bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation designs of outpatient health centres focusing on vulnerable patient groups
Authors: Winkler R , Reinsperger I
Published: November 2019

Background

Homeless and non-insured persons experience worse physical and mental health than comparable populations. Outpatient (public) health institutions, which are easily accessible, contribute considerably to the medical treatment of vulnerable patient groups. Sound evaluation methods, indicators and instruments are necessitated to target patients’ needs and to enable strategic health and social policy planning.

Methods

We conducted a systematic literature search in several databases (PubMed, EMBASE, PsycINFO etc.) for studies from 2000 to 2019 reporting on evaluations in outpatient health institutions for homeless and/ or non-insured patients. In addition, we contacted 5 Austrian public health/ research institutions dealing with complex interventions for relevant publications.

Results

12 evaluation studies and 7 evaluation reports met our inclusion criteria. Evaluation designs mostly considered various target groups and nearly all assessments pursued a ’mixed-method’ approach. 13 publications assessed socio-demographic data, 11 the use of health and social services and 7 patients’ health status. Further indicators related to ’satisfaction issues’ such as patients’ satisfaction with the provided range of health and social services (n = 7). 6 publications reported on health economic indicators. In total, 7 out of 19 studies reported on evaluation instruments; most instruments (n = 6) were on patients’ mental health status.

Conclusions

Patients represented the major target group in the included evaluations. There is little research on evaluation indicators directing on health professionals. Evaluations focusing on the intersectional levels (e.g. the impact of health programmes for vulnerable groups on various institutions) are lacking.

Key messages

Evaluation designs involving ‘hardly to reach populations’ shall consider a ‘participatory assessment approach’ to avoid drop-outs and to create a trustworthy evaluation situation. Hence, evaluation indicators shall be commonly selected and adequately reflect patients’ realities.
The experience of patients and family caregivers during Hospital-at-Home in France
Authors: Rossinot H , Marquestaut O , De Stampa M
Published: November 2019

Background

Public health policies tend to generalize the use of Hospital-At-Home (HAH) to answer the growing will of patients to be treated or to die at home. HAH is a model of care that provides acute-level services in the patient’s home with the interventions of variety of health care professionals. Relatives participate also in the interventions by helping for sick patients at home, but we lack data on the care of patients and caregivers in HAH. The aim of this study was to make an inventory of the experiences of patients and family caregivers in HAH.

Methods

The research was qualitative using nineteen semi-directed interviews from nine patients and ten caregivers of one care unit of Greater Paris University Hospitals’ HAH, and the grounded theory was used to analyze the transcripts. Caregivers were also asked, after the interview, to fill in the Zarit Burden Inventory.

Results

HAH remained mostly unknown for patients and caregivers before the admission proposition and the outlook of being admitted in HAH was perceived as positive, for both of them. Caregivers had a versatile role throughout HAH, leading to situations of suffering, but also had sources of support. The return home was considered satisfactory by both caregivers and patients, related to the quality of care and increased morale despite HAH’s organizational constraints. We noted an impact of HAH on the relationship between the patient and the caregiver(s), but caused by multiple factors: the fact that the care takes places at home, its consequences but also the disease itself.

Conclusions

HAH strongly involved the patient’s caregiver(s) all along the process. HAH’s development necessitates to associate both patients and caregivers and to take into account their needs at every step. This study highlights the need to better assess the ability of the caregiver to cope with his or her relative in HAH with acute and subacute care at home.

Key messages

Health care services need to take into account family caregivers. Hospital at home services should be developped worldwide.
Improving inmates in Norwegian prisons’ oral health
Authors: Evensen K , Næss L
Published: November 2019

Background

Inmates in Norwegian prisons have poorer dental health than the general population. Inmates are a vulnerable group, often not able to take advantage of the dental health services or able to take care of own oral health. Poor dental health may have an impact on general health, in that people with poor oral health often suffer from pain and impairment and often feel restricted in activities at school, work or home. Oral health is declared as a human right by the World Dental Federation, and has gained recognition through the World Health Organization who emphasize on strengthening public dental health programs. The aim of this study was to explore the effect of an intervention based on Motivational Interviewing (MI) on improved dental health across inmates in Norwegian prisons.

Methods

Inmates in Norwegian prisons were offered an oral examination and a small package containing toothbrush, toothpaste and floss- in addition to a short MI-intervention (20 minutes) by a dental hygienist. The participants were interviewed appr. 2 weeks later by a researcher to assess the effect of the intervention. The qualitative data-analyses were guided by thematic analysis.

Results

The findings indicate that the intervention had a positive effect on behavioural change and motivation related to dental health care. The findings indicate that the intervention improved the inmates daily dental health care through better routines and motivation.

Conclusions

The findings suggest that the intervention has a positive impact on inmates’ oral health. The inmates changed routines related to daily dental care and reported higher motivation for taking care of their oral health. This is one of the first studies that explores the effect of an intervention to improve inmates’ oral health and bridges a knowledge-gap in the literature. The findings may increase the understanding of how dental services should be organized and offered to provide dental health care for this vulnerable group.

Key messages

Poor oral health is associated with poor general health, and inmates in Norwegian prisons have poorer dental health than the general population. The aim of this study was to explore the effect of Motivational Interviewing on improved dental health across inmates. Findings: positive effect on the motivation and behavior related to oral health.
Improving diabetes care through educational intervention in primary care in rural China
Authors: Chen S , Burstrom B , Burstrom K , Qian D
Published: November 2019

Background

The burden type 2 diabetes mellitus (T2DM) is increasing in China, especially in rural areas. The New Round of Health Care Reform in China intended to strengthen primary care, and promote the vertical integration between hospital care and primary care, in order to respond to the threat of T2DM. This study aimed to assess the impact of an educational intervention to improve vertical integration and management of T2DM in primary care in rural China, on glycemic control and diabetes knowledge.

Methods

The educational intervention was conducted in cooperation between the county level hospitals and primary care in rural areas (including township health centres and village clinics). T2DM patients in three counties in Jiangsu Province were randomly divided into an intervention group, which received an education-based intervention and follow-up visits, and a control group which received standard care. Questionnaire interviews and medical records were used to collect patient data, including fasting blood glucose (FBG) level and diabetes knowledge, at baseline and follow-up, in 2015 and 2016, respectively. Difference-in difference analysis and Mann-Whitney U test were used.

Results

The FBG level decreased significantly and diabetes knowledge increased significantly in the intervention group compared to the control group. The FBG level and diabetes knowledge score improved significantly in the intervention group in all counties, but there were local variations in levels.

Conclusions

The increased integration between the county level hospital and primary care service with an educational intervention among T2DM patients had a positive impact on the FBG level and diabetes knowledge score in the intervention group compared to the control group after one year. The results are suggesting that the care of diabetes in rural China may be improved through more intense collaboration between hospital care and primary care.

Key messages

The increased integration had a positive impact on the glycemic control and diabetes knowledge among T2DM patients. Diabetes care in rural China may be improved through increased collaboration between hospital care and primary care.
Implementing treatment guidelines for ambulance services in a low- and middle income setting
Authors: Carlsson H , Blaku V , Lidberg H , Hodza-Beganovic R , Berggren P
Published: November 2019

Background

The use of clinical practice guidelines in clinical and organizational decision-making improves the care of patients and patient safety. Guidelines make healthcare consistent and efficient. In many low- and middle income countries healthcare workers depend on guidelines developed in higher income countries. For these to be useful and accepted they need to be adapted to the local setting. The aim of the study was to implement pre-hospital treatment guidelines into an organization that was not currently using guidelines. The study was partnership between a Swedish pre-hospital training organization and local ambulance service organizations in Kosovo.

Methods

An iterative process of implementing the guidelines was used: Identify guidelines appropriate for the local organization.In sets of five, have the guidelines translated into Albanian.Adapt the guidelines to the local conditions and context.Approval of guidelines by an expert group.Begin using the guidelines within the target organization.

Results

The first set of five guidelines was translated, approved, and implemented into the organizations. To improve acceptance, both practitioners and decision-makers were involved in the process. Seven workshops were held, with a total of 104 participants. In follow-up discussions participants said they accepted the guidelines and that they would be useful in their daily work.

Conclusions

It is important to evaluate to what extent the guidelines have been accepted, understood, and used. The success and acceptance is due to the flexible procedure managing the full implementation process. Adapting guidelines to fit with local needs and requirements using local experts made the guidelines accessible and useful. The workshop discussions established justification and approval.

Key messages

Involve local experts in contextualising guidelines to increase acceptance from the start. Support building a robust local implementation organization to assist and administer change.
Public Health Nurse and interprofessional collaboration related to adolescent mental health problems
Authors: Granrud M , Anderzen-Carlsson A , Bisholt B , Steffenak A K
Published: November 2019

Background

Mental health problems among adolescents account for a large portion of the global burden of disease and affect 10 - 20 % of children and adolescent worldwide. The public health nurse in the school health services is in the forefront for adolescents and play an important role in providing mental health. In order to identitfy and help the adolescents in secondary school with mental health problems the public health nurses are dependent on collaboration with other professionals. The aim of this study was to describe the variation in public health nurses perceptions of interprofessional collaboration related to mental health problems among adolescents in secondary school.

Methods

This study has a qualitative design and individual interviews were analyzed with a phenomenographic approach. Eighteen public health nurses working in school health services, strategically selected from different counties, both urban and rural areas, were included to ensure variation in the phenomena.

Findings

The analysis resulted in three descriptive categories: ’The formal structure has an impact on the interprofessional collaboration’, ’The public health nurse is an important but not always self-evident partner in interprofessional collaboration’ and ’The primary players are the teachers in collaboratioń.

Conclusions

The findings demonstrated that public health nurses are important but not always included in interprofessional collaboration and they were dependent especially of teachers to achieve good collaboration. There were variations in how public health nurses perceived interprofessional collaboration from school to school, which may give the adolescents with mental health different services. The knowledge from this study may be essential to strengthen public health nurses positions and presence in the school health service, which will benefit the adolescents with mental health problems.

Key messages

The public health nurse need to work actively to be included in interprofessional collaboration. The public health nurse are dependent on teachers and principals to achieve good collaboration.
Can clinical coordination be improved through Participatory Action Research (PAR) interventions?
Authors: Vargas I , Eguiguren P , Mogollón-Pérez A S , Samico I , López J , Bertolotto F , De Paepe P , Vázquez M L
Published: November 2019

Background

Despite the effectiveness of Participatory Action Research (PAR) in reducing the gap between evidence and practice, its use to improve care integration is rare. The aim is to analyze the factors influencing the implementation of PAR interventions to improve clinical coordination in public health services networks of Brazil, Chile, Colombia, Mexico and Uruguay.

Methods

A qualitative, descriptive-interpretative study was conducted in participating healthcare networks of each country. Focus groups and individual semi-structured interviews were conducted to a criteria sample of participants: members of Local Steering Committee (LSC)(29), professionals’ platform (PP)(28), other professionals (49) and managers(28). Thematic content analysis was performed, segmented by country and themes.

Results

Findings reveal that contextual factors, the PAR process and interventions’ content were determinants in the implementation, interacting over time, and differing among experiences. On the one hand, institutional support (providing the necessary resources) together with the interest of professionals and managers in participating, emerged as influencing factors influenced by other factors related to: the system (alignment with policies; electoral cycle), networks (lack of time due to work overload; precarious employment conditions) and individuals (limited mutual knowledge and mistrust). On the other, some characteristics of the PAR process facilitated institutional support and motivation: professionals’ participation in all activities, design flexibility and shared decision-making - also present when interventions were based on mutual adjustment - the LSC’s leadership and the facilitating role of the research team.

Conclusions

Evidence is provided that when some contextual elements converge the implementation of interventions through PAR processes can turn into a factor of motivation and cohesion, determinant for the adoption of clinical coordination interventions.

Key messages

Contributes to fill the knowledge gap in factors influencing the implementation of PAR interventions in healthcare. Provides a framework for analysis and recommendations for their implementation.
Future Physicians and Cosmetic Medical Interventions
Authors: Erbaydar N P , Cilingiroglu N , Ak M S , Aksakal M F , Bartu A , Gunes Y F , Oney M A , Ozcan A , Tumtas M B , Yilmaz H E
Published: November 2019

Background

International Union of Aesthetic Plastic Surgeons’ survey-2017 showed Turkey is the second country among others in terms of numbers of cosmetic medical interventions (CMI) in Europe and ranks ninth worldwide. Therefore future physicians’ (FT) perceptions are important on this topic as potential implementer and service user.

Objective

Objectives are: To examine FPs (interns) personal CMI experience; practiced/observed CMI; their attitude towards CMI and related factors.

Methods

Study is descriptive with 274 interns. Data collected by online survey contains 22 questions and acceptance of cosmetic surgery scale (ACSS) (Henderson and King, 2005).

Findings

Of the interns, 51.5% were female; 47.8% perceived good economic status; 40.5% had cosmetic-surgery training; 23.0% had CMI (laser on skin and teeth interventions mostly); 39.7% of these interventions were performed in private clinics while some of them are realized in beauty centers; body-perception was found (75.5%) the main motive of CMI. There was a strong relation between CMI and gender. Female interns constituted majority (p = 0.01). Respondents who had CMI had the highest scores of ACSS (p < 0,001). It was found that ACSS is positively related to positive familial and social environment (p = 0,007); negatively related with strong traditional (p = 0,005) and religious beliefs (p < 0,001); positively related with the given importance of body-perception (p = 0,015). Media effect was found important factor on ACSS scores (p < 0,001).

Conclusions

If the awareness of the quality, results, benefits and harms of CMIs is well established, it may be thought that there will be differences in attitude scale and less CMI performance. Therefore, it is necessary to constitute training programs on the different aspects of CMIs in medical curriculum.

Key messages

CMIs are not medically necessary and not a public-health issue and has economic burden. Awareness on the quality, results, benefits and harms of CMIs is should be well-clarified in the society.
Nursing processes analysis in district hospital in Lithuania
Authors: Vladickiene J , Stonkeviciute A
Published: November 2019

Background

The aim of the study - to evaluate the time devoted to the activities of therapeutic profile nursing and wastes in the nursing processes.

Methods

Time-and-motion study was applied for investigation of clinical workflow in nursing at district hospital in neurology and internal medicine departments. A total of four nurses, two nurses from each department, were observed. Duration of observation was 2 940 minutes (49 hrs).

Results

Nurses devote most of their time to administering medicines. It has been noted that there are many additional, unnecessary actions in this process. Likewise nursing staff devotes a lot of time to documentation management work: refills the same dossier when the information is recorded in paper forms, and then transfer it to the computers. For communication with patients, nursing staff spend a very small part of their working time and it is due to insufficient staff and stress and fatigue of the nurses. It is observed that the nurses of neurology and internal medicine departments spent 50.3 percent of their working time for a direct patient care, 19.3 percent of time - for indirect patient care, 22.3 percent for personal time and 8.0 percent for unit-related functions. According to the Lean methodology waste of overproduction, waiting, defects, bureaucracy, transportation, motion and human potential were identified in these departments.

Conclusions

Nurses of neurology and internal medicine departments spend most of their time for direct patient care and the least of their time for unit-related duties. Seven out of eight types of waste prevails in therapeutic departments of the district hospital.

Key messages

Adaptation of the Lean methodology of ’Visual Management’ may aid for optimizing the process of medication administration and diminishing the paper work of nurses. The manifestation of the stress and fatigue of the nurses could be reduced if the workloads of nurses were adjusted and adequately distributed.
Time trends of primary care quality across Portuguese regions: using prevention quality indicators
Authors: Santos J V , Viana J , Souza J , Lobo M , Ramalho A , Gonçalves-Pinho M , Freitas A
Published: November 2019

Background

Primary care quality is one of the main dimensions of primary care performance and can be evaluated by several methods, e.g. studying hospitalizations for conditions that could be treated, or less severe, if appropriately managed in primary care. Accordingly, the Agency for Healthcare Research and Quality (AHRQ) developed prevention quality indicators (PQIs). In this study, we aimed to compare PQIs and their time trends across Portuguese regions.

Methods

We performed a retrospective study, using all adult public hospital discharges in mainland Portugal, between 2011 and 2015. PQI rates for the overall (PQI 90) and composite indicators (i.e. 91 - acute, 92 - chronic, 93 - diabetes) were computed using AHRQ specifications. These rates were compared between the 5 Portuguese NUTS 2 regions of residence.

Results

From the total of 407,792 hospital discharges in mainland Portugal (2011-2015) 11.9% comprised the selected PQIs, the majority related the acute composite PQI, followed by the chronic composite PQI. The hospitalization rate of the overall PQI increased from 999.5 hospitalizations (2011) to 1231,0 hospitalizations/100,000 inhabitants (2015), with an increase in all NUTS 2 regions. In 2015, while Algarve and North had the lowest PQI rates, Centro and Alentejo showed the highest ones.

Conclusions

Between 2011 and 2015, there was an increasing trend of overall and composite PQI rates. Also, important differences between Portuguese regions were found that must be further studied.

The authors thank the support given by the Project ’POCI-01-0145-FEDER-030766’ (1st.IndiQare - Quality indicators in primary health care: validation and implementation of quality indicators as an assessment and comparison tool), funded by Fundação para a Ciência e a Tecnologia (FCT) and co-funded by Fundo de Desenvolvimento Regional (FEDER) through Operacional Competitividade e Internacionalização (COMPETE 2020).

Key messages

Between 2011 and 2015, overall prevention quality indicator rate increased in Portugal. There are great differences between Portuguese NUTS 2 regions regarding prevention quality indicators.
Confraternal talks impact with general practitioners on the prescription for older adults
Authors: Mauillon V
Published: November 2019

Issue

10% patients over 75 and patients aged from 66 to 75 years with a chronic disease take more than 10 concomitant drugs. Polypharmacy is a consistent risk factor of adverse drug events for elderly patients. Adverse drug reactions prevention is a national priority in view of quality of life and healthcare system costs increase.

Description

In Normandy, since November 2015, various interventions such as confraternal talks or letters send to general practitioners (GPs) have been examined to optimize medication use in older adults. More than 16 drugs prescriptions were discussed with the family practitioner and a health insurance fund’s physician-advisor. In addition, a prescription profile in elderly patients was given to this GP. Recommendations for good practices are also reminded.

Results

10 weeks of physicians prescriptions were studied during one year (from september 2015 to september 2016). 686 general practitioners (GPs) had at least one prescription over 16 drugs and 265 GPs had at least two prescriptions over 16 drugs. 166 confraternal talks or phone calls between health insurance doctors and GPs have been leaded with a medication review. 233 letters have been sent to physicians to improve prescribing. 46% of GPs received a physician-advisor led intervention. After these interventions, prescriptions drugs number has decreased (p < 0,001) and the number of GPs having more than 16 prescriptions drugs has also decreased (p = 0,27). There is no significant difference between confraternal talks and letters. However, the physicians are more confortable with the confraternal talks to discuss their prescriptions.

Lessons

Confraternal talks continued in 2017 with medication review and profile’s delivery. A two years follow-up on these accompanying interventions will be made to optimize drugs prescriptions use for elderly patients.

Key messages

The physicians are more confortable with the confraternal talks to discuss their prescriptions. There is no significant difference between confraternal talks and letters.
Demographic forecasting of population projection in Greece: A Bayesian probabilistic study
Authors: Lamnisos D , Giannakou K , Siligari T
Published: November 2019

Background

Demographic aging is an emerging issue in Greece, characterized by low fertility and increased life expectancy. Undoubtedly, demographic aging is a challenge for public health not only due to the financing of public pensions, but also for the increasing utilization of health care.

Methods

The total fertility rate and life expectancy at birth are projected probabilistically using Bayesian hierarchical models and United Nations population data for Greece from the period of 1950 to 2015. These are then converted to age-specific mortality rates and combined with a cohort component projection model. This yields probabilistic projections of total population by sex and age groups, total fertility rate (TFR), female and male life expectancies at birth and potential support ratio PSR (persons aged 20-64 per person 65+) by the year 2100.

Results

The total population in Greece in 1950 was around 7.5 million, increasing to 11 million based on the 2011 population census but is projected to decline to 7.5 million at 2100. TFR has followed a strong downward trend with 1.4 children per woman in 2005-2010 and is projected to have a slight increase to 1.6 and 1.8 children per woman for 2050 and 2100 with all values being below the replacement-level fertility. Life expectancy is expected to increase to 84 years for men and 88 years for women in 2050, and 90 years for men and 94 years for women in 2100. PSR is expected to decline dramatically from 3 in 2011 to approximately 1.5 in 2050 and 2100.

Conclusions

Over the years, Greece has lost its youthful structure and has acquired the characteristics of an aging population, reflecting the population distribution of Western countries. Demographic aging is harmful for the economic growth, the social security system, the social assistance, and it is closely linked to national defense and public health. A long-term multidimensional program is recommended to confront the demographic issue based on the previous international experience.

Key messages

Total fertility rate will be below replacement level and potential support ratio will decline dramatically. A long-term multidimensional program needs to be developed to address the demographic aging.
Assessment of State of Health and Healthcare Expenditure by Single-Person Households
Authors: Tur-Sinai A , Magnezi R , Grinvald-Fogel H
Published: November 2019

Background

The latest statistics on household size in the EU show that in 2017 around one third of households in the EU comprised single adults without children. The study documents a direct relationship between individuals’ health and patterns of healthcare expenditure by isolating single-person households and creating a new reference group in which household healthcare expenditure is based on one person’s expenditure patterns in accordance with his or her own state of health.

Methods

The study matched two surveys using Propensity Score Matching based on single-person household, age, and gender. Structural Equation Modeling (SEM) explores paths of relation between the population’s income and socioeconomic level and its health self-assessment and expenditure.

Results

Single-person households’ health expenditure increases with age and the differences in most expenditure categories are significant. The current study looks into the direct and indirect effects of income, gender, and SES on health insurance and other out-of-pocket health expenses among single-person households. A direct link exists between income, gender, and socioeconomic status (SES) and several aspects of health expenditure, depending on the specific age group. The indirect effects are attested via health status assessment, in which a negative correlation is found between self-assessed health status and various health-expenditure categories.

Conclusions

The last-mentioned result may support the general perception that single-person households who feel that they are doing better than their near-equals enjoy better health. This line of inquiry yields a better examination of how a single-person household’s state of health affects expenditure patterns without assuming ab initio that expenditure patterns attest to state of health.

Key messages

Healthcare system and policymakers have to be mindful of the profile of single-person households and should ensure to examine these households’ patterns of healthcare expenditure as a function of age. Policymakers should seek alternative sources of funding for the single-person households’ health-insurance outlays and should examine alternative ways of restraining their expenditure on dental care.
Balanced Scorecard for performance assessment in healthcare settings: a review of literature
Authors: Cacciatore P , Kannengiesser P , Carini E , Di Pilla A , Pezzullo A M , Hoxhaj I , Gabutti I , Cicchetti A , Boccia S , Specchia M L
Published: November 2019

Background

The Balanced-Scorecard (BSC) is a management tool developed in the early 1990s to balance the impact of financial and non-financial parameters and analyse the organisational performance in private companies according to four determinants. The original BSC has spread to different sectors in the last decades, including healthcare services, in numerous amended versions. The aim of our project was to identify potential indicators of BSC for performance evaluation in general hospitals.

Methods

We performed a systematic review of literature on Pubmed and Web of Science using the search string “balanced scorecard AND healthcare AND indicators”. We found 102 papers; 80 papers were removed for irrelevance, absence of full text or performance indicators. We only considered articles that followed the classic structure of BSC (Customer, Internal Processes, Financial, and Learning and Growth). The indicators listed in them were classified according to the four determinants of organisational performance.

Results

Eight articles out of 22 followed the classic structure of the BSC. The most represented category was Internal Processes (59 indicators), followed by Learning and Growth (52), Customer (40) and Financial (33). The number of common/overlapping indicators was low (5 for Internal Processes and 4 for the three other categories).

Conclusions

While BSC has spread to different settings, the list of indicators used in the classic four determinants for performance evaluation is heterogeneous. While common points can be identified between indicators, our review highlighted that every BSC is developed in a unique way which makes it difficult to identify a general framework adaptable to different hospital settings.

Key messages

The use of the Balanced Scorecard as management tool has spread to healthcare settings in the last decade. Indicators in BSC for healthcare settings are heterogeneous and only a limited number follow the standard structure of BSC.
The satisfaction of the new competencies and roles of nurses in Kazakhstan
Authors: Bekbergenova Z , Baigozhina Z , Umbetzhanova A , Kabdullina G , Abdrakhmanova A , Koikov V
Published: November 2019

Background

When interviewing nursing specialists of the Republic of Kazakhstan (RK) about the level of satisfaction with the prospects of the profession with the participation of 9039 nurses, 71% of whom believe that nurses should be given special status. To study the satisfaction of the new competencies and roles of nurses in the framework of the reform of the nursing service conducted a survey of employers

Methods

The cross-sectional study in 1417 of employers participated, of which 11% were senior doctors, 26% deputy chief physicians, 50% of heads of departments, 13% others.

Results

Analysis of the survey results showed the following: more than 70% of employers have a positive attitude towards nursing service reforms. According to 48% of employers, the functionality of nurses is expanded. 54% of nurses fully cope with new functional responsibilities. 44% of respondents say that with the expansion of the functionality of nurses, doctors have more time to perform more complex skilled work. According to 44% of employers, nurses should delegate the primary reception and examination of the patient, 42% setting the primary diagnosis, 33% deciphering the results of laboratory and instrumental studies, 21% independent visiting the patient at home, 8% active prenatal and postnatal patronage, 17% rendering pre-medical and emergency medical care. 62% of employers consider it appropriate to introduce the practice of joint training of doctors and nurses and fully support the increase in the independence of the nursing service.

Conclusions

In general, employers support the reform of nursing, are satisfied with the new competencies of nurses and have a positive attitude towards increasing their independence.

Key messages

It is necessary to improve basic training programs in medical colleges and to implement effective advanced training programs for working nurses. It is advisable to practice the introduction of co-education for doctors and nurses - the practice of inter-professional teams specialists.
Evaluation of chronic disease follow-up training of family physicians in primary care units
Authors: Buzgan B , Mete B , Pehlivan E
Published: November 2019

Background

Chronic diseases are a major cause of morbidity and mortality due to late diagnosis and insufficient treatment. This study deals with the training on chronic diseases organized by the Ministry of Health in the provinces. The aim of this study was to measure the effectiveness of training programs for family physicians in a province.

Methods

This semi experimental study was carried out during the training held in Bingöl that is eastern city of Turkey, on 22-26 October 2018 and 19-20 December 2018. The universe of the study consisted of family physicians working in the province. Of the 90 family physicians working in the province, 75 participated in the study. The training was conducted by the researchers and (before-after) 16-question test to the participants were used. The trainings cover the sub-heading Cardiovascular Risk Assessment and Diagnosis and Treatment of Hypertension. The family physicians were divided into 7 groups and were given 7-hour training. SPSS 25 program was used to analyze the data. In the analysis of data, Wilcoxon test, Cochran’s Q test and Bayesian approach samples t test were used.

Results

The average number of correct before training was 7.33 (min: 2 - max: 13), after training 12.64 (min: 7- max: 16; p < 0.001). After the training, participants’ correct answers to 15 questions increased (p < 0.001). Increase rate is 71%. Bayesian factor was found to be < 0.001 according to the results of Bayesian approach t test. There is definite evidence against the H0 hypothesis. According to the results of this quasi-experimental study, training is very effective.

Conclusions

In this study, it was shown that the education of the family physicians about the chronic diseases of the Ministry of Health is effective in increasing the knowledge level of family physicians.

Key messages

The training of the family physicians in charge of the primary health care is important. This study showed that education is very effective accorging to the pre-training.
Looking for bridge engineering: the role of an information officer in ’sanitary service’
Authors: Defaut M , Sizaret A , Manca M F
Published: November 2019

Background

Launched in 2018, ’sanitary service’ aims at training all future health professionals in prevention issues, through elaborating concrete projects designed for population identified as priority. It responds to the first axe of the National Health Strategy, which is to develop a prevention and health promotion policy. In our region, about 430 actions have been implemented by 2200 students, in interdisciplinary teams.

Objectives

From this context occurred a reflection on how a documentary product can be used as a bridge between various health disciplines and a path to health promotion. A triple goal is pursued: provide pedagogic support, share a common view and langage, help with taking action.

Results

6 theme-based document files were created. They were conceived as a collection, with a running gag in titles, colourful covers and numerous illustrations.

As for promotion and dissemination, they appeared on our website, on social networks, but also (Back to the Future?) printed as proper books and sent to our partners. Our team also got involved in methodological assistance, at university and in our resource centre.

Thanks to its formal innovation and its multidisciplinary audience, this production built a collective culture of health promotion. Overpassing sanitary service, it is now used by other professionals for different purposes, including project managers during training sessions.

Conclusions

This action faced the recurring challenge of assessing a support function such as ours, but performed in becoming a showcase to promote our structure.

Information accessibility could be improved by better internet referencing, its attraction by infographics, its efficiency by evaluation. But above all, live interaction appears to be the key in a knowledge transfer strategy.

Key messages

Sanitary service is an opportunity to picture a common view on health promotion. As documentalists, let’s build bridges to knowledge by turning into super mediators.
Predictors of job satisfaction in public hospitals in Belgrade, Serbia: a cross-sectional study
Authors: Tripković K , Odalović M , Mladenović Janković S , Nešković A , Jakovljević M
Published: November 2019

Background

Growing evidence has suggested that job satisfaction in the health-care system can affect productivity, the quality of service, and patient safety. Knowledge regarding job satisfaction of health workers and its determinants is valuable to health-care managers for decision making in the field of personnel policy. This study was aimed to assess job satisfaction among health workers in public hospitals in Belgrade, Serbia and identify its associated factors.

Methods

This was a cross-sectional study, carried out within 24 hours, in December 2018, as a part of a national survey, which is conducted annually in all health care institutions in Serbia. Data were collected by self-administered structured questionnaire, which was distributed to all health workers who were at work at the time of the survey (11,588 health workers in 26 public hospitals in Belgrade). The completed questionnaires were returned by 9,203 health workers, which constituted the response rate of 79.4%. Multivariable logistic regression was applied to identify factors significantly and independently associated with a higher level of job satisfaction.

Results

Overall, 31.4% of the respondents were satisfied with their job. Age less than 35 years [AOR = 1.40; 95% CI (1.18-1.67)], no work stress [AOR = 2.66; 95% CI (1.94-3.65)], satisfaction with time for accomplishment of tasks [AOR = 1.92; 95% CI (1.64-2.26)], satisfaction with recognition and value of health workers’ engagement [AOR = 1.79; 95% CI (1.51-2.13)], and satisfaction with leadership style and work organization [AOR = 1.90; 95% CI (1.60-2.26)] were identified as determinants with highest influence at job satisfaction.

Conclusions

Less than third of health workers in Belgrade’s hospitals were satisfied with their job, while satisfaction with various aspects of the job, age, and work stress, were identified as predictors. The results of this study could be useful in proposing strategies to improve job satisfaction of health workers.

Key messages

The job satisfaction of health workers in Belgrade’s hospitals is low. Health-care managers should pay attention to create an environment that promotes job satisfaction and reduces work stress.
Clinical psychologists in primary mental health care in Norway - what to do?
Authors: Kaspersen S L , Ådnanes M , Ose S O
Published: November 2019

Background

The past 20 years Norwegian health authorities have put significant effort into increasing the number of clinical psychologists in primary health care. By 2020, all Norwegian municipalities are required by law to have clinical psychologists available. In 2018, only about half of the 422 municipalities had fulfilled this requirement, and the number of vacant positions is growing. The purpose of this study was to investigate the usefulness of clinical psychologists in a primary care setting as perceived from primary mental health care leaders/employees and those who educate clinical psychologists at the universities.

Methods

We combined the use of open-ended questions in a survey (N = 456) among leaders and employees of primary mental health services in Norway, with data from semi-structured focus group and individual interviews (N = 15) with academic staff at the four universities in Norway that provides education for clinical psychologists.

Results

The discussion on utilisation and usefulness of clinical psychologists in Norwegian primary care often condensates into weighing time spent on a never-ending demand for individual therapy against time spent on health promotion, prevention and system level work. Traditionally, Norwegian psychologists have received education mostly focusing on treatment methodology and individual therapy most suitable for the specialist services. The curricula are now changing towards more health promotion/prevention in primary care, but still lacks focus on system level approaches like collaboration with and guidance of other professions - which are the qualities asked for from those who hire clinical psychologists in primary mental health care.

Conclusions

Interdisciplinary collaboration with a wide spectre of professionals and thereby ’working with and through others’ in the health and welfare services, was suggested to be the most efficient way of utilising psychological clinical competence.

Key messages

The Norwegian clinical psychologists’ education is becoming more primary care friendly. Psychologists in primary care must be part of interdisciplinary teams where they can work with and trough others.
A methodological support to set up multidisciplinary group practices in Southeastern France
Authors: Douchement O , Dumesnil H , Dagnet L , Saugeron B , Sonnier P , Verger P , Guagliardo V
Published: November 2019

Issue/Problem

Despite high medical densities in Southeastern France, access to prevention and care is difficult in some territories due to a lack of health professionals. The Regional Council supports multidisciplinary group practices (MGP) to improve primary care access and quality. When developing them, health professionals have to propose a health project addressing population health needs in the area.

Description of the problem

Two complementary resource centres -the Southeastern Regional Health Observatory and the Regional Committee for Health Education- collaborate to provide support to health professionals in the creation of MGP. The process includes a territorial assessment based on quantitative indicators about various environmental and socio-economic determinants, morbidity, mortality, and health-seeking behaviours. Stakeholders then discuss the results of this assessment in order to confront it to their experiences, identify priorities and design the health project: it defines the forms according to which professionals will work together and set specific objectives and activities to cover main public health needs in the corresponding territory.

Results

Since 2011, our methodological support has benefited 45 MGP projects: 19 were successful, 13 are still in progress and 13 projects were not completed. It helped decision-makers in the identification of priority territories in terms of prevention and care; it also presented outlooks of the current and coming health needs of various areas.

Lessons

Levers to the MGP setting up have been identified: a project is more successful when it is initiated by health professionals supported by local authorities, and up for discussion. On the contrary, preconceived ideas about the MGP project complicate the assessment’s appropriation.

Key messages

Taking into account the results of the assessment helps to propose MGP projects that better match population needs. It also improves collective knowledge of public health issues between health professionals and various local stakeholders.
Foreign workers’ health in agriculture: assessing health workers’ perception and training needs
Authors: Salvatori L M , Rinaldi A , Angelozzi A , Caminada S , Paglione L , Persechino B , Marceca M
Published: November 2019

Introduction

Health and safety of foreign workers employed in agriculture and zootechny present several critical areas. The multidisciplinary project ’Livingstone’, funded by INAIL and carried out by several Italian universities, aims to address some of these critical issues. One of the project research line focuses on health professionals and has the objective to investigate their perception of the risks to which foreign workers are exposed and their training needs.

Methods

A 33 items questionnaire is being self-administered to social and health professionals of three Italian regions (Lazio, Lombardia and Campania) where agriculture is developed; the administration phase will last 13 months (2018, April - 2019, May). The questionnaire has been built starting from a literature review; a pilot study have been conducted in a pilot sample in Rome in March 2018. The questionnaire is composed by five sections: general, social and professional information; characteristics of the respondents’ foreign patients/users; knowledge about health problems of foreign patients and about possible obstacles in use of health services, with a specific focus on foreign patients working in agriculture and zootechny sector; perception about health and safety risks of these workers; training background and needs, included desired training contents and modalities.

Results

The research is ongoing. 238 answered questionnaires have been collected yet. 65 of the respondents are General Practitioners; the rest are other health and social professionals. The complete results will be shown during the congress.

Conclusions

This study will contribute to widen the knowledge about health professionals’ perceptions about problems and needs of foreign workers employed in agriculture and zootechny sector.

Specific training addressed to social and health professionals will be developed from the observation of their current knowledge and from their reported needs.

Key messages

This study will contribute to widen knowledge about health professionals’ perceptions about problems and needs of foreign workers employed in agriculture and zootechny sector. Specific training addressed to social and health professionals will be developed from the observation of their current knowledge and from their reported needs.