Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.618
Filtrar
4.
Acad Med ; 96(3): 375-380, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33661849

RESUMO

A critical shortage of physicians is looming in the United States. The situation in Kentucky is especially dire, especially in rural areas. Class size constraints have resulted in the University of Kentucky College of Medicine (UK COM) unable to admit over 100 qualified Kentuckians each year. This article describes how leadership at University of Kentucky committed to addressing the state physician shortage while simultaneously strengthening relationships with critical partners through the establishment of two 4-year UK COM regional medical campuses. Based on criteria (such as a commitment to educating physicians, ample patients, sufficient willing physician preceptors, etc.), partners selected were Med Center Health, the leading health care system in southwestern Kentucky, and St. Elizabeth Healthcare, the predominant health care system in northern Kentucky. These regional campuses allow UK COM to expand its class size to 201 and total enrollment to 804, increasing from historically 70 to currently 120 graduates per year expected to practice in Kentucky. Critical to the success of this expansion is the buy-in of leadership and the Admissions Committee to consider students with a wider range of Medical College Admission Test scores. The regional clinical partners have substantially increased their teaching opportunities, with a greater ability to attract physicians. Both partners have made substantial financial contributions in support of the regional campuses. These relationships have energized UK COM engagement with its area alumni and have resulted in fewer Kentuckians referred out of state for advanced specialty care. Partnerships are also occurring with UK COM to increase graduate medical education offerings at the regional sites, fulfilling the vision of "training Kentuckians in Kentucky to practice in Kentucky."


Assuntos
Centros Médicos Acadêmicos/organização & administração , Mão de Obra em Saúde/estatística & dados numéricos , Médicos/estatística & dados numéricos , Política Pública/legislação & jurisprudência , Centros Médicos Acadêmicos/provisão & distribução , Redes Comunitárias , Educação de Pós-Graduação em Medicina/organização & administração , Humanos , Kentucky/epidemiologia , Médicos/provisão & distribução , Encaminhamento e Consulta/estatística & dados numéricos , Encaminhamento e Consulta/tendências , População Rural/estatística & dados numéricos , Especialização/estatística & dados numéricos , Planejamento Estratégico/normas , Estados Unidos/epidemiologia
6.
Mo Med ; 118(1): 45-49, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33551485

RESUMO

Healthcare providers perform lifesaving work in unusually stressful work environments due to the challenges and related risks of battling the unprecedented COVID-19 pandemic. The potential personal and professional toll is substantial. This article describes how one healthcare facility benefited from existing peer support resources to address workforce well-being, ensuring that resources were available to support workforce resilience throughout the protracted COVID response.


Assuntos
/psicologia , Pessoal de Saúde/psicologia , Mão de Obra em Saúde/estatística & dados numéricos , Saúde do Trabalhador/normas , Local de Trabalho/psicologia , Adaptação Psicológica/fisiologia , Adulto , /epidemiologia , Assistência à Saúde/organização & administração , Recursos em Saúde/provisão & distribução , Humanos , Masculino , Saúde Mental/tendências , Missouri/epidemiologia , Estresse Ocupacional/epidemiologia , Estresse Ocupacional/psicologia , /isolamento & purificação , Grupos de Autoajuda/organização & administração , Universidades/organização & administração , Local de Trabalho/estatística & dados numéricos
7.
N Z Med J ; 134(1529): 80-85, 2021 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-33582710

RESUMO

Diabetes is one of the most common chronic disorders in emerging adults (15-25 years of age), and the prevalence of both type 1 diabetes (T1D) and type 2 diabetes (T2D) in New Zealand continues to increase in this age group. Tight glycaemic control in both T1D and T2D is well known to reduce diabetic microvascular and macrovascular complications and improve survival. However, in New Zealand and worldwide, emerging adulthood is typically the period of worst glycaemic control in the lifespan due to the high prevalence of psychosocial stressors and increased insulin resistance of puberty and risk-taking behaviours. In addition, the glycaemic control of emerging adults with diabetes in New Zealand often deteriorates due to the loss of support from family and friends from moving regions, the failure of support from paediatric services to extend to emerging adulthood and the loss of public funding for insulin pump therapy as glycaemic targets are no longer met. Given the high prevalence of psychosocial stressors and the loss of support, the International Society for Paediatric and Adolescent Diabetes's (ISPAD's) guidelines recommend that emerging adults with diabetes receive ambulatory care from a dedicated multidisciplinary team consisting of 0.75 full time equivalent (FTE)/100 patients of an endocrinologist, 1-1.25 FTE/100 patients of a diabetes nurse specialist, 0.5 FTE/100 patients of a dietitian, 0.3 FTE/100 patients of a psychologist and 0.3 FTE/100 patients of a social worker or youth worker.


Assuntos
Serviços de Saúde da Criança/estatística & dados numéricos , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Endocrinologistas/provisão & distribução , Mão de Obra em Saúde/estatística & dados numéricos , Adolescente , Adulto , Criança , Serviços de Saúde da Criança/organização & administração , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Gerenciamento Clínico , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Nova Zelândia/epidemiologia , Equipe de Assistência ao Paciente/estatística & dados numéricos , Adulto Jovem
8.
Healthc Q ; 23(4): 12-16, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33475486

RESUMO

Canada's COVID-19 response has been described as slow, with reactive decision making that has left the most vulnerable populations at risk of infection and death from the virus. Yet, within and across the provincial health systems, the supply chain processes and data infrastructure needed to generate the relevant data for, and evidence of, the spread of COVID-19 and the health system's capacity to respond to the pandemic are non-existent in Canada. Emerging evidence from a national research study highlights the significance of supply chain data infrastructure and processes that offer transparent, real-time data to inform decisions that support a coordinated, evidence-informed pandemic strategy that is proactive and capable of protecting the health of every Canadian.


Assuntos
/epidemiologia , Equipamentos e Provisões/provisão & distribução , Idoso , /terapia , Canadá/epidemiologia , Assistência à Saúde/estatística & dados numéricos , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Equipamento de Proteção Individual/provisão & distribução
9.
Am J Public Health ; 111(3): 475-484, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33476234

RESUMO

Objectives. To improve understanding of the future public health workforce by analyzing first-destination employment outcomes of public health graduates.Methods. We assessed graduate outcomes for those graduating in 2015-2018 using descriptive statistics and the Pearson χ2 test.Results. In our analysis of data on 53 463 graduates, we found that 73% were employed; 15% enrolled in further education; 5% entered a fellowship, internship, residency, volunteer, or service program; and 6% were not employed. Employed graduates went to work in health care (27%), corporations (24%), academia (19%), government (17%), nonprofit (12%), and other sectors (1%). In 2018, 9% of bachelor's, 4% of master's, and 2% of doctoral graduates were not employed but seeking employment.Conclusions. Today's public health graduates are successful in finding employment in various sectors. This new workforce may expand public health's reach and lead to healthier communities overall.Public Health Implications. With predicted shortages in the governmental public health workforce and expanding hiring because of COVID-19, policymakers need to work to ensure the supply of public health graduates meets the demands of the workforce.


Assuntos
Educação Profissional em Saúde Pública/estatística & dados numéricos , Emprego/estatística & dados numéricos , Mão de Obra em Saúde/estatística & dados numéricos , Educação de Pós-Graduação/estatística & dados numéricos , Educação em Saúde/estatística & dados numéricos , Política de Saúde , Humanos
10.
Am J Ind Med ; 64(2): 73-77, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33355943

RESUMO

Globally, migrant and immigrant workers have borne the brunt of the COVID-19 pandemic as essential workers. They might be a Bulgarian worker at a meat processing plant in Germany, a Central American farmworker in the fields of California, or a Filipino worker at an aged-care facility in Australia. What they have in common is they are all essential workers who have worked throughout the coronavirus pandemic and have been infected with coronavirus at work. COVID-19 has highlighted the inequitable working conditions of these workers. In many instances, they are employed precariously, and so are ineligible for sick leave or social security, or COVID-19 special payments. If these are essential workers, they should get at least the same health and safety benefits of all nonessential workers. Improving the working and living conditions of migrant workers can and should be a positive outcome of the coronavirus pandemic.


Assuntos
/epidemiologia , Doenças Profissionais/epidemiologia , Migrantes/estatística & dados numéricos , /transmissão , Estudos Transversais , Saúde Global/estatística & dados numéricos , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Benefícios do Seguro/estatística & dados numéricos , Saúde do Trabalhador/estatística & dados numéricos , Serviços de Saúde do Trabalhador/provisão & distribução , Fatores de Risco , Licença Médica/estatística & dados numéricos , Previdência Social/estatística & dados numéricos , Valores Sociais , Fatores Socioeconômicos
11.
J Surg Res ; 257: 246-251, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32862052

RESUMO

BACKGROUND: Training diverse house staff, including those who are underrepresented in medicine, is vital to provide high-quality patient care for the communities that we serve. In 2018, the Accreditation Council for Graduate Medical Education announced new common program requirements for systematic efforts to recruit and retain a diverse workforce. However, questions remain about how to implement such efforts. MATERIALS AND METHODS: Electronic Residency Application Service (ERAS) data from eight residency programs spanning two recruitment cycles (2017-2018, 2018-2019) was reviewed. The number of candidates at each stage in the process (applicant, invited to interview, interviewed, and matched) was examined by self-identified race or ethnicity. These data were presented to residency program directors at our Graduate Medical Education committee meeting before the next recruitment cycle. Data were analyzed following the 2019-20 residency match. Odds ratios and Pearson's chi-squared test were used to assess statistical significance. RESULTS: A total of 10,445 and 10,982 medical students applied to our 8 core residency programs in 2017 and 2018, respectively. Medical students who applied and self-identified as Asian, Black or African American, and Hispanic or Latino or Spanish origin had lower odds of being invited to interview than those who self-identified as White. After data presentation, the odds of inviting Black or African American applicants to interview increased significantly. The odds of attending an interview once invited were the same across groups. CONCLUSIONS: Sharing ERAS data patterns with residency program directors was associated with a significant year over year change in interviewee diversity. Structured analysis of institutional ERAS data can provide insight into the resident selection process and may be a useful tool to improve house staff diversity.


Assuntos
Diversidade Cultural , Mão de Obra em Saúde/organização & administração , Internato e Residência/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Seleção de Pessoal/organização & administração , Estudantes de Medicina/estatística & dados numéricos , Afro-Americanos/estatística & dados numéricos , Americanos Asiáticos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Estudos de Viabilidade , Mão de Obra em Saúde/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Humanos , Internato e Residência/organização & administração , Candidatura a Emprego , Seleção de Pessoal/estatística & dados numéricos , Estados Unidos
12.
Nurse Educ Today ; 97: 104707, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33338978

RESUMO

For Nurse Education in the UK, pre-existing challenges already included the need to develop curricula to align with new Nursing and Midwifery Council (NMC) educational standards; and increased numbers entering pre-registration Nurse Education programmes in order to address workforce deficits. Further disruption due to COVID-19, forced Nurse Educators overnight to rapidly adopt and to innovatively use current and emerging technologies to maintain engagement with, and to continue delivering education to, students during the pandemic. Although the full extent of these enforced changes is unknown at this time, this paper argues that online delivery is a necessary and inevitable transition, addressing some of these pre-existing challenges, and that the pandemic has hastened this. It is therefore crucial that Nurse Educators lead the way in navigating this period of uncertainty, viewing the pandemic as an opportunity to plan for the future, to establish how online teaching and learning can continue to benefit Nurse Education in a post-COVID-19 world, not just in the UK, but across the globe.


Assuntos
Currículo/normas , Educação a Distância/tendências , Educação em Enfermagem/normas , Tocologia/normas , Docentes de Enfermagem , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Enfermeiras e Enfermeiros/provisão & distribução , Reino Unido
13.
Ciênc. Saúde Colet ; 25(12): 4957-4967, Dec. 2020. tab, graf
Artigo em Português | LILACS, Coleciona SUS, Sec. Est. Saúde SP | ID: biblio-1142714

RESUMO

Resumo Uma das preocupações ligadas à pandemia da COVID-19 se refere à capacidade da estrutura do sistema de saúde suportar a demanda por atendimento e tratamento de pessoas acometidas por esta doença. Diante disso, o objetivo deste estudo consiste em criar e mapear o Índice de Infraestrutura de Saúde (IIS) das Unidades da Federação (UFs) brasileiras, bem como verificar a sua distribuição espacial. Para isso, foi aplicada a metodologia de Análise Fatorial por Componentes Principais. Aplicou-se os testes de Bartlett e Kaiser-Meyer-Olkin para verificação da sua adequabilidade. Em seguida procedeu-se a Análise Exploratória de Dados Espaciais. Os dados foram coletados no DATASUS, COFEN, Ministério da Saúde, Portal de Compras do Governo e Portal da Transparência. Quanto aos resultados, o índice revelou que nove estados do Norte e Nordeste registraram os menores índices e cinco estados do Sudeste e Sul apresentaram os maiores índices. Foi registrado um cluster baixo-baixo nos estados do Amazonas e Pará e um Cluster alto-alto em Minas Gerais, Rio de Janeiro, São Paulo e Paraná.


Abstract One of the concerns linked to the COVID-19 pandemic is the capacity of health systems to respond to the demand for care for people with the disease. The objective of this study was to create a COVID-19 response Healthcare Infrastructure Index (HII), calculate the index for each state in Brazil, and determine its spatial distribution within and across regions. The HII was constructed using principal component factor analysis. The adequacy of the statistical model was tested using the Kaiser-Meyer-Olkin test and Bartlett's test of sphericity. The spatial distribution of the HII was analyzed using exploratory spatial data analysis. The data were obtained from DATASUS, the Federal Nursing Council, Ministry of Health, Government Procurement Portal, and the Transparency Portal. The nine states in the country's North and Northeast regions showed the lowest indices, while the five states from the Southeast and South regions showed the highest indices. Low-low clusters were observed in Amazonas and Pará and high-high clusters were found in Minas Gerais, Rio de Janeiro, São Paulo, and Paraná.


Assuntos
Humanos , Infecções por Coronavirus/terapia , Análise Espacial , Betacoronavirus , Instalações de Saúde/provisão & distribução , Acesso aos Serviços de Saúde , Brasil/epidemiologia , Análise Multivariada , Análise Fatorial , Infecções por Coronavirus/epidemiologia , Alocação de Recursos/provisão & distribução , Pandemias , Mão de Obra em Saúde/estatística & dados numéricos
14.
N Z Med J ; 133(1527): 15-25, 2020 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-33332325

RESUMO

AIM: This paper outlines the results of the Royal Australian and New Zealand College of Radiologists (RANZCR) Faculty of Radiation Oncology (FRO) 2018 workforce census. Here we report the responses of New Zealand radiation oncologists and trainees in order to understand characteristics of the New Zealand radiation oncology workforce. METHOD: The workforce census was conducted online during July-September 2018. Distribution was by Survey Monkey to all radiation oncologists (fellows, life members, educational affiliates, retired) and trainees on the RANZCR membership database, including members from Australia, New Zealand and Singapore. All responses were aggregated for analysis. This paper addresses only responses from New Zealand members. The census was designed to explore issues relevant to the New Zealand workforce, and questions from previous workforce censuses were repeated in order to monitor trends. RESULTS: The response rate for New Zealand radiation oncologists was 73.3% (44/60). The majority (67%) were male. The average age was 50.8 years. Three-fifths (59.5%) reported New Zealand ethnicity. One-third obtained their specialist qualifications outside of Australia and New Zealand. Most worked in the public sector only (63.4%), with only two in exclusive private practice. Most radiation oncologists attained a consultant post immediately on completion of training, but there were 26 who pursued an overseas fellowship. Most worked one full-time equivalent or greater (FTE), with 17.5% working less than 1.0 FTE. Radiation oncologists reported working a median of 50.0 hours per week, with half working over 10 hours above their contracted hours. Most time was spent on clinical duties with minimal time spent on research. Radiation oncologists reported seeing an average of 235 new patients per year (median: 230). Leadership positions were held by 21/43 respondents. Within 15 years, 55% of the current workforce reported an intention to retire, including 30% of those currently practising highly specialised brachytherapy. Females in the workforce were less likely to work fulltime and spent less time in research and management activities. All trainees reported full-time work, although 50% expressed a desire for part-time training. Half of the trainees reported working 6-10 hours on call, and 60% reported two or less hours of protected teaching per week. Despite this, 90% of trainees were satisfied with their career choice. CONCLUSIONS: Radiation oncology is a small specialty in New Zealand, with a significant reliance on overseas-trained specialists. The specialty continues to work significant overtime hours while time spent on research and non-clinical duties remains low. The growth in staffing between the 2014 and 2018 census has been low. Trainee numbers do not appear sufficient to meet the demand for replacing staff, due to retirements and the reduction of hours. Radiation intervention rates are low in New Zealand, but growth would be reliant on an expansion of the workforce beyond simply replacing staff losses. The radiation oncology workforce in New Zealand remains vulnerable, and careful consideration must be given to expansion and retention to ensure a viable workforce for the future.


Assuntos
Mão de Obra em Saúde/estatística & dados numéricos , Radio-Oncologistas/estatística & dados numéricos , Radioterapia (Especialidade)/educação , Radioterapia (Especialidade)/estatística & dados numéricos , Adulto , Braquiterapia/estatística & dados numéricos , Censos , Emprego/estatística & dados numéricos , Bolsas de Estudo/estatística & dados numéricos , Feminino , Humanos , Internato e Residência/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Prática Privada/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Radio-Oncologistas/provisão & distribução , Aposentadoria/estatística & dados numéricos , Fatores Sexuais , Inquéritos e Questionários , Adulto Jovem
15.
Bone Joint J ; 102-B(11): 1446-1456, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33135433

RESUMO

AIMS: Gender bias and sexual discrimination (GBSD) have been widely recognized across a range of fields and are now part of the wider social consciousness. Such conduct can occur in the medical workplace, with detrimental effects on recipients. The aim of this review was to identify the prevalence and impact of GBSD in orthopaedic surgery, and to investigate interventions countering such behaviours. METHODS: A systematic review was conducted by searching Medline, EMCARE, CINAHL, PsycINFO, and the Cochrane Library Database in April 2020, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to which we adhered. Original research papers pertaining to the prevalence and impact of GBSD, or mitigating strategies, within orthopaedics were included for review. RESULTS: Of 570 papers, 27 were eligible for inclusion. These were published between 1998 and 2020. A narrative review was performed in light of the significant heterogeneity displayed by the eligible studies. A total of 13 papers discussed the prevalence of GBSD, while 13 related to the impact of these behaviours, and six discussed mitigating strategies. GBSD was found to be common in the orthopaedic workplace, with all sources showing women to be the subjects. The impact of this includes poor workforce representation, lower salaries, and less career success, including in academia, for women in orthopaedics. Mitigating strategies in the literature are focused on providing female role models, mentors, and educational interventions. CONCLUSION: GBSD is common in orthopaedic surgery, with a substantial impact on sufferers. A small number of mitigating strategies have been tested but these are limited in their scope. As such, the orthopaedic community is obliged to participate in more thoughtful and proactive strategies that mitigate against GBSD, by improving female recruitment and retention within the specialty. Cite this article: Bone Joint J 2020;102-B(11):1446-1456.


Assuntos
Ortopedia/estatística & dados numéricos , Sexismo/prevenção & controle , Sexismo/estatística & dados numéricos , Sucesso Acadêmico , Emprego/economia , Emprego/normas , Emprego/estatística & dados numéricos , Feminino , Mão de Obra em Saúde/economia , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Masculino , Mentores , Ortopedia/economia , Ortopedia/educação , Ortopedia/normas , Papel do Médico , Prevalência , Sexismo/economia , Mudança Social , Fatores Socioeconômicos
16.
Rev. chil. fonoaudiol. (En línea) ; 19: 1-10, nov. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1148403

RESUMO

A nivel internacional se propone un mínimo de un profesional fonoaudiólogo por cada diez camas críticas o más, dependiendo de la complejidad de cada institución. En Chile no existen lineamientos similares, no obstante, el Ministerio de Salud ha generado recomendaciones para el cálculo de la brecha profesional según número y complejidad de las camas hospitalarias. El objetivo de este estudio es estimar el número de fonoaudiólogos y horas de contratación teóricas requeridas para la atención de pacientes adultos hospitalizados en instituciones públicas de alta complejidad en Chile. Para ello se realizó un estudio descriptivo, observacional, transversal. Se incluyeron todos los hospitales públicos de alta complejidad del país, excluyendo aquellos pediátricos y psiquiátricos. Como instrumentos se utilizaron el documento "Modelo de Gestión Red de Rehabilitación" del Ministerio de Salud, la base de datos actualizada del total de camas de la red hospitalaria y el software Microsoft Excel. El estudio fue aprobado por Comité Ético Científico del Hospital San Juan de Dios. En total 59 de 188 hospitales existentes en Chile fueron incluidos. De acuerdo con el análisis realizado basado en el número de camas en Chile, se requieren aproximadamente 269 fonoaudiólogos contratados 44 horas semanales para la atención de pacientes adultos en hospitales de alta complejidad. De ellos 104 se ubican en la Región Metropolitana; alrededor de 31 en la Región del BíoBío y cerca de 24 en la Región de Valparaíso. Se sugiere la revisión de las orientaciones ministeriales y la realización de un segundo estudio sobre la brecha profesional existente en Chile con los datos obtenidos.


International institutions have suggested one Speech and Language Therapist per ten critical beds, and possibly even more forhigh-complexity institutions. However, there are no similar recommendations in Chile, although the Ministry of Health has developed recommendations to calculate the number of professionals required according to the number and type of clinical bed. The aim of this study is to describe the number of Speech and Language Therapists along with the number of theorical working hours per week required for the attention of hospitalised adult patients in high-complexity hospitals in Chile, for which a descriptive, observational and transversal study was performed. High-complexity hospitals were included, excluding psychiatric and paediatric institutions. Microsoft Excel, the "Modelo de Gestión Red de Rehabilitación" guideline from the Ministry of Health, and the updated database of the clinical network beds were also used. This study was previously approved by a Research Ethics Committee from Hospital San Juan de Dios, and a total of 59 out of 188 hospitals were included. According to the analysis based on features of the clinical beds, 269 Speech and Language Therapists are required for 44 hours per week to attend adult patients in high-complexity hospitals across the country. Of the 269 professionals, 104 are needed in the Metropolitan region, approximately 31 in the Bío-Bío region and circa 24 in the Valparaíso region. According to these results, it is suggested the Ministry review its guidelines and undertake a further project in order to identify the current professional gap in Chile.


Assuntos
Humanos , Patologia da Fala e Linguagem/estatística & dados numéricos , Atenção à Saúde , Fonoaudiologia/estatística & dados numéricos , Mão de Obra em Saúde/organização & administração , Planejamento Hospitalar , Chile , Estudos Transversais , Planejamento Sanitário , Instalações de Saúde , Mão de Obra em Saúde/estatística & dados numéricos , Diretrizes para o Planejamento em Saúde , Administração Hospitalar , Hospitais/estatística & dados numéricos
18.
Emergencias ; 32(5): 320-331, 2020 09.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33006832

RESUMO

OBJECTIVES: To estimate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the organization of Spanish hospital emergency departments (EDs). To explore differences between Spanish autonomous communities or according to hospital size and disease incidence in the area. MATERIAL AND METHODS: Survey of the heads of 283 EDs in hospitals belonging to or affiliated with Spain's public health service. Respondents evaluated the pandemic's impact on organization, resources, and staff absence from work in March and April 2020. Assessments were for 15-day periods. Results were analyzed overall and by autonomous community, hospital size, and local population incidence rates. RESULTS: A total of 246 (87%) responses were received. The majority of the EDs organized a triage system, first aid, and observation wards; areas specifically for patients suspected of having COVID-19 were newly set apart. The nursing staff was increased in 83% of the EDs (with no subgroup differences), and 59% increased the number of physicians (especially in large hospitals and locations where the COVID-19 incidence was high). Diagnostic tests for the severe acute respiratory syndrome coronavirus 2 were the resource the EDs missed most: 55% reported that tests were scarce often or very often. Other resources reported to be scarce were FPP2 and FPP3 masks (38% of the EDs), waterproof protective gowns (34%), and space (32%). More than 5% of the physicians, nurses, or other emergency staff were on sick leave 20%, 19%, and 16% of the time. These deficiencies were greatest during the last half of March, except for tests, which were most scarce in the first 15 days. Large hospital EDs less often reported that diagnostic tests were unavailable. In areas where the COVID-19 incidence was higher, the EDs reported higher rates of staff on sick leave. Resource scarcity differed markedly by autonomous community and was not always associated with the incidence of COVID-19 in the population. CONCLUSION: The COVID-19 pandemic led to organizational changes in EDs. Certain resources became scarce, and marked differences between autonomous communities were detected.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Pandemias , Pneumonia Viral/epidemiologia , Absenteísmo , Adulto , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Surtos de Doenças , Serviço Hospitalar de Emergência/organização & administração , Recursos em Saúde/provisão & distribução , Necessidades e Demandas de Serviços de Saúde , Mão de Obra em Saúde/estatística & dados numéricos , Número de Leitos em Hospital , Hospitais Públicos/organização & administração , Hospitais Públicos/estatística & dados numéricos , Humanos , Incidência , Recursos Humanos em Hospital/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Alocação de Recursos , /etiologia , Espanha/epidemiologia , Triagem/organização & administração
19.
J Glob Health ; 10(2): 020509, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33110592

RESUMO

Background: The COVID-19 pandemic has overwhelmed hospitals in several areas in high-income countries. An effective response to this pandemic requires health care workers (HCWs) to be present at work, particularly in low- and middle-income countries (LMICs) where they are already in critically low supply. To inform whether and to what degree policymakers in Bangladesh, and LMICs more broadly, should expect a drop in HCW attendance as COVID-19 continues to spread, this study aims to determine how HCW attendance has changed during the early stages of the COVID-19 pandemic in Bangladesh. Methods: This study analyzed daily fingerprint-verified attendance data from all 527 public-sector secondary and tertiary care facilities in Bangladesh to describe HCW attendance from January 26, 2019 to March 22, 2020, by cadre, hospital type, and geographic division. We then regressed HCW attendance onto fixed effects for day-of-week, month, and hospital, as well as indicators for each of three pandemic periods: a China-focused period (January 11, 2020 (first confirmed COVID-19 death in China) until January 29, 2020), international-spread period (January 30, 2020 (World Health Organization's declaration of a global emergency) until March 6, 2020), and local-spread period (March 7, 2020 (first confirmed COVID-19 case in Bangladesh) until the end of the study period). Findings: On average between January 26, 2019 and March 22, 2020, 34.1% of doctors, 64.6% of nurses, and 70.6% of other health care staff were present for their scheduled shift. HCWs' attendance rate increased with time in 2019 among all cadres. Nurses' attendance level dropped by 2.5% points (95% confidence interval (CI) = -3.2% to -1.8%) and 3.5% points (95% CI = -4.5% to -2.5%) during the international-spread and the local-spread periods of the COVID-19 pandemic, relative to the China-focused period. Similarly, the attendance level of other health care staff declined by 0.3% points (95% CI = -0.8% to 0.2%) and 2.3% points (95% CI = -3.0% to -1.6%) during the international-spread and local-spread periods, respectively. Among doctors, however, the international-spread and local-spread periods were associated with a statistically significant increase in attendance by 3.7% points (95% CI = 2.5% to 4.8%) and 4.9% points (95% CI = 3.5% to 6.4%), respectively. The reduction in attendance levels across all HCWs during the local-spread period was much greater at large hospitals, where the majority of COVID-19 testing and treatment took place, than that at small hospitals. Conclusions: After a year of significant improvements, HCWs' attendance levels among nurses and other health care staff (who form the majority of Bangladesh's health care workforce) have declined during the early stages of the COVID-19 pandemic. This finding may portend an even greater decrease in attendance if COVID-19 continues to spread in Bangladesh. Policymakers in Bangladesh and similar LMICs should undertake major efforts to achieve high attendance levels among HCWs, particularly nurses, such as by providing sufficient personal protective equipment as well as monetary and non-monetary incentives.


Assuntos
Infecções por Coronavirus , Mão de Obra em Saúde/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Pandemias , Pneumonia Viral , Atenção Secundária à Saúde/estatística & dados numéricos , Atenção Terciária à Saúde/estatística & dados numéricos , Adulto , Bangladesh/epidemiologia , Betacoronavirus , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Atenção Secundária à Saúde/organização & administração , Atenção Terciária à Saúde/organização & administração
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...