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Midwifery matters

Mié, 04/07/2018 - 03:16
Publication date: Available online 3 July 2018
Source:Midwifery

Author(s): Suzanne Stalls







Categorías: Investigaciones

Banana fruit: An “appealing” alternative for practicing suture techniques in resource-limited settings

Dom, 01/07/2018 - 02:24
Publication date: Available online 30 June 2018
Source:American Journal of Otolaryngology

Author(s): Kevin Wong, Prabhat K. Bhama, Jean d'Amour Mazimpaka, Raban Dusabimana, Linda N. Lee, David A. Shaye

Purpose Suturing is an important core surgical competency that requires continued practice. The purpose of this study was to evaluate bananas as a medium for practicing suture techniques in resource-limited settings. Materials and methods Using a crossover design, 20 University of Rwanda medical students practiced suturing on banana peels and commercial foam boards. Students were randomized into 2 groups: group A practiced on foam boards first and then bananas, and group B practiced on banana peels first and then foam boards. A post-workshop survey was then administered to students to gauge their attitude towards banana peels as a suturing practice material. Suture performance for each student was graded by three fellowship-trained facial plastic surgeons based on consistent spacing, knot location, appropriate knot, absence of air knots, and adequate bite size. Results Suture performance graded by facial plastic surgeons demonstrated that suturing outcomes with bananas were equal or superior to foam in 56.7% of instances. Twenty students participated in the workshop; 16 students responded to the survey (response rate = 80%). Students were comfortable practicing suturing with banana peels (Mdn = 4, IQR = 1) and strongly agreed that suturing banana peels was a useful activity (Mdn = 5, IQR = 1). Students thought banana peels and foam were comparable learning platforms (Mdn = 3.5, IQR = 1) and felt their suturing abilities improved with practice on banana peels (Mdn = 4, IQR = 1.3). Conclusions Banana peels are a low cost, equally viable alternative to synthetic suture media.





Categorías: Investigaciones

The impact of electronic health record systems on clinical documentation times: a systematic review

Mar, 05/06/2018 - 19:04
Publication date: Available online 5 June 2018
Source:Health Policy

Author(s): Lisa Ann Baumann, Jannah Baker, Adam G. Elshaug

Background Effective management of hospital staff time is crucial to quality patient care. Recent years have seen widespread implementation of electronic health record (EHR) systems but the effect of this on documentation time is unknown. This review compares time spent on documentation tasks by hospital staff (physicians, nurses and interns) before and after EHR implementation. Methods A systematic search identified 8,153 potentially relevant citations. Studies examining proportion of total workload spent on documentation with ≥40 hours of staff observation time were included. Meta-analysis was performed for physicians, nurses and interns comparing pre- and post-EHR results. Studies were weighted by person-hours observation time. Results Twenty-eight studies met selection criteria. Seventeen were pre-EHR, nine post-EHR and two examined both periods. With implementation of EHR, physicians’ documentation time increased from 16% (95% confidence interval (CI) 11–22%) to 28% (95% CI 19–37%), nurses from 9% (95% CI 6–12%) to 23% (95% CI 15–32%) and interns from 20% (95% CI 7–32%) to 26% (95% CI 10–42%). Conclusions There is a lack of long-term follow-up on the effects of EHR implementation. Initial adjustment to EHR appears to increase documentation time but there is some evidence that as staff become more familiar with the system, it may ultimately improve work flow.





Categorías: Investigaciones

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016

Vie, 01/06/2018 - 17:47
Publication date: 2–8 June 2018
Source:The Lancet, Volume 391, Issue 10136

Author(s): GBD 2016 Healthcare Access and Quality CollaboratorsNancyFullmanJamalYearwoodSolomon MAbayCristianaAbbafatiFoadAbd-AllahJemalAbdelaAhmedAbdelalimZegeyeAbebeTeshome AbukaAbeboVictorAboyansHaftom NiguseAbrahaDaisy M XAbreuLaith JAbu-RaddadAkilew AwokeAdaneRufus AdesojiAdedoyinOlatunjiAdetokunbohTara BallavAdhikariMohsenAfaridehAshkanAfshinGinaAgarwalDominicAgiusAnuragAgrawalSutapaAgrawalAliasgharAhmad KiadaliriMiloud Taki EddineAichourMohammedAkibuRufus OlusolaAkinyemiTomi FAkinyemijuNadiaAkseerFaris HasanAl LamiFaresAlahdabZiyadAl-AlyKhurshidAlamTahiyaAlamDeenaAlasfoorMohammed IAlbittarKefyalew AddisAleneAymanAl-EyadhySyed DanishAliMehranAlijanzadehSyed MAljunidAla'aAlkerwiFrançoisAllaPeterAllebeckChristineAllenMahmoud AAlomariRajaaAl-RaddadiUbaiAlsharifKhalid AAltirkawiNelsonAlvis-GuzmanAzmeraw TAmareKebedeAmenuWalidAmmarYaw AmpemAmoakoNahlaAnberCatalina LilianaAndreiSofiaAndroudiCarl Abelardo TAntonioValdelaine E MAraújoOlatundeAremuJohanÄrnlövAlArtamanKrishna KumarAryalHamidAsayeshEphrem TsegayAsfawSolomon WeldegebrealAsgedomRana JawadAsgharMengistu MitikuAshebirNetsanet AberaAsseffaTesfay MehariAteySachin RAtreMadhu SAtterayaLeticiaAvila-BurgosEuripide Frinel G ArthurAvokpahoAshishAwasthiBeatriz PaulinaAyala QuintanillaAnimut AlebelAyalewHenok TadesseAyeleRakeshAyerTambe BetrandAyukPeterAzzopardiNatashaAzzopardi-MuscatTesleem KayodeBabalolaHamidBadaliAlaaBadawiMaciejBanachAmitavaBanerjeeAmritBanstolaRyan MBarberMiguel ABarbozaSuzanne LBarker-ColloTillBärnighausenSimonBarqueraLope HBarreroQuiqueBassatSanjayBasuBernhard TBauneShahrzadBazargan-HejaziNeerajBediEttoreBeghiMasoudBehzadifarMeysamBehzadifarBayu BegashawBekeleAbate BekeleBelachewSaba AbrahamBelayYihalem AbebeBelayMichelle LBellAminu KBelloDerrick ABennettJames RBennettIsabela MBensenorDerbew FikaduBerheEduardoBernabéRobert StevenBernsteinMirceaBeuranAshishBhallaPaurviBhattSoumyadeepBhaumikZulfiqar 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Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0–100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8–98·1) in Iceland, followed by 96·6 (94·9–97·9) in Norway and 96·1 (94·5–97·3) in the Netherlands, to values as low as 18·6 (13·1–24·4) in the Central African Republic, 19·0 (14·3–23·7) in Somalia, and 23·4 (20·2–26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1–93·6) in Beijing to 48·0 (43·4–53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6–68·8) in Goa to 34·0 (30·3–38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view—and subsequent provision—of quality health care for all populations. Funding Bill & Melinda Gates Foundation.





Categorías: Investigaciones

Nursing Competence in Geriatric/Long Term Care Curriculum Development for Baccalaureate Nursing Programs: A Systematic Review

Vie, 01/06/2018 - 17:47
Publication date: Available online 1 June 2018
Source:Journal of Professional Nursing

Author(s): Pei-Lun Hsieh, Ching-Min Chen

Background As facing the rapid growth of the elderly population, the demands for geriatric and long-term care are drastically increasing. Since one of the important strategies in preparation for long-term care system is to focus on the engagement of health care professionals, this paper applies a systematic approach to review the current geriatric and long term care courses in Bachelor of Science in Nursing (BSN) programs. This review assessed the impact of Geriatric Nursing (GN) and/or Long Term Care (LTC) courses on nursing students' knowledge, care intention and competence of Geriatric Long Term Care (GLTC) care to enable their nursing competence before graduation. Method Data related to the purpose of the study, research design, sample, curriculum content, teaching strategies, evaluation measurements and results were extracted. The methodological quality of all publications was included in the review. Results Eighteen articles were eligible for analysis, including 16 quantitative and 2 qualitative studies. The review revealed that including geriatric and long term care content in undergraduate nursing curriculum could effectively enhance students' nursing competence. Conclusion GN and LTC curriculum development should offer established content on geriatric and long term care as a foundation to implement early learning experiences in the curriculum. Both theory and clinical practice of GLTC course can be developed to increase the nursing students' knowing on the elders and the disabled through the clinical placement.





Categorías: Investigaciones

Allopathic, AYUSH and informal medical practitioners in rural India – a prescription for change

Mar, 29/05/2018 - 16:55
Publication date: Available online 29 May 2018
Source:Journal of Ayurveda and Integrative Medicine

Author(s): Shailaja Chandra, Kishor Patwardhan

This paper looks at the treatment seeking behaviour of rural households and presents factors that discourage them from using public health facilities. It also brings out how Allopathic medical graduates as well as institutionally qualified AYUSH doctors predominantly offer services in cities and townships which results in lakhs of village households having to depend on unqualified medical practitioners as the first line of medical treatment; also how this situation will continue unless the approach to providing medical treatment is modified. Continued dependence on unqualified practitioners is fraught with dangers of incorrect diagnosis, irrational drug use, resulting in the spread of multi-drug resistance. The reality that surrounds Allopathic practice by AYUSH doctors has also been described along with the educational underpinnings of accepting this approach. We opine that existing state policies that legitimise Allopathic practice by non-Allopathic practitioners do not help the rural poor to access proper medical treatment for acute conditions. Also, it does not enhance the credibility of the indigenous systems of medicine among which Ayurveda is the dominant system. First, we position our views in the context of the recently introduced National Medical Commission (NMC) Bill 2017 and provisions which call for the assessment of the need for human resources for health and building a road map to achieve the same. Second, we advocate re-inventing the pre-independence system of trained medical auxiliaries enrolled on a new schedule of the respective state medical register, authorised to give immediate medical treatment and making informed referrals for further diagnosis or specialised treatment. Finally, we recommend reinforcing the AYUSH systems to tackle emerging non-communicable diseases which are affecting all population cohorts adversely and, in whose prevention and management, the AYUSH systems are reported to possess special skills and competence.





Categorías: Investigaciones

Reflections of a Cardiac Surgeon Turned Global Health Educator

Mar, 29/05/2018 - 16:55
Publication date: Available online 29 May 2018
Source:The Annals of Thoracic Surgery

Author(s): Michael C. Sinclair







Categorías: Investigaciones

Sláintecare – a ten-year plan for Irish health reform devised through political consensus

Mar, 22/05/2018 - 15:00
Publication date: Available online 22 May 2018
Source:Health Policy

Author(s): Sara Burke, Sarah Barry, Rikke Siersbaek, Bridget Johnston, Maebh Ní Fhallúin, Steve Thomas

In May 2017, an Irish cross-party parliamentary committee published the ‘Houses of the Oireachtas Committee on the Future of Healthcare “Sláintecare” report’. The report known as ‘Sláintecare’ was unique and historic as it is the first time there has been a cross-party political consensus for major health reform in Ireland. Sláintecare sets out a high level policy road map roadmap to deliver whole system reform and universal healthcare, phased over a ten year period and costed. Sláintecare details reform proposals which, if delivered, will establish; a universal, single-tier health service where patients are treated solely on the basis of health need; the reorientation of the health system ‘towards integrated primary and community care, consistent with the highest quality of patient safety in as short a time-frame as possible’. Sláintecare has five interrelated components: population health, entitlements and access to healthcare; integrated care, funding. In this article, the authors use documents/materials in the public domain (parliamentary reports, public hearings, submissions to the Committee, media coverage, the final report of the Committee, speeches by Committee members) to describe the policy process and the main contents of the proposed Sláintecare reforms. It is too soon tell if the political consensus in the policy formation can hold for its implementation.





Categorías: Investigaciones

The Meaning of “Capacity Building” for the Nurse Workforce in Sub-Saharan Africa: An Integrative Review

Dom, 06/05/2018 - 10:14
Publication date: Available online 5 May 2018
Source:International Journal of Nursing Studies

Author(s): Laura Jean Ridge, Robin Toft Klar, Amy Witkoski Stimpfel, Allison Squires

Background “Capacity building” is an international development strategy which receives billions of dollars of investment annually and is utilized by major development agencies globally. However, there is a lack of consensus around what “capacity building”, or even “capacity” itself, means. Nurses are the frequent target of capacity building programming in sub-Saharan Africa as they provide the majority of healthcare in that region. Objectives This study explored how “capacity” was conceptualized and operationalized by capacity building practitioners working in sub-Saharan Africa to develop its nursing workforce, and to assess Hilderband and Grindle's (1996) “Dimensions of Capacity” model was for fit with “capacity’s” definition in the field. Design An integrative review of the literature using systematic search criteria. Data Sources Searched included PubMed, the Cumulative Index for Nursing and Allied Health Literature Plus, the Excerpt Medica Database, and Web of Science. Review Methods This review utilized conventional content analysis to assess how capacity building practitioners working in sub-Saharan Africa utilize the term “capacity” in the nursing context. Content analysis was conducted separately for how capacity building practitioners described “capacity” versus how their programs operationalized it. Identified themes were then assessed for fit with Hilderband and Grindle's (1996) “Dimensions of Capacity” model. Results Analysis showed primary themes for conceptualization of capacity building of nurses by practitioners included: human resources for health, particularly pre- and post- nursing licensure training, and human (nursing) resource retention. Other themes included: management, health expenditure, and physical resources. There are several commonly used metrics for human resources for health, and a few for health expenditures, but none for management or physical resources. Overlapping themes of operationalization include: number of healthcare workers, post-licensure training, and physical resources. The Hilderband and Grindle (1996) model was a strong fit with how capacity is defined by practitioners working on nursing workforce issues in sub-Saharan Africa. If overall significant differences between conceptualization and operationalization emerged, as the reader I want to know what these differences were. Conclusions This review indicates there is significant informal consensus on the definition of “capacity” and that the Hilderbrand and Grindle (1996) framework is a good representation of that consensus. This framework could be utilized by capacity building practitioners and researchers as those groups plan, execute, and evaluate nursing capacity building programming.





Categorías: Investigaciones

How do gender relations affect the working lives of close to community health service providers? Empirical research, a review and conceptual framework

Dom, 06/05/2018 - 10:14
Publication date: Available online 5 May 2018
Source:Social Science & Medicine

Author(s): Rosalind Steege, Miriam Taegtmeyer, Rosalind McCollum, Kate Hawkins, Hermen Ormel, Maryse Kok, Sabina Rashid, Lilian Otiso, Mohsin Sidat, Kingsley Chikaphupha, Daniel Gemechu Datiko, Rukhsana Ahmed, Rachel Tolhurst, Woedem Gomez, Sally Theobald

Close-to-community (CTC) providers have been identified as a key cadre to progress universal health coverage and address inequities in health service provision due to their embedded position within communities. CTC providers both work within, and are subject to, the gender norms at community level but may also have the potential to alter them. This paper synthesises current evidence on gender and CTC providers and the services they deliver. This study uses a two-stage exploratory approach drawing upon qualitative research from the six countries (Bangladesh, Indonesia, Ethiopia, Kenya, Malawi, Mozambique) that were part of the REACHOUT consortium. This research took place from 2013 to 2014. This was followed by systematic review that took place from January–September 2017, using critical interpretive synthesis methodology. This review included 58 papers from the literature. The resulting findings from both stages informed the development of a conceptual framework. We present the holistic conceptual framework to show how gender roles and relations shape CTC provider experience at the individual, community, and health system levels. The evidence presented highlights the importance of safety and mobility at the community level. At the individual level, influence of family and intra-household dynamics are of importance. Important at the health systems level, are career progression and remuneration. We present suggestions for how the role of a CTC provider can, with the right support, be an empowering experience. Key priorities for policymakers to promote gender equity in this cadre include: safety and well-being, remuneration, and career progression opportunities. Gender roles and relations shape CTC provider experiences across multiple levels of the health system. To strengthen the equity and efficiency of CTC programmes gender dynamics should be considered by policymakers and implementers during both the conceptualisation and implementation of CTC programmes.





Categorías: Investigaciones

Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review

Vie, 04/05/2018 - 09:44
Publication date: Available online 3 May 2018
Source:International Journal of Nursing Studies

Author(s): Greta G. Cummings, Kaitlyn Tate, Sarah Lee, Carol A. Wong, Tanya Paananen, Simone P.M. Micaroni, Gargi E. Chatterjee

Background Leadership is critical in building quality work environments, implementing new models of care, and bringing health and wellbeing to a strained nursing workforce. However, the nature of leadership style, how leadership should be enacted, and its associated outcomes requires further research and understanding. We aimed to examine the relationships between various styles of leadership and outcomes for the nursing workforce and their work environments. Methods The search strategy of this systematic review included 10 electronic databases. Published, quantitative studies that examined the correlations between leadership behaviours and nursing outcomes were included. Quality assessments, data extractions and analysis were completed on all included studies by independent reviewers. Results A total of 43,994 titles and abstracts were screened resulting in 129 included studies. Using content analysis, 121 outcomes were grouped into six categories: 1) staff satisfaction with job factors, 2) staff relationships with work, 3) staff health & wellbeing, 4) relations among staff, 5) organizational environment factors and 6) productivity & effectiveness. Our analysis illuminated patterns between relational and task focused leadership styles and their outcomes for nurses and nursing work environments. For example, 52 studies reported that relational leadership styles were associated with higher nurse job satisfaction, whereas 16 studies found that task-focused leadership styles were associated with lower nurse job satisfaction. Similar trends were found for each category of outcomes. Conclusions The findings of this systematic review provide strong support for the employment of relational leadership styles to promote positive nursing workforce outcomes and related organizational outcomes. Leadership focused solely on task completion is insufficient to achieve optimum outcomes for the nursing workforce. Relational leadership practices need to be encouraged and supported by individuals and organizations to enhance nursing job satisfaction, retention, work environment factors and individual productivity within healthcare settings.





Categorías: Investigaciones

Building quality improvement capacity for HIV programs in sub-Saharan Africa: An innovative, mixed-method training course

Jue, 03/05/2018 - 09:35
Publication date: Available online 2 May 2018
Source:Journal of the Association of Nurses in AIDS Care

Author(s): Gillian Dougherty, Allison George, Carla Johnson, Ilka Rondinelli, Lauren Walker, Miriam Rabkin







Categorías: Investigaciones

Challenges and opportunities in planetary health for primary care providers

Sáb, 28/04/2018 - 08:36
Publication date: May 2018
Source:The Lancet Planetary Health, Volume 2, Issue 5

Author(s): Edward Xie, Enrique Falceto de Barros, Alan Abelsohn, Airton Tetelbom Stein, Andy Haines







Categorías: Investigaciones

Chapter 6 How Pharmacy Education Contributes to Patient and Pharmaceutical Care

Mié, 25/04/2018 - 08:15
Publication date: 2018
Source:Pharmacy Education in the Twenty First Century and Beyond

Author(s): Ahmed Awaisu, David R. Mottram

In recent years, pharmacy practice has undergone a significant evolution toward patient-centered care. These changes have occurred primarily as a result of demographic changes in population as well as political and economic forces modulating the healthcare systems in many countries. Pharmacy education has undoubtedly made a significant contribution to practice advancement. For the future pharmacy education, globally, needs to develop the educational outcomes, professional competencies, curricular content and processes that are required to prepare competent graduates to assume an integrated and accountable role in the healthcare system by having defined responsibilities for direct patient care. This will result in the development of effective patient care practitioners with appropriate skills, knowledge, and competencies to provide optimal pharmaceutical care and to advance health outcomes. This chapter is primarily intended to provide insight into the evolution of patient and pharmaceutical care as a new model of practice and how pharmacy education contributes in these transformations around the world.





Categorías: Investigaciones

Chapter 14 Capacity Building in Pharmacy Education

Mié, 25/04/2018 - 08:15
Publication date: 2018
Source:Pharmacy Education in the Twenty First Century and Beyond

Author(s): Claire Anderson, Arijana Meštrović

Having a competent and capable pharmacy workforce depends on the capacity of the academic workforce to teach and train. Careful planning of the academic workforce is a critical component of developing academic capacity. Quality assurance requirements are addressing academic workforce development and capacity building in many different aspects, but certainly as one of the main perquisites for accreditation and international recognition. Academic capacity is one of the International Pharmaceutical Federation (FIP) Workforce Development Goals launched in Nanjing in 2016 (FIP, 2017), positioned in the first place among other goals. There remain a number of barriers to achieving academic capacity on a global scale and this chapter discusses those barriers and some solutions to them.





Categorías: Investigaciones

Measuring patient-provider communication skills in Rwanda: Selection, adaptation and assessment of psychometric properties of the Communication Assessment Tool

Mar, 24/04/2018 - 07:57
Publication date: Available online 23 April 2018
Source:Patient Education and Counseling

Author(s): Vincent Kalumire Cubaka, Michael Schriver, Peter Vedsted, Gregory Makoul, Per Kallestrup

Objective To identify, adapt and validate a measure for providers’ communication and interpersonal skills in Rwanda. Methods After selection, translation and piloting of the measure, structural validity, test-retest reliability, and differential item functioning were assessed. Results Identification and adaptation: The 14-item Communication Assessment Tool (CAT) was selected and adapted. Validity and reliability testing Content validation found all items highly relevant in the local context except two, which were retained upon understanding the reasoning applied by patients. Eleven providers and 291 patients were involved in the field-testing. Confirmatory factor analysis showed a good fit for the original one factor model. Test-retest reliability assessment revealed a mean quadratic weighted Kappa = 0.81 (range: 0.69-0.89, N = 57). The average proportion of excellent scores was 15.7% (SD: 24.7, range: 9.9-21.8%, N = 180). Differential item functioning was not observed except for item 1, which focuses on greetings, for age groups (p = 0.02, N = 180). Conclusion The Kinyarwanda version of CAT (K-CAT) is a reliable and valid patient-reported measure of providers’ communication and interpersonal skills. K-CAT was validated on nurses and its use on other types of providers may require further validation. Practice implication K-CAT is expected to be a valuable feedback tool for providers in practice and in training.





Categorías: Investigaciones

“I wanted a skeleton … they brought a prince”: a qualitative investigation of factors mediating the implementation of a Performance Based Incentive program in Malawi

Mar, 24/04/2018 - 07:57
Publication date: Available online 23 April 2018
Source:SSM - Population Health

Author(s): Shannon A. McMahon, Adamson S. Muula, Manuela De Allegri

While several evaluations have examined the extent to which performance based financing (PBF) programs induce changes in the quantity and quality of health services provided, less is known about the process of implementing PBF. We conducted a process evaluation of a PBF intervention in Malawi that focused on understanding moderators of program implementation. Informed by a seminal theory of implementation, we first created a timeline and taxonomy of key events in the program lifeline and then undertook 25 in-depth interviews with stakeholders including implementers, central-level ministry officials and district-level health staff. While seven “moderator categories” emerged in this study, two categories (program complexity and quality of delivery) proved especially crucial in terms of moderating implementation and sparking adaptations. Complexity refers primarily to the manner in which PBF requires that those implementing the program have business acumen and forecasting skills, which are often beyond the purview of a clinician’s training and thus proved challenging. Regarding quality of delivery, the program struggled to issue rewards in a timely and adequate manner, which proved highly problematic as it undermined a bedrock feature of PBF. Adaptations and adaptability refers here to a program’s ability to make changes; the program proved rigid in several respects although nimble in terms of adjusting the verification process (upon noticing revengeful behaviors in peer verification). This PBF program is unique in several respects and findings cannot be generalized to all PBF programs. Nevertheless, process evaluations that draw from or expand upon existing implementation theories can allow researchers to better disentangle complex programming. We hope that more process evaluations, which track both core elements and necessary adaptations of PBF implementation, can further advance understandings of why PBF implementation functions or fails within a given setting, thereby enhancing implementers’ abilities to replicate facilitators and bypass barriers.





Categorías: Investigaciones

Trends in future health financing and coverage: future health spending and universal health coverage in 188 countries, 2016–40

Mar, 24/04/2018 - 07:57
Publication date: Available online 17 April 2018
Source:The Lancet

Author(s): Global Burden of Disease Health Financing Collaborator NetworkJoseph LDielemanNafisSadatAngela YChangNancyFullmanCristianaAbbafatiPawanAcharyaArsène KouablanAdouAliasgharAhmad KiadaliriKhurshidAlamRezaAlizadeh-NavaeiAla'aAlkerwiWalidAmmarCarl Abelardo TAntonioOlatundeAremuSolomon WeldegebrealAsgedomTesfay MehariAteyLeticiaAvila-BurgosRakeshAyerHamidBadaliMaciejBanachAmritBanstolaAleksandraBaracAbate BekeleBelachewCharlesBirungiNicola LBragazziNicholas J KBreitbordeLuceroCahuana-HurtadoJosipCarFerránCatalá-LópezAbigailChapinCatherine SChenLalitDandonaRakhiDandonaAhmadDaryaniSamath DDharmaratneManishaDubeyDumessaEdessaErikaEldrenkampBabakEshratiAndréFaroAndrea BFeiglAma PFennyFlorianFischerNataliyaFoigtKyle JForemanMamataGhimireSrinivasGoliAlemayehu DesalegneHailuSamerHamidiHilda LHarbSimon IHayDeliaHendrieGloriaIkileziMehdiJavanbakhtDennyJohnJost BJonasAlexanderKaldjianAmirKasaeianYawukal ChaneKasahunIbrahim AKhalilYoung-HoKhangJagdishKhubchandaniYun JinKimJonas MKingeSoewartaKosenKristopher JKrohnG AnilKumarAlessandraLafranconiHiltonLamStefanListlHassanMagdy Abd El RazekMohammedMagdy Abd El RazekAzeemMajeedRezaMalekzadehDeborah CarvalhoMaltaGabrielMartinezGeorge AMensahAtteMeretojaAngelaMicahTed RMillerErkin MMirrakhimovFitsum WeldegebrealMlashuEbrahimMohammedShafiuMohammedMarkMosesSeyyed MeysamMousaviMohsenNaghaviVinayNangiaFrida NamnyakNgalesoniCuong TatNguyenTrang HuyenNguyenYirgaNiriayoMehdiNorooziMayowa OOwolabiTejasPatelDavid MPereiraSuzannePolinderMostafaQorbaniAnwarRafayAlirezaRafieiVafaRahimi-MovagharRajesh KumarRaiUshaRamChhabi LalRanabhatSarah ERayRobert CReinerHaniye SadatSajadiRoccoSantoroJoão VascoSantosAbdur RazzaqueSarkerBennSartoriusMaheswarSatpathySadaf GSepanlouMasood AliShaikhMehdiSharifJunSheAzizSheikhMark GShrimeMekonnenSisaySamirSonejiMoslemSoofiReed J DSorensenHenokTadesseTianchanTaoTaraTemplinAzeb GebresilassieTesemaSubashThapaRuoyanTobe-GaiRomanTopor-MadryBach XuanTranKhanh BaoTranTung ThanhTranEduardo AUndurragaTommiVasankariFrancesco SViolanteAndreaWerdeckerTissaWijeratneGelinXuNaohiroYonemotoMustafa ZYounisChuanhuaYuMaysaa El SayedZakiBiancaZlavogChristopher J LMurray

Background Achieving universal health coverage (UHC) requires health financing systems that provide prepaid pooled resources for key health services without placing undue financial stress on households. Understanding current and future trajectories of health financing is vital for progress towards UHC. We used historical health financing data for 188 countries from 1995 to 2015 to estimate future scenarios of health spending and pooled health spending through to 2040. Methods We extracted historical data on gross domestic product (GDP) and health spending for 188 countries from 1995 to 2015, and projected annual GDP, development assistance for health, and government, out-of-pocket, and prepaid private health spending from 2015 through to 2040 as a reference scenario. These estimates were generated using an ensemble of models that varied key demographic and socioeconomic determinants. We generated better and worse alternative future scenarios based on the global distribution of historic health spending growth rates. Last, we used stochastic frontier analysis to investigate the association between pooled health resources and UHC index, a measure of a country's UHC service coverage. Finally, we estimated future UHC performance and the number of people covered under the three future scenarios. Findings In the reference scenario, global health spending was projected to increase from US$10 trillion (95% uncertainty interval 10 trillion to 10 trillion) in 2015 to $20 trillion (18 trillion to 22 trillion) in 2040. Per capita health spending was projected to increase fastest in upper-middle-income countries, at 4·2% (3·4–5·1) per year, followed by lower-middle-income countries (4·0%, 3·6–4·5) and low-income countries (2·2%, 1·7–2·8). Despite global growth, per capita health spending was projected to range from only $40 (24–65) to $413 (263–668) in 2040 in low-income countries, and from $140 (90–200) to $1699 (711–3423) in lower-middle-income countries. Globally, the share of health spending covered by pooled resources would range widely, from 19·8% (10·3–38·6) in Nigeria to 97·9% (96·4–98·5) in Seychelles. Historical performance on the UHC index was significantly associated with pooled resources per capita. Across the alternative scenarios, we estimate UHC reaching between 5·1 billion (4·9 billion to 5·3 billion) and 5·6 billion (5·3 billion to 5·8 billion) lives in 2030. Interpretation We chart future scenarios for health spending and its relationship with UHC. Ensuring that all countries have sustainable pooled health resources is crucial to the achievement of UHC. Funding The Bill & Melinda Gates Foundation.





Categorías: Investigaciones

Structured integration of family planning curriculum: Comparative assessment of knowledge and skills among new medical graduates in Ethiopia

Vie, 13/04/2018 - 16:30
Publication date: Available online 13 April 2018
Source:Contraception

Author(s): Berhanu G Gebremeskel, Alula M. Teklu, Lia T Gebremedhin, Solomon W Beza, Tegbar Yigzaw, Munir K Eshetu, Mengistu H Damtew, Yolanda R. Smith

Objective To assess if structured integration of a comprehensive family planning (FP) training into a medical school curriculum improves FP knowledge and skill scores of medical interns. Study design We compared mean contraception knowledge scores of interns in a medical school with the integrated FP curriculum [intervention school] (n=56) to interns at four conventional medical curriculum schools without structured reinforcement of FP content [control schools] (n=161) in Ethiopia. A survey with 19 multiple choice contraception questions was administered. We also compared the mean contraception skills scores of the two groups at four Objective Structured Clinical Examination (OSCE) stations. The survey included self-reported number of contraception procedures and self-assessed competencies on a Likert scale. Results 217 interns who have completed an Ob-Gyn rotation participated in the study. Interns from the intervention school reported performing substantially higher numbers of contraception procedures and rated themselves as being competent/highly competent across all procedures compared to the control schools (p<.001 for both). The mean knowledge score was significantly higher in the intervention school [13.1 vs. 8.7, difference 4.5, 95% CI: (3.7–5.2), p<.001]. The mean contraceptive implant insertion skill score was two-fold higher for interns in the intervention school [22 points vs. 11, difference 10.7, 95% CI: (8.6–12.8), p<.001 out of a maximum possible point of 30]. Statistically significant differences in skill scores were also observed for intrauterine device IUD insertion [15 vs. 12, p<.01] and implant removal [11 vs. 9, p=.01]. Conclusion A structured integration of family planning curriculum was associated with higher scores in knowledge, clinical skills, and self-assessed competencies. Implications. Integrating comprehensive family planning training in medical curriculum can lead to graduating physicians who are more competent to offer the full range of FP options.





Categorías: Investigaciones

The Midwifery Services Framework: Lessons learned from the initial stages of implementation in six countries

Mié, 11/04/2018 - 16:08
Publication date: Available online 11 April 2018
Source:Midwifery

Author(s): Shantanu Garg, Nester T. Moyo, Andrea Nove, Martha Bokosi

In 2015, the International Confederation of Midwives (ICM) launched the Midwifery Services Framework (MSF): an evidence-based tool to guide countries through the process of improving their sexual, reproductive, maternal and newborn health services through strengthening and developing the midwifery workforce. The MSF is aligned with key global architecture for sexual, reproductive, maternal and newborn health and human resources for health. This third in a series of three papers describes the experience of starting to implement the MSF in the first six countries that requested ICM support to adopt the tool, and the lessons learned during these early stages of implementation. The early adopting countries selected a variety of priority work areas, but nearly all highlighted the importance of improving the attractiveness of midwifery as a career so as to improve attraction and retention, and several saw the need for improvements to midwifery regulation, pre-service education, availability and/or accessibility of midwives. Key lessons from the early stages of implementation include the need to ensure a broad range of stakeholder involvement from the outset and the need for an in-country lead organisation to maintain the momentum of implementation even when there are changes in political leadership, security concerns or other barriers to progress.





Categorías: Investigaciones

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