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2.
BMJ Glob Health ; 6(3)2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33758014

RESUMEN

We have worked to develop a Clinical Information Network (CIN) in Kenya as an early form of learning health systems (LHS) focused on paediatric and neonatal care that now spans 22 hospitals. CIN's aim was to examine important outcomes of hospitalisation at scale, identify and ultimately solve practical problems of service delivery, drive improvements in quality and test interventions. By including multiple routine settings in research, we aimed to promote generalisability of findings and demonstrate potential efficiencies derived from LHS. We illustrate the nature and range of research CIN has supported over the past 7 years as a form of LHS. Clinically, this has largely focused on common, serious paediatric illnesses such as pneumonia, malaria and diarrhoea with dehydration with recent extensions to neonatal illnesses. CIN also enables examination of the quality of care, for example that provided to children with severe malnutrition and the challenges encountered in routine settings in adopting simple technologies (pulse oximetry) and more advanced diagnostics (eg, Xpert MTB/RIF). Although regular feedback to hospitals has been associated with some improvements in quality data continue to highlight system challenges that undermine provision of basic, quality care (eg, poor access to blood glucose testing and routine microbiology). These challenges include those associated with increased mortality risk (eg, delays in blood transfusion). Using the same data the CIN platform has enabled conduct of randomised trials and supports malaria vaccine and most recently COVID-19 surveillance. Employing LHS principles has meant engaging front-line workers, clinical managers and national stakeholders throughout. Our experience suggests LHS can be developed in low and middle-income countries that efficiently enable contextually appropriate research and contribute to strengthening of health services and research systems.


Asunto(s)
Servicios de Salud del Niño/normas , Prestación de Atención de Salud/normas , Accesibilidad a los Servicios de Salud/normas , Investigación sobre Servicios de Salud , Mejoramiento de la Calidad , /epidemiología , Niño , Preescolar , Países en Desarrollo , Diarrea/epidemiología , Diarrea/prevención & control , Humanos , Lactante , Recién Nacido , Kenia/epidemiología , Malaria/epidemiología , Malaria/prevención & control , Pandemias , Neumonía/epidemiología , Neumonía/prevención & control
4.
J Prim Care Community Health ; 12: 21501327211005303, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33759622

RESUMEN

As the COVID-19 health crisis continues to reshape healthcare, systems across the country face increasing pressure to adapt their models of care to expand access to care, while also improving efficiency and quality in the face of limited resources. Consequently, many have shown a growing interest and receptivity to the expansion of telehealth models to help meet these demands. Electronic consultations (eConsults) are a telehealth modality that allow for a non-face-to-face asynchronous consultation between a primary care provider (PCP) and a specialist aimed at facilitating specialist input without the need for a patient visit. The aim of this case study is to describe eConsults, how they differ from traditional in person models of care and other models of telemedicine and to review the evidence related to the effectiveness of eConsults by PCPs and clinicians from multiple specialties at the University of Colorado School of Medicine. We have worked to develop an infrastructure, delivery system integration, and care model adaptations that aim to improve delivery system performance by ensuring proper care in appropriate settings and lowering costs through reduced utilization. Lastly, we have increased care coordination, improved collaboration and better care transitions through strengthening of relationships between community-based PCPs and academic medical center-based specialists. This work has resulted in cost savings to patients and positive provider satisfaction.


Asunto(s)
Centros Médicos Académicos , Creación de Capacidad , Prestación de Atención de Salud/métodos , Atención Primaria de Salud , Derivación y Consulta , Consulta Remota , Especialización , Colorado , Conducta Cooperativa , Prestación de Atención de Salud/normas , Eficiencia , Electrónica , Reforma de la Atención de Salud , Accesibilidad a los Servicios de Salud , Humanos , Relaciones Interprofesionales , Pandemias , Aceptación de la Atención de Salud , Médicos de Atención Primaria , Facultades de Medicina
7.
Cien Saude Colet ; 26(3): 1013-1022, 2021 Mar.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-33729355

RESUMEN

The article aims to discuss the care provided by female healthcare workers in Brazil during the Covid-19 pandemic, based on a sociological analysis by authors who discuss such care as devalued and poorly paid work performed to a large extent by low-income women. The work involves social constructions of emotions and has used the body as a work instrument in care for others. In addition, the increasingly precarious nature of health work in Brazilian society, aggravated in recent decades, with an increase in temporary contracts, loss of labor rights, overload of tasks, and adverse work conditions, among others, adds to the increase in medical and hospital care in the Covid-19 pandemic. In this context, female healthcare workers experience lack of personal protective equipment, fear of coronavirus infection, concerns with their children and other family members, and illness and death of coworkers and themselves. The article highlights the need for government attention and management of healthcare work and professional societies, analyzing the work conditions female healthcare workers are experiencing in confronting the pandemic.


Asunto(s)
/epidemiología , Prestación de Atención de Salud , Personal de Salud , Pandemias , Actitud Frente a la Muerte , Brasil/epidemiología , /transmisión , Prestación de Atención de Salud/economía , Prestación de Atención de Salud/normas , Prestación de Atención de Salud/tendencias , Familia , Miedo , Femenino , Personal de Salud/economía , Personal de Salud/psicología , Humanos , Programas Nacionales de Salud , Equipo de Protección Personal/provisión & distribución , Salarios y Beneficios/tendencias , Factores Sexuales , Factores Sociológicos , Lugar de Trabajo/psicología , Lugar de Trabajo/normas
8.
BMC Public Health ; 21(1): 447, 2021 03 05.
Artículo en Inglés | MEDLINE | ID: mdl-33673813

RESUMEN

BACKGROUND: Amidst the COVID-19 pandemic, governments, health experts, and ethicists have proposed guidelines about ICU triage and priority access to a vaccine. To increase political legitimacy and accountability, public support is important. This study examines what criteria beyond medical need are deemed important to be perceived of priority COVID-19 healthcare access. METHOD: Two conjoint experiments about priority over ICU treatment and early COVID-19 vaccination were implemented in a probability-based sample of 1461 respondents representative of the Netherlands. Respondents were asked who should receive treatment out of two fictitious healthcare claimants that differed in in age, weight, complying with corona policy measures, and occupation, all randomly assigned. Average marginal coefficient effects are estimated to assess the relative importance of the attributes; attributes were interacted with relevant respondent characteristics to find whether consensus exists in this relative ranking. RESULTS: The Dutch penalize those not complying with coronavirus policy measures, and the obese, but prioritize those employed in 'crucial' sectors. For these conditions, there is consensus among the population. For age, young people are prioritized for ICU treatment, while the middle-aged are given priority over a vaccine, with younger respondents favoring healthcare for elderly claimants, while older respondents favor support for young cohorts. CONCLUSION: People who have no control over their social risk and are able to reciprocate to society are considered as more deserving of priority of COVID-19 healthcare. Our findings provide fair support for the implemented ethical guidelines about ICU-treatment and COVID-19 vaccines.


Asunto(s)
/prevención & control , Cuidados Críticos/normas , Prestación de Atención de Salud/normas , Instituciones de Salud/normas , Accesibilidad a los Servicios de Salud/normas , Vacunación/normas , Adulto , Anciano , Anciano de 80 o más Años , Consenso , Cuidados Críticos/estadística & datos numéricos , Prestación de Atención de Salud/estadística & datos numéricos , Femenino , Instituciones de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Pandemias , Guías de Práctica Clínica como Asunto , Vacunación/estadística & datos numéricos
9.
PLoS One ; 16(3): e0247274, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33647032

RESUMEN

INTRODUCTION: The coronavirus 2019 (COVID-19) has overwhelmed the health systems of several countries, particularly those within the African region. Notwithstanding, the relationship between health systems and the magnitude of COVID-19 in African countries have not received research attention. In this study, we investigated the relationship between the pervasiveness of the pandemic across African countries and their Global Health Security Index (GHSI) scores. MATERIALS AND METHODS: The study included 54 countries in five regions viz Western (16); Eastern (18); Middle (8); Northern (7); and Southern (5) Africa. The outcome variables in this study were the total confirmed COVID-19 cases (per million); total recoveries (per million); and the total deaths (per million). The data were subjected to Spearman's rank-order (Spearman's rho) correlation to determine the monotonic relationship between each of the predictor variables and the outcome variables. The predictor variables that showed a monotonic relationship with the outcome were used to predict respective outcome variables using multiple regressions. The statistical analysis was conducted at a significance level of 0.05. RESULTS: Our results indicate that total number of COVID-19 cases (per million) has strong correlations (rs >0.5) with the median age; aged 65 older; aged 70 older; GDP per capita; number of hospital beds per thousand; Human Development Index (HDI); recoveries (per million); and the overall risk environment of a country. All these factors including the country's commitments to improving national capacity were related to the total number of deaths (per million). Also, strong correlations existed between the total recoveries (per million) and the total number of positive cases; total deaths (per million); median age; aged 70 older; GDP per capita; the number of hospital beds (per thousand); and HDI. The fitted regression models showed strong predictive powers (R-squared>99%) of the variances in the total number of COVID-19 cases (per million); total number of deaths (per million); and the total recoveries (per million). CONCLUSIONS: The findings from this study suggest that patient-level characteristics such as ageing population (i.e., 65+), poverty, underlying co-morbidities-cardiovascular disease (e.g., hypertension), and diabetes through unhealthy behaviours like smoking as well as hospital care (i.e., beds per thousand) can help explain COVID-19 confirmed cases and mortality rates in Africa. Aside from these, other determinants (e.g., population density, the ability of detection, prevention and control) also affect COVID-19 prevalence, deaths and recoveries within African countries and sub-regions.


Asunto(s)
/epidemiología , Prestación de Atención de Salud/normas , Adulto , África/epidemiología , Anciano , /mortalidad , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/epidemiología , Comorbilidad , Diabetes Mellitus/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Densidad de Población , Pobreza , Prevalencia , Factores de Riesgo , Fumar/efectos adversos
11.
Epidemiol Infect ; 149: e75, 2021 03 16.
Artículo en Inglés | MEDLINE | ID: mdl-33722335

RESUMEN

We investigated whether countries with higher coverage of childhood live vaccines [BCG or measles-containing-vaccine (MCV)] have reduced risk of coronavirus disease 2019 (COVID-19)-related mortality, while accounting for known systems differences between countries. In this ecological study of 140 countries using publicly available national-level data, higher vaccine coverage, representing estimated proportion of people vaccinated during the last 14 years, was associated with lower COVID-19 deaths. The associations attenuated for both vaccine variables, and MCV coverage became no longer significant once adjusted for published estimates of the Healthcare access and quality index (HAQI), a validated summary score of healthcare quality indicators. The magnitude of association between BCG coverage and COVID-19 death rate varied according to HAQI, and MCV coverage had little effect on the association between BCG and COVID-19 deaths. While there are associations between live vaccine coverage and COVID-19 outcomes, the vaccine coverage variables themselves were strongly correlated with COVID-19 testing rate, HAQI and life expectancy. This suggests that the population-level associations may be further confounded by differences in structural health systems and policies. Cluster randomised studies of booster vaccines would be ideal to evaluate the efficacy of trained immunity in preventing COVID-19 infections and mortality in vaccinated populations and on community transmission.


Asunto(s)
/inmunología , Inmunidad Innata/inmunología , Cobertura de Vacunación/estadística & datos numéricos , Vacuna BCG/administración & dosificación , Vacuna BCG/inmunología , Prestación de Atención de Salud/normas , Prestación de Atención de Salud/estadística & datos numéricos , Humanos , Inmunización Secundaria/normas , Inmunización Secundaria/estadística & datos numéricos , Modelos Lineales , Vacuna Antisarampión/administración & dosificación , Vacuna Antisarampión/inmunología , Calidad de la Atención de Salud/normas , Calidad de la Atención de Salud/estadística & datos numéricos
12.
J Surg Oncol ; 123(5): 1353-1360, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33523484

RESUMEN

BACKGROUND AND OBJECTIVES: Patient engagement software is a ubiquitous and expensive commercially available tool designed to improve transitions of care. There are currently no high-quality patient and provider-level data about the usability of these products for surgical oncology patients. This study aims to better understand patient and provider attitudes and perceptions about the implementation of such technology. METHODS: Focused interviews were conducted following the demonstration of a provider-built mobile technology platform. Interviews were audio-recorded, transcribed, and analyzed. Data were consensus coded inductively and categorized into themes regarding patient and provider perspectives on the usability and implementation of MobiMD. RESULTS: Our interviews revealed four consistent themes: (1) patients feel there is a lack of reliable resources for patient education; (2) both patients and providers are supportive of using a mobile application; (3) providers perceive patient onboarding as an added burden on current workflows; and (4) after onboarding, providers express that such an application would optimize current workflows. CONCLUSIONS: Patients perceive a need for improved perioperative education. Providers and patients agree that a mobile technology platform would be an effective solution in addressing this need. Effective implementation of such an intervention may improve patient education and engagement, leading to improved patient outcomes.


Asunto(s)
Prestación de Atención de Salud/normas , Aplicaciones Móviles/estadística & datos numéricos , Neoplasias/cirugía , Atención al Paciente/normas , Medición de Resultados Informados por el Paciente , Pautas de la Práctica en Medicina/normas , Telemedicina/métodos , Humanos , Neoplasias/patología , Neoplasias/psicología , Percepción , Resultado del Tratamiento
13.
J Prev Med Public Health ; 54(1): 17-21, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33618495

RESUMEN

In 2020, the coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented disruptions to global health systems. The Korea has taken full-fledged actions against this novel infectious disease, swiftly implementing a testing-tracing-treatment strategy. New obligations have therefore been given to the Health Insurance Review and Assessment Service (HIRA) to devote the utmost effort towards tackling this global health crisis. Thanks to the universal national health insurance and state-of-the-art information communications technology (ICT) of the Korea, HIRA has conducted far-reaching countermeasures to detect and treat cases early, prevent the spread of COVID-19, respond quickly to surging demand for the healthcare services, and translate evidence into policy. Three main factors have enabled HIRA to undertake pandemic control preemptively and systematically: nationwide data aggregated from all healthcare providers and patients, pre-existing ICT network systems, and real-time data exchanges. HIRA has maximized the use of data and pre-existing network systems to conduct rapid and responsive measures in a centralized way, both of which have been the most critical tactics and strategies used by the Korean healthcare system. In the face of new obligations, our promise is to strive for a more responsive and resilient health system during this prolonged crisis.


Asunto(s)
/prevención & control , Intercambios de Seguro Médico/normas , Pandemias/prevención & control , /epidemiología , Prestación de Atención de Salud/normas , Prestación de Atención de Salud/tendencias , Intercambios de Seguro Médico/tendencias , Humanos , Pandemias/estadística & datos numéricos , República de Corea
14.
Am J Nurs ; 121(3): 48-52, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33625011

RESUMEN

ABSTRACT: This article describes the case of a chronically ill patient whose care was grossly mismanaged as a result of the policies and practices of a dysfunctional health system. This case illustrates the importance of truly listening to patients and communicating effectively with colleagues within the health care system. It also discusses appropriate steps for the practice of patient-centered care, including a reevaluation of late arrival policies at hospitals and clinics.


Asunto(s)
Neoplasias de la Mama Masculina/diagnóstico , Enfermedad Crónica , Prestación de Atención de Salud/normas , Hernia Abdominal/cirugía , Atención Dirigida al Paciente , Infecciones Urinarias/tratamiento farmacológico , Anciano , Hospitales/normas , Humanos , Masculino , Enfermeras Practicantes
17.
Obstet Gynecol ; 137(3): 487-492, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33543895

RESUMEN

The use of telemedicine in U.S. perinatal care has drastically increased during the coronavirus disease 2019 (COVID-19) pandemic, and will likely continue given the national focus on high-value, patient-centered care. If implemented in an equitable manner, telemedicine has the potential to reduce disparities in care access and related outcomes that stem from systemic racism, implicit biases and other forms of discrimination within our health care system. In this commentary, we address implementation factors that should be considered to ensure that disparities are not widened as telemedicine becomes more integrated into care delivery.


Asunto(s)
/prevención & control , Prestación de Atención de Salud/normas , Disparidades en Atención de Salud , Atención Perinatal/métodos , Telemedicina/economía , /epidemiología , Femenino , Política de Salud , Humanos , Aceptación de la Atención de Salud , Embarazo , Estados Unidos
19.
BMJ Open ; 11(1): e043590, 2021 01 19.
Artículo en Inglés | MEDLINE | ID: mdl-33468529

RESUMEN

INTRODUCTION: The COVID-19 pandemic resulted in a national lockdown in India from midnight on 25 March 2020, with conditional relaxation by phases and zones from 20 April. We evaluated the impact of the lockdown in terms of healthcare provisions, physical health, mental health and social well-being within a multicentre cross-sectional study in India. METHODS: The SMART India study is an ongoing house-to-house survey conducted across 20 regions including 11 states and 1 union territory in India to study diabetes and its complications in the community. During the lockdown, we developed an online questionnaire and delivered it in English and seven popular Indian languages (Hindi, Tamil, Marathi, Telegu, Kannada, Bengali, Malayalam) to random samples of SMART-India participants in two rounds from 5 May 2020 to 24 May 2020. We used multivariable logistic regression to evaluate the overall impact on health and healthcare provision in phases 3 and 4 of lockdown in red and non-red zones and their interactions. RESULTS: A total of 2003 participants completed this multicentre survey. The bivariate relationships between the outcomes and lockdown showed significant negative associations. In the multivariable analyses, the interactions between the red zones and lockdown showed that all five dimensions of healthcare provision were negatively affected (non-affordability: OR 1.917 (95% CI 1.126 to 3.264), non-accessibility: OR 2.458 (95% CI 1.549 to 3.902), inadequacy: OR 3.015 (95% CI 1.616 to 5.625), inappropriateness: OR 2.225 (95% CI 1.200 to 4.126) and discontinuity of care: OR 6.756 (95% CI 3.79 to 12.042)) and associated depression and social loneliness. CONCLUSION: The impact of COVID-19 pandemic and lockdown on health and healthcare was negative. The exaggeration of income inequality during lockdown can be expected to extend the negative impacts beyond the lockdown.


Asunto(s)
/prevención & control , Prestación de Atención de Salud/normas , Diabetes Mellitus/psicología , Salud Mental , Aislamiento Social/psicología , Adulto , Anciano , Estudios Transversales , Diabetes Mellitus/tratamiento farmacológico , Femenino , Servicios de Salud , Humanos , India , Modelos Logísticos , Soledad , Masculino , Persona de Mediana Edad , Análisis Multivariante , Encuestas y Cuestionarios
20.
Am J Respir Crit Care Med ; 203(1): 14-23, 2021 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-33385220

RESUMEN

Rationale: Decisions in medicine are made on the basis of knowledge and reasoning, often in shared conversations with patients and families in consideration of clinical practice guideline recommendations, individual preferences, and individual goals. Observational studies can provide valuable knowledge to inform guidelines, decisions, and policy.Objectives: The American Thoracic Society (ATS) created a multidisciplinary ad hoc committee to develop a research statement to clarify the role of observational studies-alongside randomized controlled trials (RCTs)-in informing clinical decisions in pulmonary, critical care, and sleep medicine.Methods: The committee examined the strengths of observational studies assessing causal effects, how they complement RCTs, factors that impact observational study quality, perceptions of observational research, and, finally, the practicalities of incorporating observational research into ATS clinical practice guidelines.Measurements and Main Results: There are strengths and weakness of observational studies as well as RCTs. Observational studies can provide evidence in representative and diverse patient populations. Quality observational studies should be sought in the development of ATS clinical practice guidelines, and medical decision-making in general, when 1) no RCTs are identified or RCTs are appraised as being of low- or very low-quality (replacement); 2) RCTs are of moderate quality because of indirectness, imprecision, or inconsistency, and observational studies mitigate the reason that RCT evidence was downgraded (complementary); or 3) RCTs do not provide evidence for outcomes that a guideline committee considers essential for decision-making (e.g., rare or long-term outcomes; "sequential").Conclusions: Observational studies should be considered in developing clinical practice guidelines and in making clinical decisions.


Asunto(s)
Investigación Biomédica/normas , Toma de Decisiones Clínicas , Cuidados Críticos/normas , Prestación de Atención de Salud/normas , Medicina Basada en la Evidencia/normas , Estudios Observacionales como Asunto/normas , Enfermedades Torácicas/terapia , Humanos , Guías de Práctica Clínica como Asunto , Sociedades Médicas , Estados Unidos
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