Results of EAHP's 2023 shortages survey.

AIMS AND OBJECTIVE: The aim of the European Association of Hospital Pharmacists (EAHP)'s 2023 shortages survey was to collect data on causes and mitigation strategies of shortages of medicines and medical devices and their impact on patient care. The survey targeted hospital pharmacists (HPs), physicians (PHYs), nurses (NRS) and other healthcare professionals (OHCPs). A separate set of questions addressed patients (PTNs). METHODS: A 49-question survey was carried out by a team at EAHP, collecting information from European HPs, PTNs, NRS, PHYs and OTHCs on shortages of medicines and medical devices in their respective countries. The survey ran from 27 February to 19 May 2023. The results were analysed by EAHP. RESULTS: There were 1497 HP responses to the 2023 survey. While 95% (n=1429) of HPs and 86% (n=127) of OHCPs consider medicine shortages an ongoing problem, 84% (n=48) of PHYs and 68% (n=15) of NRS also agreed. Shortages of active pharmaceutical ingredients (77%, n=1148), manufacturing (67%, n=1007) and supply chain problems (50%, n=752) are major causes of shortages according to HPs as well as NRS and OHCPs; PHYs (49%, n=18) consider pricing to be the driver. More than 60% (n=765) of HPs, 55% (n=11) of NRS, 57% (n=30) of PHYs and 46% (n=56) of OHCPs experienced shortages of medical devices in 2022. Antimicrobials were most affected, according to all respondent groups, followed by analgesics, anaesthetics, cardiovascular and paediatric medicines. HPs (59%, n=269), NRS (57%, n=4), OHCPs (56%, n=37) and PHYs (54%, n=14) consider delays in care as the main consequence of medication shortages. CONCLUSIONS: Shortages of medicines and medical devices affect healthcare services and patient care. Increased transparency and access to information regarding ongoing and emerging shortages as well as better preparedness of healthcare professionals is crucial to their effective management.

Ethical dilemmas in prioritizing patients for scarce radiotherapy resources.

BACKGROUND: Radiotherapy is an essential component of cancer treatment, yet many countries do not have adequate capacity to serve all patients who would benefit from it. Allocation systems are needed to guide patient prioritization for radiotherapy in resource-limited contexts. These systems should be informed by allocation principles deemed relevant to stakeholders. This study explores the ethical dilemmas and views of decision-makers engaged in real-world prioritization of scarce radiotherapy resources at a cancer center in Rwanda in order to identify relevant principles. METHODS: Semi-structured interviews were conducted with a purposive sample of 22 oncology clinicians, program leaders, and clinical advisors. Interviews explored the factors considered by decision-makers when prioritizing patients for radiotherapy. The framework method of thematic analysis was used to characterize these factors. Bioethical analysis was then applied to determine their underlying normative principles. RESULTS: Participants considered both clinical and non-clinical factors relevant to patient prioritization for radiotherapy. They widely agreed that disease curability should be the primary overarching driver of prioritization, with the goal of saving the most lives. However, they described tension between curability and competing factors including age, palliative benefit, and waiting time. They were divided about the role that non-clinical factors such as social value should play, and agreed that poverty should not be a barrier. CONCLUSIONS: Multiple competing principles create tension with the agreed upon overarching goal of maximizing lives saved, including another utilitarian approach of maximizing life-years saved as well as non-utilitarian principles, such as egalitarianism, prioritarianism, and deontology. Clinical guidelines for patient prioritization for radiotherapy can combine multiple principles into a single allocation system to a significant extent. However, conflicting views about the role that social factors should play, and the dynamic nature of resource availability, highlight the need for ongoing work to evaluate and refine priority setting systems based on stakeholder views.

Public preferences in healthcare resource allocation: A discrete choice experiment in South Korea.

OBJECTIVES: This study aimed to explore the public view on priority-setting criteria for healthcare resource allocation. Specifically, it investigates how the value of a quality-adjusted life year (QALY) varies depending on patient characteristics. METHODS: A discrete choice experiment was conducted using an online sample of the general South Korean population. Respondents were presented with two competing treatment scenarios. The attributes of the scenarios were age at disease onset, life expectancy without treatment, life-years gain with treatment, health-related quality of life (HRQoL) without treatment, and HRQoL gains with treatment. Two hundred choice sets were generated and randomly allocated into 20 blocks. A conditional logit model was used to estimate the factors affecting the respondents' choices. RESULTS: A total of 3,482 respondents completed the survey. The larger the QALY gain, the more likely it was that the scenario would be chosen but with a diminishing marginal value. Respondents prioritized 40-year-old patients over 5-year-olds and 5-year-olds over 70-year-olds and prioritized baseline HRQoL of 40% and 60% over 20%. Patients at the end of life were not preferred to those with a longer life expectancy. CONCLUSION: Overall, respondents preferred health-maximizing options without explicit consideration for end-of-life patients or those with poor health. In addition, they revealed a kinked preference for patient age, prioritizing middle-aged patients over children and older people.

Increasing the number of pharmacist-led medication order reviews using the available workforce: a retrospective study.

BACKGROUND: Due to staffing constraints, several hospitals have defined targeting strategies for pharmacist-led medication order review, leaving non-targeted patients exposed to potential harmful drug-related problems (DRPs). Using targeting criteria to stratify medication order review level (level 1 (L1): orders, basic patient characteristics; level 2 (L2) or comprehensive medication order review: orders, patient characteristics, medical records, laboratory results) could make it possible to save time and increase the overall number of medication order reviews. This study aims to define targeting criteria to stratify medication order review level and estimate the time saved for the performance of additional medication order reviews. METHOD: This retrospective single-centre study included all medication order reviews performed in 2020; DRPs were collected to assess the medication order review level required to detect them. Logistic regressions were performed to define patient characteristics associated with L2. These targeting criteria were applied to the cohort to estimate the time saved and the number of additional medication order reviews which could have been performed using this approach. RESULTS: 2478 DRPs were reported; 54.2% (1343/2748) could have been detected using an L1 medication order review (representing 48.2% of the patients (829/1721)). L2 medication order reviews were significantly associated with age ≥65 years, male, and renal clearance <60 mL/min (OR≥75yo=1.79; OR65-74yo=1.74; ORfemale=0.74; OR30-59mL/min=1.67; OR<30mL/min=2.62; p<0.05). Sex being a confounding factor, only age and renal clearance were used as targeting criteria. The time saved was estimated at 274 hours per year, leading to an additional 1720 medication order reviews (54 hospital beds). CONCLUSION: The proposed approach would maintain a satisfying level of safety and quality for patients, by performing an L2 medication order review for targeted patients based on age and renal clearance, while improving medication order review coverage with an L1 medication order review for non-targeted patients, using the available workforce.

Addressing the Burnout and Shortage of Nurses in the Philippines.

Burnout among Filipino nurses poses a significant threat to an understaffed Philippine healthcare system, leading to resignations, change of profession, and migration to other countries, thereby exacerbating the shortage in the local nursing sector. While workplace mental health programs and interventions can help alleviate burnout, it is crucial to address the structural factors contributing to burnout among Filipino nurses, such as low salaries, delayed benefits, understaffing, overwork, and job insecurity. Therefore, mobilizing existing resources and improving policies are critical steps that need to be taken to effectively address burnout among nurses. Measures such as increasing salaries, timely provision of benefits, and filling vacant government regular positions can contribute to improving the working conditions for nurses in the Philippines. Moreover, by undertaking these measures, the Philippines can advance just working and living conditions for nurses, while also mitigating the challenges posed by the shortage of nurses within its healthcare system.

Global research trends and hotspots in pharmaceutical care: a bibliometric analysis and visualisation using CiteSpace and VOSviewer.

OBJECTIVE: Pharmaceutical care is closely related to the outcome and prognosis of disease treatment. This study analyses the research status, hotspots, frontiers and development trends of pharmaceutical care from the perspective of bibliometrics. METHODS: Related literature on pharmaceutical care published in the Web of Science Core Collection database was collected and knowledge maps were drawn by science information visualisation software Citespace 6.1 .R3 and VOSviewer 1.6.17.0. RESULTS: A total of 3289 institutions from 105 countries/regions published 2906 papers in 669 academic journals, which were cited 50 027 times. The top three countries/regions by the number of publications are the USA, UK and Brazil. The top three institutions are Utrecht University and the University of Groningen in the Netherlands, and University College London in the UK. The top three journals are American Journal of Pharmaceutical Education, International Journal of Clinical Pharmacy and American Journal of Health-System Pharmacy. The top three authors are Hersberger KE, Bouvy ML and Hughes CM. The most co-cited is Hepler CD, and the most co-cited influential is Strand LM. COVID-19 pandemic, chronic obstructive pulmonary disease and pharmacy practice are the most cutting edge topics in the field of research in pharmaceutical care. Pharmaceutical service and clinical pharmacy are research hotspots in pharmaceutical care. CONCLUSION: In the past 10 years, papers in the field of pharmaceutical care have shown a significant growth trend and scholars have become increasingly interested in research on related content in the field of pharmaceutical care. Our research results are of great significance for improving the connotation construction of pharmaceutical care and improving patient satisfaction and prognosis, and can also be used as an important reference for relevant scholars to select scientific research topics for subsequent research. The objective basis for relevant government departments is to modify and formulate health policies or measures.

Health professionals' knowledge about ethical criteria in the allocation of resources in the COVID-19 pandemic.

Due to the rapid advance of the pandemic caused by COVID-19, several countries perceived that human and material resources would be insufficient to meet the demand of infected patients. The aim of this study is to analyze the knowledge of health professionals working in the pandemic about the application of ethical criteria in decision-making in situations of resource scarcity. This is a cross-sectional, descriptive, and quantitative survey study, conducted from June to December 2020, with health professionals working in the COVID-19 pandemic in Brazil. We applied a questionnaire to assess the professionals' knowledge about ethical criteria in decision-making in the allocation of scarce resources during the pandemic, containing 14 questions and possible score from 0 to 70, which was developed by researchers from documents and protocols validated by organizations from various countries, available in the first months of the pandemic, a sociodemographic characterization questionnaire and a self-assessment questionnaire regarding knowledge about bioethics. A total of 197 health professionals participated in the study, 37.6% of whom were nurses and 22.8% of whom were physicians, working in the Family Health Unit (28.4%) with a degree at the level of specialization (46.2%). Moreover, (9.5%) of nurses, (18.2%) of dental surgeons and (24.4%) of physicians reported that they have no prior knowledge about bioethics. Physicians and hospital workers scored higher on the knowledge assessment questionnaire. The mean score of the participants was 45.4 (SD = 7.2). Investments in training and professional education in the field of health focused on Bioethics are necessary, considering models and ethical theories that help professionals, managers and society to better position themselves in the face of pandemic contexts.

Assessment of the appropriateness of antibiotic prescribing in an acute UK hospital using a national audit tool: a single centre retrospective survey.

INTRODUCTION: Antibiotic use drives antibiotic resistance. The UK antimicrobial resistance (AMR) strategy aims to reduce antibiotic use. We aimed to quantify excess antibiotic use in a district general hospital in south-west England. METHODS: Medical patients discharged in August 2020 who had received antibiotics were included. An audit tool of antibiotic prescribing appropriateness was used to collect relevant clinical information regarding each patient case. The appropriateness of antibiotic use was then determined by two infection specialists and excess days of therapy (DOTs) calculated. RESULTS: 647 patients were discharged in August 2020. Of the 1658 antibiotic DOTs for the 184 patients reviewed, 403 (24%) were excess DOTs. The excess antibiotic DOTs were prescribed in 92 patients (50%); 112/403 (27.8%) excess DOTs originated at the initiation of antibiotic therapy (time point A); 184/403 (45.7%) of excess DOTs occurred at the antibiotic review pre-72 hours (time point B); and 107/403 (26.6%) of excess DOTs were due to protracted antibiotic courses (time point C). CONCLUSION: 24% of antibiotic DOTs were deemed unnecessary. The greatest opportunity to reduce antibiotic use safely was the pre-72 hours antibiotic review, which may provide a target for reducing excess antimicrobial therapy in line with the national AMR strategy.

Availability of antidotes in Moroccan hospitals: a national survey.

AIM: The lack of availability of antidotes is a challenge for hospitals all over the world. The objective of our study was to investigate the availability of antidotes in Moroccan hospitals. METHODS: A cross-sectional, questionnaire-based study was conducted from November 2018 to April 2019. The questionnaire was sent to 25 hospitals in order to investigate the availability of 42 selected antidotes based on the International Programme on Chemical Safety list. RESULTS: The survey response rate was 68%. Of the 42 selected antidotes, 38 (90.5%) were available depending on the hospitals included in the study. We found a strong correlation between the availability of antidotes and hospital bed capacity, and logistic regression analysis revealed that bed capacity is the only factor strongly associated with higher antidote stock levels. Some essential antidotes such as digoxin-specific antibody, protamine sulfate, flumazenil and glucagon were unavailable in many of the small- and medium-sized hospitals, and methylene blue, sodium nitroprussiate, Prussian blue and anti-snake venom were absent in all of the hospitals. CONCLUSION: Despite the great efforts that have been made to improve the availability of antidotes in Morocco, some of these vital products are still lacking in Moroccan hospitals.

Covid-19 and age discrimination: benefit maximization, fairness, and justified age-based rationing.

Age-based rationing remains highly controversial. This question has been paramount during the Covid-19 pandemic. Analyzing the practices, proposals, and guidelines applied or put forward during the current pandemic, three kinds of age-based rationing are identified: an age-based cut-off, age as a tiebreaker, and indirect age rationing, where age matters to the extent that it affects prognosis. Where age is allowed to play a role in terms of who gets treated, it is justified either because this is believed to maximize benefits from scarce resources or because it is believed to be in accordance with the value of fairness understood as (a) fair innings, where less priority is given to those who have lived a full life or (b) an egalitarian concern for the worse off. By critically assessing prominent frameworks and practices for pandemic rationing, this article considers the balance the three kinds of age-based rationing strike between maximizing benefits and fairness. It evaluates whether elements in the proposals are, in fact, contrary to the justifications of these measures. Such shortcomings are highlighted, and it is proposed to adjust prominent proposals to care for the worse off more appropriately and better consider whether the acquired benefits befalls the young or the old.

The pandemic is not the great equalizer: front-line labor and rationing in COVID-19 critical care.

BACKGROUND: Framed as "the great-equalizer," the COVID-19 pandemic has intensified pressure to adapt critical care labor and resulted in rationing by healthcare workers across the world. OBJECTIVE: To critically investigate how hospital intensive care units are critical sites of care labor and examine how rationing highlights key features of healthcare labor and its inequalities. METHODS: A practice-oriented ethnographic study was conducted in a United States academic ICU by a medical anthropologist and medical intensivists with global health expertise. The analysis drew on 57 in-depth interviews and 25 months of participant observation between 2020 and 2021. RESULTS: Embodied labor constitutes sites and practices of shortage or rationing along three domains: equipment and technology, labor, and emotions and energy. The resulting workers' practices of adaptation and resilience point to a potentially more robust global health labor politics based on seeing rationing as work. CONCLUSION: Studies of pandemic rationing practices and critical care labor can disrupt too-simple comparative narratives of Global North/South divides. Further studies and efforts must address the toll of healthcare labor.

CONTEXTE: Présentée comme « le grand égalisateur ¼, la pandémie de COVID-19 a accentué la pression pour adapter le travail des soins intensifs et a entraîné le rationnement des travailleurs de la santé dans le monde entier. OBJECTIF: Étudier de manière critique comment les unités de soins intensifs des hôpitaux sont des sites critiques dans le système de santé et examiner comment le rationnement met en évidence les caractéristiques clés du travail de la santé et ses inégalités. MÉTHODES: Une étude ethnographique axée sur la pratique a été menée dans une unité de soins intensifs universitaire des États-Unis par un anthropologue médical et des médecins intensivistes spécialisés dans la santé mondiale. L'analyse s'est appuyée sur 57 entretiens approfondis et 25 mois d'observation participante entre 2020 et 2021. RÉSULTATS: Le travail incarné constitue des sites et des pratiques de pénurie ou de rationnement le long de trois domaines : équipement et technologie, travail, émotions et énergie. Les pratiques d'adaptation et de résilience des travailleurs qui en résultent indiquent une politique du travail potentiellement plus robuste dans le domaine de la santé mondiale, fondée sur une vision du rationnement en tant que travail. CONCLUSION: Les études sur les pratiques de rationnement en cas de pandémie et sur le travail dans le domaine des soins intensifs peuvent perturber les récits comparatifs trop simples des divisions Nord/Sud. D'autres études et efforts doivent porter sur le coût du travail dans le secteur des soins de santé.

Beta-lactam allergy in patients: an antibiotic stewardship challenge.

BACKGROUND: Patients are commonly reported as being allergic to beta-lactam (BL) antibiotics. However, many patients with this reported allergy are able to receive BL treatments because they do not have true allergies. In many cases these are simply intolerances due to side effects reported as an allergy. Delabelling these patients leads to better clinical outcomes, optimal antibiotic usage, decreased bacterial resistance and reduced healthcare costs. Therefore, the aims of this study were to identify incorrectly labelled BL allergies in hospitalised patients and to assess antibiotic use in delabelled patients in order to establish a quality indicator to optimise antimicrobial treatments. METHODS: A prospective study was conducted in which hospitalised patients treated with antimicrobial drugs and labelled as 'BL-allergic' were identified by clinical pharmacists. An allergist assessed whether patients were suitable candidates for a skin test or oral challenge. The Allergy Service removed 'BL-allergic' labels if negative results were obtained. Delabelled patients were followed up by clinical pharmacists to study the use of BL antibiotics as a result of the delabelling programme. RESULTS: A total of 176 suspected allergic patients were identified and 91 (51.7%) were tested either by a skin test or oral challenge based on the patient indicators. Seven (16.4%) patients tested were allergic to BL antibiotics, 76 (83.5%) were totally delabelled and eight (0.1%) were partially delabelled. Thirty-two (38.1%) delabelled patients required antibiotic treatment in another inpatient or outpatient setting, of whom 27 (84.3%) patients with a new infectious episode received BL treatments while five (15.7%) continued to receive antimicrobial treatments without BL. CONCLUSION: After the implementation of a protocol to detect incorrect BL allergy labels, 83.5% of the patients in this cohort were completely delabelled. This shows that there is a clear opportunity to optimise the use of antibiotics by delabelling 'BL-allergic' patients.

Workload and quality of nursing care: the mediating role of implicit rationing of nursing care, job satisfaction and emotional exhaustion by using structural equations modeling approach.

BACKGROUND: Nursing workload and its effects on the quality of nursing care is a major concern for nurse managers. Factors which mediate the relationship between workload and the quality of nursing care have not been extensively studied. This study aimed to investigate the mediating role of implicit rationing of nursing care, job satisfaction and emotional exhaustion in the relationship between workload and quality of nursing care. METHODS: In this cross-sectional study, 311 nurses from four different hospitals in center of Iran were selected by convenience sampling method. Six self-reported questionnaires were completed by the nurses. The data were analyzed by SPSS version 16. Structural equation modeling was used to determine the relationships between the components using Stata 14 software. RESULTS: Except direct and mutual relationship between workload and quality of nursing care (P ≥ 0.05), the relationship between other variables was statistically significant (P < 0.05). The hypothesized model fitted the empirical data and confirmed the mediating role of implicit rationing of nursing care, job satisfaction and emotional exhaustion in the relationship between workload and the quality of nursing care (TLI, CFI > 0.9 and RMSEA < 0.08 and χ2/df < 3). CONCLUSION: Workload affects the quality of the provided nursing care by affecting implicit rationing of nursing care, job satisfaction and emotional exhaustion. Nurse managers need to acknowledge the importance of quality of nursing care and its related factors. Regular supervision of these factors and provision of best related strategies, will ultimately lead to improve the quality of nursing care.

Overnight joint replacement surgery: a pilot Australian study.

BACKGROUND: With a stretched healthcare system and elective surgery backlog, measures to improve efficiency and decrease costs associated with surgical procedures need to be prioritized. This study compares the benefits of multi-disciplinary involvement in an enhanced recovery after surgery (ERAS) protocol-led overnight model following total hip replacement (THR) and total knee replacement (TKR). METHODS: Patients in each of two private hospitals undergoing THR or TKR were prospectively enrolled. One hospital (Overnight) was fully committed to the ERAS protocol implementation on all levels and formed the treatment group while in the other hospital (control), patients only had the anaesthetic and operative procedure as part of the ERAS protocol but did not follow the perioperative measures of the protocol. Outcomes on hospital length of stay (LOS), inpatient rehabilitation, functional outcomes, satisfaction, adverse events and readmission rates were investigated. RESULTS: Median LOS in the Overnight group was significantly smaller than in the control group (1 vs. 3 days, P < 0.0001). The Overnight group had lower rates of inpatient rehabilitation utilization (4% vs. 41.2%, P < 0.0001), similar improvements in functional hip and knee scores and no increased rate of adverse events or readmission. All patients in both groups were satisfied with their treatment. CONCLUSION: Overnight THR and TKR can safely be performed in the majority of patients, with a multi-disciplinary approach protocol and involvement of all perioperative stakeholders.

Promoting sports strength development based on the integration of physical fitness and national health / Promovendo o desenvolvimento da força esportiva com base na integração da aptidão física e da saúde nacional / Promoviendo el desarrollo de la fuerza deportiva sobre la base de una integración de la aptitud física y de la salud nacional

ABSTRACT Objective: Sports play a crucial role in China's national sportsmanship. Therefore, it is necessary to further promote China's development as a sports powerhouse. People's health needs to be raised to the pinnacle of the national fitness strategy, and the government should seriously implement people's health work. Methods: the construction of the "Powerful Country for Sports" and "Healthy China" provides a more precise direction for the development of national fitness and opens a broader path for the development of national health. The dream of a powerful country in sports has a long history, and different times have different definitions. Results: building a sports power is a strategic project for the development of modern socialist capability with Chinese characteristics. Accelerating the construction of a sports power is related to national prosperity and rejuvenation, and is closely related to the happiness of the people. Conclusions: the barrier preventing the sustainable development of national sports break and create a new driving force for the development of a sports power only by solving the problem of displacement in building a sports power and promoting the deep integration of national fitness and health. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Objetivo: O esporte desempenha um papel crucial no espírito esportivo nacional da China. Portanto, é necessário promover ainda mais o desenvolvimento da China como uma potência esportiva. A saúde das pessoas precisa ser elevada ao auge da estratégia nacional de aptidão física, e o governo deveria implementar seriamente o trabalho de saúde das pessoas. Métodos: a construção do "País poderoso para o esporte" e da "China saudável" fornece uma direção mais precisa para o desenvolvimento da aptidão física nacional e abre um caminho mais amplo para o desenvolvimento da saúde nacional. O sonho de um país poderoso no esporte tem uma longa história, e tempos diferentes têm definições diferentes. Resultados: a construção de uma potência esportiva é um projeto estratégico para o desenvolvimento de uma capacidade socialista moderna com características chinesas. Acelerar a construção de uma potência esportiva está relacionado com a prosperidade e o rejuvenescimento nacional, e está intimamente relacionado com a felicidade do povo. Conclusões: somente resolvendo o problema do deslocamento na construção de uma potência esportiva e promovendo a integração profunda da condição física e da saúde nacional se poderá quebrar a barreira que impede o desenvolvimento sustentável do esporte nacional e criar uma nova força motriz para o desenvolvimento de uma potência esportiva. Nível de evidência II; Estudos terapêuticos - investigação de resultados de tratamento.

Resumen Objetivo: Los deportes desempeñan un papel crucial en el espíritu deportivo nacional de China. Por lo tanto, es necesario seguir promoviendo el desarrollo de China como potencia deportiva. Es necesario elevar la salud del pueblo a la cúspide de la estrategia nacional de aptitud física, y el gobierno debe implementar seriamente el trabajo de salud de las personas. Métodos: la construcción del "País poderoso en deportes" y de la "China saludable" proporciona una dirección más precisa para el desarrollo de la aptitud física nacional y abre un camino más amplio para el desarrollo de la salud nacional. El sueño de un país poderoso en el deporte tiene una larga historia, y diferentes épocas tienen diferentes definiciones. Resultados: la construcción de una potencia deportiva es un proyecto estratégico para el desarrollo de la capacidad socialista moderna con características chinas. Acelerar la construcción de una potencia deportiva está relacionado con la prosperidad y el rejuvenecimiento nacionales, y está estrechamente relacionado con la felicidad del pueblo. Conclusiones: sólo resolviendo el problema del desplazamiento en la construcción de una potencia deportiva y promoviendo la integración profunda de la aptitud y la salud nacionales se puede romper la barrera que impide el desarrollo sostenible del deporte nacional y crear una nueva fuerza motriz para el desarrollo de una potencia deportiva. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados de tratamiento.

Increasing implicit rationing of care in nursing homes: A time-series cross-sectional analysis.

BACKGROUND: Implicit rationing of nursing care is a socio-ecological problem where care workers, due to lack of resources, have to leave necessary nursing care activities undone. Cross-sectional studies on implicit rationing of nursing home care revealed associations with organizational and work environment characteristics. However, little is known on how implicit rationing of nursing care varies over time in nursing homes. OBJECTIVE: This study's purpose was to describe changes in levels and patterns of implicit rationing of nursing care in Swiss nursing homes over time, while accounting for key explanatory factors related to organizational, work environment, and individual characteristics. DESIGN: Time-series cross-sectional analysis. SETTING: Nursing homes in Switzerland. PARTICIPANTS: A convenience sample of 47 nursing homes and 3269 care workers from all educational levels participating in two multicenter cross-sectional studies (the Swiss Nursing Home Human Resources Project) conducted in 2013 and 2018. METHODS: To quantify implicit rationing of nursing care, care workers' data were collected via the nursing home version of the Basel Extent of Rationing of Nursing Care instrument. To control for leadership ability, staffing and resource adequacy, we used the Nursing Work Index-Practice Environment Scale. Objective measures including turnover, staffing and skill mix levels were aggregated at the nursing home level. Our analyses included multiple linear mixed models, using time as a fixed effect and nursing home as a random effect. RESULTS: We found overall increases of rationing of care activities over the five-year period studied, with documentation and social activities most rationed at both measurement points (overall coefficients varied between 0.11 and 0.23, as well as the 95%-confidence intervals between 0.05 and 0.30). Moreover, a considerable increase in rationing of activities of daily living (coefficient of 0.47 in 2013 and 0.63 in 2018) was observed. CONCLUSIONS: Alongside long-term deterioration of staff resources, increases in rationing of nursing care are a worrying development, particularly given their potential negative impacts both on residents and on care workers. To assess nursing home care quality and to determine adequate staffing levels and skill mixes, policy makers and nursing home managers should consider regular monitoring of rationing of nursing care. TWEETABLE ABSTRACT: Time-series cross-sectional analysis reveals increasing rationing of nursing care activities in Swiss nursing homes from 2013 to 2018.

When rationing becomes inevitable in a pandemic: A discussion on the ethical considerations from a public health perspective.

Objectives: Coronavirus Disease 2019 has presented extreme difficulties to healthcare resource allocation worldwide. Health resources, particularly during a pandemic, are limited even in developed countries. The main challenge for healthcare professionals is to be able to ration resources in an ethical manner. Therefore, this leads to ethical considerations that we aim to discuss in this paper, based on which, recommendations can be made for reference by healthcare management, policymakers, and public health practitioners. Study design: This is a discussion paper. Methods: A brief review of the major principles as they relate to the notion of rationing in a pandemic was conducted. We organized an ethical discussion from public health perspectives based on these major principles. Results: Prior to deciding the principles to adopt, a transparent and robust guideline for rationing must be established. There are four considerations that need to be made: transparency, consistency, inclusiveness, and accountability. There does not exist a "perfect" principle to adopt during rationing. However, in the authors' opinion, the most obvious principles that would be unsuitable during a healthcare crisis would be the equal worth and prioritarian principles. This leaves the equity principle, utilitarian and urgent need principles. Conclusion: The recommendation of this discussion paper is to adopt multiple principles according to the situation of each country or even the particular hospital.

[Analysis of variation trend in health workforce equity allocation in China].

OBJECTIVE: To analyze the long-term trends of the changes in the equity of China's health workforce allocation to provide a reference for the more balanced and orderly development of China's health system. METHODS: The Gini coefficient was used to evaluate the degree of equity in the allocation of health workforce between regions, and the Gini coefficients for the allocation of doctors and nurses based on population and regional gross domestic product (GDP) distribution were calculated respectively. RESULTS: In 2019, the number of licensed (assistant) physicians per 1 000 population in China was 2.77, and the number of registered nurses per 1 000 population was 3.18. The Gini coefficient for the distribution of licensed (assistant) physicians by population was 0.141 in 2002, decreasing to 0.081 by 2014 and then remained stable. The Gini coefficient for the distribution of registered nurses by population was 0.164 in 2002 and decreased to 0.066 in 2018. The Gini coefficient for the distribution of licensed (assistant) physicians by GDP was 0.236 in 2002, decreased to 0.169 in 2013, then increased to 0.183 and remained stable. The Gini coefficient for the distribution of registered nurses by GDP was 0.206 in 2002, decreased to 0.150 in 2013, and then increased each year to 0.180 in 2019. The equity of the allocation of registered nurses by population was worse than the equity of the allocation of licensed (assistant) physicians in 2002, and in 2016, for the first time, exceeded that of licensed (assistant) physicians. CONCLUSION: Equity in the allocation of health workforce across China has improved, but the improvement in equity between regions has hit a bottleneck, with health workforce allocation in the western regions still relatively scarce. Although nursing workforce allocation equity caught up with licensed (assistant) physicians, the number of licensed (assistant) physicians is close to that of developed western countries, while there is a large gap in registered nurses. It is recommended that the relevant authorities make good long-term planning for health workforce, further increase the policy for the introduction of health workforce in the western region, and increase the supply of healthcare services in the western region with the help of digital transformation of healthcare and internet healthcare. At the same time, they should further increase investment in resources for higher nursing education and actively plan to cope with the ageing population.