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2.
Healthc Policy ; 16(1): 112-124, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32813643

RESUMO

To inform Canada's research response to COVID-19, the Canadian Institutes of Health Research's Institute of Health Services and Policy Research (IHSPR) conducted a rapid-cycle priority identification process. Seven COVID-19 priorities for health services and policy research were identified: system adaptation and organization of care; resource allocation decision-making and ethics; rapid synthesis and comparative policy analysis of the COVID-19 response and outcomes; healthcare workforce; virtual care; long-term consequences of the pandemic; and public and patient engagement. Three additional cross-cutting themes were identified: supporting the health of Indigenous Peoples and vulnerable populations, data and digital infrastructure, and learning health systems and knowledge platforms. IHSPR hopes these research priorities will contribute to the broader ecosystem for collective research investment and action.


Assuntos
Infecções por Coronavirus/prevenção & controle , Assistência à Saúde/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pesquisa , Canadá/epidemiologia , Infecções por Coronavirus/epidemiologia , Política de Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Pneumonia Viral/epidemiologia
4.
J Prim Care Community Health ; 11: 2150132720947963, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32757817

RESUMO

The first documented case of COVID-19 in the United States occurred on January 30th, 2020. Soon after, a global pandemic was declared in March 2020 with each state issuing stay at home orders based on population, risk for community transmission and current number of positive cases. A priority for each region was to develop efficient systems for testing large patient volumes in a safe manner to reduce the risk of community transmission. A community based United States health care system in the upper mid-west implemented a drive through testing site in an attempt to divert suspected cases of COVID-19 away from larger patient areas while protecting staff and patients. This commentary outlines the planning, work flow and challenges of implementing this drive through testing site in a rural community setting.


Assuntos
Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Programas de Rastreamento/métodos , Pandemias , Pneumonia Viral/diagnóstico , Serviços de Saúde Rural/organização & administração , Infecções por Coronavirus/epidemiologia , Pesquisa sobre Serviços de Saúde , Humanos , Pneumonia Viral/epidemiologia , Estados Unidos/epidemiologia
5.
J Natl Black Nurses Assoc ; 31(1): 60-63, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32853498

RESUMO

African-Americans with hypertension continue to demonstrate poor blood pressure (BP) control and have markedly lower rates of hypertension self-management compared to non-African-Americans. Innovative and practical solutions such as mHealth technology are promising and can be leveraged to promote self-management of hypertension. Substantial evidence has demonstrated the importance of community support in improving patients' management of chronic illnesses. Unfortunately, such programs do not offer technology-based interventions (TBI) as a delivery method. Thus, this paper describes the design and rationale of an ongoing pilot study that incorporates TBI using a community-based participatory approach.


Assuntos
Afro-Americanos/educação , Educação de Pacientes como Assunto , Obesidade Pediátrica/etnologia , Obesidade Pediátrica/prevenção & controle , Afro-Americanos/estatística & dados numéricos , Criança , Pesquisa sobre Serviços de Saúde , Humanos , Projetos Piloto , Atenção Primária à Saúde/métodos , Melhoria de Qualidade , População Rural/estatística & dados numéricos
6.
Curr Opin Ophthalmol ; 31(5): 427-434, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32740067

RESUMO

PURPOSE OF REVIEW: The COVID-19 pandemic has posed an unprecedented challenge to the healthcare community. To reduce disease transmission, national regulatory agencies temporarily recommended curtailment of all nonurgent office visits and elective surgeries in March 2020, including vitreoretinal outpatient care in the USA. The effect of these guidelines on utilization of vitreoretinal care has not been explored to date. RECENT FINDINGS: Retinal outpatient visits, new patient visits, intravitreal antivascular endothelial growth factor injections and in-office multimodal retinal imaging has seen a significant decline in utilization in the early phase of the pandemic. Intravitreal injections were performed at a comparatively higher rate than office visits. Utilization appeared to steadily increase in April 2020. Telemedicine visits, enabled by new national legislation for all areas of medicine, have been adopted to a modest degree by the retina community. SUMMARY: In-office retinal care declined in response to the COVID-19 pandemic and national regulatory guidelines limiting nonurgent care. These trends in practice patterns and care utilization may be of interest to vitreoretinal providers and all ophthalmologists at large.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pandemias/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Padrões de Prática Médica/estatística & dados numéricos , Doenças Retinianas , Corpo Vítreo/patologia , Assistência Ambulatorial/estatística & dados numéricos , Bases de Dados Factuais , Assistência à Saúde/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Humanos , Doenças Retinianas/diagnóstico , Doenças Retinianas/terapia , Telemedicina/estatística & dados numéricos , Estados Unidos/epidemiologia
7.
Gesundheitswesen ; 82(7): 639-645, 2020 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-32698207

RESUMO

More than half of the German population has difficulties in dealing with health information. It is an important task of health services research to examine how healthcare professionals and health care organizations can meet this challenge. This short version of the DNVF Memorandum Health Literacy (Part 1) defines the terms of individual and organizational health literacy, presents the national and international state of research and ethical aspects of health literacy research in health care settings. Central research topics and future research desiderata are derived.


Assuntos
Letramento em Saúde , Alemanha , Pessoal de Saúde , Pesquisa sobre Serviços de Saúde , Humanos
8.
Gesundheitswesen ; 82(7): e77-e93, 2020 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-32698208

RESUMO

More than half of the German population has difficulties in dealing with health information. It is an important task of health services research to examine how healthcare professionals and health care organizations can meet this challenge. The DNVF Memorandum Health Literacy (Part 1) defines the terms of individual and organizational health literacy, presents the national and international state of research and ethical aspects of health literacy research in health care settings. The relevance of health literacy research is worked out in different phases of life, for different target groups and in different healthcare contexts. Central research topics and future research desiderata are derived.


Assuntos
Letramento em Saúde , Assistência à Saúde , Alemanha , Pessoal de Saúde , Pesquisa sobre Serviços de Saúde , Humanos
9.
Rev Bras Epidemiol ; 23: e200072, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32638848

RESUMO

INTRODUCTION: Primary care is considered a gateway to other levels of care, however, men seek mainly specialized or emergency services, especially when they already have some affection. OBJECTIVE: the objective was to verify how male users evaluate first contact access in primary care. METHODOLOGY: Cross-sectional study, conducted in Campina Grande/PB, from October 2016 to February 2017, with 384 men. A sociodemographic form and the Primary Care Assessment Tool (PCATool) were used. RESULTS: There was an association between service use and age (p = 0.001), income (p = 0.036), creed (p = 0.018) and knowledge of the National Men's Health Policy (p = 0.007); The components of first contact access (utilization and accessibility) obtained a score of 5.79 and 2.7 respectively, being this attribute considered by users as poorly oriented to primary care. Ensuring accessibility and reception in primary care is critical. The service must be organized to have the ability to receive and respond positively to the health demands of the population, to have resoluteness and ability to link the service with the user. CONCLUSION: Users do not perceive primary care as a gateway to the health system, and efforts should be made to ensure first contact access.


Assuntos
Acesso aos Serviços de Saúde , Atenção Primária à Saúde , Brasil , Estudos Transversais , Pesquisa sobre Serviços de Saúde , Humanos , Masculino
10.
Rev Bras Epidemiol ; 23 Suppl 1: e200013.SUPL.1, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32638981

RESUMO

OBJECTIVE: To evaluate the attributes of PHC from the perspective of users, interviewed in a telephone survey in Belo Horizonte. METHODS: Cross-sectional population-based study. Data from Vigitel 2015 that included an additional module on PHC assessment were used. A reduced version of PCATool-Brasil with adaptations was used. RESULTS: We interviewed 872 users and there was a predominance of women, older adults, adults with low levels of education, those without a partner, those who described themselves as brown, and those without health insurance. The overall score of the Vigitel assessment was 5.48 (95%CI 5.35 - 5.61) and the reduced PCATool was 5.01 (95%CI 4.86 - 5.15). In both instruments, the scores of the attributes first contact (utilization), longitudinality, and coordination (care) were higher than the general score with the highest value (5.48). The mean score of the first contact attribute (utilization) was the highest rated by users considering the Vigitel assessment instrument (7.09; 95%CI 6.93 - 7.26). In general, the evaluations of the instruments are coinciding, but the attributes first contact (utilization), completeness (available services) and coordination (information system) presented better mean scores in the Vigitel evaluation instrument when compared to the reduced PCATool. There was no difference in the evaluation according to Regional Health. CONCLUSION: The use of the reduced version of the PCATool in a telephone survey and with small adaptations to the local reality, showed a new possibility for the evaluation of PHC services, and may become useful in the management of health services.


Assuntos
Pesquisa sobre Serviços de Saúde/métodos , Atenção Primária à Saúde , Inquéritos e Questionários , Telefone , Adulto , Idoso , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Fatores Socioeconômicos
11.
Crit Care ; 24(1): 386, 2020 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-32605581

RESUMO

Mass critical care caused by the severe acute respiratory syndrome corona virus 2 pandemic poses an extreme challenge to hospitals. The primary goal of hospital disaster preparedness and response is to maintain conventional or contingency care for as long as possible. Crisis care must be delayed as long as possible by appropriate measures. Increasing the intensive care unit (ICU) capacities is essential. In order to adjust surge capacity, the reduction of planned, elective patient care is an adequate response. However, this involves numerous problems that must be solved with a sense of proportion. This paper summarises preparedness and response measures recommended to acute care hospitals.


Assuntos
Infecções por Coronavirus/terapia , Cuidados Críticos/organização & administração , Planejamento em Desastres/organização & administração , Hospitais , Incidentes com Feridos em Massa , Pandemias , Pneumonia Viral/terapia , Infecções por Coronavirus/epidemiologia , Pesquisa sobre Serviços de Saúde , Humanos , Pneumonia Viral/epidemiologia
12.
Rev Infirm ; 69(260-261): 19-21, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32600589

RESUMO

The treatment of septic shock is a medical emergency. International guidelines advise immediate care and the first hour is generally critical. It is an emergency on both an etiological and symptomatic level.


Assuntos
Choque Séptico/terapia , Serviços Médicos de Emergência , Pesquisa sobre Serviços de Saúde , Humanos , Guias de Prática Clínica como Assunto
14.
Curr Opin Infect Dis ; 33(4): 304-311, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32657967

RESUMO

PURPOSE OF THE REVIEW: Laboratory-developed tests (LDTs) are essential for the clinical care of immunocompromised individuals. These patients often require specialized testing not available from commercial manufacturers and are therefore dependent on the laboratory to create, validate, and perform these assays. Recent paradigm-shifting legislation could alter the way that LDTs are operationalized and regulated. RECENT FINDINGS: On March 5th, 2020 the Verifying Accurate and Leading-Edge In-Vitro Clinical Tests Development Act (VALID) was introduced in the US Congress. This statute would overhaul existing regulatory framework by unifying the oversight of LDTs and commercial in-vitro diagnostic tests (IVDs) through the FDA. If enacted, LDTs would be subject to regulatory requirements like those found in commercial submissions for market review. Stakeholders continue to discuss the details and scope of the proposed legislation in the setting of the Severe Acute Respiratory Syndrome Coronavirus 2 pandemic, where LDTs are integral to the national COVID-19 response. SUMMARY: Congressional lawmakers have introduced legislation to alter the regulatory framework governing LDTs. Moving forward, a balance must be struck to ensure the availability of safe and accurate testing without delays or overregulation that could be harmful to patients. The downstream implications of how VALID and other legislation will impact laboratories, clinicians, and patients warrant close examination.


Assuntos
Serviços de Laboratório Clínico/legislação & jurisprudência , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Hospedeiro Imunocomprometido , Laboratórios Hospitalares/legislação & jurisprudência , Pneumonia Viral/diagnóstico , Incerteza , United States Food and Drug Administration/legislação & jurisprudência , Betacoronavirus/patogenicidade , Congressos como Assunto , Pesquisa sobre Serviços de Saúde/legislação & jurisprudência , Humanos , Pandemias , Garantia da Qualidade dos Cuidados de Saúde , Estados Unidos
15.
BMC Med Ethics ; 21(1): 60, 2020 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-32664908

RESUMO

BACKGROUND: As the COVID-19 (coronavirus) pandemic develops, healthcare professionals are looking for support with, and guidance to inform, the difficult decisions they face. In the (current) absence of an authoritative national steer in England, professional bodies and local organisations have been developing and disseminating their own ethical guidance. Questions inevitably arise, some of which are particularly pressing during the pandemic, as events are unfolding quickly and the field is becoming crowded. My central question here is: which professional ethical guidance should the professional follow? MAIN BODY: Adopting a working definition of "professional ethical guidance", I offer three domains for a healthcare professional to consider, and some associated questions to ask, when determining whether - in relation to any guidance document - they should "bin it or pin it". First, the professional should consider the source of the guidance: is the issuing body authoritative or, if not, at least sufficiently influential that its guidance should be followed? Second, the professional should consider the applicability of the guidance, ascertaining whether the guidance is available and, if so, whether it is pertinent. Pertinence has various dimensions, including whether the guidance applies to this professional, this patient and/or this setting, whether it is up-to-date, and whether the guidance addresses the situation the professional is facing. Third, the professional should consider the methodology and methods by which the guidance was produced. Although the substantive quality of the guidance is important, so too are the methods by which it was produced. Here, the professional should ask whether the guidance is sufficiently inclusive - in terms of who has prepared it and who contributed to its development - and whether it was rigorously developed, and thus utilised appropriate processes, principles and evidence. CONCLUSION: Asking and answering such questions may be challenging, particularly during a pandemic. Furthermore, guidance will not do all the work: professionals will still need to exercise their judgment in deciding what is best in the individual case, whether or not this concerns COVID-19. But such judgments can and should be informed (and constrained) by guidance, and hopefully these preliminary observations will provide some useful pointers for time-pressed professionals.


Assuntos
Infecções por Coronavirus , Ética Médica , Pessoal de Saúde/ética , Pandemias , Pneumonia Viral , Guias de Prática Clínica como Assunto , Betacoronavirus , Códigos de Ética , Pesquisa sobre Serviços de Saúde , Humanos , Pandemias/ética
16.
Health Res Policy Syst ; 18(1): 80, 2020 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-32664985

RESUMO

BACKGROUND: The COVID-19 pandemic is a complex global public health crisis presenting clinical, organisational and system-wide challenges. Different research perspectives on health are needed in order to manage and monitor this crisis. Performance intelligence is an approach that emphasises the need for different research perspectives in supporting health systems' decision-makers to determine policies based on well-informed choices. In this paper, we present the viewpoint of the Innovative Training Network for Healthcare Performance Intelligence Professionals (HealthPros) on how performance intelligence can be used during and after the COVID-19 pandemic. DISCUSSION: A lack of standardised information, paired with limited discussion and alignment between countries contribute to uncertainty in decision-making in all countries. Consequently, a plethora of different non-data-driven and uncoordinated approaches to address the outbreak are noted worldwide. Comparative health system research is needed to help countries shape their response models in social care, public health, primary care, hospital care and long-term care through the different phases of the pandemic. There is a need in each phase to compare context-specific bundles of measures where the impact on health outcomes can be modelled using targeted data and advanced statistical methods. Performance intelligence can be pursued to compare data, construct indicators and identify optimal strategies. Embracing a system perspective will allow countries to take coordinated strategic decisions while mitigating the risk of system collapse.A framework for the development and implementation of performance intelligence has been outlined by the HealthPros Network and is of pertinence. Health systems need better and more timely data to govern through a pandemic-induced transition period where tensions between care needs, demand and capacity are exceptionally high worldwide. Health systems are challenged to ensure essential levels of healthcare towards all patients, including those who need routine assistance. CONCLUSION: Performance intelligence plays an essential role as part of a broader public health strategy in guiding the decisions of health system actors on the implementation of contextualised measures to tackle COVID-19 or any future epidemic as well as their effect on the health system at large. This should be based on commonly agreed-upon standardised data and fit-for-purpose indicators, making optimal use of existing health information infrastructures. The HealthPros Network can make a meaningful contribution.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Assistência à Saúde/organização & administração , Planejamento em Saúde/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Saúde Global , Programas Governamentais , Política de Saúde , Pesquisa sobre Serviços de Saúde/organização & administração , Humanos , Cooperação Internacional , Informática Médica
17.
Emerg Med Clin North Am ; 38(3): 549-562, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32616278

RESUMO

Emergency department (ED) operations reflect the intersection of factors external and internal to the ED itself, with unique problems posed by community and academic environments. ED crowding is primarily caused by a lack of inpatient beds for patients admitted through the ED. Changes to front-end operations, such as point-of-care testing and putting physicians in triage, can yield benefits in throughput, but require individual cost analyses. Balancing physician workloads can lead to substantial improvements in throughput. Observation pathways can reduce crowding while maintaining safety. Physician and nurse well-being is an underappreciated topic within operations, and demands close attention and further research.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Aglomeração , Pesquisa sobre Serviços de Saúde , Humanos , Recursos Humanos
18.
Stud Health Technol Inform ; 272: 257-260, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32604650

RESUMO

The Action Research aimed to develop of Quality Assurances System for Medical Laboratory in the Primary Care Units (PCUs), Roi Et province, Thailand. Data were collected by a questionnaire, in-depth interviews within a participatory process, employing both descriptive statistics, and inferential statistics. The results revealed that the process for the system included 7 steps: 1) Situation analysis, 2) Analyze and evaluate the situations, 3) Making a plan, 4) Action within planning, 5) Observation, 6) Reflection, and 7) Evaluation and implementation. The results also concluded consisted of 4 main activities: 1) Internal Quality Control 2) Intra-facilitator and support 3) Informal Quality Assessment and 4) Participatory System Evaluation. Recommendations of the study were included the model as of the main local policies, and create and encourage quality concept as the positive attitudes for staff and generate quality of working culture among the PCUs team.


Assuntos
Pesquisa sobre Serviços de Saúde , Atenção Primária à Saúde , Unidades Hospitalares , Humanos , Inquéritos e Questionários , Tailândia
19.
Global Health ; 16(1): 59, 2020 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-32646522

RESUMO

Coronavirus Disease is impacting the entire world. As the first country that has needed to confront this disease, China has responded with unprecedented and hugely successful public health initiatives. Almost simultaneous with the awareness of the potential for widespread loss of life, the first Chinese university recognizing the likely psychological impacts of COVID-19, assembled the first university-based professional team to offer pandemic-related mental health services to the Chinese public. This paper describes the work that we provided and the challenges encountered. The challenges are described in four contexts: the organizational/systemic level, the technical perspective, the therapeutic process, and the ethical aspects. We also provide recommendations on what we can do in the short term, and future improvements that can be made.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Serviços de Saúde Mental/organização & administração , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , China/epidemiologia , Pesquisa sobre Serviços de Saúde , Humanos , Universidades
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