to a better understanding of requirements for the successful implementation of integrated TH services in the field of COPD management. Consequently, it may encourage healthcare professionals to implement TH-supported services as part of routine COPD management.


Asunto(s)
Prestación Integrada de Atención de Salud/métodos , Personal de Salud/psicología , Enfermedad Pulmonar Obstructiva Crónica/terapia , Telemedicina/organización & administración , Grecia , Humanos , Entrevistas como Asunto , Grupo de Atención al Paciente , Investigación Cualitativa , Automanejo
20.
PLoS One ; 15(9): e0239472, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32956391

RESUMEN

BACKGROUND: Resilience engineering has been advocated as an alternative to the management of safety over the last decade in many domains. However, to facilitate metrics for measuring and helping analyze the resilience potential for emergency departments (EDs) remains a significant challenge. The study aims to redesign the Hollnagel's resilience assessment grid (RAG) into a custom-made RAG (ED-RAG) to support resilience management in EDs. METHODS: The study approach had three parts: 1) translation of Hollnagel's RAG into Chinese version, followed by generation of a tailored set of ED-RAG questions adapted to EDs; 2) testing and revising the tailored sets until to achieve satisfactory validity for application; 3) design of a new rating scale and scoring method. The test criteria of the ED-RAG questionnaire adopted the modified three-level scoring criteria proposed by Bloom and Fischer. The study setting of the field test is a private regional hospital. RESULTS: The fifth version of ED-RAG was acceptable after a field test. It has three sets of open structured questions for the potentials to respond, monitor, and anticipate, and a set of structured questions for the potential to learn. It contained 38 questions corresponding to 32 foci. A new 4-level rating scale along with a novel scaling method can improve the scores conversion validity and communication between team members and across investigations. This final version is set to complete an interview for around 2 hours. CONCLUSIONS: The ED-RAG represents a snapshot of EDs'resilience under specific conditions. It might be performed multiple times by a single hospital to monitor the directions and contents of improvement that can supplement conventional safety management toward resilience. Some considerations are required to be successful when hospitals use it. Future studies to overcome the potential methodological weaknesses of the ED-RAG are needed.


Asunto(s)
Servicio de Urgencia en Hospital/organización & administración , Administración de la Seguridad/organización & administración , Encuestas y Cuestionarios , China , Gestión de Recursos de Personal en Salud , Humanos , Entrevistas como Asunto , Traducción , Carga de Trabajo
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA