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1.
Orthop Clin North Am ; 51(2): 161-168, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32138854

RESUMEN

Despite the increase in utilization of total joint arthroplasty (TJA) throughout high-income countries, there is a lack of access to basic surgical care, including TJA, in low- and middle-income countries (LMICs). Multiple strategies, including short-term surgical trips, establishment of local TJA centers, and education-based international academic collaborations, have been used to bridge the gap in access to quality TJA. The authors review the obstacles to providing TJA in LMICs, the outcomes of the 3 strategies in use to bridge gaps, and a framework for the establishment and maintenance of meaningful international collaborations.


Asunto(s)
Artroplastia de Reemplazo , Ortopedia , Osteoartritis/cirugía , Artroplastia de Reemplazo/economía , Artroplastia de Reemplazo/educación , Artroplastia de Reemplazo/ética , Artroplastia de Reemplazo/normas , Prestación de Atención de Salud/economía , Prestación de Atención de Salud/ética , Prestación de Atención de Salud/organización & administración , Prestación de Atención de Salud/normas , Humanos , Cooperación Internacional , Internacionalidad , Ortopedia/economía , Ortopedia/educación , Ortopedia/organización & administración , Ortopedia/normas
2.
East Mediterr Health J ; 26(2): 143-151, 2020 Feb 24.
Artículo en Inglés | MEDLINE | ID: mdl-32141591

RESUMEN

Background: It is important to identify variables that influence life expectancy in order to develop strategies to improve health care systems and thereby increase life expectancy. Aims: In this study, a decision tree was built using a chi-square automatic interaction detector technique in order to identify variables influencing life expectancy at birth. Methods: Data were taken from the databases of the World Bank, World Health Organization and World Life Expectancy. Data from 166 countries for the year 2013 were extracted for 25 selected input variables related to mortality, health and the environment, child health, economy and demography in order to build the decision tree. Results: Of the 25 variables, nine had a significant influence on life expectancy: percentage of the population using improved sanitation facilities; death rates per 100 000 population for HIV/AIDS, liver disease, stroke and coronary heart disease; percentage of the urban population using improved drinking-water sources; total fertility rate (births per woman); public health expenditure (percent of government expenditure); and health expenditure per capita. Conclusions: Improving these variables may result in significant increases in life expectancy and quality of life. At the country level, appropriate strategies can be developed to improve the quality and performance of health care systems.


Asunto(s)
Árboles de Decisión , Prestación de Atención de Salud/organización & administración , Prestación de Atención de Salud/normas , Esperanza de Vida , Salud Pública , Tasa de Natalidad , Causas de Muerte , Demografía , Predicción , Gastos en Salud , Humanos , Mortalidad , Factores Socioeconómicos
7.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(1): 6-7, 2020 Jan 06.
Artículo en Chino | MEDLINE | ID: mdl-31914561

RESUMEN

This article illustrates that health management, as one of the tools of health service, plays an important role in the control and treatment of chronic diseases as well as the history of health management development in China. It was pointed out that currently the concept of health management is not well established in China and the practice of health management in the Chinese market is quite in a mess. Therefore, there is an urgent need for the standardization of health management practice. The China Health Management Association released an organizational standard entitled "Standard for Chronic Disease Health Management" in November, 2019. It is comprehensive, science-based, easy to use and fit into the Chinese situation and it is expected that it will facilitate the development of health management in China.


Asunto(s)
Prestación de Atención de Salud/organización & administración , China , Enfermedad Crónica/prevención & control , Prestación de Atención de Salud/normas , Humanos , Estándares de Referencia
9.
BMC Med ; 18(1): 17, 2020 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-31996199

RESUMEN

BACKGROUND: There has been a successful push towards parasitological diagnosis of malaria in Africa, mainly with rapid diagnostic tests (mRDTs), which has reduced over-prescribing of artemisinin-based combination therapies (ACT) to malaria test-negative patients. The effect on prescribing for test-positive patients has received much less attention. Malaria infection in endemic Africa is often most dangerous for young children and those in low-transmission settings. This study examined non-prescription of antimalarials for patients with malaria infection demonstrated by positive mRDT results, and in particular these groups who are most vulnerable to poor outcomes if antimalarials are not given. METHODS: Analysis of data from 562,762 patients in 8 studies co-designed as part of the ACT Consortium, conducted 2007-2013 in children and adults, in Cameroon, Ghana, Nigeria, Tanzania, and Uganda, in a variety of public and private health care sector settings, and across a range of malaria endemic zones. RESULTS: Of 106,039 patients with positive mRDT results (median age 6 years), 7426 (7.0%) were not prescribed an ACT antimalarial. The proportion of mRDT-positive patients not prescribed ACT ranged across sites from 1.3 to 37.1%. For patients under age 5 years, 3473/44,539 (7.8%) were not prescribed an ACT, compared with 3833/60,043 (6.4%) of those aged ≥ 5 years. The proportion of < 5-year-olds not prescribed ACT ranged up to 41.8% across sites. The odds of not being prescribed an ACT were 2-32 times higher for patients in settings with lower-transmission intensity (using test positivity as a proxy) compared to areas of higher transmission. mRDT-positive children in low-transmission settings were especially likely not to be prescribed ACT, with proportions untreated up to 70%. Of the 7426 mRDT-positive patients not prescribed an ACT, 4121 (55.5%) were prescribed other, non-recommended non-ACT antimalarial medications, and the remainder (44.5%) were prescribed no antimalarial. CONCLUSIONS: In eight studies of mRDT implementation in five African countries, substantial proportions of patients testing mRDT-positive were not prescribed an ACT antimalarial, and many were not prescribed an antimalarial at all. Patients most vulnerable to serious outcomes, children < 5 years and those in low-transmission settings, were most likely to not be prescribed antimalarials, and young children in low-transmission settings were least likely to be treated for malaria. This major public health risk must be addressed in training and practice. TRIAL REGISTRATION: Reported in individual primary studies.


Asunto(s)
Antimaláricos/uso terapéutico , Artemisininas/uso terapéutico , Malaria/tratamiento farmacológico , Pautas de la Práctica en Medicina , Adolescente , Adulto , Niño , Preescolar , Prestación de Atención de Salud/normas , Femenino , Ghana , Humanos , Malaria/diagnóstico , Masculino , Persona de Mediana Edad , Nigeria , Prescripciones , Sector Privado , Tanzanía , Uganda , Adulto Joven
12.
Int J Med Inform ; 134: 104040, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31865055

RESUMEN

BACKGROUND: Blockchain can be described as an immutable ledger, logging data entries in a decentralized manner. This new technology has been suggested to disrupt a wide range of data-driven domains, including the health domain. OBJECTIVE: The purpose of this study was to systematically review, assess and synthesize peer-reviewed publications utilizing/proposing to utilize blockchain to improve processes and services in healthcare, health sciences and health education. METHOD: A structured literature search on the topic was conducted in October 2018 relevant bibliographic databases. RESULT: 39 publications fulfilled the inclusion criteria. The result indicates that Electronic Health Records and Personal Health Records are the most targeted areas using blockchain technology. Access control, interoperability, provenance and data integrity are all issues that are meant to be improved by blockchain technology in this field. Ethereum and Hyperledger fabric seem to be the most used platforms/frameworks in this domain. CONCLUSION: This study shows that the endeavors of using blockchain technology in the health domain are increasing exponentially. There are areas within the health domain that potentially could be highly impacted by blockchain technology.


Asunto(s)
/normas , Prestación de Atención de Salud/normas , Registros Electrónicos de Salud/normas , Intercambio de Información en Salud/normas , Registros de Salud Personal , Mejoramiento de la Calidad , Humanos
13.
Support Care Cancer ; 28(1): 249-259, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31030278

RESUMEN

BACKGROUND: It is unknown how many distressed patients receive the additional supportive care recommended by Australian evidence-based distress management guidelines. The study identifies the (1) distress screening practices of Australian cancer services; (2) barriers to improving practices; and (3) implementation strategies which are acceptable to service representatives interested in improving screening practices. METHOD: Clinic leads from 220 cancer services were asked to nominate an individual involved in daily patient care to complete a cross-sectional survey on behalf of the service. Questions related to service characteristics; screening and management processes; and implementation barriers. Respondents indicated which implementation strategies were suitable for their health service. RESULTS: A total of 122 representatives participated from 83 services (51%). The majority of respondents were specialist nurses or unit managers (60%). Approximately 38% of representatives' services never or rarely screen; 52% who screen do so for all patients; 55% use clinical interviewing only; and 34% follow referral protocols. The most common perceived barriers were resources to action screening results (74%); lack of time (67%); and lack of staff training (66%). Approximately 65% of representatives were interested in improving practices. Of the 8 implementation strategies, workshops (85%) and educational materials (69%) were commonly selected. Over half (59%) indicated a multicomponent implementation program was preferable. CONCLUSIONS: Although critical gaps across all guideline components were reported, there is a broad support for screening and willingness to improve. Potential improvements include additional services to manage problems identified by screening, more staff time for screening, additional staff training, and use of patient-report measures.


Asunto(s)
Tamizaje Masivo , Neoplasias/psicología , Pautas de la Práctica en Medicina/normas , Estrés Psicológico/diagnóstico , Estrés Psicológico/terapia , Adulto , Australia/epidemiología , Instituciones Oncológicas/normas , Auditoría Clínica , Estudios Transversales , Prestación de Atención de Salud/normas , Femenino , Adhesión a Directriz/estadística & datos numéricos , Humanos , Masculino , Tamizaje Masivo/métodos , Tamizaje Masivo/normas , Neoplasias/diagnóstico , Neoplasias/epidemiología , Neoplasias/terapia , Pautas de la Práctica en Medicina/estadística & datos numéricos , Mejoramiento de la Calidad/normas , Derivación y Consulta/normas , Derivación y Consulta/estadística & datos numéricos , Estrés Psicológico/epidemiología , Estrés Psicológico/etiología , Encuestas y Cuestionarios
14.
BMC Health Serv Res ; 19(1): 951, 2019 Dec 10.
Artículo en Inglés | MEDLINE | ID: mdl-31823781

RESUMEN

BACKGROUND: Responsive regulation assumes that the parties being regulated are trustworthy and motivated by social responsibility. This assumes that regulation based upon trust will improve the regulated organization more effectively than other regulation models. The purpose of our qualitative study was to unravel the most important elements of trust in the inspectee which can support the inspector's work and to develop a model and a framework of trust that can be used by the inspectors to legitimize their trust in the inspectee. METHODS: We conducted an empirical study on trust regarding the regulation of care services to reveal how trust in the inspectee is conceptualized and assessed. Based on literature and empirical research, we synthesized the concept of trust into six elements, five regarding behavior, and a sixth looking at information about its context. We developed a practical framework for the concept to reduce the conceptual ambiguity, strengthen regulatory assessment, and support appropriate tailoring of the regulatory response. RESULTS: Six elements with respect to trust emerged from the data: showing integrity; transparency; ability to learn; accepting feedback; showing actual change in behavior; context information. These five behavioral elements, plus the context information were merged into a Framework of Trust and designed into an interactive PDF document. CONCLUSIONS: This study has sought to address a gap in the empirical knowledge regarding the assessment of trust in the inspectee. The results aim to inform and clarify the regulatory conceptualization and understanding of trust in the inspectee. Other inspectorates may learn from these results for their own practice and explore whether operational deployment of our Framework of Trust effects their assessment and enforcement strategies.


Asunto(s)
Formación de Concepto , Prestación de Atención de Salud/normas , Regulación y Control de Instalaciones , Confianza , Investigación Empírica , Humanos , Países Bajos , Investigación Cualitativa
15.
Artículo en Inglés | MEDLINE | ID: mdl-31861096

RESUMEN

The Integrated Multimorbidity Care Model (IMCM), developed by the Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS), proposes a set of 16 multidimensional components (i.e., recommendations) to improve the care of persons with multimorbidity in Europe. This study aimed at analyzing the potential applicability of the IMCM. We followed a qualitative approach that comprised two phases: (1) The design of a case study based on empirical clinical data, which consisted of a hypothetical woman with multimorbidity, type 2 diabetes mellitus, mental health, and associated social problems, and (2) the creation of a consensus group to gather the opinions of a multidisciplinary group of experts and consider the potential applicability of the IMCM to our case study. Experts described how care should be delivered to this patient according to each model component, suggested the use of specific rating scales and tools to assess her needs in a comprehensive and regular way, and pointed our crucial health and social resources to improve her care process. Experts also highlighted patient-centered, integrated and tailored care as one of the keystones of quality healthcare. Our results suggest that the IMCM is applicable in complex patients with multimorbidity.


Asunto(s)
Enfermedad Crónica/terapia , Prestación de Atención de Salud/normas , Diabetes Mellitus Tipo 2/terapia , Salud Mental , Multimorbilidad , Comorbilidad , Consenso , Manejo de la Enfermedad , Europa (Continente) , Femenino , Envejecimiento Saludable , Humanos , Calidad de la Atención de Salud
16.
BMC Health Serv Res ; 19(1): 818, 2019 Nov 08.
Artículo en Inglés | MEDLINE | ID: mdl-31703682

RESUMEN

BACKGROUND: While Medicare is a federal health insurance program, managed Medicare limits access to healthcare services to networks within states or territories. However, if a natural disaster requires evacuation, displaced patients are at risk of losing coverage for their benefits. Previous literature has discussed the quality of managed Medicare plans within Puerto Rico but has not addressed the adequacy of this coverage if residents are displaced to the continental United States. We explore Hurricane Maria's impact on a resident of Puerto Rico with chronic health problems, and the challenges he faces seeking healthcare in New York. CASE PRESENTATION: A 59-year-old male with a history of diabetes mellitus type II, coronary artery disease, peripheral vascular disease status post right foot amputation, and end-stage kidney disease on hemodialysis was admitted in October of 2017 for chest pain and swelling of legs for 5 days. The patient had missed his last three dialysis sessions after Hurricane Maria forced him to leave Puerto Rico. In examining this patient's treatment, we observe the effect of Hurricane Maria on the medical management of Puerto Rican residents and identify challenges managed Medicare may pose to patients who cross state or territory lines. CONCLUSIONS: We employ this patient's narrative to frame a larger discussion of Puerto Rican managed Medicare and provide additional recommendations for healthcare providers. Moreover, we consider this case in the context of disaster-related continuity of care for patients with complex medical conditions or treatment regimens. To address the gaps in the care of these patients, this article proposes (1) developing system-based approaches for screening displaced patients, (2) increasing the awareness of Special Enrollment Periods related to Medicare among healthcare providers, and (3) creating policy solutions to assure access to care for patients with complex medical conditions.


Asunto(s)
Tormentas Ciclónicas , Prestación de Atención de Salud/normas , Desastres , Medicare/normas , Afecciones Crónicas Múltiples/terapia , Hispanoamericanos , Humanos , Seguro de Salud , Masculino , Turismo Médico , Persona de Mediana Edad , Afecciones Crónicas Múltiples/etnología , Ciudad de Nueva York , Aceptación de la Atención de Salud , Puerto Rico/etnología , Refugiados , Diálisis Renal , Estados Unidos
17.
J Rehabil Med ; 51(11): 861-868, 2019 Dec 16.
Artículo en Inglés | MEDLINE | ID: mdl-31690950

RESUMEN

OBJECTIVE: To explore the health situation and identify specific health challenges in non-Western immigrants with polio in Norway, by comparing their status with Western immigrants with polio and native Norwegians with polio. DESIGN: A questionnaire covering demographics, polio history, life satisfaction, medical, psychological and social conditions was answered by 1,408 persons with polio, among them 34 immigrants from non-Western countries and 32 immigrants from Western countries. RESULTS: The non-Western immigrant polio group had a mean age of 46 years, were highly educated, reported high frequency of mental health problems and only one-third was working. Mean age for contracting polio was 2.8 years. Only 30% was hospitalized in the acute phase and 80% reported severe leg weakness. Use of a powered wheelchair was reported by 72%. Post-polio symptoms had started at a mean age of 31 years. The non-Western immigrant group reported more fatigue, pain and loneliness, and a high proportion reported insufficient assistance from the public health system. CONCLUSION: The group of non-Western immigrants with polio in Norway reported more health and social problems than the group of Western immigrants with polio or the native Norwegian group with polio, even though they were younger and more highly educated. Their complex psychological and social situation requires active intervention from the health system, and health professionals need extra skills to deal most effectively with their situation.


Asunto(s)
Prestación de Atención de Salud/normas , Emigrantes e Inmigrantes/estadística & datos numéricos , Poliomielitis/epidemiología , Síndrome Pospoliomielitis/epidemiología , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Noruega , Poliomielitis/psicología
19.
BMC Health Serv Res ; 19(1): 891, 2019 Nov 27.
Artículo en Inglés | MEDLINE | ID: mdl-31771573

RESUMEN

BACKGROUND: Provider recognition of level of functioning may be suboptimal in the dialysis setting, and this lack of recognition may lead to less patient-centered care. We aimed to assess whether delivery of an app-based, individualized functioning report would improve patients' perceptions of patient-centeredness of care. METHODS: In this pre-post pilot study at three outpatient dialysis facilities in metropolitan Atlanta, an individualized functioning report-including information on physical performance, perceived physical functioning, and community mobility-was delivered to patients receiving hemodialysis (n = 43) and their providers. Qualitative and quantitative approaches were used to gather patient and provider feedback to develop and assess the report and app. Paired t test was used to test for differences in patient perception of patient-centeredness of care (PPPC) scores (range, 1 = most patient-centered to 4 = least patient-centered) 1 month after report delivery. RESULTS: Delivery of the reports to both patients and providers was not associated with a subsequent change in patients' perceptions of patient-centeredness of their care (follow-up vs. baseline PPPC scores of 2.35 vs. 2.36; P > 0.9). However, patients and providers generally saw the potential of the report to improve the patient-centeredness of care and reacted positively to the individualized reports delivered in the pilot. Patients also reported willingness to undergo future assessments. However, while two-thirds of surveyed providers reported always or sometimes discussing the reports they received, most (98%) participating patients reported that no one on the dialysis care team had discussed the report with them within 1 month. CONCLUSIONS: Potential lack of fidelity to the intervention precludes definitive conclusions about effects of the report on patient-centeredness of care. The disconnect between patients' and providers' perceptions of discussions of the report warrants future study. However, this study introduces a novel, individualized, multi-domain functional report that is easily implemented in the setting of hemodialysis. Our pilot study provides guidance for improving its use both clinically and in future pragmatic research studies, both within and beyond the dialysis population.


Asunto(s)
Atención Dirigida al Paciente/normas , Diálisis Renal/normas , Actividades Cotidianas , Prestación de Atención de Salud/normas , Femenino , Humanos , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Proyectos Piloto , Mejoramiento de la Calidad/normas , Encuestas y Cuestionarios
20.
Z Evid Fortbild Qual Gesundhwes ; 147-148: 34-44, 2019 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-31732386

RESUMEN

BACKGROUND: Evidence-based and formally consensus-based clinical practice guidelines (S3-CPGs) are a valuable source for the development of quality indicators (QIs) in Germany. While deriving QIs from guideline recommendations is a mandatory part of the development of S3-CPGs within the National Program for Disease Management Guidelines (DMGP) and the German Guideline Program in Oncology (GGPO), there is no such obligation in the guideline program of the Association of the Scientific Medical Societies in Germany (AWMF) (MS program). Despite that, several S3-CPGs in the MS program have been published with QIs in the last years while some DMGP and one GGPO S3 guidelines have failed to meet this requirement. From the perspective of the guideline authors of all three mentioned programs, the present qualitative study examined why S3-CPGs do or do not contain QIs and explored the factors perceived by authors as either facilitating or hampering in the QI development process. METHODS: Semi-structured interviews were conducted with authors of 22 S3-CPGs, 11 of which represented guidelines containing QIs and 11 of which represented guidelines without QIs. Authors of guidelines containing QIs (n=11) were asked about the perceived decisive reasons for formulating QIs and about facilitators and barriers during the QI development process. Authors of guidelines without QIs (n=11) gave reasons for not formulating QIs. Interviews were analyzed using structuring qualitative content analysis. RESULTS: Within the MS program, not formulating QIs was mainly attributed to the lack of a mandatory requirement and to insufficient funding of guideline projects. Amongst DMGP authors, a low priority of QI development prevailed, which was, for example, due to already existing QIs or to their lacking implementation. In the GGPO guideline examined, not formulating QIs was due to the guideline topic (prevention) - for this topic, there was a lack of suitable evidence and data sources. If QIs were developed, the most important facilitating factor in the development process, across all programs, was the methodological support provided by the guideline program. Important hampering factors included the additional time required for QI development and concerns regarding the implementation of many potential QIs, especially due to a lack of data availability. DISCUSSION: For regular development of QIs within S3-CPG projects, the incorporation of such a requirement in the guideline program is a necessary, but not a sufficient, condition. Other pivotal factors include systematic methodological support, adequate financial and staff resources and the perceived meaningfulness and relevance of guideline-based QI development, measured in terms of the actual implementation of already existing QIs. CONCLUSION: The study reveals starting points for measures to strengthen the consideration of QI development in German S3-CPG projects, especially within the MS program. Without substantial structural changes, especially of the resources of guideline groups, and without an overall concept covering the entire process from QI development to QI implementation, guideline-based QI development will remain heavily dependent on the (self-)motivation of guideline groups.


Asunto(s)
Recursos en Salud , Guías de Práctica Clínica como Asunto/normas , Indicadores de Calidad de la Atención de Salud/normas , Sociedades Médicas , Protocolos Clínicos/normas , Prestación de Atención de Salud/normas , Alemania , Humanos , Oncología Médica , Investigación Cualitativa
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