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2.
Cien Saude Colet ; 26(10): 4769-4782, 2021 Oct.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-34730662

RESUMEN

Since 2010, the organization of the Brazilian Unified Health System has as its main model the Health Care Networks, based on the Integrated Health Service Networks recommended by the Pan American Health Organization. This study aims to analyze the scientific production on Health Care Networks the integrative literature review method. The research was conducted in databases using the descriptors: Health Care Network and its counterparts in Portuguese and Spanish. A total of 27 articles were selected, including conceptual studies, case reports, implementation analyses and evaluation studies. The analysis of the publications evidenced five cores of meaning: the Health Care Network paradigm; Primary Care as network coordinator; regionalization, networks and regional governance; network care; and challenges for implementation. The results of this review point to two central questions: how to overcome the fragmentation of care, ensuring integrality, composing health care networks from distinct theoretical conceptions? And how can the production of care networks impact inter-federative relations, the financing process, the access to the system and the quality of health care processes?


Asunto(s)
Atención a la Salud , Atención Primaria de Salud , Instituciones de Salud , Servicios de Salud , Humanos , Organizaciones
3.
Gesundheitswesen ; 83(S 01): S33-S38, 2021 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-34731891

RESUMEN

The German living donor register Safety of the Living Kidney Donor - The German National Register (SOLKID-GNR) collects data of the medical and psychosocial outcome of living kidney donors. For the first time in Germany, a prospective data collection allows a scientifically based long-term analysis of how a living kidney donation influences the psychological and physical health of living kidney donors. This will contribute directly to improve the information and care of living kidney donors.


Asunto(s)
Trasplante de Riñón , Donadores Vivos , Recolección de Datos , Alemania/epidemiología , Servicios de Salud , Humanos
4.
BMC Public Health ; 21(1): 2022, 2021 11 06.
Artículo en Inglés | MEDLINE | ID: mdl-34742268

RESUMEN

BACKGROUND: Prevention and control (P&C) of Corona Virus Disease 2019 (COVID-19) is still a critical task in most countries and regions. However, there are many single evaluation indexes to assess the quality of COVID-19 P&C. It is necessary to synthesize the single evaluation indexes reasonably to obtain the overall evaluation results. METHODS: This study was divided into three steps. Step 1: In February 2020, the improved Delphi method was used to establish the quality evaluation indexes system for COVID-19 P&C. Step 2: in March 2020, the CRITIC method was used to adjust the Order Relation Analysis (G1) method to obtain the subjective and objective (S&O) combination weights. The comprehensive evaluation value was obtained using the weighted Efficacy Coefficient (EC) method, weighted TOPSIS method, weighted rank-sum ratio (RSR) method, and weighted Grey Relationship Analysis (GRA) method. Finally, the linear normalization method was used to synthesize the evaluation values of different evaluation methods. Step 3: From April 2020 to May 2021, this evaluation method was used to monitor and assess COVID-19 P&C quality in critical departments prospectively. The results were reported to the departments monthly. RESULT: A quality evaluation indexes system for COVID-19 P&C was established. Kendall's consistency test shows that the four evaluation method had good consistency (χ2 = 43.429, P<0.001, Kendall's consistency coefficient = 0.835). The Spearman correlation test showed that the correlation between the combined evaluation results and the original method was statistically significant(P < 0.001). According to the Mann-Kendall test, from March 2020 to May 2021, the mean value of COVID-19 P&C quality in all critical departments showed an upward trend (P < 0.01). CONCLUSIONS: The combined comprehensive evaluation method based on the S&O combined weight was more scientific and comprehensive than the single weighting and evaluation methods. In addition, monitoring and feedback of COVID-19 P&C quality were helpful for the improvement of P&C quality.


Asunto(s)
COVID-19 , Hospitales Generales , Servicios de Salud , Humanos , Estudios Prospectivos , SARS-CoV-2
5.
Prim Care ; 48(4): 545-554, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34752268

RESUMEN

Nexplanon is the only contraceptive implant currently available in the United States. It exerts its contraceptive effects primarily by suppressing ovulation. The Nexplanon is the most effective method of long-acting reversible contraception. The implant should be removed by the end of the third year of use. Persons will experience a rapid return to fertility once the implant is removed. All health care providers must be trained on Nexplanon before performing insertions or removals of the implant. A Nexplanon can be inserted and/or removed as an office-based procedure. The most common adverse reaction is change in menstrual bleeding patterns.


Asunto(s)
Anticonceptivos Femeninos , Implantes de Medicamentos , Femenino , Servicios de Salud , Humanos , Estados Unidos
6.
Pan Afr Med J ; 40: 26, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34733394

RESUMEN

Introduction: the COVID-19 pandemic since its emergence has posed a great danger to the health of the general populace while impacting the Nigerian healthcare delivery significantly. Since its emergence, the health system has been stretched with overwhelming responsibilities. The study assessed health providers´ perceived impact of coronavirus pandemic on the uptake of health care services in South West Nigeria. Methods: a descriptive cross-sectional design using an online structured survey was used to elicit responses from 385 Nigerian health workers selected by convenience sampling technique. Data analysis was done with the Statistical Package for Social Sciences (SPSS) version 26. Comparison of the uptake of healthcare before and during the COVID-19 pandemic was performed using the Chi-square test. Results: findings revealed a significant difference between the uptake of health care prior and during the COVID-19 pandemic (χ2= 92.77, p=0.000) as 253 respondents (65.7%) reported that the hospital recorded a low turn-out of patients during the pandemic and 184 (47.8%) indicated that some of the facility units/departments were temporarily closed due to COVID-19 pandemic. Similarly, there was a significant difference between health-related conditions requiring hospital admission before and during COVID-19 pandemic (χ2=3.334 p=0.046). Factors influencing uptake of health services during the COVID-19 pandemic are: fear of nosocomial infection, fear of stigmatization, and misconception/misinformation on COVID-19 diseases and care. Conclusion: the Nigerian health system in the past months has been remarkably impacted by the pandemic. This calls for immediate restructuring to maintain an equitable distribution of care, while minimizing risk to patients and health providers.


Asunto(s)
COVID-19/psicología , Atención a la Salud/estadística & datos numéricos , Servicios de Salud/estadística & datos numéricos , Pandemias/prevención & control , Adulto , Ansiedad , COVID-19/epidemiología , COVID-19/prevención & control , Estudios Transversales , Miedo , Femenino , Personal de Salud , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Nigeria , Aceptación de la Atención de Salud/psicología , SARS-CoV-2 , Encuestas y Cuestionarios
7.
Int J Equity Health ; 20(1): 240, 2021 11 04.
Artículo en Inglés | MEDLINE | ID: mdl-34736455

RESUMEN

Co-design as a participatory method aims to improve health service design and implementation. It is being used more frequently by researchers and practitioners in various health and social care settings. Co-design has the potential for achieving positive outcomes for the end users involved in the process; however, involvement of diverse ethnic minority population in the process remains limited. While the need to engage with diverse voices is identified, there is less information available on how to achieve meaningful engagement with these groups. Ethnic minorities are super-diverse population and the diversity between and within these groups need consideration for optimising their participation in co-design. Based on our experience of working with diverse ethnic minority groups towards the co-design of consumer engagement strategies to improve patient safety in cancer services as part of the two nationally-funded research projects in Australia, we outline reflections and practical techniques to optimise co-design with people from diverse ethnic backgrounds. We identify three key aspects of the co-design process pertinent to the involvement of this population; 1) starting at the pre-commencement stage to ensure diverse, seldom heard consumers are invited to and included in co-design work, 2) considering logistics and adequate resources to provide appropriate support to address needs before, during and beyond the co-design process, and 3) supporting and enabling a diversity of contributions via the co-design process.


Asunto(s)
Grupos Étnicos , Grupos Minoritarios , Servicios de Salud , Accesibilidad a los Servicios de Salud , Humanos , Investigadores
8.
Bull World Health Organ ; 99(11): 805-818, 2021 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-34737473

RESUMEN

Objective: To review the evidence on the impact on measurable outcomes of performance-based incentives for community health workers (CHWs) in low- and middle-income countries. Methods: We conducted a systematic review of intervention studies published before November 2020 that evaluated the impact of financial and non-financial performance-based incentives for CHWs. Outcomes included patient health indicators; quality, utilization or delivery of health-care services; and CHW motivation or satisfaction. We assessed risk of bias for all included studies using the Cochrane tool. We based our narrative synthesis on a framework for measuring the performance of CHW programmes, comprising inputs, processes, performance outputs and health outcomes. Findings: Two reviewers screened 2811 records; we included 12 studies, 11 of which were randomized controlled trials and one a non-randomized trial. We found that non-financial, publicly displayed recognition of CHWs' efforts was effective in improved service delivery outcomes. While large financial incentives were more effective than small ones in bringing about improved performance, they often resulted in the reallocation of effort away from other, non-incentivized tasks. We found no studies that tested a combined package of financial and non-financial incentives. The rationale for the design of performance-based incentives or explanation of how incentives interacted with contextual factors were rarely reported. Conclusion: Financial performance-based incentives alone can improve CHW service delivery outcomes, but at the risk of unincentivized tasks being neglected. As calls to professionalize CHW programmes gain momentum, research that explores the interactions among different forms of incentives, context and sustainability is needed.


Asunto(s)
Agentes Comunitarios de Salud , Motivación , Atención a la Salud , Servicios de Salud , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto
9.
Artículo en Inglés | MEDLINE | ID: mdl-34770237

RESUMEN

Technological changes have led to important advances in medical diagnoses and treatments that prolong the informal care process. Support from the personal network of informal caregivers is an undervalued resource and the changes that have occurred over time are unknown. The aim of this study was to analyze the changes in personal network support among informal caregivers and to examine the effect of these changes on self-perceived caregiver health, with a focus on differences between men and women and caregivers with high and low levels of burden We also investigated caregiver perceptions and explanations of changes to their support network (losses and additions and no change). Using a mixed-methods approach, data were obtained from 32 caregivers that were intentionally selected in Spain, who were interviewed twice with a one-year interval. In the quantitative phase, personal networks analysis was performed with Egonet software, which obtained data on the composition and functional content in social support from 1600 personal relationships (25 alters for each ego in the two waves). In the qualitative phase, semi-structured interviews were conducted in the two waves with a guide in order to explore the changes in informal support resources over time. The selected men with high levels of burden pointed out a loss of network support with more discouraging reports compared with the low-burden male caregivers. Furthermore, the selected women with low burden levels mentioned losses too; however, their reports were more positive. Women reported improved health, especially those with low burden scores in the first wave and those who did not lose support. Caregivers with a high initial burden and who lost support reported worse health, particularly men and women with a strong sense of duty toward care. Social support from personal networks is important for caregiver health and its effects are influenced by gender roles. Our findings could help by improving the relational and social capital of informal caregivers and adapting them to the new needs of formal home care systems.


Asunto(s)
Cuidadores , Apoyo Social , Carga del Cuidador , Femenino , Servicios de Salud , Humanos , Masculino , Factores Sexuales
10.
Assist Inferm Ric ; 40(3): 175-182, 2021.
Artículo en Italiano | MEDLINE | ID: mdl-34783322

RESUMEN

. The complexity of the nursing research in the primary health care: methodological challenges and suggestions. INTRODUCTION: Research in primary care nursing has grown in the last decades addressing the national and international call aimed at increasing the primary health care services. METHOD: A of the main possible challenges that researchers might encounter in primary care research is proposed, as well as suggestions aimed at implementing strong research methodologies. RESULTS: The study designs feasible in this setting such as that observational, randomized cluster and/or pragmatic trials, stepped wedge designs, and mixed-method studies are discussed; as well as strategies to involve the population, e.g., with participatory research; how to describe the interventions and the possible outcomes sensitive to the family/community nurses care to consider. CONCLUSIONS: National and international guidelines promote the implementation of the family/community nurses. Many Italian regions are implementing the model tailored to the context: these initiatives should be accompanied studies capable to document their outcomes.


Asunto(s)
Investigación en Enfermería , Servicios de Salud , Humanos , Atención Primaria de Salud , Proyectos de Investigación
11.
Am J Cardiol ; 160: 31-39, 2021 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-34740394

RESUMEN

Chest pain (CP) has been reported in 20% to 40% of patients 1 year after percutaneous coronary intervention (PCI), though rates of post-PCI health-care utilization (HCU) for CP in nonclinical trial populations are unknown. Furthermore, the contribution of noncardiac factors - such as pulmonary, gastrointestinal, and psychological - to post-PCI CP HCU is unclear. Accordingly, the objectives of this study were to describe long-term trajectories and identify predictors of post-PCI CP-related HCU in real-world patients undergoing PCI for any indication. This retrospective cohort study included patients receiving PCI for any indication from 2003 to 2017 through a single integrated health-care system. Post-PCI CP-related HCU tracked through electronic medical records included (1) office visits, (2) emergency department (ED) visits, and (3) hospital admissions with CP or angina as the primary diagnosis. The strongest predictors of CP-related HCU were identified from >100 candidate variables. Among 6386 patients followed an average of 6.7 years after PCI, 73% received PCI for acute coronary syndrome (ACS), 19% for stable angina, and 8% for other indications. Post-PCI CP-related HCU was common with 26%, 16%, and 5% of patients having ≥1 office visits, ED visits, and hospital admissions for CP within 2 years of PCI. The following factors were significant predictors of all 3 CP outcomes: ACS presentation, documented CP >7 days prior to the index PCI, anxiety, depression, and syncope. In conclusion, CP-related HCU following PCI was common, especially within the first 2 years. The strongest predictors of CP-related HCU included coronary disease attributes and psychological factors.


Asunto(s)
Dolor en el Pecho/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Visita a Consultorio Médico/estadística & datos numéricos , Intervención Coronaria Percutánea , Síndrome Coronario Agudo/cirugía , Anciano , Anciano de 80 o más Años , Angina de Pecho , Angina Estable/cirugía , Angina Inestable/cirugía , Ansiedad/epidemiología , Estudios de Cohortes , Depresión/epidemiología , Femenino , Servicios de Salud/estadística & datos numéricos , Humanos , Accidente Cerebrovascular Isquémico/epidemiología , Enfermedades Pulmonares/epidemiología , Masculino , Persona de Mediana Edad , Infarto del Miocardio sin Elevación del ST/cirugía , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Infarto del Miocardio con Elevación del ST/cirugía , Factores Sexuales
12.
Artículo en Inglés | MEDLINE | ID: mdl-34769964

RESUMEN

People who have had a transient ischemic attack (TIA) or mild stroke have a high risk of recurrent stroke. Secondary prevention programs providing support for meeting physical activity recommendations may reduce this risk. Most evidence for the feasibility and effectiveness of secondary stroke prevention arises from programs developed and tested in research institute settings with limited evidence for the acceptability of programs in 'real world' community settings. This qualitative descriptive study explored perceptions of participation in a secondary stroke prevention program (delivered by a community-based multidisciplinary health service team within a community gym) by adults with TIA or mild stroke. Data gathered via phone-based semi-structured interviews midway through the program, and at the end of the program, were analyzed using constructivist grounded theory methods. A total of 51 interviews from 30 participants produced two concepts. The first concept, "What it offered me", describes critical elements that shape participants' experience of the program. The second concept, "What I got out of it" describes perceived benefits of program participation. Participants perceived that experiences with peers in a health professional-led group program, held within a community-based gym, supported their goal of changing behaviour. Including these elements during the development of health service strategies to reduce recurrent stroke risk may strengthen program acceptability and subsequent effectiveness.


Asunto(s)
Ataque Isquémico Transitorio , Accidente Cerebrovascular , Adulto , Ejercicio Físico , Servicios de Salud , Humanos , Ataque Isquémico Transitorio/prevención & control , Prevención Secundaria , Accidente Cerebrovascular/prevención & control
13.
Trials ; 22(1): 809, 2021 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-34781994

RESUMEN

BACKGROUND: The aim of this paper is to describe the utility of various recruitment modalities utilized in the Working to Increase Stability through Exercise (WISE) study. WISE is a pragmatic randomized trial that is testing the impact of a 3-year, multicomponent (strength, balance, aerobic) physical activity program led by trained volunteers or delivered via DVD on the rate of serious fall-related injuries among adults 65 and older with a past history of fragility fractures (e.g., vertebral, fall-related). The modified goal was to recruit 1130 participants over 2 years in three regions of Pennsylvania. METHODS: The at-risk population was identified primarily using letters mailed to patients of three health systems and those over 65 in each region, as well as using provider alerts in the health record, proactive recruitment phone calls, radio advertisements, and presentations at community meetings. RESULTS: Over 24 months of recruitment, 209,301 recruitment letters were mailed, resulting in 6818 telephone interviews. The two most productive recruitment methods were letters (72% of randomized participants) and the research registries at the University of Pittsburgh (11%). An average of 211 letters were required to be mailed for each participant enrolled. Of those interviewed, 2854 were ineligible, 2,825 declined to enroll and 1139 were enrolled and randomized. Most participants were female (84.4%), under age 75 (64.2%), and 50% took an osteoporosis medication. Not having a prior fragility fracture was the most common reason for not being eligible (87.5%). The most common reason provided for declining enrollment was not feeling healthy enough to participate (12.6%). CONCLUSIONS: The WISE study achieved its overall recruitment goal. Bulk mailing was the most productive method for recruiting community-dwelling older adults at risk of serious fall-related injury into this long-term physical activity intervention trial, and electronic registries are important sources and should be considered.


Asunto(s)
Accidentes por Caídas , Ejercicio Físico , Accidentes por Caídas/prevención & control , Anciano , Terapia por Ejercicio , Femenino , Servicios de Salud , Humanos , Factores de Riesgo
14.
J Pak Med Assoc ; 71(11): 2676-2677, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34783761

RESUMEN

With the rising obesity pandemic, a large number of patients seek healthcare facilities. However, many healthcare centers are inept in catering to provide a friendly infrastructure to cater patients with obesity. In this paper we provide a simple, easily adaptable framework that could enhance health care facilities making them for friendly to patients with obesity. We propose an eight A framework namely, Awareness, Availability, Accessibility, Affordability, Attractiveness, All-inclusiveness, Attitudes of assistance and Auditability. The first four attributes relate to encourage the patient to seek health care by making it attractive and the next 4 attributes enhance adherence to the given advice. In addition, we also describe the components of obesity friendly.


Asunto(s)
Atención a la Salud , Instituciones de Salud , Servicios de Salud , Humanos , Obesidad/epidemiología , Obesidad/prevención & control
15.
Cien Saude Colet ; 26(suppl 3): 5187-5200, 2021.
Artículo en Portugués | MEDLINE | ID: mdl-34787210

RESUMEN

In Brazil, the growth of agribusiness to the detriment of family agriculture occurred while concealing social, environmental and human health damages. The objective was to compare living and working conditions and access to health services between agricultural and non-agricultural workers. Data from the National Health Survey (PNS) on living and working conditions, sociodemographic, economic characteristics, and access to health services from a representative sample of the employed Brazilian population were adopted. Pearson's chi-square test was used, with a significance level of 0.05, taking the complex sampling design into consideration. Agricultural workers suffered from worse living conditions, lower purchasing power, greater exposure to solar radiation and chemical agents, and a higher frequency and severity of occupational accidents compared to non-agricultural workers. The agricultural population had greater coverage of the Family Health Service and sought medical care from the Unified Health System (SUS) to treat diseases, while the non-agricultural workers sought private medical care for preventive actions. The differences found between these workers imply different patterns of illness and define specific health needs.


Asunto(s)
Agricultura , Agricultores , Brasil , Servicios de Salud , Accesibilidad a los Servicios de Salud , Humanos
16.
Cien Saude Colet ; 26(suppl 3): 5351-5360, 2021.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-34787224

RESUMEN

This study explores access to health services for lesbians in the light of current literature. A literature search was conducted using various databases and an interpretive synthesis of the findings of the selected articles was produced anchored in the concepts of habitus and symbolic violence developed by Pierre Bourdieu. Two main themes and their respective units of meaning were identified: (a) barriers and difficulties experienced by lesbians in accessing healthcare (issues related to coming out as a lesbian and difficulties experienced by health services and professionals in dealing with lesbian women); and (b) lesbian women's experiences in health services (unequal care, invisibility, and feeling uncomfortable). We conclude that, despite advances in policy and care protocols, sexual and gender diversity needs to be widely discussed in social, educational, and health settings.


Asunto(s)
Homosexualidad Femenina , Minorías Sexuales y de Género , Femenino , Servicios de Salud , Accesibilidad a los Servicios de Salud , Necesidades y Demandas de Servicios de Salud , Humanos
17.
Front Public Health ; 9: 735654, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34746081

RESUMEN

Background: Primary health care (PHC) is an important part of health systems in the world and in China. To improve the efficiency of PHC institutions (PHCIs), many countries have implemented reforms, including China's health care reform since 2009. This study aims to evaluate the impact of this reform on the efficiency of PHCIs from the perspective of the whole health system. Methods: Data were collected from China Health Statistical Yearbooks and China Statistical Yearbooks published from 2005 to 2019. By taking the number of beds, health technicians and PHCIs as inputs and the proportion of diagnosis, treatment and admission in PHCIs as outputs, Malmquist DEA was used to evaluate the efficiency change of PHCIs, and panel data regression was performed to analyze the impact of the reform and other factors on such efficiency. The interaction between reform and economic level was also estimated. Results: The MPI in Beijing, Tianjin, Shanghai, Hunan, and Guangdong improved after the reform. The efficiency improvement in Beijing, Tianjin and Shanghai is mainly reflected in the growth of TC, whereas the efficiency improvement in Guangdong and Hunan is mainly reflected in the growth of EC. Meanwhile, the EC and TC in Hebei, Heilongjiang, Shandong, and other provinces deteriorated. The deterioration of MPI in Shanxi, Inner Mongolia and Jilin was mainly attributed to EC. while the deterioration of MPI in Liaoning, Anhui, and Fujian provinces is mainly attributed to TC. Since 2009, the reform exerted a negative impact on MPI (ß = -0.06; P < 0.01), TC (ß = -0.048; P < 0.01) and EC (ß = -0.03; P < 0.01). And such negative impact was weaker in economically developed areas (ß = 0.076; P < 0.01). Conclusions: Attention should be paid to future reforms: China should continue investing in PHCIs, establish a structurally integrated and functionally complementary delivery system and promote the coordination of reform policies to avoid the adverse impacts of other reform policies on PHCIs.


Asunto(s)
Países en Desarrollo , Reforma de la Atención de Salud , China , Demografía , Servicios de Salud
18.
Artículo en Inglés | MEDLINE | ID: mdl-34769537

RESUMEN

The northeast of Thailand is well-known as a popular destination where many male Westerners marry Thai women and settle down there. However, little is known about their health and well-being. This study aims to explore the Western husbands' health status and identify barriers hindering their healthcare access. A qualitative case study was conducted from November 2020 to May 2021. In-depth interviews and focus group discussions with 42 key informants who were involved with social and health issues among these expatriates were carried out. The social determinants framework was adapted for guiding the interviews. Data were triangulated with field notes, document reviews, and researchers' observations. Inductive thematic analysis was applied. Results showed that most male expatriates who married Thai women in the northeast were in their retirement years and had non-communicable diseases, health risk behaviors, and mental health problems. Most of them did not purchase health insurance and held negative impressions toward Thai public hospitals' quality of care, which was denoted as the main barrier to accessing healthcare services. Other significant barriers consisted of high treatment costs commonly charged by private hospitals and language issues. While the improvement of healthcare quality and the provision of friendly health services are important, public communication with foreign residents, especially male expatriates, is recommended to increase understanding and improve perceptions of the Thai healthcare systems. A regular population-based survey on the health and well-being of expatriates in Thailand, a cost study of a health insurance package, a survey study on willingness to pay for health insurance premiums, and a feasibility survey exploring the opportunity to establish either voluntary or compulsory health insurance among this group should be undertaken.


Asunto(s)
Accesibilidad a los Servicios de Salud , Servicios de Salud , Femenino , Estado de Salud , Humanos , Masculino , Núcleo Familiar , Investigación Cualitativa , Tailandia
19.
Sex Reprod Health Matters ; 29(1): 1985826, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34779749

RESUMEN

Sexual and reproductive health and rights (SRHR) and universal health coverage (UHC) are fundamental to health as a human right. One way that countries operationalise UHC is through the development of an essential package of health services (EPHS), which describes a list of clinical and public health services that a government aspires to provide for their population. This study reviews the contents of 46 countries' EPHS against the standard of the Guttmacher-Lancet Report's (GLR) nine essential SRHR interventions. The analysis is conducted in two steps; EPHS are first categorised according to the level of specificity of their contents using a case classification scheme, then the most detailed EPHS are mapped onto the GLR's nine essential SRHR interventions. The results highlight the variations of EPHS and provide information on the inclusion of the GLR nine essential SRHR interventions in low- and lower-middle income countries' EPHS. This study also proposes a case classification scheme as an analytical tool to conceptualise how EPHS fall along a spectrum of specificity and defines a set of keywords for evaluating the contents of policies against the standard of the GLR. These analytical tools and findings can be relevant for policymakers, researchers, and organisations involved in SRHR advocacy to better understand the variations in detail among countries' EPHS and compare governments' commitment to SRHR as a human right.


Asunto(s)
Salud Reproductiva , Salud Sexual , Países en Desarrollo , Servicios de Salud , Humanos , Derechos Sexuales y Reproductivos
20.
BMC Health Serv Res ; 21(1): 1245, 2021 Nov 18.
Artículo en Inglés | MEDLINE | ID: mdl-34789259

RESUMEN

BACKGROUND: Today's healthcare provision is facing several challenges, that cause the level of complexity to increase at a greater rate than the managerial capacity to effectively deal with it. One of these challenges is the demand for person-centered care in an approach that is tuned towards shared decision-making. Flexibility is needed to adequately respond to individual needs. METHODS: We elaborate on the potential of service modularity as a foundation for person-centered care delivered in a shared decision-making context, and examine to what extent this can improve healthcare. We primarily focused on theory building. To support our effort and gain insight into how service modularity is currently discussed and applied in healthcare, we conducted a scoping review. RESULTS: Descriptions of actual implementations of modularity in healthcare are rare. Nevertheless, applying a modular perspective can be beneficial to healthcare service improvement since those service modularity principles that are still missing can often be fulfilled relatively easily to improve healthcare practice. Service modularity offers a way towards flexible configuration of services, facilitating the composition of tailored service packages. Moreover, it can help to provide insight into the possibilities of care for both healthcare professionals and patients. CONCLUSIONS: We argue that applying a modular frame to healthcare services can contribute to individualized, holistic care provision and can benefit person-centered care. Furthermore, insight into the possibilities of care can help patients express their preferences, increasing their ability to actively participate in a shared decision-making process. Nevertheless, it remains essential that the healthcare professional actively collaborates with the patient in composing the care package, for which we propose a model. Altogether, we posit this can improve healthcare practice, especially for the people receiving care.


Asunto(s)
Atención a la Salud , Personal de Salud , Servicios de Salud , Humanos , Atención Dirigida al Paciente , Investigación Cualitativa
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