bluuebunny/crossref_metadata_2025_split huggingface dataset:
Infrequent patient-physician conversations about sexual health at an Austrian university hospital
Authors: Komlenac N , Hochleitner M 
Published: November 2019

Abstract

Background
Many physical diseases are associated with sexual health problems. Studies concerning physicians’ barriers to patient-physician conversations concerning sexual health often fail to go beyond descriptive analyses of such barriers. The current study focused on finding those barriers that best predict the frequency of patient-physician conversations concerning sexual health.

Methods
An online-questionnaire assessed physicians’ sociodemographic information, frequency of holding a discussion on sexual health issues with their patients, and self-perceived barriers to asking patients about sexual health issues. The study was conducted at an Austrian university hospital. 102 physicians (53.9% women/46.1% men) participated. Logistic regression models were calculated to analyze associations between physicians’ barriers and the frequency of patient-physician conversations concerning sexual health in everyday practice.

Results
Of the physicians, 61.8% reported having a discussion on sexual health with their patients at least rarely in their everyday clinical practice. Physicians’ barriers that predicted low frequency of patient-physician conversations concerning sexual health were: expecting the patient to initiate such a conversation, not feeling responsible for this health issue, fear of offending the patient, and one’s own shame and discomfort.

Conclusions
In contrast to other studies about physicians’ barriers to patient-physician conversations concerning sexual health, in the current study time constrains were not a prominent barrier to such conversations. Future training should help physicians recognize the relevance of sexual health in one’s medical discipline and they should be taught how to overcome their feelings of shame or how to cope with patients’ negative reactions during patient-physician conversations concerning sexual health.

Key messages
University hospital physicians rarely address sexual health issues in patient-physician conversations. Physicians most often handed the responsibility to initiate such conversations to the patient.
Used and foregone of primary care in French university students
Authors: Tavolacci M , Habihirwe P , Déchelotte P , Ladner J 
Published: November 2019

Abstract

Background
University students tend to find it difficult to ask for help especially when it comes to health issues. The objective of the study was to determine the health issues of general practitioner and the reasons of primary care foregone in university students.

Methods
A cross sectional study was conducted in 2018 in Normandy university students (France). The socio demographic characteristics of the university students were collected. The primary care seeking during the previous 12 months were assessed by the consultation to the general practitioner and categorized: acute physical issues (stomach aches, cough ...), chronic physical issues (asthma, diabetes...), mental health issues (stress, anxiety...) and preventive medicine (vaccine, certificate...). The foregone of primary care during the previous 12 months and the barriers to accessing primary health-care-seeking were also collected.

Results
1179 university students (58.0% of women, age mean 20.4 years) were included. Frequency of health issues in the last 12 months were preventive issues (57.2%), acute physical issues (52.2%), chronic physical issues (16.7%) and psychological issues (18.4%). The foregone of primary care of the university students was reported by 20.5% of university students. The three main barriers reported by these students to accessing primary health-care-seeking behaviour were self-treatment (60.6%), lake of time (64.7%) and financial barriers (25.4%). Logistic regression showed that the foregone of primary care was positively associated with being female students AOR=1.69 CI95% (1.21-2.36), grant holder AOR=1.52 CI95% (1.10-2.02), and living in rented accommodation AOR=1.47 CI95% (1.03-2.02).

Conclusions
Half of university students consult the general practitioner for physical concerns and one fifth for psychological disorders. However with 20% of primary care foregone by university students, the access of primary care in the targeted population could be improved.

Key messages
One fifth of university students foregoes to primary care. Female students, grant holder and living in accommodation are the risk factors of foregone of primary care.
Associated factors to the perception of clinical coordination in the Catalan national health system
Authors: Esteve Matalí L , Vargas I , Sánchez E , Cots F , Plaja P , Avecilla À , Ramon I , Medarde E , Colomés L , Vázquez for GAIA M L 
Published: November 2019

Abstract

Background
Clinical coordination across levels of care is a priority for health systems. The aim is to analyse the factors associated to a high perception of clinical coordination of primary (PC) and secondary care (SC) doctors of the Catalan national health system (NHS).

Methods
Cross-sectional study based on the self-administered online questionnaire COORDENA-CAT. Data collection: October-December 2017. Study population: PC and SC (acute and long term) doctors of the public Catalan NHS that had been working for at least one year in the organization, had direct contact with patients and related with doctors of the other level of care. The participation rate was 20.5%, with a sample of 3308 doctors. Outcome variable: perception of clinical coordination across levels of care. Explanatory variables: socio-demographic, employment characteristics, attitude towards work, type of area (according to type of hospital and managing entity), interactional factors, organizational factors and knowledge of existing coordination mechanisms. Stratification variable: level of care. Descriptive and multivariate analysis by logistic regression.

Results
Only 32.13% of PC doctors and 35.72% of SC doctors found that patient care was coordinated across care levels within their area. In both levels of care, knowing the doctor of the other level; finding that their practice influences the other care level; finding that the organization’s management facilitates coordination; working in an area where the same entity manages SC and majority of PC and to hold joint clinical case conferences are factors positively associated to a high perception of clinical coordination. Besides, there are other positively associated factors exclusive for each level of care.

Conclusions
Several common interactional and organizational factors are positively associated to a high perception of care coordination. Introducing policies to enhance such factors can foster care coordination in the Catalan NHS.

Key messages
This study found out factors associated to clinical coordination across care levels in each level. It helps to develop specific coordination policies by level of care to address those factors.
Healthcare Use in Multimorbidity Patients
Authors: Quinaz Romana G , Kislaya I , Cunha Goncalves S , Salvador M R , Nunes B , Matias Dias C 
Published: November 2019

Abstract

Background
The existence of multiple chronic conditions in the same patient is a public health problem, recognized as relevant to health systems. Individuals with multimorbidity have additional health needs, which in the context of continuous increase of life expectancy, imply a heavy burden to healthcare services.

Methods
We analysed the association between healthcare use (primary care, medical specialist consultations and hospitalizations) and multimorbidity in the Portuguese population aged 25-74 years old, using the Health Examination Survey (n = 4911) data. Logistic regression models adjusted for predisposing (age, education) and enabling (income, region of residence) factors were fitted separately for male and female. Odds ratios and CI95% were estimated.

Results
Prevalence of multimorbidity was 38.3% (95%CI: 35.4%; 41.3%). In males, after adjustment for confounding and when compared to patients without chronic conditions, multimorbidity was associated with greater use of primary care (OR = 3.7; CI95%: 2.3-5.8), medical specialist consultations (OR = 1.9; CI95%: 1.1-3.4) and hospitalizations (OR = 1.8; CI95%: 1.2-2.7). In female, statistically significant association between multimorbidity and healthcare use was observed for primary care (OR = 2.6; CI95%: 1.6-4.3) and medical specialist consultations (OR = 2.8; CI95%: 2.0-3.9), but not for hospitalizations. Both male and female with multimorbidity reported greater use of primary care, compared to individuals with only one chronic condition (OR = 2.4; CI95%: 1.3-4.4 and OR = 1.7; CI95%: 1.1-2.8, respectively).

Conclusions
Our results show a greater healthcare use in patients with multimorbidity, both in primary and hospital care. The availability of scientific evidence regarding the healthcare use, by patients with multimorbidity, may substantiate the discussion about the possible need for the Portuguese health system to adapt to these patients, with changes in policies that will allow better and more efficient treatment.

Key messages
This study may support the discussion about the adaptation of Portuguese health system to patitents with multimorbidity. Further discussion on policy change is needed, targeting an efficient management of these patients.
Does case management provides support for staff facing frequent users of emergency departments?
Authors: von Allmen M , Grazioli V , Kasztura M , Lemoine M , Chastonay O , Hugli O , Daeppen J B , Bodenmann P 
Published: November 2019

Abstract

Background
Frequent users of emergency departments (FUED; 5 ED visits during the preceding 12 months) account for a disproportionate part of ED visits, causing a wide range of work difficulties to ED staff potentially leading to FUED discrimination. Whereas case management (CM) tailored to FUED leads to a reduction in ED visits, CM impact on ED staff has not been explored yet. This study aimed to compare ED staff perceptions of FUED with and without dedicated CM support.

Methods
Participants (N = 253) were ED staff (81 physicians; 172 nurses/assistant nurses) of two Swiss university hospitals, one with CM and one without CM support. Perceptions regarding FUED (i.e., knowledge and awareness of the issue extent; related work difficulties; FUEDs’ legitimate use of ED resources) were measured with a 25-item online survey (4 to 10-level Likert scales). Multivariable regression analyses were conducted to 1) explore the associations between CM implementation and FUED perceptions, and 2) test the moderating effect of profession (physician or nurse/nurse assistant) on these associations. All analyses were adjusted by gender and years of practical experience.

Results
Physicians with CM considered FUED as a less important problem (=.375, R2=.11, p &lt;.05) and rated their knowledge of FUED issue higher (=.245, R2=.077, p &lt;.05) compared to those without CM. In contrast, nurses without CM perceived fewer FUED-related work difficulties (i.e., feeling of failure and helplessness) than nurses with CM. (=-1.01, R2=.06, p &lt;.05) No significant difference was found regarding ED staff’s perceptions of FUEDs’ legitimate use of ED resources and frequentation, nor on nurses’ knowledge of the issue.

Conclusions
These results suggest that CM intervention for FUED is a potential source of support for ED physicians working with FUED. Further qualitative research is needed to explore why nurses without CM support reported feeling less failure and helplessness regarding FUED.

Key messages
By highlighting a different impact of CM on nurses’ perception, this study illustrates where CM intervention might be improved. This study supports CM as a promising intervention for FUED by potentially having a positive impact on ED physicians’ perception besides the one previously proved on FUEDs’ number of visits and QOL.
Waiting times in cardiology and quality of care: analysis of performances in an Italian hospital
Authors: Olivero E , Bert F , Corezzi C , Rossello P , Alaria P , Siliquini R , Scarmozzino A 
Published: November 2019

Abstract

Background
The identification of diseases in an early stage is essential to improve prognosis and survival of patients. Consequently, waiting times for cardiological performances are widely recognized in Europe as evaluation items for healthcare quality. Our study aims to analyse waiting times of the main procedures in the cardiology ward of a huge hospital of Northern Italy and to compare them with the regional benchmark.

Methods
Data of the cardiology ward of “Molinette” hospital (Turin, Italy) about the waiting times for clinical procedures in the period 2016-2017 were collected. In particular, we gathered number of health care services and mean waiting times (MWT) for “Echocardiography” (EC), “First Cardiological Visit” (FCV), “Holter ECG” (HECG), “Percutaneous Transluminal Coronary Angioplasty performed within 2 days for people with myocardial infarction” (PTCA). We compared then our results with the benchmarks identified by the regional law.

Results
In the period considered, in “Molinette” hospital 11,565 ECs were performed, with a MWT of 31 days in 2016 and 16 days in 2017, well below the benchmark (40 days). The total number of FCVs was 5,156 with a MWT of 18 and 13 days in 2016 and 2017 respectively, again under the benchmark (30 days). The HECGs were 3,805, with a MWT of 53 (2016) and 32 (2017) days (benchmark 40 days). PTCAs performed within 2 days (benchmark 85%) were 160 (77.7%) in 2016 and 138 (85.2%) in 2017.

Discussion
In 2017, the waiting times of “Molinette” hospital were inferior to the regional benchmarks, for all the cardiological procedures considered. Shorter MWTs allow a more rapid planning of further diagnostic tests and treatments and, therefore, a consequent better quality of care. It’s important for European hospitals to assess and compare these indicators in order to guarantee a fast and appropriate care to their patients.

Key messages
Waiting times are an indicator of early diagnosis and treatment and are useful to assess the quickness and quality of health care provided in European hospitals. Cardiological procedures in “Molinette” hospital of Turin are provided with waiting times shorter than benchmarks. It would be interesting to compare these results with other big European hospitals.
Mergers of primary care organizations: a systematic review of the literature
Authors: Pascucci D , Sindoni A , De Vito C , Damiani G 
Published: November 2019

Abstract

Background
Mergers as large-scale collaborations in primary care organizations have become a commonplace in developed countries to offer economies of scale and more efficient delivery of care to population. The aim of this systematic review is to summarize the scientific evidence on the relationship between the increase in the size of organizations providing primary care services and their performance.

Methods
The PICO model was adopted and three electronic databases (Medline, Scopus, ISI Web of Knowledge) were searched using appropriate keywords. Screening by title and abstract and data extraction were performed by two independent investigators. Articles, written in English, evaluating the performance after increasing the size of an organization were included. Selected articles were assessed for quality and risk of bias using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Process and outcome quality indicators were used for evaluation.

Results
From a total of 1337, 12 studies met the inclusion criteria and 103 indicators were identified: 59.2% did not show any variation, 33.9% improved significantly after the merger, 6.9% worsened after the merger. In particular, diabetes care did not show any statistically significant variation in 40.0 % of the indicators, while 10.0 % showed an improvement and 10.0% a worsening in clinical outcomes. A significant negative association was found between practice list size and reported non-urgent or urgent doctors’ availability (P &lt; 0.05, both). The process of merging also created perceptions of takeover and had a negative effect on staff.

Conclusions
The effects of mergers are conflicting and there is little evidence that the performance is associated with the size of the structures involved. Assessment on the impact of primary care mergers should to be related to the population needs and the context where these processes are carried out.

Key messages
Merging processes may lead to contrasting results. To assess periodically and systematically the impact of mergers in a continuous quality improvement cycle.
A qualitative study on cancer patientś experiences with financial burden and financial distress
Authors: Schröder S L , Schumann N , Richter M 
Published: November 2019

Abstract

Background
Financial toxicity was hardly examined in the context of public health. It is proven that financial distress following a cancer diagnosis can have an impact on the quality of life and mortality. Additionally, it was found that subjective indicators of financial toxicity have a stronger effect than objective indicators. Nevertheless, less is known about how higher costs can impact on the individual patient’s well-being. The aim of this study was to analyse the major drivers that lead from financial consequences to subjective financial distress in a country with statutory health insurance.

Methods
Qualitative semi-structured interviews were conducted with 39 cancer patients, aged between 40 and 86 years, in Germany. Inductive content analysis of data was performed and the individual patient's pathways are recently compared and contrasted.

Results
Above all, we found that financial distress is not only induced by higher costs and lower available money. Moreover, independently of whether patients experienced any financial decline, they experienced making financial adjustments and feeling financially stressed. The preliminary results show that the patient's ability of good money management and trust in one’s own skills being able to get along with less money might predict psychosocial consequences.

Conclusions
Screening instruments for financial toxicity are important to effectively detect patients whose quality of life might be worsened by their financial situation. It might be that rather financial skills than the amount of costs are important indicators of financial distress.

Key messages
Even cancer patients experiencing almost no financial decline during the period of cancer treatment might experience lower quality of life caused by financial distress. The ability and trust in oneself money management might have the strongest impact on subjective financial stress.
Experience of clinical nursing guidelines development in Kazakhstan
Authors: Umbetzhanova A , Bekbergenova Z h , Koikov V , Baigozhina Z , Zhunussova D , Kabdullina G , Abdrakhmanova A 
Published: November 2019

Abstract

Issue/problem
Since 2019, Kazakhstan has been implementing a project to develop standards for nursing services. The aim of project is support of practical nurses with the latest available evidence via development of clinical nursing guidelines (CPG) as well as standard operational procedures (SOP), sustainable development of this area.

Description of the problem
As part of reforming the system of nursing education in Kazakhstan, applied baccalaureate for nurses was introduced. Shortcomings of current nursing education, the introduction of digitalization and e-health, poor quality of medical services, justified need of standardization. Within the framework of the project, development groups including nurses and medical specialists were organized. The following priority topics were selected: management of diabetes, asthma, CHF, prevention of CVD. Development group uses a guide for adaptation which was prepared by project international partners from Finland. Three trainings were conducted for nursing professionals. These trainings step by step provide comprehensive knowledge on adaptation process. recommendations to local conditions.

Results
The main outcome of the joint work is the training of a nursing research committee, who will be responsible for sustainable development of this direction. The second result is guidelines for nurses, which are very demanded in the field. The third outcome is reflexing and gaining experience in overcoming barriers for further work.

Lessons
Adaptation of CPG is preferred approach for countries with a low level of socio-economic development because of less resource, time consuming. The adaptation process requires work commitment, a sufficient level of English proficiency, respect of authorship, but taking into account local conditions.

Key messages
Adaptation of nursing CPGs is an important part of standardization of medical services in order to improve the quality of medical care. Thorough planning of the process, training of development group will allow overcome barriers to implementation.
The endless story of copayment insurance in Slovenia - is it necessary?
Authors: Albreht T 
Published: November 2019

Abstract

Issue/problem
Slovenia maintains its specific type of voluntary health insurance, which is actually a complementary health insurance (CHI). The main criticism against it was in its regressivity as the premium is flat-rate, equal for all insured.

Description of the problem
The share of CHE in total health expenditure (THE) has been growing until recently and now represents roughly 15% of THE. Even if remains an important source of financing, there are still pressures to abolish it. The present government again set its abolishment as one of the priorities. As much as it is regressive in essence, some of the negative effects of regresivity were offset by the State stepping in by paying the copayments for those citizens who are in need of social cash benefits.

Results
CHI contributed to the stability of the funding of Slovenia’s health care system. The space for the increases has become very limited as it covers up to 90% of the price in the case of many medicines, several dental procedures, rehabilitation and similar services. That means that additional increases with offsets to CHI from the compulsory health insurance are not possible. When the need for these emerges, CHI will not be a solution anymore, which means that an alternative needs to be found. From the several options we explored, the most probable is a gradual increase in the compulsory health insurance contributions.

Conclusions
CHI in Slovenia remains a controversial topic although its criticism has lost edge recently. Partly, this was due to the clear demonstration of its contribution to the stabilisation of the THE in the times of austerity. On the other hand, the mass of money in the compulsory health insurance has increased due to the economic growth and the need to offset costs to CHI was reduced. But, as there is little space left for such actions with the new crisis, a clear scenario on how to address the need for additional funds in the health care system is needed.

Key messages
Complementary health insurance contributed to the stability of health expenditure during crisis. The main alternative to CHI is its full inclusion into the compulsory health insurance.