bluuebunny/crossref_metadata_2025_split huggingface dataset:
How professions make intersectoral governance happen in the context of Denmark
Authors: Burau V , Ledderer L , Kuhlmann E 
Published: October 2020

Abstract

Background
Intersectoral governance is recognised as key to achieving better healthcare, but our understanding of how to make this happen is limited. Earlier studies on individual professionals fail to acknowledge the resources of health professions as collective actors and pay very little attention to professional agency to support intersectoral governance. The aim is to add new knowledge on how professions contribute to intersectoral governance in healthcare.

Methods
The study develops a novel conceptual framework, distinguishing between the what, the how and the why of professional agency. The study is based on a secondary analysis of five qualitative case studies of coordination in Denmark, conducted 2011-8 and with a total of 89 hours observations, 18 focus groups, 36 interviews. The case selection identified studies from different organisational settings. Coordination was the key indicator of intersectoral governance and used for coding and for drawing up a data display for more systematic analysis.

Results
Health professions engage in a wide range of coordination activities; this includes documenting, monitoring, meeting, giving practical support and teaching. Health professions employ diverse mechanisms to adapt coordination activities to local contexts; this is about flexibility and combining mechanisms in a highly tailored way. When they engage in coordination activities, health professions draw on two different rationales: one relates to better healthcare services for patients, the other to professional interests, including work conditions.

Conclusions
Health professions engage in coordination that spans sectors, organisations and/or professional groups; thus professions are key to making intersectoral governance happen.

Key messages
Health professions have many resources highly relevant for coordination. Policy and administrative decision makers need to better support health professions to strengthen intersectoral governance.
Integrated transitional care for older patients discharged from hospital and ED
Authors: Jensen N , Pulkki J , Liljas A E M , Burström B , Andersen I , Schön P , Tynkkynen L-K , Keskimäki I , Jämsen E 
Published: October 2020

Abstract

Background
Care integration through high level care continuation for older patients discharged from the hospital may secure positive health outcomes and reduce subsequent emergency visits. Integrated transitional care is, however, challenged by fragmented care delivery systems. We explored integrated transitional care from the delivery system perspective in three Nordic cities (Copenhagen, Stockholm and Tampere) to compare levels of integration of social and health service delivery systems and care paths for older patients discharged from hospital.

Methods
Information on organizational structure and care integration was obtained from administrative documents, legislation and statistics, webpages of the cities, and empirical studies. Based on the material we outlined the degree of integration at different levels and mapped the possible care paths for older patients discharged from the hospital for each city.

Results
All three cities are characterized by fragmented care systems for older patients based on financially and organizationally independent institutions. Sweden and Denmark, however, have introduced legislation to steer the integration of services between the local and regional level actors. However, older patients still have complex care paths after discharge from hospital care.

Conclusions
The fragmented care systems for older patients consisting of independent institutions across local and regional levels may impede integrated transitional care. Alternative care settings for older people with different needs could be an asset, but they can also form a hurdle for care continuation if the responsibilities and liaison between these sites are not clear.

Key messages
The fragmented organisation of care systems for older patients may impede integrated transitional care. The care facilities for older patients after discharge is targeted to accommodate the complex and varying needs, but pose challenges for continuity of care.
Is the EU ready for a generic set of indicators for health system performance? A qualitative study
Authors: Perić N , Ullmann T , Hofmarcher M M , Or Z , Simon J 
Published: October 2020

Abstract

Background
As part of the EU funded BRIDGE Health project, 23 headline indicators for assessing and comparing the performance of public health systems were proposed. They were shortlisted out of the currently existing and often overlapping pool of over 2000 health system performance assessment (HSPA) indicators. In this qualitative study, we explored their validity and perceived national-level utility for policy making and factors affecting the potential uptake of an indicator hierarchy (headline, operational & explanatory levels) at Member States' and EU levels.

Methods
Semi-structured interviews with a purposive sample of 24 policy makers and senior policy advisors from 15 EU Member States and one candidate country were performed between July and November 2018. All interviews were transcribed and coded using summative and directed content analysis to generate thematic categories in MAXQDA.

Results
Preliminary results suggest that experts positively perceived the overall balance of the shortlist across performance domains reflecting most of the important policy areas. However, some further amendments to the generic set of indicators were recommended to increase their policy relevance and measurement validity while keeping the size manageable. The concept and usage of headline HSPA indicators is mostly viewed as a communication tool whereas more granular information at explanatory levels is perceived to be more appropriate for data driven policymaking and cross-country learning.

Conclusions
Interviews showed a considerable heterogeneity in the feasibility of applying a generic HSPA framework in an EU-wide health strategy as a compass for improvement through comparisons of health systems. Factors such as flexibility in adaptation to the national context, improvement in building knowledge capacity, potential misinterpretation in the 'European Semester' context, as well as lack of appropriately defined benchmarks were recurrent themes in hindering its uptake.

Key messages
Policy makers assess explanatory level indicators to be more actionable than headline level indicators. To facilitate the use of headline indicators at EU-level as a navigation tool for health systems, the list has to be stable to create trends and sufficiently flexible in adapting to new priorities.
Responsibilities for patients? A comparison between US-based VA and the Danish healthcare system
Authors: Jervelund S , Miake-Lye I , Shekelle P , Goldzweig C , Froelich A , Krasnik A 
Published: October 2020

Abstract

Background
The European healthcare systems aim to leave no one behind. Responsibility for the patients may nevertheless be less clearly placed, even in a welfare context such as the Danish healthcare system (DHS). Contrastingly, the Veterans Affairs (VA) in the US is known for their high quality of care and strong care coordination. To understand how responsibility for patients is understood in VA and DHS, we investigated how health providers in the two healthcare systems view their responsibilities to the patients and which tools are used to support responsibility for patients.

Methods
Semi-structured face-to-face interviews with 23 managers and healthcare providers in VA and DHS were conducted in 2013 and 2014. The interviews were of 42-82 minutes of duration and transcribed verbatim. Data were analysed using thematic analysis.

Results
The responsibility for the individual patient was clearly placed on the general practitioner in VA, and VA providers felt responsible for their enrolled patients and not just the patients who seek care. In DHS, the responsibility of the treatment was often divided between several providers and this often created dissonance on who is responsible for the care. VA providers made a systematic and active effort to reach out to the individual patients who do not turn up for an appointment as well as for clinical outliers who had pronounced medical needs. In DHS, the responsibility of seeking and attending healthcare laid upon the individual patient. DHS providers seldom played an active part in contacting no-show patients resulting that vulnerable patients may not get the care they need.

Conclusions
Learning from VA suggests that a clear placement of responsibility will help patients, especially vulnerable patients, to get timely and well-coordinated care. Patient outreach is an important tool to grasp vulnerable patients who are likely to fall between two stools or who need the care the most supporting high quality of care.

Key messages
Clear placement of responsibility for patients will help vulnerable patients to get timely and well-coordinated care. Patient outreach is an important tool to grasp vulnerable patients who are likely to fall between two stools.
Effectiveness of interventions related to continuity of health care in five Latin America countries
Authors: Espinel-Flores V , Vargas I , Samico I , Eguiguren P , Mogollón-Pérez A , López J , Bertolotto F , Vázquez Navarrete M L 
Published: October 2020

Abstract

Background
Evaluation of interventions to improve continuity of care across care levels is scarce in Latin America. The

Aim
to analyse the impact of implemented interventions on the perception of continuity of care of chronic patients in public health care networks of five LA countries (Brazil, Chile, Colombia, Mexico, and Uruguay).

Methods
Quasi-experimental study (controlled before and after design). Comparable networks, one intervention (IN) and one control (CN) were selected in each country. Baseline (2015) and evaluation (2017) surveys were conducted applying CCAENA questionnaire® to a sample of patients with chronic conditions (392/network; 784/country/year). Result variables: information continuity (exchange of clinical information) and clinical management continuity (repetition of exams, accessibility of primary care (PC) and secondary care (SC), perception of agreement between PC and SC doctors and of collaboration between PC and SC doctors. Descriptive analysis were conducted, and chi-square test was calculated to determine significant changes.

Results
An increase in the perception of continuity of information between care levels was observed in the IN of all countries, but Colombia. Clinical management continuity: decrease in the repetition of exams and increase in accessibility of consultation with the specialist in all countries but Mexico. The accessibility of PC doctor decreased in the IN in all countries. No differences in the perception of agreement between PC and SC doctors regarding diagnosis, treatment and recommendations were found. The perception of collaboration between PC and SC doctors increased in the five countries.

Conclusions
Consistent with expected results, the level of perceived information continuity and clinical management continuity increased in the IN, with differences between countries. Further multivariate analyses will be conducted to explore the differences between the IN and CN.

Key messages
Provides a cross-country comparison of the perception of continuity of care in patients with chronic conditions. Contributes to fill the knowledge gap on the effectiveness of participatory interventions improving continuity of care.
Pain assessment of elderly with neurocognitive disorders in long-term care: an occupational lens
Authors: Ruest M , Léonard G , Lagueux E , Boissy P , Milot M H , Bourbonnais A , Guay M 
Published: October 2020

Abstract

Background
Occupational performance of older adults living in long-term care facilities is influenced by environmental possibilities and service provision. Pain among older adults with neurocognitive disorders might be a factor mitigating functional status. However, pain evaluation during daily routine through advanced stages of the disorder is scarce.

Objective
Identify pain-related behaviors of older adults with neurocognitive disorders during their morning routine in long-term care facilities.

Methods
A multiple-case study based on an embedded concurrent mixed methods design (quan-QUAL) was conducted in Quebec (Canada) in three long-term care units. Older adults with a neurocognitive disorder were observed (from 7:00 to 12:00 AM) and evaluated through the accomplishment of their morning routine. Through inter- and intra-case analyses, pain assessment scales (PACSLAC-II, Algoplus and DS-DAT) and morning routine assessment (occupational therapist's observations of the person, occupations and environment, functional autonomy measure, field notes) were integrated in mixed methods matrixes.

Results
Sixteen (n = 16) participants (average age: 76 years old [59, 93]) with various but advanced functional declines and pain symptoms were included. Participants' significant occupations all related to basic activities of daily living. Hygiene care and getting dressed were occupations for which an alteration of occupational performance was identified.

Conclusions
During their morning routine, older adults with a neurocognitive disorder living in long-term care facilities are facing pain symptoms and occupational deprivation, limiting the fulfilment of their needs and their engagement in occupations. Accordingly, older adults' occupations in relation to their environment should also be considered in future studies investigating pain.

Key messages
Occupational performance of older adults with a neurocognitive disorder living in long term care facilities is limited to basic activities of daily living. Assessment of pain of patients with a neurocognitive disorder in long-term care units should include the identification of environmental and occupational factors contributing to this pain.
Ergonomic risk factors and physical fatigue among ambulance workers in Bulgaria
Authors: Samuneva-Zhelyabova M , Lyubomirova K , Kundurjiev T 
Published: October 2020

Abstract

Background
Ambulance workers' job is characterized by extended shifts, inconsistent shift patterns, poor sleep, non-ergonomic work places and work postures, high levels of physical and mental strain. Fatigue in the Emergency Medical Services (EMS) workplace may be related to high patient care loads, demanding work schedules, physical overload and associated stress. The impaired health of those workers can result in pressure on health and insurance systems for treating them as well as bad health care services for emergency patients.

Methods
The study was conducted among 468 workers in emergency healthcare centers in Bulgaria in the period from December 2017 to April 2018. A sociological method was used - a questionniare. The results of the study are presented using descriptive statistics and Chi-square test.

Results
The biggest part of participants complained from ergonomic hazards such as lifting, carrying weights have negative impact on their health: 71.1% of the ambulance drivers, 61.4% of the doctors, 53% of paramedics, followed by nurses with 52.4% and sanitarians with 51.9%. The distribution by positions show that high levels of physical fatigue are among paramedics 59.1%, followed by doctors - 58.3%, nurses 47.6%, medical orderly 33.3% and ambulance drivers 31.9%. The highest levels of the physical fatigue are among respondents at age up to 35 years. Risk reduction measures were developed and distributed among ambulance workers and their employers. Special stress coping strategies were implemented.

Conclusions
Work among ambulance workers is associated with a number of risks as among the main once are ergonomics and related high levels of physical fatigue at the end of the working day.

Key messages
The levels of ergonomic hazards are high among ambulance workers. Ergonomic hazards have negative impact on ambulance workers’ health and the prevalence of musculoskeletal disorders is very high.
Brazilian’s Health Policy and its misalignment with international guidelines for Health Promotion
Authors: Tristão F I , Gomes I M 
Published: October 2020

Abstract
Following the First Health Promotion Conference in Ottawa in 1986, several other global level Conferences were held, and Shanghai was the last City to host the 9th Health Promotion Conference in 2016, where several world leaders assume commitments that meet the common cause of the topic in question, presenting robust outcomes such as the Letters, Declarations and Implementation Guides.
This work aimed to analyze the coherence of the development of the current National Health Plan in Brazil in relation to the central axes of the most recent international documents, referring to the Shanghai Declaration and the Guide for the National Implementation of the Shanghai Declaration.
The results showed that Brazil presents a National Health Plan that definitely does not include the actions proposed in the most recent international documents, such as the Shanghai Conference report and the Guide for National Implementation of the Shanghai Declaration. Paradoxically, Brazil has other institutionally implemented instruments that consider the activities recommended from these international documents in a very satisfactory way. Among these instruments are a specific National Policy on Health Promotion, and several Health Care Programs and Networks aimed at some of the National Policy on Health Promotion strengthening axes, such as the National Tobacco Control Program, the Health at School Program, the Health Gym Program, in addition to other related National Policies, such as the National Policy on Integrative and Complementary Practices and the National Policy on Medicinal Plants and Herbal Medicines.
It is concluded that the National Health Plan is a symbolic instrument that is not in line with international recommendations and, contradictorily, it is also not in line with the own policies and programs that are successfully implemented and developed in national territory.

Key messages
There is a misalignment between the real meaning that a National Health Plan should present and its current content, what leads to an insuficent instrument for enhancing health promotion. While the national health plan is out of alignment with strengthening health promotion, other nationwide specific policies developed reinforce international guidelines.
Development of an instrument measuring Navigation Health Literacy in the Health Literacy Survey 2019
Authors: Griese L , Schaeffer D , Berens E , Nowak P , Pelikan J 
Published: October 2020

Abstract

Background
Complex and intransparent structures are the main reasons why it is difficult for patients to navigate the healthcare system. Thus, patients need specific competencies to deal with health information related to orientation and finding the right pathways through the healthcare system. The aim was therefore to develop an internationally applicable instrument for measuring Navigation Health Literacy (N-HL) within the European Health Literacy Survey 2019 (HLS19).

Methods
Item development was conducted by a working group within the HLS19 consortium. It consisted of a scoping review on definitions, concepts and instruments, development of a definition of N-HL, a concept mapping and first item formation. The items were further developed by an evaluation by 6 experts, 4 focus group discussions, and feedback from members of the HLS19 Consortium. Finally, the feedback was integrated into the instrument and pretested in 33 interviews.

Results
10 publications providing concepts and instruments assessing navigational aspects were identified, but the process of dealing with information was scarcely considered. Therefore, based on the HL definition by Sørensen et al. (2012) N-HL was defined as difficulties in finding, understanding, appraising and applying health information for navigating the healthcare system. In total, 10 tasks at system, organization and interaction level emerged within this definition, on which the final instrument is based. Of 15 initial items, 3 items were assessed as not relevant by experts. The feedback from focus group and HLS19 discussions lead to further revision and addition of items. The final instrument consists of 12 items which proved to be applicable in the pretest.

Conclusions
The instrument can be used to assess N-HL in international population studies and has been used within the HLS19 study to generate internationally comparable data on N-HL for the first time. By that it can form a basis for intervention development and monitoring.

Key messages
An instrument for measuring navigation health literacy (N-HL) is important to assess and monitor difficulties of patients to navigate the healthcare system and to underpin intervention development. The N-HL instrument of HLS19 can be used to assess N-HL in international population studies and provides internationally comparable data.
Point-of-care testing and counseling at community pharmacies
Authors: Sevikyan A , Kazaryan I , Vardanyan L , Amirkhanyan A 
Published: October 2020

Abstract
An increasing number of patients seek advice at community pharmacies in terms of prevention, detection and initial management of certain conditions and diseases. Some countries have introduced pharmacy-based screening programs and counseling. The objective of this work was to analyze the situation on providing screening and counseling at community pharmacies in Armenia.
The staff of randomly selected community pharmacies located in various regions of Armenia was asked to complete pre-tested questionnaire. The data were analysed with SPSS statistical software, version 22.0.
62.9% of 353 responded professionals reported availability of conditions for monitoring blood pressure, 14.4% - for monitoring glucose level, 11.3% - for doing pregnancy test, 9.6% - for testing cholesterol, 2.0% - for monitoring asthma using peak flow meter. 86.7% indicated accessibility of conditions for private discussion with patients. Small number of pharmacy professionals reported that during the last year they were engaged in diabetes management (10.2%) and HIV/AIDS/TB management (7.9%). 7.4% of respondents were involved in family planning activity. 97.5% of pharmacy professionals considers that being active in providing general health information to patients is important and 89.2% reported about being active. The number of professionals who are active in providing general health information to patients is significantly higher among those who attended continuing education courses than among those who did not (p = 0.003).
Only part of community pharmacies is able to provide point-of-care testing. Professionals are rarely involved in disease management. They are active in providing general health information. Continuing education improves situation with engagement of pharmacy professionals in public health activity.

Key messages
There is need to improve the situation with providing point-of-care testing at community pharmacies. Training increases involvement of community pharmacists in public health.