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1.
Artigo em Inglês | MEDLINE | ID: mdl-34074233

RESUMO

Abstract: With COVID-19 affecting millions of people around the globe, quarantine of international arrivals is a critical public health measure to prevent further disease transmission in local populations. This measure has also been applied in the repatriation of citizens, undertaken by several countries as an ethical obligation and legal responsibility. This article describes the process of planning and preparing for the repatriation operation in South Australia during the COVID-19 pandemic. Interagency collaboration, development of a COVID-19 testing and quarantining protocol, implementing infection prevention and control, and building a specialised health care delivery model were essential aspects of the repatriation operational planning, with a focus on maintaining dignity and wellbeing of the passengers as well as on effective prevention of COVID-19 transmission. From April 2020 to mid-February 2021, more than 14,000 international arrivals travellers have been repatriated under the South Australian repatriation operations. This paper has implications to inform ongoing repatriation efforts in Australia and overseas in a pandemic situation.


Assuntos
COVID-19/epidemiologia , Controle de Infecções/legislação & jurisprudência , Saúde Pública/legislação & jurisprudência , Quarentena/legislação & jurisprudência , COVID-19/diagnóstico , COVID-19/transmissão , Teste para COVID-19/métodos , Teste para COVID-19/normas , Atenção à Saúde , Humanos , Controle de Infecções/métodos , Regulamento Sanitário Internacional , Pandemias , Saúde Pública/métodos , Quarentena/métodos , Medição de Risco , Fatores de Risco , SARS-CoV-2/isolamento & purificação , Austrália do Sul/epidemiologia , Viagem
2.
Front Public Health ; 9: 661042, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34095066

RESUMO

Coronavirus disease 2019 (COVID-19) has disproportionately affected residents, their families, staff, and operators of congregate care settings. Assisted living (AL) is a type of long-term care setting for older adults who need supportive care but not ongoing nursing care and emphasizes a social model of care provision. Because AL is a type of long-term care, it has at times been referenced along with nursing homes in discussions related to COVID-19 but not recognized for its different care practices that pose unique challenges related to COVID-19; in that manner, it has largely been left out of the COVID-19 discourse, although ~812,000 older adults live in AL. To identify COVID-19 issues specific to AL, stakeholders with expertise in AL operations, policy, practice, and research (n = 42) were recruited to participate in remote interviews between July and September 2020. Using a thematic analysis, we derived the following overarching themes: (1) Policymakers are disconnected from and lack an understanding of the AL context; (2) AL administrators were left to coordinate, communicate, and implement constantly changing guidelines with little support; (3) AL organizations faced limited knowledge of and disparate access to funding and resources; (4) state-level regulatory requirements conflicted with COVID-19 guidelines resulting in uncertainty about which rules to follow; and (5) AL operators struggled to balance public health priorities with promoting their residents' quality of life and well-being. To develop evidence-informed policy and avoid unintended consequences, AL operators, direct care workers, residents, and clinicians practicing in these settings should have opportunities to provide feedback throughout the policy development process, both state and national.


Assuntos
COVID-19 , Idoso , Atenção à Saúde , Humanos , Casas de Saúde , Qualidade de Vida , SARS-CoV-2 , Estados Unidos/epidemiologia
3.
Ned Tijdschr Tandheelkd ; 128(6): 331-338, 2021 Jun.
Artigo em Holandês | MEDLINE | ID: mdl-34096933

RESUMO

Oral and general health are inextricable. In primary care, the fields of care by general practioners, youth healthcare, healthcare for older people and oral care are all distinctly separated. Healthcare professionals are increasingly confronted with the complexity and increase in Noncommunicable diseases (NCD's) and an aging population. The aetiology of NCD's in primary care concern the professional fields of all healthcare professionals mentioned, meaning that lifestyle-related risks might be prevented more effectively through collaboration. In primary care, the number of medically compromised people is on the rise and healthcare professionals encounter each other's patients, whose risks remain invisible to them. Through collaboration such problems could be faced more effectively. Better integration of oral care into primary care can also contribute to the quality of care and safety of care receivers, and reduce further inequality. In order to better design this integration with the help of innovation, more practicebased research and implementation is needed.


Assuntos
Atenção à Saúde , Atenção Primária à Saúde , Adolescente , Idoso , Envelhecimento , Pessoal de Saúde , Humanos
4.
Wiad Lek ; 74(5): 1208-1212, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34090292

RESUMO

OBJECTIVE: The aim: is to analyze the realities and to determine prospects of the medical reform in Ukraine as a method of public administration of healthcare. PATIENTS AND METHODS: Materials and methods: The given paper uses an integrated approach, which consists in the study of public administration of healthcare as a single whole with the coordinated functioning of all its constituents; besides this, the methods, which were used at the empirical and theoretical levels, such as, an abstract logical method, a method of analyses and synthesis, and a method of comparison were applied in the given research. CONCLUSION: Conclusions: The medical reform is not a goal in itself, but when implementing the reform, it is necessary to consider other related processes, such as globalization, technological progress, urbanization, demographic crisis, macro-economic situation, unfinished distribution of the rights of property in business, specialization. Now, there is «The Strategy of the Reformation of Healthcare of Ukraine¼. And the proper use of the complex of methods of public administration, directed both at balanced growth of the national health field, and prevention of negative influence of related sectors and fields of national economy guarantees its successful realization.


Assuntos
Atenção à Saúde , Internacionalidade , Comércio , Humanos , Ucrânia
5.
Wiad Lek ; 74(5): 1237-1240, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34090297

RESUMO

OBJECTIVE: The aim: Scientific justification of the public health management methods and instruments for improvement of its effectiveness. PATIENTS AND METHODS: Materials and methods: The authors conducted a complex research of the public health of Ukraine personnel resources development during the system establishment and building. CONCLUSION: Conclusions: The paper justifies the competence-based model of a specialist (the postgraduate educational level) as well as the university educational standards of the first (bachelor) and second (master) levels of specialty 229 "Public health", knowledge branch 22 "Healthcare". The authors have established insufficient level of the youth motivation for obtaining the specialty certification and described disadvantages of both advocacy program within the public health system and its leadership within the preventive system component. The authors emphasize the necessity of an integrated preventive program maintaining and strengthening the population health, using the advocacy component and available information resources of the public health.


Assuntos
Atenção à Saúde , Saúde Pública , Adolescente , Humanos , Ucrânia
6.
Wiad Lek ; 74(5): 1256-1261, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34090301

RESUMO

OBJECTIVE: The aim: Of this research was to investigate the impact of quarantine restrictions on the health care system in Ukraine, quality of providing and accessibility of health care services for population during quarantine; analyze the influence of economic and social outcomes of epidemy on state of health care. PATIENTS AND METHODS: Materials and methods: For this paper was made a retrospective analysis of COVID-19 morbidity statistics, economic indicators and governmental decrees aimed at resolving the problem of the spreading of coronavirus and ensuring the proper work of medical institutions at all levels of health care. This work includes analysis of data for the period since the beginning of quarantine on the territory of Ukraine in March 2020 till present time. CONCLUSION: Conclusions: The complexity of the socio-political and economic situation in Ukraine and the conduct of hostilities in the east of the country have significantly complicated the fight against the spread of coronavirus in the country. Negative changes in the indicators of hospital security were observed both at the secondary level - treatment of patients with COVID-19, and the primary level - primary contact with the patient, primary care, prevention measures. In the long run, this will have significant implications for the individual health of those who have not been able to receive quality care, as well as for public health in general.


Assuntos
COVID-19 , Epidemias , Atenção à Saúde , Humanos , Estudos Retrospectivos , SARS-CoV-2 , Ucrânia/epidemiologia
7.
Zhonghua Yi Shi Za Zhi ; 51(2): 97-102, 2021 Mar 28.
Artigo em Chinês | MEDLINE | ID: mdl-34098702

RESUMO

Intelligent medicine is a discipline system developed and established in the background of a rapid development of science and technology. Information technology represented by artificial intelligence, VR(virtual reality) technology and the 1G (first-generation) communication laid a foundation for intelligent medicine. Internet technology, such as 3D printing, robot system and wearable medical devices have helped to improve the development of intelligent medicine. The application of intelligent medicine infiltrated medical imaging, auxiliary diagnosis, surgical operation, hospital management, pharmaceutical development, healthcare system and other aspects of the medical system. Currently, the cutting-edge technologies such as 5G medical, medical cloud platform/big data, advanced material synthesis, 4D printing, AR(Augmented Reality)/MR(Mixed Reality), super intelligence and other technologies have comprehensively driven human society into the era of intelligent medicine.


Assuntos
Medicina , Realidade Virtual , Inteligência Artificial , Atenção à Saúde , Humanos , Inteligência
8.
BMC Health Serv Res ; 21(1): 560, 2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34098942

RESUMO

BACKGROUND: Medical education should ensure graduates are equipped for practice in modern health-care systems. Practicing effectively in complex health-care systems requires contemporary attributes and competencies, complementing core clinical competencies. These need to be made overt and opportunities to develop and practice them provided. This study explicates these attributes and generic competencies using Group Concept Mapping, aiming to inform pre-vocational medical education curriculum development. METHODS: Group Concept Mapping is a mixed methods consensus building methodology whereby ideas are generated using qualitative techniques, sorted and grouped using hierarchical cluster analysis, and rated to provide further quantitative confirmation of value. Health service providers from varied disciplines (including medicine, nursing, allied health), health profession educators, health managers, and service users contributed to the conceptual model's development. They responded to the prompt 'An attribute or non-clinical competency required of doctors for effective practice in modern health-care systems is...' and grouped the synthesized responses according to similarity. Data were subjected to hierarchical cluster analysis. Junior doctors rated competencies according to importance to their practice and preparedness at graduation. RESULTS: Sixty-seven contributors generated 338 responses which were synthesised into 60 statements. Hierarchical cluster analysis resulted in a conceptual map of seven clusters representing: value-led professionalism; attributes for self-awareness and reflective practice; cognitive capability; active engagement; communication to build and manage relationships; patient-centredness and advocacy; and systems awareness, thinking and contribution. Logic model transformation identified three overarching meta-competencies: leadership and systems thinking; learning and cognitive processes; and interpersonal capability. Ratings indicated that junior doctors believe system-related competencies are less important than other competencies, and they feel less prepared to carry them out. CONCLUSION: The domains that have been identified highlight the competencies necessary for effective practice for those who work within and use health-care systems. Three overarching domains relate to leadership in systems, learning, and interpersonal competencies. The model is a useful adjunct to broader competencies frameworks because of the focus on generic competencies that are crucial in modern complex adaptive health-care systems. Explicating these will allow future investigation into those that are currently well achieved, and those which are lacking, in differing contexts.


Assuntos
Competência Clínica , Médicos , Atenção à Saúde , Humanos , Liderança , Profissionalismo
9.
BMC Health Serv Res ; 21(1): 558, 2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34098952

RESUMO

BACKGROUND: There is general scarcity of research on key elements of implementation processes and the factors which impact implementation success. Implementation of healthcare interventions is a complex process. Tools to support implementation can facilitate this process and improve effectiveness of the interventions and clinical outcomes. Understanding the impact of implementation support tools is a critical aspect of this process. The objective of this study was to solicit knowledge and agreement from relevant implementation science and knowledge translation healthcare experts in order to develop a process model of key elements in the implementation process. METHODS: A two round, modified Delphi study involving international experts in knowledge translation and implementation (researchers, scientists, professors, decision-makers) was conducted. Participants rated and commented on all aspects of the process model, including the organization, content, scope, and structure. Delphi questions rated at 75% agreement or lower were reviewed and revised. Qualitative comments supported the restructuring and refinement. A second-round survey followed the same process as Round 1. RESULTS: Fifty-four experts participated in Round 1, and 32 experts participated in Round 2. Twelve percent (n = 6) of the Round 1 questions did not reach agreement. Key themes for revision and refinement were: stakeholder engagement throughout the process, iterative nature of the implementation process; importance of context; and importance of using guiding theories or frameworks. The process model was revised and refined based on the quantitative and qualitative data and reassessed by the experts in Round 2. Agreement was achieved on all items in Round 2 and the Delphi concluded. Additional feedback was obtained regarding terminology, target users and definition of the implementation process. CONCLUSIONS: High levels of agreement were attained for all sub-domains, elements, and sub-elements of the Implementation Process Model. This model will be used to develop an Implementation Support Tool to be used by healthcare providers to facilitate effective implementation and improved clinical outcomes.


Assuntos
Atenção à Saúde , Pessoal de Saúde , Técnica Delfos , Humanos , Inquéritos e Questionários , Pesquisa Médica Translacional
10.
BMC Health Serv Res ; 21(1): 557, 2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34098957

RESUMO

BACKGROUND: Older persons with polypharmacy are at increased risk of harm from medications. Therefore, it is important that physicians and nurses, together with the persons, evaluate medications to avoid hazardous polypharmacy. It remains unclear how healthcare professionals experience such evaluations. This study aimed to explore physicians' and nurses' experiences from evaluations of older persons' medications, and their related actions to manage concerns related to the evaluations. METHOD: Individual interview data from 29 physicians and nurses were collected and analysed according to the critical incident technique. RESULTS: The medication evaluation for older persons was influenced by the working conditions (e.g. healthcare professionals' clinical knowledge, experiences, and situational conditions) and working in partnership (e.g. cooperating around and with the older person). Actions taken to manage these evaluations were related to working with a plan (e.g. performing day-to-day work and planning for continued treatment) and collaborative problem-solving (e.g. finding a solution, involving the older person, and communicating with colleagues). CONCLUSION: Working conditions and cooperation with colleagues, the older persons and their formal or informal caregivers, emerged as important factors related to the medication evaluation. By adjusting their performance to variations in these conditions, healthcare professionals contributed to the resilience of the healthcare system by its capacity to prevent, notice and mitigate medication problems. Based on these findings, we hypothesize that a joint plan for continued treatment could facilitate such resilience, if it articulates what to observe, when to act, who should act and what actions to take in case of deviations from what is expected.


Assuntos
Pessoal de Saúde , Análise e Desempenho de Tarefas , Idoso , Idoso de 80 Anos ou mais , Cuidadores , Atenção à Saúde , Humanos , Polimedicação
11.
BMC Med Inform Decis Mak ; 21(1): 182, 2021 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-34098959

RESUMO

BACKGROUND: Early diagnosis for the diabetes complications is clinically demanding with great significancy. Regarding the complexity of diabetes complications, we applied a multi-label classification (MLC) model to predict four diabetic complications simultaneously using data in the modern electronic health records (EHRs), and leveraged the correlations between the complications to further improve the prediction accuracy. METHODS: We obtained the demographic characteristics and laboratory data from the EHRs for patients admitted to Changzhou No. 2 People's Hospital, the affiliated hospital of Nanjing Medical University in China from May 2013 to June 2020. The data included 93 biochemical indicators and 9,765 patients. We used the Pearson correlation coefficient (PCC) to analyze the correlations between different diabetic complications from a statistical perspective. We used an MLC model, based on the Random Forest (RF) technique, to leverage these correlations and predict four complications simultaneously. We explored four different MLC models; a Label Power Set (LP), Classifier Chains (CC), Ensemble Classifier Chains (ECC), and Calibrated Label Ranking (CLR). We used traditional Binary Relevance (BR) as a comparison. We used 11 different performance metrics and the area under the receiver operating characteristic curve (AUROC) to evaluate these models. We analyzed the weights of the learned model and illustrated (1) the top 10 key indicators of different complications and (2) the correlations between different diabetic complications. RESULTS: The MLC models including CC, ECC and CLR outperformed the traditional BR method in most performance metrics; the ECC models performed the best in Hamming loss (0.1760), Accuracy (0.7020), F1_Score (0.7855), Precision (0.8649), F1_micro (0.8078), F1_macro (0.7773), Recall_micro (0.8631), Recall_macro (0.8009), and AUROC (0.8231). The two diabetic complication correlation matrices drawn from the PCC analysis and the MLC models were consistent with each other and indicated that the complications correlated to different extents. The top 10 key indicators given by the model are valuable in medical application. CONCLUSIONS: Our MLC model can effectively utilize the potential correlation between different diabetic complications to further improve the prediction accuracy. This model should be explored further in other complex diseases with multiple complications.


Assuntos
Complicações do Diabetes , Diabetes Mellitus , China , Atenção à Saúde , Complicações do Diabetes/diagnóstico , Diabetes Mellitus/diagnóstico , Registros Eletrônicos de Saúde , Humanos , Curva ROC
12.
Soins ; 66(855): 60-63, 2021 May.
Artigo em Francês | MEDLINE | ID: mdl-34103145

RESUMO

The progress made in the medical field thanks to artificial intelligence and its applications has developed doctors' knowledge and patients' knowledge of how to act. By giving a voice to all stakeholders in care, a commons of digital healthcare practices can be formed. Certain therapeutic support and monitoring tools, based on dialogue between health professionals, already exist. By guiding them by means of an approach of collective ethics, they, and likewise artificial intelligence, can help to foster inclusion.


Assuntos
Inteligência Artificial , Atenção à Saúde , Instalações de Saúde , Pessoal de Saúde , Humanos
13.
Georgian Med News ; (313): 176-180, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34103453

RESUMO

The article reviews the medical and social vaccination-related initiatives in different countries of the world aimed at maintaining the balance between the public interest and respect for rights. A separate emphasis is put on exceptions to general rules of compulsory vaccination of children based on religious, philosophic and other personal beliefs of their parents. The connection between the medical and social initiatives applied in different countries, exemption from vaccination for non-medical reasons and reduction of herd immunity is determine. The methods of the research include the comparative method, i.e. the comparison of Ukrainian and international medical and social initiatives related to vaccination of children; the statistical method which is used for generalization of vaccination-related information of the World Health Organization and the European Centre for Disease Prevention and Control; the systematic analysis aimed at identification of existing shortcomings and positive experience of state policies of children vaccination in different countries of the world; the linguo-cognitive analysis, i.e the analysis of reasons for judgements with relation to the role of vaccination in modern countries and those social and medical initiatives that are allowed to be used in certain states to ensure exercise of human rights. Even a slight reduction in numbers of vaccinated children caused by parents' hesitancy due to certain non-medical reasons, religious and philosophic beliefs will have negative consequences for the public health and country's economy. Looking for a balance of human rights and public interest when it comes to vaccination resulted in establishing by the supranational judicial institutions of the prevalence of social necessity over individual rights. These findings should play a key role in the selection by different states of vaccination-related medical and social initiatives.


Assuntos
Direitos Humanos , Vacinação , Criança , Atenção à Saúde , Humanos , Saúde Pública
14.
BMJ Open ; 11(6): e045988, 2021 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-34135041

RESUMO

OBJECTIVES: Compassion is a key indicator of quality care that is reportedly eroding from patients' care experience. While the need to assess compassion is recognised, valid and reliable measures are lacking. This study developed and validated a clinically informed, psychometrically rigorous, patient-reported compassion measure. DESIGN: Data were collected from participants living with life-limiting illnesses over two study phases across four care settings (acute care, hospice, long term care (LTC) and homecare). In phase 1, data were analysed through exploratory factor analysis (EFA), with the final items analysed via confirmatory factor analysis (CFA) in phase 2. The Schwartz Center Compassionate Care Scale (SCCCS), the revised Edmonton Symptom Assessment Scale (ESAS-r) and Picker Patient Experience Questionnaire (PPEQ) were also administered in phase 2 to assess convergent and divergent validity. SETTING AND PARTICIPANTS: 633 participants were recruited over two study phases. In the EFA phase, a 54-item version of the measure was administered to 303 participants, with 330 participants being administered the final 15-item measure in the CFA phase. RESULTS: Both EFA and CFA confirmed compassion as a single factor construct with factor loadings for the 15-item measure ranging from 0.76 to 0.86, with excellent test-retest reliability (intraclass correlation coefficient range: 0.74-0.89) and excellent internal reliability (Cronbach's alpha of 0.96). The measure was positively correlated with the SCCCS (r=0.75, p<0.001) and PPEQ (r=0.60, p<0.001). Participants reporting higher experiences of compassion had significantly greater well-being and lower depression on the ESAS-r. Patients in acute care and hospice reported significantly greater experiences of compassion than LTC residents. CONCLUSIONS: There is strong initial psychometric evidence for the Sinclair Compassion Questionnaire (SCQ) as a valid and reliable patient-reported compassion measure. The SCQ provides healthcare providers, settings and administrators the means to routinely measure patients experiences of compassion, while providing researchers a robust measure to conduct high-quality research.


Assuntos
Empatia , Medidas de Resultados Relatados pelo Paciente , Atenção à Saúde , Análise Fatorial , Humanos , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários
15.
BMC Health Serv Res ; 21(1): 567, 2021 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-34107941

RESUMO

BACKGROUND: Healthcare practitioners (HCPs) play a crucial role in recognising, responding to, and supporting female patients experiencing intimate partner abuse (IPA). However, research consistently identifies barriers they perceive prevent them from doing this work effectively. These barriers can be system-based (e.g. lack of time or training) or personal/individual. This review of qualitative evidence aims to synthesise the personal barriers that impact HCPs' responses to IPA. METHODS: Five databases were searched in March 2020. Studies needed to utilise qualitative methods for both data collection and analysis and be published between 2010 and 2020 in order to qualify for inclusion; however, we considered any type of healthcare setting in any country. Article screening, data extraction and methodological appraisal using a modified version of the Critical Appraisal Skills Program checklist for qualitative studies were undertaken by at least two independent reviewers. Data analysis drew on Thomas and Harden's thematic synthesis approach. RESULTS: Twenty-nine studies conducted in 20 countries informed the final review. A variety of HCPs and settings were represented. Three themes were developed that describe the personal barriers experienced by HCPs: I can't interfere (which describes the belief that IPA is a "private matter" and HCPs' fears of causing harm by intervening); I don't have control (highlighting HCPs' frustration when women do not follow their advice); and I won't take responsibility (which illuminates beliefs that addressing IPA should be someone else's job). CONCLUSION: This review highlights the need for training to address personal issues in addition to structural or organisational barriers. Education and training for HCPs needs to: encourage reflection on their own values to reinforce their commitment to addressing IPA; teach HCPs to relinquish the need to control outcomes so that they can adopt an advocacy approach; and support HCPs' trust in the critical role they can play in responding. Future research should explore effective ways to do this within the context of complex healthcare organisations.


Assuntos
Pessoal de Saúde , Violência por Parceiro Íntimo , Atenção à Saúde , Feminino , Instalações de Saúde , Humanos , Violência por Parceiro Íntimo/prevenção & controle , Pesquisa Qualitativa
16.
Pneumologie ; 75(6): 457-473, 2021 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-34116577

RESUMO

Pulmonary rehabilitation of asthma and COPD patients can improve their physical performance and quality of life, maintain participation in social and professional life and actively promote self-help. In addition, the resources for acute medical treatment can be spared. In case of COPD, rehabilitation directly after exacerbation can also improve the poor survival prognosis and reduce the risk of emergency hospital readmission. Therefore, pulmonary rehabilitation is an essential component of evidence-based long-term management of both bronchial asthma and, in particular, COPD. In the German healthcare system, however, pneumological rehabilitation is offered only for a small fraction of patients. Despite a very good evidence of pulmonary rehabilitation, especially in COPD patients, their share in all rehabilitation services is remarkably low. It does not even amount to 3 % of all medical rehabilitation measures approved by the German Pension Insurance.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Pneumologia , Atenção à Saúde , Humanos , Readmissão do Paciente , Qualidade de Vida
17.
BMC Health Serv Res ; 21(1): 575, 2021 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-34120603

RESUMO

BACKGROUND: In recent years, there has been a growing interest in health care personalization and customization (i.e. personalized medicine and patient-centered care). While some positive impacts of these approaches have been reported, there has been a dearth of research on how these approaches are implemented and combined for health care delivery systems. The present study undertakes a scoping review of articles on customized care to describe which patient characteristics are used for segmenting care, and to identify the challenges face to implement customized intervention in routine care. METHODS: Article searches were initially conducted in November 2018, and updated in January 2019 and March 2019, according to Prisma guidelines. Two investigators independently searched MEDLINE, PubMed, PsycINFO, Web of Science, Science Direct and JSTOR, The search was focused on articles that included "care customization", "personalized service and health care", individualized care" and "targeting population" in the title or abstract. Inclusion and exclusion criteria were defined. Disagreements on study selection and data extraction were resolved by consensus and discussion between two reviewers. RESULTS: We identified 70 articles published between 2008 and 2019. Most of the articles (n = 43) were published from 2016 to 2019. Four categories of patient characteristics used for segmentation analysis emerged: clinical, psychosocial, service and costs. We observed these characteristics often coexisted with the most commonly described combinations, namely clinical, psychosocial and service. A small number of articles (n = 18) reported assessments on quality of care, experiences and costs. Finally, few articles (n = 6) formally defined a conceptual basis related to mass customization, whereas only half of articles used existing theories to guide their analysis or interpretation. CONCLUSIONS: There is no common theory based strategy for providing customized care. In response, we have highlighted three areas for researchers and managers to advance the customization in health care delivery systems: better define the content of the segmentation analysis and the intervention steps, demonstrate its added value, in particular its economic viability, and align the logics of action that underpin current efforts of customization. These steps would allow them to use customization to reduce costs and improve quality of care.


Assuntos
Atenção à Saúde , Assistência Centrada no Paciente , Humanos
18.
J BUON ; 26(2): 303-305, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34076972

RESUMO

COVID-19 pandemic has obviously affected patients' behavior towards seeking medical help as well as physicians' decision in the management of emergencies. Our recent experience as surgeons at a COVID-19 referral hospital revealed cases which share an alerting characteristic: the delay in appropriate management. Unfortunately for COVID-19 negative patients a "coronacentric" health system has been adopted. In view of measures applied to avoid spread of the disease, a significant delay in patients' presentation as well as in their in-hospital management is observed. We present cases where delay in appropriate management affected the patients' outcome and underline the fact that balancing between COVID-19 safety measures and a patient who needs urgent treatment can be very challenging and stressful.


Assuntos
Abscesso Abdominal/cirurgia , Teste para COVID-19 , COVID-19/diagnóstico , Atenção à Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Tempo para o Tratamento , Abscesso Abdominal/diagnóstico , Adulto , Idoso de 80 Anos ou mais , Apendicite/diagnóstico , Apendicite/cirurgia , COVID-19/prevenção & controle , COVID-19/transmissão , Progressão da Doença , Evolução Fatal , Feminino , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/cirurgia , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/cirurgia , Tempo de Internação , Abscesso Hepático/diagnóstico , Abscesso Hepático/terapia , Masculino , Megacolo/diagnóstico , Megacolo/cirurgia , Pessoa de Meia-Idade , Segurança do Paciente , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
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