Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 86.993
Filtrar
1.
Washington, D.C.; OPS; 2024-05-15.
Não convencional em Espanhol | PAHO-IRIS | ID: phr-59607

RESUMO

Esta publicación analiza el grado de alineamiento entre la necesidad de priorizar el primer nivel de atención con el desempeño presupuestario en salud y la capacidad de absorción del sector salud del incremento de los recursos financieros en el periodo 2019 a 2021. La Estrategia de OPS/OMS para el Establecimiento de Sistemas de Salud Resilientes enfatiza la necesidad de priorizar las inversiones en el primer nivel de atención por su incidencia en los niveles de acceso y cobertura. En este ámbito, los presupuestos públicos sirven como el mecanismo por excelencia de revisión de políticas públicas donde se plasman las prioridades de los gobiernos y los diferentes actores del sistema de salud, se articula el modelo de atención y se reasignan recursos ante eventos de emergencia sanitaria. La relevancia del presupuesto público se manifiesta también en la propuesta de incrementar la inversión en salud proveniente de recursos públicos, principalmente ingresos generales (o impuestos) acercándose al 6% del PIB incluido en la estrategia de Salud Universal de la OPS/OMS. El periodo de análisis de esta publicación se caracterizó por un incremento sin precedentes en el flujo de recursos financieros hacia el sector salud para asegurar la capacidad de respuesta del sistema de salud frente a la emergencia sanitaria originada por la pandemia de la Covid-19. La mayor priorización de recursos públicos para salud se viabilizó a través de la implementación de diferentes mecanismos de expansión fiscal, y la utilización de recursos de emergencia; así como a través de las innovaciones en las reglas de gestión financiera pública. Del análisis en este documento elaborado para ocho países de la región utilizando información presupuestaria de acceso público se obtienen varias lecciones que relevan la importancia de fortalecer capacidades de gestión para una asignación más rápida, eficaz y equitativa que se traduzca a la vez en una ejecución presupuestaria más eficiente y equitativa de acuerdo con los objetivos sanitarios. Queda asimismo como tarea pendiente, el relacionar la asignación y uso de estos recursos con las barreras de acceso no-financieras y la interrupción de los servicios esenciales durante el mismo periodo.


Assuntos
Financiamento dos Sistemas de Saúde , Cobertura Universal de Saúde , Qualidade da Assistência à Saúde , Gastos Públicos com Saúde
2.
Artigo em Inglês | PAHO-IRIS | ID: phr-59518

RESUMO

[ABSTRACT]. This report provides a summary of childhood cancer and the efforts made in the Dominican Republic to address child and adolescent cancer in line with the World Health Organization’s Global Initiative for Childhood Cancer. Information was obtained by review of recent local and international literature on pediatric oncology. As a result of the Global Initiative, a meeting was held by the Council of Ministers of Health of Central America to support the development of national pediatric cancer plans for each country. The objectives of these plans are to improve overall survival and quality of care for children with cancer through early detection, diagnosis, and treatment. In the Dominican Republic, several steps have been taken in the past 5 years to enhance diagnosis and care of children with cancer. For example, the National Committee of Childhood Cancer, headed by the Ministry of Public Health and including relevant stakeholders, was established to develop the national childhood cancer plan. In addition, a campaign was launched to raise awareness of childhood cancer, and the first early detection manual and public policy on child and adolescent cancer were published. A government initiative has been working to improve the hospital infrastructure and expand the pediatric cancer center, and a national course on early detection of pediatric cancers has been held. In 2023, the National Strategic Childhood Cancer Plan 2023–2030 was launched in the Dominican Republic. The plan will help policy-makers, implementers, researchers, and advocates enhance diagnosis and care of children with cancer.


[RESUMEN]. En este informe se presenta un resumen del cáncer infantil y las medidas adoptadas por República Dominicana para abordar el cáncer en la población infantil y adolescente en consonancia con la Iniciativa Mundial contra el Cáncer Infantil de la Organización Mundial de la Salud. La información se obtuvo mediante el análisis de las publicaciones nacionales e internacionales recientes sobre oncología pediátrica. Como resultado de la Iniciativa Mundial, el Consejo de Ministros de Salud de Centroamérica celebró una reunión para brindar apoyo a la elaboración de planes nacionales sobre el cáncer infantil para cada país. Los objetivos de estos planes son mejorar la supervivencia general y la calidad de la atención que se presta a la población infantil con cáncer mediante la detección temprana, el diagnóstico y el tratamiento. En los últimos cinco años, República Dominicana ha adoptado varias medidas para mejorar el diagnóstico y la atención prestada a la población infantil con cáncer. Así, por ejemplo, se creó el Comité Nacional de Cáncer Infantil, encabezado por el Ministerio de Salud e integrado por las partes interesadas pertinentes, para elaborar el plan nacional sobre el cáncer infantil. Además, se puso en marcha una campaña de sensibilización sobre el cáncer infantil y se publicaron el primer manual de detección precoz y la primera política pública sobre el cáncer en la población infantil y adolescente. Mediante una iniciativa gubernamental se ha buscado mejorar la infraestructura hospitalaria y ampliar el centro de atención a pacientes oncológicos pediátricos, al tiempo que se ha impartido un curso nacional sobre detección precoz del cáncer infantil. En el 2023, República Dominicana puso en marcha el Plan Estratégico Nacional sobre Cáncer Infantil 2023-2030. Este plan será útil a los responsables de la formulación de políticas, las personas encargadas de su ejecución, los investigadores y los promotores para mejorar el diagnóstico y la atención prestada a la población infantil con cáncer.


[RESUMO]. Este relatório fornece um resumo sobre o câncer infantil e os esforços da República Dominicana para enfrentar a doença em crianças e adolescentes, em consonância com a Iniciativa Global para o Câncer Infantil da Organização Mundial da Saúde. As informações foram obtidas por meio de uma revisão da literatura local e internacional recente sobre oncologia pediátrica. Em consequência da Iniciativa Global, o Conselho de Ministros da Saúde da América Central se reuniu para apoiar a elaboração de planos nacionais de câncer pediátrico para cada país. Os objetivos desses planos são melhorar a sobrevida global e a qualidade da atenção a crianças com câncer por meio de detecção, diagnóstico e tratamento precoces. Na República Dominicana, várias medidas foram tomadas nos últimos cinco anos para melhorar o diagnóstico e a atenção a crianças com câncer. Por exemplo, o Comitê Nacional de Câncer Infantil, que é chefiado pelo Ministério da Saúde e inclui as partes interessadas pertinentes, foi criado para elaborar o plano nacional de câncer infantil. Foi lançada uma campanha de conscientização sobre o câncer infantil no país. Além disso, foram publica- dos o primeiro manual de detecção precoce e a política pública de câncer infantojuvenil. Uma iniciativa do governo vem trabalhando para melhorar a infraestrutura hospitalar e ampliar o centro de câncer pediátrico e ministrou um curso nacional sobre a detecção precoce de cânceres pediátricos. Em 2023, foi lançado o Plano Estratégico Nacional de Câncer Infantil 2023–2030 na República Dominicana. O plano ajudará formuladores de políticas, implementadores, pesquisadores e defensores da causa a aprimorar o diagnóstico e a atenção a crianças com câncer.


Assuntos
Neoplasias , Criança , Adolescente , Política Pública , Qualidade da Assistência à Saúde , República Dominicana , Neoplasias , Criança , Adolescente , Política Pública , Qualidade da Assistência à Saúde , República Dominicana , Criança , Qualidade da Assistência à Saúde
3.
Int J Equity Health ; 23(1): 101, 2024 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-38760667

RESUMO

BACKGROUND: More than half of the people with Tuberculosis (TB) symptoms in India seek care from the private sector. People with TB getting treatment from private sector in India are considered to be at a higher risk for receiving suboptimal quality of care in terms of incorrect diagnosis and treatment, lack of treatment adherence support with a high loss to follow-up rate that could eventually increase their risk of drug resistance. The current study aims at documenting the approach and efforts taken by the Kerala state to partner with the private health care delivery providers for ensuring quality TB care to the people with presumed TB reaching them. METHODS: A case study approach was adopted with review of all available literature followed by five Key Informant Interviews to understand the case through a primary descriptive exploration. Grounded theory approach was used to generating the single theory of the case itself that explains it. RESULTS: Kerala state has taken a variety of interventions to ensure universal access to TB care for citizens reaching the private sector with documented improvement in the quality of TB care. Key learnings from these initiatives were (i) patients need to be at the centre of partnerships, (ii) good governance is essential for ensuring Universal Health Coverage in a mixed health system, (iii) data intelligence is required to guide partnerships, (iv) identification of the correct 'problems' is crucial for effective design of partnerships and (v) a platform for meaningful dialogue of key stakeholders is needed. CONCLUSION: Kerala experience demonstrated that if governments take a proactive role in engaging the private sector, in an informed and evidence-based way, they can leverage the advantages of the private sector while protecting the public health interest.


Assuntos
Acessibilidade aos Serviços de Saúde , Setor Privado , Qualidade da Assistência à Saúde , Tuberculose , Humanos , Índia , Tuberculose/terapia , Acessibilidade aos Serviços de Saúde/normas , Qualidade da Assistência à Saúde/normas , Cobertura Universal do Seguro de Saúde , Parcerias Público-Privadas
4.
J Prim Care Community Health ; 15: 21501319241255917, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38761365

RESUMO

INTRODUCTION/OBJECTIVES: Social determinants of health (SDoH) screening and intervention in pediatric primary care depends upon caregiver disclosure of adverse household or social conditions and thus may be influenced by perceived bias or stigma. This paper examines to what extent parents' experience of their child's medical home is associated with their perceptions of a practice-based social needs intervention. METHODS: We conducted a cohort study of data reported by 73 parents of children obtaining care in a medical home with an embedded SDoH navigation program. Using survey data collected in October 2021 and October 2022, we calculated descriptive statistics and non-parametric bivariate analyses of the association between engagement with the SDoH navigation program and parent-reported social needs, stress, and perception of care quality as measured by the Person-Centered Primary Care Measure (PCPCM). RESULTS: Initial ratings of care quality were high (mean baseline PCPCM score = 3.63) and remained high on second interview (mean change in PCPCM score = -0.04, 95%CI -0.16, 0.09, P = .58) despite significant reductions in parents' ratings of access to care over time. Parents reported substantial stress, unmet social needs, and unmet healthcare needs, with 41 families (56%) ever using the practice-based SDoH program, including 16 (22%) who were new users in 2022. There was no association observed between PCPCM score and parent stress, unmet social needs, or use of SDoH services. CONCLUSIONS: Parents' perceptions of care delivered in their child's medical home appears to be stable on repeat measurement, and independent of family context or interactions with social needs navigation services offered in the practice.


Assuntos
Pais , Atenção Primária à Saúde , Determinantes Sociais da Saúde , Humanos , Feminino , Masculino , Criança , Pais/psicologia , Pré-Escolar , Qualidade da Assistência à Saúde , Adolescente , Estudos de Coortes , Adulto , Pediatria/métodos , Avaliação das Necessidades , Inquéritos e Questionários , Lactente , Assistência Centrada no Paciente
5.
Epidemiol Psychiatr Sci ; 33: e27, 2024 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-38747198

RESUMO

AIMS: Cancer is one of the main causes of death in persons with severe mental illness (SMI). Although their cancer incidence is similar, or sometimes even potentially lower compared to the general population, their cancer mortality remains higher. The role of healthcare provision and care equity in this mortality is increasingly being addressed in research, but available studies are limited in their scope. In this context, our aim was to compare colorectal cancer (CRC) care pathways from screening to end-of-life care in patients with and without pre-existing SMI on a national scale. METHODS: This research leverages real-world data from the French national health claims database, covering the entire population, to assess cancer screening, diagnosis, treatment and post-treatment follow-up as well as quality of care (QOC) pathways among patients with incident CRC in 2015-2018, considering whether they had pre-existing SMI. We matched patients with SMI with three patients without - on age, sex, region of residence, year of cancer incidence and cancer type and location at presentation - as well as nationally established quality of CRC care indicators and regression models adjusting for relevant socio-economic, clinical and care provider-related covariates. RESULTS: Among patients with incident CRC, 1,532 individuals with pre-existing SMI were matched with individuals without SMI. After adjusting for covariates, both colon and rectal cancer patients with SMI were less likely to participate in the national CRC screening programme and to receive advanced diagnostic examinations (e.g., colonoscopies and several complementary diagnostic examinations). They also had lower odds of receiving combined treatments (e.g., neoadjuvant chemotherapy, radiotherapy and excision) and of having access to targeted therapy or capecitabine but higher odds for invasive care (e.g., stoma). Colon cancer patients with SMI were also more likely to have no treatment at all, and rectal cancer patients with SMI were less likely to receive post-treatment follow-up. Suboptimal QOC was observed for both groups of patients, but to a higher extent for patients with SMI, with statistically significant differences for indicators focusing on diagnosis and post-treatment follow-up. CONCLUSIONS: Our findings reveal discrepancies across the care continuum of CRC between individuals with and without SMI and provide initial avenues on where to focus future efforts to address them, notably at the entry and exit stages of cancer care pathways, while calling for further research on the mechanisms preventing equity of physical healthcare for individuals with SMI.


Assuntos
Neoplasias Colorretais , Detecção Precoce de Câncer , Transtornos Mentais , Assistência Terminal , Humanos , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/terapia , Neoplasias Colorretais/diagnóstico , Assistência Terminal/estatística & dados numéricos , Masculino , Feminino , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Detecção Precoce de Câncer/estatística & dados numéricos , Idoso , França/epidemiologia , Adulto , Incidência , Qualidade da Assistência à Saúde , Procedimentos Clínicos , Programas de Rastreamento
7.
Healthc Policy ; 19(3): 33-41, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38721732

RESUMO

This paper examines the contentious issue of using contracted surgical facilities (CSFs) for scheduled eye surgeries within Canada's publicly funded healthcare system. Despite the debate over the use of CSFs, there is a stark lack of Canadian-focused empirical evidence to guide policy decisions. This paper uses the Organisation for Economic Co-operation and Development's healthcare system performance conceptual model - access, quality and cost/expenditures - as a framework to explore the debates surrounding CSFs. It highlights the mixed evidence from international studies and proposes recommendations for policy makers to ensure equitable access, maintain high-quality care and achieve cost-effectiveness. The paper underscores the necessity for informed policy making supported by robust empirical research, stakeholder engagement and continuous policy evaluation to address the challenges posed by the integration of CSFs into Canada's healthcare landscape.


Assuntos
Acessibilidade aos Serviços de Saúde , Canadá , Humanos , Política de Saúde , Qualidade da Assistência à Saúde , Setor Privado , Procedimentos Cirúrgicos Oftalmológicos
9.
BMC Health Serv Res ; 24(1): 592, 2024 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-38715066

RESUMO

BACKGROUND: Considering the significance of care delegation in enhancing the quality of nursing care and ensuring patient safety, it is imperative to explore nurses' experiences in this domain. As such, this study aimed to explore the experiences of Iranian nurses regarding the delegation of care. METHODS: This qualitative study was conducted between 2022 and 2023, employing the content analysis method with a conventional approach. The study utilized purposeful sampling method to select qualified participants. Data collection was carried out through in-depth and semi-structured interviews utilizing open-ended questions. The data analysis process followed the steps proposed by Graneheim and Lundman (2004) and involved the use of MAXQDA version 12 software. To ensure the trustworthiness of the data, the study employed the four rigor indices outlined by Lincoln and Guba (1985). RESULTS: In the present study, a total of 15 interviews were conducted with 12 participants, the majority of whom were women. The age range of the participants fell between 25 and 40 years. Through qualitative data analysis, eight subcategories and three main categories of "insourcing of care", "outsourcing of care" and "delegating of care to non-professionals" were identified. Additionally, the overarching theme that emerged from the analysis was "delegation of care, a double-edged sword". CONCLUSIONS: The results of the study revealed that the delegation of care occurred through three distinct avenues: to colleagues within the same unit, to colleagues in other units, and to non-professionals. Delegating care was found to have potential benefits, such as reducing the nursing workload and fostering teamwork. However, it was also observed that in certain instances, delegation was not only unhelpful but also led to missed nursing care. Therefore, it is crucial to adhere to standardized principles when delegating care to ensure the maintenance of high-quality nursing care.


Assuntos
Pesquisa Qualitativa , Qualidade da Assistência à Saúde , Humanos , Feminino , Irã (Geográfico) , Qualidade da Assistência à Saúde/normas , Adulto , Masculino , Entrevistas como Assunto , Cuidados de Enfermagem/normas , Atitude do Pessoal de Saúde , Recursos Humanos de Enfermagem Hospitalar/psicologia
10.
BMJ Open ; 14(5): e082011, 2024 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-38697765

RESUMO

BACKGROUND: Kenya still faces the challenge of mothers and neonates dying from preventable pregnancy-related complications. The free maternity policy (FMP), implemented in 2013 and expanded in 2017 (Linda Mama Policy (LMP)), sought to address this challenge. This study examines the quality of care (QoC) across the continuum of maternal care under the LMP in Kenya. METHODS: We conducted a convergent parallel mixed-methods study across multiple levels of the Kenyan health system, involving key informant interviews with national stakeholders (n=15), in-depth interviews with county officials and healthcare workers (HCWs) (n=21), exit interview survey with mothers (n=553) who utilised the LMP delivery services, and focus group discussions (n=9) with mothers who returned for postnatal visits (at 6, 10 and 14 weeks). Quantitative data were analysed descriptively, while qualitative data were analysed thematically. All the data were triangulated at the analysis and discussion stage using a framework approach guided by the QoC for maternal and newborns. RESULTS: The results showed that the expanded FMP enhanced maternal care access: geographical, financial and service utilisation. However, the facilities and HCWs bore the brunt of the increased workload and burnout. There was a longer waiting time for the initial visit by the pregnant women because of the enhanced antenatal care package of the LMP. The availability and standards of equipment, supplies and infrastructure still posed challenges. Nurses were multitasking and motivated despite the human resources challenge. Mothers were happy to have received care information; however, there were challenges regarding respect and dignity they received (inadequate food, over-crowding, bed-sharing and lack of privacy), and they experienced physical, verbal and emotional abuse and a lack of attention/care. CONCLUSIONS: Addressing the negative aspects of QoC while strengthening the positives is necessary to achieve the Universal Health Coverage goals through better quality service for every woman.


Assuntos
Serviços de Saúde Materna , Cuidado Pós-Natal , Qualidade da Assistência à Saúde , Humanos , Quênia , Feminino , Gravidez , Adulto , Serviços de Saúde Materna/normas , Cuidado Pós-Natal/normas , Continuidade da Assistência ao Paciente , Recém-Nascido , Cuidado Pré-Natal/normas , Política de Saúde , Pesquisa Qualitativa , Assistência Perinatal/normas , Grupos Focais , Adulto Jovem
11.
BMJ Open ; 14(5): e079415, 2024 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-38702083

RESUMO

BACKGROUND: Increasing levels of poor glycaemic control among Thai patients with type 2 diabetes mellitus (T2DM) motivated us to compare T2DM care between urban and suburban primary care units (PCUs), to identify gaps in care, and to identify significant factors that may influence strategies to enhance the quality of care and clinical outcomes in this population. METHODS: We conducted a cross-sectional study involving 2160 patients with T2DM treated at four Thai PCUs from 2019 to 2021, comprising one urban and three suburban facilities. Using mixed effects logistic regression, we compared care factors between urban and suburban PCUs. RESULTS: Patients attending suburban PCUs were significantly more likely to undergo eye (adjusted OR (AOR): 1.83, 95% CI 1.35 to 1.72), foot (AOR: 1.61, 95% CI 0.65 to 4.59) and HbA1c (AOR: 1.66, 95% CI 1.09 to 2.30) exams and achieved all ABC (HbA1c, blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C)) goals (AOR: 2.23, 95% CI 1.30 to 3.83). Conversely, those at an urban PCU were more likely to undergo albuminuria exams. Variables significantly associated with good glycaemic control included age (AOR: 1.51, 95% CI 1.31 to 1.79), T2DM duration (AOR: 0.59, 95% CI 0.41 to 0.88), FAACE (foot, HbA1c, albuminuria, LDL-C and eye) goals (AOR: 1.23, 95% CI 1.12 to 1.36) and All8Q (AOR: 1.20, 95% CI 1.05 to 1.41). Chronic kidney disease (CKD) was significantly linked with high triglyceride and HbA1c levels (AOR: 5.23, 95% CI 1.21 to 7.61). Elevated HbA1c levels, longer T2DM duration, insulin use, high systolic BP and high lipid profile levels correlated strongly with diabetic retinopathy (DR) and CKD progression. CONCLUSION: This highlights the necessity for targeted interventions to bridge urban-suburban care gaps, optimise drug prescriptions and implement comprehensive care strategies for improved glycaemic control, DR prevention and CKD progression mitigation among in Thai patients with T2DM. The value of the clinical target aggregate (ABC) and the process of care aggregate (FAACE) was also conclusively demonstrated.


Assuntos
Diabetes Mellitus Tipo 2 , Hemoglobinas Glicadas , Atenção Primária à Saúde , Humanos , Diabetes Mellitus Tipo 2/terapia , Masculino , Feminino , Tailândia , Estudos Transversais , Pessoa de Meia-Idade , Idoso , Hemoglobinas Glicadas/análise , Análise Multinível , Pressão Sanguínea , Retinopatia Diabética/terapia , Retinopatia Diabética/epidemiologia , Qualidade da Assistência à Saúde , Modelos Logísticos , População Suburbana , Controle Glicêmico , LDL-Colesterol/sangue , População Urbana/estatística & dados numéricos , Adulto , População do Sudeste Asiático
12.
BMJ Open Qual ; 13(Suppl 2)2024 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-38719520

RESUMO

BACKGROUND: Patient safety and healthcare quality are considered integral parts of the healthcare system that are driven by a dynamic combination of human and non-human factors. This review article provides an insight into the two major human factors that impact patient safety and quality including compassion and leadership. It also discusses how compassion is different from empathy and explores the impact of both compassion and leadership on patient safety and healthcare quality. In addition, this review also provides strategies for the improvement of patient safety and healthcare quality through compassion and effective leadership. METHODS: This narrative review explores the existing literature on compassion and leadership and their combined impact on patient safety and healthcare quality. The literature for this purpose was gathered from published research articles, reports, recommendations and guidelines. RESULTS: The findings from the literature suggest that both compassion and transformational leadership can create a positive culture where healthcare professionals (HCPs) prioritise patient safety and quality. Leaders who exhibit compassion are more likely to inspire their teams to deliver patient-centred care and focus on error prevention. CONCLUSION: Compassion can become an antidote for the burnout of HCPs. Compassion is a behaviour that is not only inherited but can also be learnt. Both compassionate care and transformational leadership improve organisational culture, patient experience, patient engagement, outcomes and overall healthcare excellence. We propose that transformational leadership that reinforces compassion remarkably improves patient safety, patient engagement and quality.


Assuntos
Empatia , Liderança , Segurança do Paciente , Qualidade da Assistência à Saúde , Humanos , Segurança do Paciente/normas , Segurança do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Cultura Organizacional , Atenção à Saúde/normas , Atenção à Saúde/métodos
14.
Am J Med Qual ; 39(3): 123-130, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38713600

RESUMO

Current maternal care recommendations in the United States focus on monitoring fetal development, management of pregnancy complications, and screening for behavioral health concerns. Often missing from these recommendations is support for patients experiencing socioeconomic or behavioral health challenges during pregnancy. A Pregnancy Medical Home (PMH) is a multidisciplinary maternal health care team with nurse navigators serving as patient advocates to improve the quality of care a patient receives and health outcomes for both mother and infant. Using bivariate comparisons between PMH patients and reference groups, as well as interviews with project team members and PMH graduates, this evaluation assessed the impact of a PMH at an academic medical university on patient care and birth outcomes. This PMH increased depression screenings during pregnancy and increased referrals to behavioral health care. This evaluation did not find improvements in maternal or infant birth outcomes. Interviews found notable successes and areas for program enhancement.


Assuntos
Serviços de Saúde Materna , Assistência Centrada no Paciente , Melhoria de Qualidade , Humanos , Gravidez , Feminino , Assistência Centrada no Paciente/organização & administração , Melhoria de Qualidade/organização & administração , Serviços de Saúde Materna/normas , Serviços de Saúde Materna/organização & administração , Adulto , Qualidade da Assistência à Saúde/organização & administração , Resultado da Gravidez , Estados Unidos , Equipe de Assistência ao Paciente/organização & administração , Complicações na Gravidez/terapia
15.
BMC Health Serv Res ; 24(1): 572, 2024 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-38698426

RESUMO

BACKGROUND: Patient-centredness has become a central quality indicator for oncology care. Elements include shared decision-making, patient navigation and integration of psychosocial care, which impact patient-reported and clinical outcomes. Despite efforts to promote patient-centred care in Germany in recent decades, implementation remains fragmented. Further, research on patient experiences with cancer care and its determinants is limited. Therefore, this study examines which patient- and facility-specific factors are associated with patient-centred quality care delivery. METHODS: A cross-sectional study was conducted among 1,121 cancer patients in acute treatment, rehabilitation, and aftercare for different cancer entities across Germany. A participatory developed questionnaire was used. Outcome measures were the quality of physician-patient interaction and provision of psychosocial care during acute care. Predictors comprised patient-specific characteristics and treatment facility-specific factors. Multiple linear regression and multivariate binary logistic regression analyses were performed. In addition, a content analysis of open-ended comments on the patients' overall cancer care needs was applied. RESULTS: Multiple linear regression analysis showed recent diagnosis (ß=-0.12, p = < 0.001), being male (ß=-0.11, p = 0.003), and having a preference for passive decision-making (ß=-0.10, p = 0.001) to be significantly associated with higher interaction quality, but not age, education and health insurance type. An overall low impact of patient characteristics on interaction quality was revealed (adj. R2 = 0.03). Binary logistic regression analysis demonstrated the availability of central contact persons (OR = 3.10, p < 0.001) followed by recent diagnosis (p < 0.001), having breast cancer (p < 0.001) and being female (OR = 1.68, p < 0.05) to significantly predict offering psycho-oncological counselling to patients in acute care facilities. The availability of peer support visiting services (OR = 7.17, p < 0.001) and central contact persons (OR = 1.87, p < 0.001) in the care facility, breast cancer diagnosis (p < 0.001) and a higher level of education (p < 0.05) significantly increased the odds of patients receiving information about peer support in the treatment facility. Despite relatively satisfactory quality of physician-patient interactions in cancer care (M = 3.5 (± 1.1)), many patients expressed that better patient-centred communication and coordinated, comprehensive cancer care are needed. CONCLUSION: The findings reflect effective developments and improvements in cancer care and suggest that patients' social characteristics are less decisive for delivering patient-centred quality care than systemic factors surrounding the care facilities. They can serve to inform oncology care in Germany.


Assuntos
Neoplasias , Assistência Centrada no Paciente , Relações Médico-Paciente , Humanos , Estudos Transversais , Alemanha , Feminino , Masculino , Neoplasias/terapia , Neoplasias/psicologia , Pessoa de Meia-Idade , Idoso , Inquéritos e Questionários , Adulto , Satisfação do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde
16.
BMC Health Serv Res ; 24(1): 579, 2024 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-38702670

RESUMO

OBJECTIVES: In middle-income countries, poor physician-patient communication remains a recognized barrier to enhancing healthcare quality and patient satisfaction. This study investigates the influence of provider-patient communication skills on healthcare quality and patient satisfaction in the rural primary healthcare setting in China. METHODS: Data were collected from 504 interactions across 348 rural primary healthcare facilities spanning 21 counties in three provinces. Using the Standardized Patient method, this study measured physician-patient communication behaviors, healthcare quality, and patient satisfaction. Communication skills were assessed using the SEGUE questionnaire framework. Multivariate linear regression models and multivariate logistic regression models, accounting for fixed effects, were employed to evaluate the impact of physicians' communication skills on healthcare quality and patient satisfaction. RESULTS: The findings indicated generally low provider-patient communication skills, with an average total score of 12.2 ± 2.8 (out of 24). Multivariate regression models, which accounted for physicians' knowledge and other factors, demonstrated positive associations between physicians' communication skills and healthcare quality, as well as patient satisfaction (P < 0.05). Heterogeneity analysis revealed stronger correlations among primary physicians with lower levels of clinical knowledge or more frequent training. CONCLUSION: This study emphasizes the importance of prioritizing provider-patient communication skills to enhance healthcare quality and patient satisfaction in rural Chinese primary care settings. It recommends that the Chinese government prioritize the enhancement of provider-patient communication skills to improve healthcare quality and patient satisfaction.


Assuntos
Comunicação , Satisfação do Paciente , Relações Médico-Paciente , Atenção Primária à Saúde , Qualidade da Assistência à Saúde , Humanos , China , Satisfação do Paciente/estatística & dados numéricos , Atenção Primária à Saúde/normas , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Inquéritos e Questionários , Serviços de Saúde Rural/normas , População Rural , Competência Clínica
17.
BMC Health Serv Res ; 24(1): 581, 2024 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-38702707

RESUMO

BACKGROUND: Patient education is a vital role of nurses in nurse-led clinics(NLCs). Since 2011, independent NLCs entitled health education Nurse-led clinics(HENLCs) have been established in Iran. In order for this newly developed service to be able to perform perfectly in implementation and evaluation, it should be explained based on one of the quality evaluation models. The objective of the study was to determine the dimension of service quality in HENLCs based on service providers' and service recipients' experience. METHODS: This research is a qualitative study of directed content analysis type conducted between May and November 2020. Twenty-nine participants who had rich experiences in the patient education in HENLCs were interviewed in this study. Asarroodi et al.'s (2018) qualitative content analysis method was used for data analysis, and MaxQDA software was used for data management. We used credibility, dependability, and Confirmability to confirm the trustworthiness of the study's findings. RESULTS: In this study service providers including managers, policymakers, decision-makers, nurses, physicians, and service recipients including patients and families participated. Seven generic categories, including (1) a competent and self-motivated nurse educator, (2) an easily accessible and comfortable environment, (3) informational-educational materials and health education equipment, (4) motivational facilities, (5) access to the health education support team, (6) organizational communication supporting the education process, and (7) receiving the patient education fee, constituted the main category of structure. Five generic categories, including (1) assessment and determination of the educational needs of the target group, (2) description of the nurse's duties, (3) teaching-learning methods, (4) patient referral, and (5) the process of preparing and publishing educational content, constituted the main category of process. One generic category called evaluation constituted the main category of outcome. CONCLUSION: Based on the results of this study, it is suggested to managers to pay attention to the dimensions of the quality model of Donabedian (SPO) in setting up and developing the performance of HENLCs, it is recommended that future quantitative studies based on the categories formed in this study evaluate the observance of the dimensions of structure, process and outcome.


Assuntos
Pesquisa Qualitativa , Qualidade da Assistência à Saúde , Humanos , Irã (Geográfico) , Masculino , Feminino , Adulto , Padrões de Prática em Enfermagem , Pessoa de Meia-Idade , Educação em Saúde
18.
BMC Health Serv Res ; 24(1): 576, 2024 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-38702719

RESUMO

BACKGROUND: The transition of patients between care contexts poses patient safety risks. Discharges to home from inpatient care can be associated with adverse patient outcomes. Quality in discharge processes is essential in ensuring safe transitions for patients. Current evidence relies on bivariate analyses and neglects contextual factors such as treatment and patient characteristics and the interactions of potential outcomes. This study aimed to investigate the associations between the quality and safety of the discharge process, patient safety incidents, and health-related outcomes after discharge, considering the treatments' and patients' contextual factors in one comprehensive model. METHODS: Patients at least 18 years old and discharged home after at least three days of inpatient treatment received a self-report questionnaire. A total of N = 825 patients participated. The assessment contained items to assess the quality and safety of the discharge process from the patient's perspective with the care transitions measure (CTM), a self-report on the incidence of unplanned readmissions and medication complications, health status, and sociodemographic and treatment-related characteristics. Statistical analyses included structural equation modeling (SEM) and additional analyses using logistic regressions. RESULTS: Higher quality of care transition was related to a lower incidence of medication complications (B = -0.35, p < 0.01) and better health status (B = 0.74, p < 0.001), but not with lower incidence of readmissions (B = -0.01, p = 0.39). These effects were controlled for the influences of various sociodemographic and treatment-related characteristics in SEM. Additional analyses showed that these associations were only constant when all subscales of the CTM were included. CONCLUSIONS: Quality and safety in the discharge process are critical to safe patient transitions to home care. This study contributes to a better understanding of the complex discharge process by applying a model in which various contextual factors and interactions were considered. The findings revealed that high quality discharge processes are associated with a lower likelihood of patient safety incidents and better health status at home even, when sociodemographic and treatment-related characteristics are taken into account. This study supports the call for developing individualized, patient-centered discharge processes to strengthen patient safety in care transitions.


Assuntos
Nível de Saúde , Alta do Paciente , Segurança do Paciente , Qualidade da Assistência à Saúde , Humanos , Alta do Paciente/normas , Masculino , Feminino , Segurança do Paciente/normas , Pessoa de Meia-Idade , Idoso , Inquéritos e Questionários , Adulto , Análise de Classes Latentes , Autorrelato , Readmissão do Paciente/estatística & dados numéricos
19.
Acta Oncol ; 63: 259-266, 2024 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-38698699

RESUMO

BACKGROUND: Danish Palliative Care Database comprises five quality indicators: (1) Contact with specialised palliative care (SPC) among referred patients, (2) Waiting time of less than 10 days, (3) Proportion of patients who died from (A) cancer or (B) non-cancer diseases, and had contact with SPC, (4) Proportion of patients completing the patient-reported outcome measure at baseline (EORTC QLQ-C15-PAL), and (5) Proportion of patients discussed at a multidisciplinary conference. PURPOSE: To investigate changes in the quality indicators from 2010 until 2020 in cancer and non-cancer patients. Patients/material: Patients aged 18+ years who died from 2010 until 2020. METHOD: Register-based study with the Danish Palliative Care Database as the main data source. Indicator changes were reported as percentage fulfilment. RESULTS: From 2010 until 2020, the proportion of patients with non-cancer diseases in SPC increased slightly (2.5-7.2%). In 2019, fulfilment of the five indicators for cancer and non-cancer were: (1) 81% vs. 73%; (2) 73% vs. 68%; (3A) 50%; (3B) 2%; (4) 73% vs. 66%; (5) 73% vs. 65%. Whereas all other indicators improved, the proportion of patients waiting less than 10 days from referral to contact decreased. Differences between type of unit were found, mainly lower for hospice. INTERPRETATION: Most patients in SPC had cancer. All indicators except waiting time improved during the 10-year period. The establishment of the Danish Palliative Care Database may have contributed to the positive development; however, SPC in Denmark needs to be improved, especially regarding a reduction in waiting time and enhanced contact for non-cancer patients.


Assuntos
Bases de Dados Factuais , Neoplasias , Cuidados Paliativos , Humanos , Cuidados Paliativos/normas , Cuidados Paliativos/estatística & dados numéricos , Dinamarca , Neoplasias/terapia , Feminino , Idoso , Masculino , Pessoa de Meia-Idade , Adulto , Idoso de 80 Anos ou mais , Indicadores de Qualidade em Assistência à Saúde , Adulto Jovem , Sistema de Registros , Melhoria de Qualidade , Adolescente , Medidas de Resultados Relatados pelo Paciente , Encaminhamento e Consulta/estatística & dados numéricos , Qualidade da Assistência à Saúde
20.
Int J Qual Health Care ; 36(2)2024 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-38706179

RESUMO

Patient experience has recently become a key driver for hospital quality improvement in South Korea, marked by the introduction of the Patient Experience Assessment (PXA) within its National Health Insurance in 2017. While the PXA has garnered special attention from the media and hospitals, there has been a lack of focus on its structural determinants, hindering continuous and sustained improvement in patient experience. Given the relatively low number of practicing nurses per 1000 population in South Korea and the significant variation in nurse staffing levels across hospitals, the staffing level of nurses in hospitals could be a crucial structural determinant of patient experience. This study examines the association between patient experience and hospital nurse staffing levels in South Korea. We used individual- and hospital-level data from the 2019 PXA, encompassing 7250 patients from 42 tertiary hospitals and 16 235 patients from 109 non-tertiary general hospitals with 300 or more beds. The dependent variables were derived from the complete set of 21 proper questions on patient experience in the Nurse and other domains. The main explanatory variable was the hospital-level Nurse Staffing Grade (NSG), employed by the National Health Insurance to adjust reimbursement to hospitals. Multilevel ordered/binomial logistic or linear regression was conducted accounting for other hospital- and patient-level characteristics as well as acknowledging the nested nature of the data. A clear, positive association was observed between patient experience in the Nurse domain and NSG, even after accounting for other characteristics. For example, the predicted probability of reporting the top-box category of "Always" to the question "How often did nurses treat you with courtesy and respect?" was 70.3% among patients from non-tertiary general hospitals with the highest NSG, compared to 63.1% among patients from their peer hospitals with the lowest NSG. Patient experience measured in other domains that were likely to be affected by nurse staffing levels also showed similar associations, although generally weaker and less consistent than in the Nurse domain. Better patient experience was associated with higher hospital nurse staffing levels in South Korea. Alongside current initiatives focused on measuring and publicly reporting patient experience, strengthening nursing and other hospital workforce should also be included in policy efforts to improve patient experience.


Assuntos
Recursos Humanos de Enfermagem Hospitalar , Satisfação do Paciente , Admissão e Escalonamento de Pessoal , República da Coreia , Humanos , Recursos Humanos de Enfermagem Hospitalar/provisão & distribuição , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Idoso , Centros de Atenção Terciária , Melhoria de Qualidade , Inquéritos e Questionários , Qualidade da Assistência à Saúde , Programas Nacionais de Saúde
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...