Health Services Insights最新文献

{"title":"Identifying Patient Subpopulations with Significant Race-Sex Differences in Emergency Department Disposition Decisions.","authors":"Peter Lin, Nilay T Argon, Qian Cheng, Christopher S Evans, Benjamin Linthicum, Yufeng Liu, Abhishek Mehrotra, Laura Murphy, Mehul D Patel, Serhan Ziya","doi":"10.1177/11786329241277724","DOIUrl":"https://doi.org/10.1177/11786329241277724","url":null,"abstract":"<p><strong>Background/objectives: </strong>The race-sex differences in emergency department (ED) disposition decisions have been reported widely. Our objective is to identify demographic and clinical subgroups for which this difference is most pronounced, which will facilitate future targeted research on potential disparities and interventions.</p><p><strong>Methods: </strong>We performed a retrospective analysis of 93 987 White and African-American adults assigned an Emergency Severity Index of 3 at 3 large EDs from January 2019 to February 2020. Using random forests, we identified the Elixhauser comorbidity score, age, and insurance status as important variables to divide data into subpopulations. Logistic regression models were then fitted to test race-sex differences within each subpopulation while controlling for other patient characteristics and ED conditions.</p><p><strong>Results: </strong>In each subpopulation, African-American women were less likely to be admitted than White men with odds ratios as low as 0.304 (95% confidence interval (CI): [0.229, 0.404]). African-American men had smaller admission odds compared to White men in subpopulations of 41+ years of age or with very low/high Elixhauser scores, odds ratios being as low as 0.652 (CI: [0.590, 0.747]). White women were less likely to be admitted than White men in subpopulations of 18 to 40 or 41 to 64 years of age, with low Elixhauser scores, or with Self-Pay or Medicaid insurance status with odds ratios as low as 0.574 (CI: [0.421, 0.784]).</p><p><strong>Conclusions: </strong>While differences in likelihood of admission were lessened by younger age for African-American men, and by older age, higher Elixhauser score, and Medicare or Commercial insurance for White women, they persisted in all subgroups for African-American women. In general, patients of age 64 years or younger, with low comorbidity scores, or with Medicaid or no insurance appeared most prone to potential disparities in admissions.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11378179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Impact of COVID-19 on Cervical Cancer Screening Services: A Qualitative Study of Healthcare Providers' and Women's Perspectives and Experiences.","authors":"Fennie Mantula, Yoesrie Toefy","doi":"10.1177/11786329241275883","DOIUrl":"10.1177/11786329241275883","url":null,"abstract":"<p><p>A qualitative exploration was conducted to analyse the reasons behind the low utilisation of cervical cancer screening services in Gwanda district, Zimbabwe, focusing on the impact of the COVID-19 pandemic. The study involved 5 focus group discussions with 36 women, utilising maximum variation sampling to explore the effects of COVID-19 on screening coverage. Additionally, in-depth interviews were conducted with 25 health-care providers from primary health facilities and the provincial hospital offering screening services. The results suggest a decline in the progress of the cervical cancer screening programme due to the disruptions caused by COVID-19 which subsequently reduced women's access to screening and treatment services. It was anticipated that restoring women's confidence in adherence to screening would require time post-pandemic. Moreover, findings highlighted the potential progression of undetected precursor lesions to advanced cancer stages during non-screening periods, which may increase future cervical cancer morbidity and mortality. The findings underscore the importance of integrating cervical cancer screening messaging within broader health communication strategies to emphasise the significance of health interventions for overall well-being. This study recommends the adoption of more efficient screening methods, such as Human-Papillomavirus self-sampling to mitigate future disruptions in screening services, thereby guiding policymakers towards implementing best screening approaches.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effects of Ghana's Free Maternal and Healthcare Policy on Maternal and Infant Healthcare: A Scoping Review.","authors":"Emefa Awo Adawudu, Kizito Aidam, Elisha Oduro, Dennis Miezah, Allison Vorderstrasse","doi":"10.1177/11786329241274481","DOIUrl":"10.1177/11786329241274481","url":null,"abstract":"<p><p>Ghana was the first sub-Saharan country to implement a National Health Insurance Scheme (NHIS). In furtherance of the nation's Universal Health Coverage (UHC) goals, in 2008, Ghana actualized plans for a Free Maternal Healthcare Policy (FMHCP) under the NHIS. The FMHCP was aimed at removing financial barriers to accessing maternal and neonatal health services. This scoping review was conducted to map out the literature on the effects of the FMHCP under the NHIS on the utilization of maternal and infant health care in Ghana. Six databases including CINAHL, PubMed, Sage Journals, Academic Search Premier, Science Direct, and Medline were searched in conducting this review with key terms. A total of 175 studies were retrieved after the search and finally, 23 articles were included in the study after various stages of elimination. The review followed the reporting guidelines stated in the Preferred Reporting Items for Systematic and Meta-analyses Extensions for Scoping Reviews (PRISMA-ScR). The results showed an overall increase in the utilization of antenatal care, facility-based delivery, and postnatal care services. However, certain systemic issues persist regarding access to maternal and infant healthcare. Socio-demographic inequalities such as maternal level of education, place of residence, and economic status likewise barriers such as the existence of out-of-pocket payments, long distance to health facilities, and poor distribution of resources in rural areas hindered the utilization of maternal and infant healthcare. The country faces significant work to eliminate existing barriers and inequalities to ensure that it achieves its UHC goals.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Barriers and Facilitators to Implementing a Novel Referral System for Outpatient Geriatric Services: The Geri-Hub Quality Improvement Initiative.","authors":"Guillaume Lim Fat, Kristina M Kokorelias, Erica Foronda, Bindhu Sadasivan, Lindy Romanovsky","doi":"10.1177/11786329241274482","DOIUrl":"10.1177/11786329241274482","url":null,"abstract":"<p><strong>Background: </strong>In healthcare systems prioritizing care of older adults, resource limitations and escalating demand often impede access to outpatient specialized geriatric services.</p><p><strong>Objectives: </strong>This study, theoretically guided by the Consolidated Framework for Implementation Research (CFIR), aimed to explore barriers and facilitators in implementing a centralized \"Geri-Hub.\" The Geri-Hub is a centralized intake system established within 2 hospital systems to coordinate outpatient and community-based services for older adults, aiming to connect them with the most appropriate care in a timely manner.</p><p><strong>Methods: </strong>Qualitative insights were gathered from healthcare professionals at 2 academic institutions in the process of consolidating services. Through open-ended surveys and semi-structured interviews, we solicited feedback on referral management, waiting times, and overall work experiences.</p><p><strong>Results: </strong>Thirteen frequently referring providers and a cohort of 9 geriatricians, along with 4 administrators, contributed to the study. Geriatricians emphasized streamlined referrals, flexible scheduling for urgent cases, and a target wait time of 3 months. Administrators stressed standardized referral procedures, defined roles, and accessible referral information.</p><p><strong>Discussion: </strong>The findings underscored the need for straightforward referral processes, enhanced communication on referral statuses, and reduced wait times. Optimizing these processes could potentially mitigate resource utilization issues and improve patient outcomes in healthcare systems. This research highlights the critical role of timely access to geriatric services during transformative phases in healthcare delivery.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11366105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142106748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Healthcare Marketing: A Bibliometric Study and Research Agenda.","authors":"Piotr Rościszewski, Mariusz Stępień, Justyna Berniak-Woźny","doi":"10.1177/11786329241266648","DOIUrl":"https://doi.org/10.1177/11786329241266648","url":null,"abstract":"<p><p>The evolution of our lives has forced changes to the healthcare system and consequently established healthcare marketing as an essential element of health services, including primary health care (PHC). This article aims to analyze the size, structure, and dynamics of research on primary healthcare marketing to identify the main topics and research trends in this area. The authors conducted a bibliographic analysis based on the methods of performance analysis and scientific mapping. The bibliographical analysis covered 1981 publications selected from the Scopus database and was carried out with the use of the MS Excel and VOSviewer applications. The results were supplemented with an in-depth analysis of 34 publications selected based on bibliographic coupling analysis to determine key research trends and results, which increased the understanding of the research area. The conducted research proves that the issue of marketing in primary health care is rarely addressed by researchers, which translates into very limited research results and little impact on the decision-making process in this area. This research field requires much greater commitment, especially in the areas indicated in the future research agenda recommendations.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11359442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142106749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of COVID-19 Among People With Disabilities in Plumtree, Zimbabwe: A Mixed-Method Survey.","authors":"Lindiwe Ndlovu, Nicholas Mudonhi, Nomathemba Sibanda, Wilfred Njabulo Nunu, Norman Manyeruke","doi":"10.1177/11786329241274484","DOIUrl":"10.1177/11786329241274484","url":null,"abstract":"<p><strong>Introduction: </strong>Persons with disabilities are the most affected by rising pandemics worldwide. COVID-19 has affected people with disabilities in many areas of their lives; however, its impact has been overlooked. This study aimed to assess the effects of COVID-19 on people with disabilities in Plumtree, Zimbabwe, to develop a disability-inclusive approach in response to COVID-19.</p><p><strong>Methods: </strong>A concurrent mixed-methods approach was used to collect qualitative and quantitative data from 7 key informants and ninety-two participants with disabilities, from January to May 2023. Quantitative data were analysed using STATA software version 12 and Microsoft Excel. Multiple Logistic Regression, Chi-square test, and paired-sample test were used to test for associations among COVID-19 cases, source of income, key challenges, and demographic characteristics. Qualitative data were analysed and presented in the form of themes.</p><p><strong>Results: </strong>We recruited more females (56.5%) than males with disabilities, and more than half were unemployed (56.5%). In contrast, only 3.3% of the respondents were formally employed. The results also indicated a significant relationship between age and COVID-19 positivity (<i>P</i> = .025). The results also indicated that efforts were being made by government and non-governmental departments to assist people with disabilities during the pandemic through finance, food, awareness campaigns, and social support.</p><p><strong>Conclusion: </strong>Restriction measures put in place disturbed the livelihood of people with disabilities in Plumtree. Therefore, entrepreneurship programmes targeting vulnerable groups, including people with disabilities, should be introduced to ensure that their sources of income are sustained despite emergencies or pandemics.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11348347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Influence of Institutional Logics and Emotions on the Uptake of Cervical Cancer Screening: A Case Study From Xai-Xai, Mozambique.","authors":"Gefra Fulane, Maria Major, Cesaltina Lorenzoni, Khatia Munguambe","doi":"10.1177/11786329231224619","DOIUrl":"10.1177/11786329231224619","url":null,"abstract":"<p><p>This study investigates the role of emotional attachment to competing institutional logics on women's uptake of cervical cancer screening in Mozambique. Through a qualitative study conducted in Xai-Xai, Southern Mozambique, we identify 2 concurrent logics in the context of screening: preservation logic, influenced by social-cultural norms, and the prevention logic, centered around screening. Women, affected by emotions such as shame, fear, and marital subordination, often become attached to the preservation logic, which influences their values and contradicts acceptance of screening. However, some women with marital autonomy may reflect on both logics and gradually detach themselves from the preservation norms and show their intention to adopt life-saving behavior by accepting screening. It is through their emotions that women show their attachment to and detachment from competing logics, reinforcing traditional norms on the one hand, or giving them the means to adopt preventive measures on the other. The study indicates that cultural expectations, shame and the desire to preserve intimacy tie women to the logic of preservation and have a negative impact on participation in cervical cancer screening. Consequently, to improve screening uptake in Mozambique, the authorities need to adapt screening to socio-cultural and emotional factors, empower women, and effectively engage communities.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11348342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modelling the Wage Bill and Budget Space for Health Workforce in Ghana: Implications for Sustainable Health Professions Education Policy.","authors":"Hamza Ismaila, Juliet Nabyonga-Orem, Yolande Heymans, Christmal Dela Christmals","doi":"10.1177/11786329241271568","DOIUrl":"10.1177/11786329241271568","url":null,"abstract":"<p><p>Global discussions on health systems strengthening have lately tilted towards increasing investments in human resources for health to address health workforce challenges, especially shortages and employment. Countries have, as a result, increased investments in the health workforce by expanding the production and recruitment of the needed health workforce, with the resultant effects of increasing health workforce budget space and the unending clamour by health policy actors for further increases. Despite these calls, there has been no wage bill affordability and budget space analysis to rationalise the sustainable production of and demand for health workers, which is the thrust of Ghana's current health workforce policy and strategy. Using an adapted approach (the Asamani approach), the study modelled the supply of some essential health workers and their associated cost of employment, compared it with the modelled budget space for health workforce employment and then drew conclusions on the wage bill sustainability for policy consideration. Of the seven cadres considered in the study (doctors, professional nurses, midwives, enrolled nurses, community health nurses, pharmacists and biomedical scientists), who constitute about 97% of the wage bill, the study found the baseline stock to be 129 378 in 2022, which was estimated to increase to 199 715 by 2027 and 254 466 by 2032 with corresponding wage bills of US$869.4 million and US$ 1.1 billion, respectively, holding routine salary increases constant. The budget space for health was, meanwhile, projected to be US$899.3 million and US$1.1 billion in 2022 and 2032 respectively, out of a projected overall government fiscal space of US$7 billion per year. This study concludes that, given current levels and mix of production, Ghana was estimated to expend an average of 88% of its health budget space as wage bill cost. This was 54.4% over the global median and 95.6% over the African Region's median, making the current regime unsustainable.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11331453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142004094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the Carbon Footprint of Telemedicine: A Systematic Review.","authors":"Casper van der Zee, Jennifer Chang-Wolf, Marc A Koopmanschap, Redmer van Leeuwen, Robert Pl Wisse","doi":"10.1177/11786329241271562","DOIUrl":"10.1177/11786329241271562","url":null,"abstract":"<p><strong>Background: </strong>Healthcare is responsible for 4% to 10% of carbon emissions worldwide, of which 22% is related to transport. Telemedicine emerged as a potential solution to reduce the footprint, for example, by reducing travel. However, a need to understand which variables to include in carbon footprint estimations in telemedicine limits our understanding of the beneficial impact telemedicine might have on our environment. This paper aims to systematically assess the reported carbon footprint and include variables assessed by the literature, comparing telemedicine with usual care.</p><p><strong>Methods: </strong>The systematic review followed the PRISMA guidelines in PubMed, Medline, Embase and Scopus. A quality assessment was performed using a transparency checklist for carbon footprint calculators. Carbon emissions were evaluated based on four categories, including patient travel, and streamlined life cycle assessment (LCA) for assessing included variables relevant to telemedicine.</p><p><strong>Results: </strong>We included 33 articles from 1117 records for analysis. The average transparency score was 38% (range 18%-68%). The median roundtrip travel distance for each patient was 131 km (interquartile range [IQR]: 60.8-351), or 25.6 kgCO₂ (IQR: 10.6-105.6) emissions. There is high variance among included variables. Saved emissions are structurally underestimated by not including external factors such as a streamlined LCA.</p><p><strong>Conclusions: </strong>Telemedicine aids in reducing emissions, with travel distance being the most significant contributor. Additionally, we recommend accounting for the LCA since it highlights important nuances. This review furthers the debate on assessing carbon footprint savings due to telemedicine.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11320403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Lack of Tourism-Based Health Services Amid Global Aging: How Tourism and Health Practices Can Combine to Benefit the Aging Population.","authors":"Jun Wen","doi":"10.1177/11786329241271570","DOIUrl":"10.1177/11786329241271570","url":null,"abstract":"","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11316958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141916578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}