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2.
BMC Health Serv Res ; 19(1): 969, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842833

RESUMO

BACKGROUND: To our knowledge, no instrument has been developed and tested for measuring unfinished care in Norwegian nursing home settings. The Basel Extent of Rationing of Nursing Care for Nursing Homes instrument (BERNCA-NH) was developed and validated in Switzerland to measure the extent of implicit rationing of nursing care in nursing homes. The BERNCA-NH comprises a list of nursing care activities in which a care worker reports the frequency to which activities were left unfinished over the last 7 working days as a result of lack of time. The aim of this study was to adapt and modify a Norwegian version of the BERNCA-NH intended for all care workers, and assess the instruments' psychometric properties in a Norwegian nursing home setting. METHODS: The BERNCA-NH was translated into Norwegian and modified to fit the Norwegian setting with inputs from individual cognitive interviews with informants from the target population. The instrument was then tested in a web-based survey with a final sample of 931 care workers in 162 nursing home units in different parts of Norway. The psychometric evaluation included score distribution, response completeness and confirmatory factor analysis (CFA) of a hypothesised factor structure and evaluation of internal consistency. Hypothesised relation to other variables was assessed through correlations between the subscale scores and three global ratings. RESULTS: The Norwegian version of BERNCA-NH comprised four subscales labelled: routine care, 'when required' care, documentation and psychosocial care. All subscales demonstrated good internal consistency. The CFA supported the four-factor structure with fit statistics indicating a robust model. There were moderate to strong bivariate associations between the BERNCA-NH subscales and the three global ratings. Three items which were not relevant for all care workers were not included in the subscales and treated as single items. CONCLUSIONS: This study found good psychometric properties of the Norwegian version BERNCA-NH, assessed in a sample of care workers in Norwegian nursing homes. The results indicate that the instrument can be used to measure unfinished care in similar settings.


Assuntos
Alocação de Recursos para a Atenção à Saúde , Pesquisas sobre Serviços de Saúde , Cuidados de Enfermagem , Casas de Saúde , Traduções , Adulto , Assistência à Saúde , Análise Fatorial , Feminino , Pessoal de Saúde , Recursos em Saúde/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Psicometria
3.
Artigo em Inglês | MEDLINE | ID: mdl-31430889

RESUMO

Integrated healthcare has received considerable attention and has developed into the highly important health policy known as Integrated Healthcare in County (IHC) against the background of the Grading Diagnosis and Treatment System (GDTS) in rural China. However, the causal conditions under which different integrated health-care modes might be selected are poorly understood, particularly in the context of China's authoritarian regime. This study aims to identify these causal conditions, and how they shape the mode selection mechanism for Integrated Healthcare in County (IHC). A theoretical framework consisting of resource heterogeneity, governance structure, and institutional normalization was proposed, and a sample of fifteen IHCs was selected, with data for each IHC being collected from news reports, work reports, government documents and field research for Fuzzy-sets Qualitative Comparative Analysis (fsQCA). This study firstly pointed out that strong governmental control and centralization are necessary conditions for the administration-oriented organization mode (MOA). Additionally, this research found three critical configured paths in the selection of organizational modes. Specifically, we found that the combination of low resource heterogeneity, weak governmental control, centralization, and normalization was sufficient to explain the selection path of the insurance-driven organization mode (MOI); the combination of low resource heterogeneity, strong governmental control, centralization, and normalization was sufficient for selecting MOA; and the combination of weak governmental control, weak centralization, and weak normalization was sufficient for selecting the contractual organization mode (MOC). Our study highlighted the necessity and feasibility of constructing different IHC modes separately and promoting their development gradually, as a result of the complex relationships among the causal conditions described above, thus helping to optimize the distribution of health resources and integrate the healthcare system.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Serviços de Saúde Rural/organização & administração , China , Governo , Administração de Instituições de Saúde , Política de Saúde , Recursos em Saúde/organização & administração , Humanos , Modelos Organizacionais
4.
Emerg Med J ; 36(10): 620-624, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31292206

RESUMO

OBJECTIVES: The last decade has seen rapid expansion of emergency care systems across Africa, although they remain underdeveloped. In Zambia, the Ministry of Health has taken interest in improving the situation and data are needed to appropriately guide system strengthening efforts. The Emergency Care Assessment Tool (ECAT) provides a context-specific means of measuring capacity of healthcare facilities in low- and middle-income countries. We evaluated Zambian public hospitals using the ECAT to inform resource-effective improvements to the nation's healthcare system. METHODS: The ECAT was administered to the lead clinician in the emergency unit at 23 randomly sampled public hospitals across seven of Zambia's 10 provinces in March 2016. Data were collected regarding hospitals' perceived abilities to perform a number of predefined signal functions - life-saving procedures that encompass the need for both skills and resources. Signal functions (36 for intermediate facilities, 51 for advanced) related to six sentinel conditions that represent a large burden of morbidity and mortality from emergencies. We report the proportion of procedures that each level of hospital was capable of, along with barriers to delivery of care. RESULTS: Across all hospitals, most of the level-appropriate emergency care procedures could be performed. Intermediate level (district) hospitals were able to perform 75% (95% CI 73.2 to 76.8) of signal functions for the six conditions. Among advanced level hospitals, provincial hospitals were able to perform 68.6% (67.4% to 69.7%) and central hospitals 96.1% (95% CI 93.5 to 98.7) Main failures in delivery of care were attributed to a lack of healthcare worker training and availability of consumable resources, such as medicines or supplies. CONCLUSION: Zambian public hospitals have reasonable capacity to care for acutely ill and injured patients; however, there is a need for increased training and improved supply chains.


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Estudos Transversais , Países em Desenvolvimento , Serviços Médicos de Emergência/organização & administração , Tratamento de Emergência/estatística & dados numéricos , Recursos em Saúde/organização & administração , Recursos em Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Hospitais Públicos/organização & administração , Humanos , Zâmbia
5.
PLoS One ; 14(7): e0219197, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31276535

RESUMO

Addressing critical global health issues, such as antimicrobial resistance, infectious disease outbreaks, and natural disasters, requires strong coordination and management across sectors. The One Health approach is the integrative effort of multiple sectors working to attain optimal health for people, animals, and the environment, and is increasingly recognized by experts as a means to address complex challenges. However, practical application of the One Health approach has been challenging. The One Health Systems Mapping and Analysis Resource Toolkit (OH-SMART) introduced in this paper was designed using a multistage prototyping process to support systematic improvement in multi-sectoral coordination and collaboration to better address complex health concerns through an operational, stepwise, and practical One Health approach. To date, OH-SMART has been used to strengthen One Health systems in 17 countries and has been deployed to revise emergency response frameworks, improve antimicrobial resistance national action plans and create multi agency infectious disease collaboration protocols. OH-SMART has proven to be user friendly, robust, and capable of fostering multi-sectoral collaboration and complex system-wide problem solving.


Assuntos
Assistência à Saúde/métodos , Saúde Única/normas , Saúde Única/tendências , Animais , Surtos de Doenças/prevenção & controle , Recursos em Saúde/organização & administração , Humanos , Análise de Sistemas
6.
BMC Health Serv Res ; 19(1): 243, 2019 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-31014325

RESUMO

BACKGROUND: Redispensing unused medications that have been returned to outpatient pharmacies by patients may reduce waste and healthcare costs. However, little is known regarding the extra costs associated with this process, nor the price level of medications for which this is economically beneficial. The objective of this study was to assess costs associated with redispensing unused medications in the pharmacy and the price level at which redispensing becomes cost-beneficial. METHODS: A micro-costing study was conducted in four Dutch outpatient pharmacies for medications requiring room-temperature storage and requiring refrigeration. First, the pharmacy's necessary additional process steps and resources for redispensing were identified. Second, time required for each process step was simulated. Third, required resources were quantified by calculating labour, purchasing and overhead costs. Lastly, a model with different scenarios was constructed to calculate the price of a medication package at which redispensing becomes cost-beneficial. RESULTS: Three main additional process steps for redispensing were identified: (1) pack medications with product quality indicators before dispensing, (2) assess quality of medications returned to the pharmacy (temperature storage, package integrity, expiry date) and (3a) restock medications fulfilling quality criteria or (3b) dispose of medications not fulfilling criteria. Total time required for all steps up to restock one medication package was on average 5.3 (SD ±0.3) and 6.8 (SD ±0.3) minutes for medications stored at room-temperature and under refrigeration, respectively, and associated costs were €5.54 and €7.61. Similar outcomes were found if a medication package would ultimately be disposed of. The price level primarily depended upon the proportion of dispensed packages returned unused to the pharmacy and fulfilling the quality criteria: if 5% is returned, of which 60% fulfils quality criteria, the price level was €101 per package for medications requiring room-temperature storage and €215 per package for those requiring refrigeration. However, if 10% is returned, of which 60% fulfils the quality criteria, the price level decreases to €53 and €109, respectively (arbitrary proportions). CONCLUSIONS: Redispensing unused medications in the pharmacy is at least cost-beneficial if applied to expensive medications.


Assuntos
Serviços Comunitários de Farmácia/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Recursos em Saúde/economia , Medicamentos sob Prescrição/economia , Gerenciamento de Resíduos/economia , Serviços Comunitários de Farmácia/organização & administração , Recursos em Saúde/organização & administração , Humanos
7.
J Nurs Scholarsh ; 51(3): 289-298, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30919555

RESUMO

PURPOSE: To explore Lebanese nurses' perspectives on the impact of the protracted Syrian refugee (SR) crisis on nurses working in hospitals and primary healthcare centers in Lebanon. DESIGN: A qualitative research design drawing on a semistructured in-depth interview approach. METHODS: We recruited participants through the Order of Nurses in Lebanon. We interviewed six primary healthcare nurses and six nursing directors working in regions with high concentration of SRs. We used the thematic inductive approach to analyze the data. FINDINGS: Two themes emerged. In Theme I, nurses and nursing directors described the SR health profile as poor at baseline, and as the crisis was protracting the type of diseases shifted from acute to chronic with convoluted complications. As for determinants of health, SRs had poor health literacy and poor living conditions. In Theme II, nurses and nursing directors voiced the impact of the SR crisis on nurses, nursing practice, healthcare system, and host community. They cited fatigue, burnout, and depleted compassionate care at the individual level; rationing and stressed interpersonal relationships at the practice level; shortage in resources and poor performance at the healthcare system level; and a shift in the patient population that led the host community to seek health care elsewhere. Alternatively, more money was injected, and new services and clinical programs were introduced. CONCLUSIONS: Lebanese nurses bore a profound burden as a result of the SR crisis. Should this crisis be replicated in other contexts, the important lessons learned encompass (a) increasing access to care to refugees, coupled with an emergency plan to increase human health resources; (b) improving preparedness of nurses in handling priority health conditions; (c) documenting and reporting the challenges and resilience of health workers, especially nurses facing the crisis; and (d) engaging more nurses to be at the policy table. CLINICAL RELEVANCE: There is a need to prepare nurses for efficient response to crisis related to refugee health by increasing human resources and training them to be competent in delivering safe and high-quality care necessary to respond to the special healthcare needs of the refugees.


Assuntos
Atitude do Pessoal de Saúde , Assistência à Saúde , Recursos Humanos de Enfermagem/psicologia , Refugiados , Adulto , Assistência à Saúde/organização & administração , Assistência à Saúde/normas , Empatia , Feminino , Recursos em Saúde/organização & administração , Acesso aos Serviços de Saúde/normas , Administração Hospitalar/normas , Humanos , Líbano , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Pesquisa Qualitativa , Síria
8.
Account Res ; 26(3): 246-251, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30793632

RESUMO

Most accounts of research ethics focus on the importance of a handful of ethical and epistemological norms for the conduct of science, such as honesty, integrity, transparency, accountability, objectivity, collegiality, fairness, social responsibility, but have little to say about another, less well-known norm that also deserves attention: stewardship of research resources. Many of the behaviors and practices that are widely regarded as unethical or ethically questionable involve wasting or misusing money, time, and other resources. While good stewardship of resources may not be as crucial to the ethics of science as other norms, it is an important consideration that scientists should keep in mind when managing their own resources or mentoring students and trainees in the responsible conduct of research. Additional investigation into the ethics of stewardship may help us better understand how this norm interacts with other research norms and guides scientific conduct.


Assuntos
Ética em Pesquisa , Recursos em Saúde/ética , Recursos em Saúde/organização & administração , Pesquisadores
10.
Health Aff (Millwood) ; 38(1): 8-13, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30615533

RESUMO

In Maryland communities such as Annapolis, Health Enterprise Zones have spurred investment and experimentation in care delivery.


Assuntos
Assistência à Saúde/organização & administração , Recursos em Saúde/organização & administração , Acesso aos Serviços de Saúde , Atenção Primária à Saúde/organização & administração , Populações Vulneráveis , Humanos , Maryland
11.
Int J Health Plann Manage ; 34(1): e776-e788, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30370553

RESUMO

PURPOSE: Distribution network plays a vital role on the efficiency and the responsiveness of a supply chain. Any product or service goes through a network until it reaches the final customer. Health care systems incorporate distribution networks to better provide health services to patients. In this study, a distribution network for communicable diseases has been developed. The proposed network addresses Hepatitis A in Jordan as a case study, as it is considered one of the common communicable diseases in Jordan. FINDINGS: A regression model was developed to predict future incidents of Hepatitis A in Jordan to build a distribution network based on the future required resources. An optimization clustering model was used to structure the appropriate distribution network. The proposed network was compared with the current network used for distribution of medications for Hepatitis A. CONCLUSION: The new network incurs less cost in delivering medications to the required hospitals as the traveling distance is less. As future work, it is recommended to incorporate more communicable diseases to develop more realistic distribution network.


Assuntos
Assistência à Saúde , Recursos em Saúde/organização & administração , Hepatite A/epidemiologia , Doenças Transmissíveis , Feminino , Hepatite A/tratamento farmacológico , Humanos , Incidência , Jordânia/epidemiologia , Análise de Regressão
12.
JAMA Ophthalmol ; 137(2): 208-211, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30520949

RESUMO

In 2016, the report Making Eye Health a Population Health Imperative: Vision for Tomorrow was published by the National Academies of Sciences, Engineering, and Medicine. Conference presentations and key stakeholder discussions have continued the dialogue initiated by this report. In 2018, a stakeholder meeting assessed the feasibility of establishing a backbone organization, a national center that can provide technical and resource assistance regarding eye and vision health. This meeting also resulted in a consensus to translate the report recommendations into action through 7 core functions: (1) supporting ongoing surveillance efforts, (2) establishing and strengthening a national multisector network of partner organizations, (3) creating an online vision and population health toolkit, (4) integrating and expanding early-detection initiatives across diverse clinical and nonclinical settings, (5) expanding eye and vision health education, (6) identifying and disseminating evidence-based interventions, and (7) exploring the integration of eye and vision health interventions into broader chronic care models. The report's recommendations aim to improve vision and health equity in the United States and should be implemented through an ongoing centrally coordinated campaign.


Assuntos
Oftalmopatias/prevenção & controle , Educação em Saúde , Promoção da Saúde/métodos , Recursos em Saúde/organização & administração , Vigilância em Saúde Pública/métodos , Seleção Visual/métodos , Pessoas com Deficiência Visual/reabilitação , Conferências de Consenso como Assunto , Guias como Assunto , Humanos , Estados Unidos
15.
J Am Assoc Nurse Pract ; 30(11): 597-599, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30422874

RESUMO

Nurse practitioners can be a powerful frontline force by collectively raising awareness of human trafficking (HT) through education; advocating for policy change at the local/state/federal level, providing primary prevention for contributory risk factors; and building a strong HT prevention program with the Social-Ecological Model. Together, NPs can lead through practice, education, advocacy, and research to promote optimal health outcomes and to end human trafficking.


Assuntos
Tráfico de Pessoas/prevenção & controle , Profissionais de Enfermagem/tendências , Defesa do Paciente/tendências , Recursos em Saúde/organização & administração , Tráfico de Pessoas/estatística & dados numéricos , Humanos , Populações Vulneráveis/estatística & dados numéricos
16.
Vaccine ; 36(49): 7487-7495, 2018 11 26.
Artigo em Inglês | MEDLINE | ID: mdl-30366804

RESUMO

Efforts driving universal coverage have recently been strengthened through implementation of the Global Vaccine Action Plan (GVAP) where cost estimates for immunization support were developed totaling US$40 billion of donor assistance by 2020. In addition to resource mobilization, there has been an increasing focus on improving both vaccine access and delivery systems. We track donor assistance for immunization by funding objective and channel from 1990 to 2016, and illustrate projections through 2020 to inform progress of the GVAP. Using available data from development agencies supporting immunization, we categorize funding by vaccine and quantify support for systems strengthening. We split time into four periods including the post universal childhood immunization era (1990-1999) and Gavi's three funding phases between 2000 and 2015, during which annualized funding changes are estimated. Lastly, we perform a linear extrapolation through 2020 to predict the success of stipulated resource mobilization targets. Double counting was eliminated and results presented in real 2017 US dollars. Over the last 27 years, funding for immunization increased by 10.5% annually, with non-Gavi funding increasing by 7.1% and Gavi funding by 23.6% in the last 17 years. Gavi disbursements targeting vaccines and health system improvements increased uniformly at 15%, compared to 22.5% for vaccines and 11.7% for system strengthening from non-Gavi channels. Funding fluctuated for non-Gavi channels with disbursements declining before 2000 and during Gavi funding phase II, while Gavi disbursements continued to grow relative the previous phase. New and underused vaccines were prioritized by Gavi whereas non-Gavi channels focused on elimination efforts. Projected funding targets were estimated to be on track for Gavi contrary to non-Gavi support which was estimated to remain 40% below the stipulated target. Renewed assessments for funding requirements need to be undertaken, while strengthening existing resource efficiencies in order to achieve current global universal coverage targets.


Assuntos
Saúde Global/economia , Recursos em Saúde/organização & administração , Financiamento da Assistência à Saúde , Programas de Imunização/economia , Cooperação Internacional , Vacinas/economia , Comportamento Cooperativo , Programas Governamentais/economia , Recursos em Saúde/economia , Humanos , Cobertura Universal do Seguro de Saúde , Vacinas/administração & dosagem
17.
Artigo em Inglês | MEDLINE | ID: mdl-30332771

RESUMO

The objective of this paper is to analyze the provincial efficiency of the Chinese community health care service and its differences. This study allows us to predict the provincial differences in the efficiency of the Chinese community health care service from 2017 to 2026. This study analyzes the contributions of inter-regional and intra-regional differences in the total efficiency difference. We use the Super-SBM (Slacks-based Model) data envelopment analysis (DEA) model, Grey Model GM (1,1) for grey prediction, and the group-based Theil index decomposition method to study Chinese provincial panel data from 2008 to 2016. Results show that a fluctuating trend existed in the average provincial efficiency of community health services from 2008 to 2016. The community health services in a considerable number of provincial areas were inefficient. This study also reveals that there existed apparent inter-provincial differences in efficiency in Chinese community health services. The inter-provincial differences of the efficiency of Chinese community health services revealed by the Theil index declined at a relatively slow pace. With regard to the provincial efficiency difference of the Chinese community health service, the intra-regional efficiency difference is the most important structural reason for the overall efficiency difference, which explains the overall difference to a large extent. The inter-regional efficiency difference among the eastern, central, and western regions becomes the secondary structural reason, which should not be ignored. In conclusion, focus should be put on restructuring the investments into medical resources for community health service in each Chinese province. More attentions should be put into narrowing the inter-regional efficiency differences of the Chinese provincial community health service. The strategies targeted at reducing the inter-regional efficiency differences should not be ignored, so as to facilitate the improvement of overall efficiency of the Chinese community health service.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Eficiência Organizacional/estatística & dados numéricos , China , Serviços de Saúde Comunitária/estatística & dados numéricos , Recursos em Saúde/organização & administração , Modelos Teóricos
18.
Rev Epidemiol Sante Publique ; 66(6): 385-394, 2018 Nov.
Artigo em Francês | MEDLINE | ID: mdl-30309672

RESUMO

BACKGROUND: The aim of this study is to analyze and to compare data from 2015, focusing on hospital care for patients with multiple sclerosis from three French regions with different characteristics in terms of prevalence, size and number of multiple sclerosis competencies and resource centers. METHODS: All hospital admissions from the PMSI MCO 2015 database, with a principal or related diagnosis (PD-RD) of G35* ("multiple sclerosis") were extracted. We also extracted chemotherapy treatments administered in hospital, during admissions with a significant associated diagnosis (SAD) of G35*, if the PD or RD was coded Z512 ("non-tumor chemotherapy"). The analyzed regions corresponded to those of 2015, some of which have since merged. RESULTS: There were 95,359 hospital admissions for multiple sclerosis in France in 2015 among a total cohort of 21,102 patients, resulting in a total cost of € 54.1m. Patients with MS were managed mainly in the ambulatory setting, which accounted for 88.5 % of all admissions. The Rhône-Alpes region represented 7.6 % of national admissions for MS, 9.6 % of patients, and 14 % of inpatient days, contributing 10.4 % of the national cost of MS care. 58.4 % of stays were managed by the two main multiple sclerosis centers. The Nord-Pas-de-Calais region represented 9.8 % of national admissions, 10 % of patients, 6.6 % of inpatient days, and 9.1 % of the national cost. 29.8 % of stays were managed by the main multiple sclerosis center. The Centre region represented 2.7 % of stays, 2.8 % of patients, 3.1 % of inpatient days, and 2.8 % of the national cost. 28.4 % of stays were managed by the main multiple sclerosis center. CONCLUSION: This study highlights the diversity of multiple sclerosis hospital management and care between these three regions.


Assuntos
Procedimentos Clínicos/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Esclerose Múltipla/epidemiologia , Esclerose Múltipla/terapia , Padrões de Prática Médica , Adulto , Competência Clínica/estatística & dados numéricos , Procedimentos Clínicos/economia , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/normas , Bases de Dados Factuais , Feminino , França/epidemiologia , Recursos em Saúde/economia , Recursos em Saúde/organização & administração , Recursos em Saúde/normas , Recursos em Saúde/estatística & dados numéricos , Hospitalização/economia , Humanos , Masculino , Martinica/epidemiologia , Pessoa de Meia-Idade , Esclerose Múltipla/economia , Padrões de Prática Médica/economia , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos
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