bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes and conditions for sustaining changes of Participatory Action Research interventions
Authors: Vargas I , Eguiguren P , Mogollón-Pérez A , Samico I , Bertolotto F , López J , Vázquez Navarrete M L 
Published: October 2020

Abstract

Background
Finding new strategies for care integration has become a priority for many health systems in Latin America. Although the implementation of interventions through a participatory action research (PAR) approach is considered effective, its application in health services is scarce.

Aim
to analyse impact of PAR interventions on care coordination, and aspects for sustainability and transferability in public healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay.

Methods
A qualitative, descriptive-interpretative study was conducted in each healthcare network. Focus groups and individual semi-structured interviews were conducted to a criteria sample of Local Steering Committee (29), Platform of professionals (28), professionals (49) y managers (28). A thematic content analysis was conducted, segmented by country and themes. Different interventions were designed and implemented through a PAR process: joint meetings to discuss clinical cases and/or training; shared care guidelines; offline virtual consultations; a (back) referral form; and an induction program.

Results
Informants highlighted that joint meetings based on reflexive methods contributed substantially to improving contextually relevant elements of clinical coordination - communication in patient follow-up, clinical agreement, appropriateness of referrals - and administrative coordination. The meetings, alongside the PAR process, helped to improve interaction between professionals, fostering willingness to collaborate. No significant contributions were identified in the remaining interventions due to the low uptake. A necessary condition for the sustainability and replicability of the interventions was that the PAR process had to be used appropriately in a favorable context.

Conclusions
Evidence is provided on the significant contribution of interventions to improving locally relevant clinical coordination elements and professional interaction when implemented through an adequate PAR process.

Key messages
It contributes to fill the gap regarding the impact of PAR interventions on care coordination. A key aspect for impact and sustainability is an adequate use of PAR approach in a favourable context.
Challenges to effective governance in developing health systems: a qualitative study in Malawi
Authors: Masefield S C , Msosa A , Grugel J 
Published: October 2020

Abstract
Effective governance is vital in maintaining and improving health systems but has received little attention in research, especially in developing countries. All United Nations (UN) members have committed to Universal Health Coverage (UHC) by 2030. Malawi, a member and one of the five poorest countries in the world, is highly dependent on donor contributions. Recent poor governance of government-funded healthcare saw donors withdraw funding, limiting services and resources. The government identifies the need for better oversight to improve health system efficiency and achieve UHC. This study contributes to a better understanding of the relationship between governance and health systems in developing countries moving towards UHC by identifying stakeholder perceptions of the challenges in this area, using Malawi as a case study.
Interviews were conducted with 22 representatives of non-government organisations, civil society groups, local government and government-funded organisations and governance bodies and the transcripts and field notes were analysed using inductive thematic analysis.
Four main issues emerged: accountability; resource management; power dynamics; non-government actors. We conclude that political, structural and financial challenges are seen as barriers to effective health governance at all levels (national, local, service provider). These include little monitoring of health policy implementation, little accountability of the government to the public on health policies and spending decisions, and poor resource management, especially in the drug supply chain. In response to the government's perceived disinterest, non-government initiatives (often supported by donors) advocate for greater governance and monitor the health sector, including progress towards UHC. Poor governance adversely affects health system functioning and may prevent developing countries achieving UHC by 2030.

Key messages
There are political, structural and financial challenges at all levels of the Malawian health system (national, local, service provider) that are perceived as barriers to effective health governance. Poor governance adversely affects health system functioning, limiting the services and resources available, and may prevent the goal of Universal Health Coverage by 2030 in developing countries.
Evaluation of teamwork and its associated factors in the emergency rooms of Sousse - Tunisia
Authors: Lamine H , Tyss M , Tlili M A , Taghouti E , Aouicha W , Zedini C , Ben rejeb M , Chelbi S 
Published: October 2020

Abstract

Background
In recent years, patient safety has become a priority and a major target for improvement especially in the emergency rooms. According to the French National Authority for Health, 1/3 of serious adverse events could be avoided thanks to better coordination and better communication between the teams. Thus, this study aimed to describe the perceptions of healthcare professionals in the emergency rooms of Sousse-Tunisia regarding teamwork, and to determine the factors influencing it.

Methods
It is a descriptive cross-sectional study, conducted between December 2018 and April 2019. It included all the caregivers working in all the emergency rooms of Sousse-Tunisia. The measurement tool used in this study was “Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS)” Teamwork Perception Questionnaire. Data were coded and analyzed by The Statistical Package for Social Sciences (SPSS 20.0).

Results
A total of 110 participants were recruited with a participation rate of 72.36%. Nurses represent more than half of the respondents (56.4%). Average work experience was 7.27 years. The Teamwork overall score was 2.5±0.5. The most developed dimension was leadership (2.7±0.8) and the less developed dimension was communication (2.3±0.7). Women had a significantly higher overall score than men (2.6±0.5, 2.4±0.3, p = 0.017). Results also showed that emergency technicians have significantly higher overall score than doctors and nurses (p = 1 × 10-5). The overall score also varied significantly across the hospitals (p = 0.016).

Conclusions
Our results showed that the level of teamwork still needs to be improved. Furthermore, various factors are associated with teamwork, and that should be taken into consideration to guide the future interventions.

Key messages
There is a direct relationship between the quality of care and the effectiveness of teamwork. It is necessary to focus on the affecting factors of teamwork, in order to prevent adverse events.
Tracking the progress of primary care reforms in Kerala India: Findings from a baseline assessment
Authors: Negi J , Nambiar D 
Published: October 2020

Abstract
The south Indian state of Kerala has a legacy of gains in population health at a low cost. Kerala's recent health reform initiative has emphasized increasing the scope and quality of primary care services. Beginning in 2017, 171 of 848 Primary Health Centres (PHCs) were upgraded to Family Health Centres (FHCs) by increasing staff, training, infrastructure and working hours. In support of this process, we carried out a baseline assessment to assess differences between upgraded FHCs and PHCs
We undertook a cross-sectional study in four districts randomly selected from clusters made using data from the latest National Family Health Survey (2015-16). One FHC and PHC per district were randomly chosen. Monitoring indicators were selected through a modified Delphi process; a structured questionnaire was shared with health staff to report data for the financial year 2018-19.
The eight facilities jointly served a population of 2,79,992 (60% in FHC). The proportion of average monthly outpatients to the population served was 8.3% in FHCs as against 7.9% in PHCs. The patients screened for high blood pressure and blood sugar in FHCs was nearly double that in PHCs. FHCs were better equipped with patient amenities, laboratory and staff. Coverage indicators like full antenatal care, full immunisation were higher than the national average but not appreciably different in PHCs versus FHCs, nor were health outcomes like low birth weight among infants and acute diarrhoeal diseases among under-fives. Findings were presented to the facility, district and state officials and feedback sought.
Primary care reforms in Kerala has improved infrastructure but are still in their early days, reflected in the lack of difference in coverage and outcome indicators. A robust monitoring process benefits from periodic surveys providing valuable insights to the program implementation

Key messages
Health care reforms in resource poor settings need to be monitored rigorously and constructing a base line data is vital in measuring the change. Primary care reforms in Kerala has improved infrastructure but are still in their early days, reflected in the lack of difference in coverage and outcome indicators.
Global Trigger Tool methodology to detect adverse events: pilot study at Academic Hospital of Udine
Authors: Scarpis E , Degan S , De Corti D , Mellace F , Cocconi R , Farneti F 
Published: October 2020

Abstract

Introduction
Identification and measurement of adverse events (AEs) is crucial for patient safety in order to monitor them over time and to implement quality improvement programs, testing if they are effective. Global Trigger Tool (GTT) has been proposed as a low-cost method, being also the most effective to detect AEs. This study aims to describe the number of triggers, the rate and level of AEs identified by GTT and the most frequent type of AE.

Methods
The Italian version of the GTT was used. Ten paper-based clinical records (CRs) randomly selected every 2 weeks were reviewed from January to April 2019 by three independent reviewers (two nurses, one doctor) at the Academic Hospital of Udine. The AEs rates calculated are: AEs per 1,000 patient-days, AEs per 100 admissions, percentage of admissions with an AE. AEs were classified by harm levels according to National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP).

Results
CRs reviewed were 80. Mean age of the patients was 69.3±16.4, women were 37.5%. Mean hospitalisation was 16.8±15.3. Nine were the cases of re-hospitalisation within 30 days (11.3%). The total number of trigger was 156. AEs were 31, with at least one AE on 27.5% of admissions, 38.8 AEs per 100 admissions and 23 AEs per 1,000 patient-days. AEs with harm level E, F and H were respectively 5 (16.1%), 24 (77.4%) and 2 (6.5%). The most frequent type of AE were hospital acquired infections with 15 cases (48.4%).

Conclusions
The most frequent type of AE was the hospital acquired infections. Rates and levels of AEs were higher than other international studies, probably because of the limited number of CRs reviewed.

Key messages
Global Trigger Tool is an effective method to detect adverse patient safety events in order to monitor them over time. The most frequent type of adverse events was the hospital acquired infections.
Gender disparity in the physicians in public sector in Bangladesh: a mixed-method exploratory study
Authors: Tuly I , Bhattacharyya D , Shafique S , Hossain S h , Anwar I 
Published: October 2020

Abstract

Background
Gender equality is needed in health service delivery systems to support universal health coverage (UHC). Women are reluctant to visit male doctors for medical problems. However, number of female doctors is inadequate in many low and middle income countries (LMICs) which is a challenge for establishing gender-sensitive health system. We explored the production and distribution of female physicians in the public sector in Bangladesh to support policy for actions.

Methodology
This is a mixed-method exploratory study using documentary review; Key Informant Interviews and secondary data analysis. Multiple stakeholder consultations and a policy dialogue were organized to validate the study findings.

Results
An increasing trend of female medical students was observed since 2011 in admission. In 2018, out of total 5528 students enrolled, 54% were female whereas 46% were male. However, fewer female doctors were enrolled in the public service compared to their male peers. The male-female ratio was almost 2:1 in the public sector. Out of 471 sub-district health managers, 52 were female; out of 64 district health mangers only one was female; and out of 8 Division Directors only one was female. Female doctors reported to face practical problems in rural settings with regard to housing, safety and security. There is no provision of deploying married couples at the same or nearby health facilities. All these compelled female doctors to quit rural posting or even the government service. Moreover, female physicians prefer certain specialties such as obstetrics and gynaecology, medicine and certain basic subjects which may create more gender imbalance in service delivery system.

Conclusions
In adequate number of female physicians in public sector and their retention in rural areas is a major concern for the health systems in Bangladesh. Policy attention is needed to take necessary steps to make gender-responsive health systems to improve health service to achieve UHC.

Key messages
Poor presence of female physicians in deployed doctors in public sector in Bangladesh creates problems in health service delivery and is becoming a major concern for the health systems in Bangladesh. Policy needs to take remedial measures to make women-friendly working environment in the public sector hospitals in Bangladesh to provide health service delivery for all leaving no one behind.
Assessment of patient safety culture in intensive care units and factors affecting it
Authors: Tlili M A , Aouicha W , Lamine H , Taghouti E , Dhiab M B e n , Mtiraoui A , Thouraya A , Zedini C , Ben Rejeb M , Mallouli M 
Published: October 2020

Abstract

Background
The intensive care units are a high-risk environments for the occurrence of adverse events with serious consequences. The development of patient safety culture is a strategic focus to prevent these adverse events and improve patient safety and healthcare quality. This study aimed to assess patient safety culture in Tunisian intensive care units and to determine its associated factors.

Methods
It is a multicenter, descriptive cross-sectional study, among healthcare professionals of the intensive care units in the Tunisian center. The data collection was spread over a period of 2 months (October-November 2017). The measuring instrument used is the validated French version of the Hospital Survey On Patient Safety Culture questionnaire. Data entry and analysis was carried out by the Statistical Package for Social Sciences (SPSS 20.0) and Epi Info 6.04. Chi-square test was used to explore factors associated with patient safety culture.

Results
A total of 404 professionals participated in the study with a participation rate of 81.94%, spread over 10 hospitals and 18 units. All dimensions were to be improved. The overall perception of safety was 32.35%. The most developed dimension was teamwork within units with a score of 47.87% and the least developed dimension was the non-punitive response to error (18.6%). The patient safety culture was significantly more developed in private hospitals in seven of the 10 dimensions. Participants working in small units had a significantly higher patient safety culture. It has been shown that when workload is reduced the patient safety culture was significantly increased.

Conclusions
This study has shown that the patient safety culture still needs to be improved and allowed a clearer view of the safety aspects requiring special attention. Thus, improving patient safety culture. by implementing the quality management and error reporting systems could contribute to enhance the quality of healthcare provided to patients.

Key messages
The culture of culpability is the main weakness in the study. Encouraging event reporting and learning from errors s should be priorities in hospitals to enhance patient safety and healthcare quality.
Physical multimorbidity, mental health and unplanned admissions from 2008 to 2018 in Abruzzo region
Authors: Cedrone F , Di Giovanni P , D'Addezio M , Di Martino G , Masciarelli M , Meo F , Scampoli P , Staniscia T 
Published: October 2020

Abstract

Background
Multimorbidity is defined as the presence of more than one long-term disorder and it is associated with increased use of health services. Socioeconomic deprivation and mental health conditions may lead to undesirable additional unplanned admission to hospital (urgent or emergency admission). This study examines the association among unplanned admission, multimorbidity, mental health and socioeconomic deprivation for both preventable and not preventable hospitalization.

Methods
We conducted a retrospective analysis of hospital discharge records between 2008 and 2018 in Abruzzo, an Italian region. Multilevel logistic regression models were implemented for both preventable and not preventable unplanned admissions. We set as levels the district of residence and Local Health Authority. As independent variables we used the Italian Deprivation Index of the district of residence to mitigate socioeconomic inequalities, unweighted count of physical health conditions (0, 1, 2, 3, ≥4), the presence of a diagnosis of mental health condition. All the models were also adjusted for age and gender.

Results
We selected 2,017,720 non preventable admissions, 836,808 (41.45%) of which unplanned, and 152,938 preventable admissions, 107,336 (70.18%) of which unplanned. Both unplanned and potentially unplanned admissions were associated with increasing physical multimorbidity (for ≥4 v. 0 condition, OR 4.85; CI95% 4.26-5.53 for unplanned admission and OR 1.42; CI95% 1.11-1.83 for preventable unplanned admission) and with mental health conditions (OR 1.66; CI95% 1.57-1.75 for unplanned admission and OR 1.18; CI95% 1.00-1.38 for preventable unplanned admission).

Conclusions
Co-occurrence of physical multimorbidity and mental health condition was associated either with unplanned admission or unplanned preventable admission. Primary care interventions targeting multimorbidity are necessary to reduce the hospital service burden.

Key messages
Physical multimorbidity substantially affects the use of acute hospital services. Primary care interventions targeting multimorbidity are necessary to reduce the hospital service burden.
Practice of dispensing antimicrobial medicines from community pharmacies
Authors: Amirkhanyan A , Vardanyan L , Sevikyan A , Kazaryan I , Melikyan M 
Published: October 2020

Abstract

Background
Inappropriate use of antimicrobial medicines is one of the main causes of antimicrobial resistance (AMR). The objective of this work was to study the situation on dispensing antimicrobials from pharmacy outlets in Armenia.

Methods
The study was implemented in 30 community pharmacies from different regions of Yerevan. Medicines dispensed to 900 patients/caregivers (30 visitors in each pharmacy outlet) were analyzed. The following indicators were calculated: the percentage of antimicrobials prescribed by physicians, the percentage of visitors, who got antimicrobials without providing a prescription and so on.

Results
Antimicribials (n = 171) consisted 11.3% of all the dispensed medicines (N = 1513). Only 25 (14.6%) antimicrobials were dispensed to visitors who had prescriptions. Only 19 (12.6%) of 151 medicines provided without prescription were OTC-medicines, other 132 (87.4%) were prescription only medicines. According to information received from visitors, 58.5% of all dispensed antimicrobials were selected by physicians, 10.5% of antimicrobials were advised by pharmacists and almost one third was selected by patients, family members, etc. More than 90% of the total number of visitors, whom antimicrobials were dispensed, got them without providing a prescription. 13 patients received 2 and more antimicrobials.

Conclusions
Many prescription only antimicrobials are dispensed from community pharmacies without prescription and some medicines are not prescribed by physicians. That means many antimicrobials are used inappropriately. There is need in strategy that could prevent dispensing antimicrobials without prescription.

Key messages
Dispensing prescription only antimicrobials without prescription can compromise rational use of medicines. Professional knowledge and public awareness about AMR should be improved.
Primary health care and national household random sampling surveys: contributions from Brazil
Authors: Pinto L F , Gonçalves M R , Katz N , Silva R S , Schmitz C A A , Siqueira A C S , Roman R , Molina-Bastos C G , Oliveira M M C , D'Avila O P 
Published: October 2020

Abstract
Primary health care has been considered by the World Health Organization (WHO) as the most efficient way of organizing health systems in order to achieve universal health coverage, preserving its attributes and focusing on people. Several countries in the world have developed instruments to measure access, use of services and lifestyles of their populations. In Europe, European Union members have validated the European Health Interview Survey (EHIS / Eurostat), which is in its third wave of application. Brazil, for over 20 years, has developed, through the Brazilian Institute of Geography and Statistics (IBGE) - the Brazilian Federal Statistics Bureau - in partnership with the Ministry of Health, a national household health survey throughout its territory, the so-called National Health Survey (PNS). PNS-2019 questionnaire innovated by including a module of questions that allows assessing the scores of the attributes proposed by Shi and Starfield in the 2000s. The Primary Care Assessment Tool (PCAT) was included in its brazilian statistically validated version for adult users and applied in more than 100,000 households in all five regions and 27 states in Brazil. Over a six-month period, a sample of approximately 10,000 adults was registered, according to the inclusion criteria of the PCAT considered (being 18 years old or older, having had more than one medical appointment in the last six months, having performed this appointment in a public primary health care facility). We consider it essential to use statistically validated instruments that allow cross-country comparisons and we encourage Governments all over the world to follow Brazilian example in incorporating in their national health surveys a module containing the validated version of the PCAT. This instrument has already been validated and used in the evaluation of primary care in regions of all five continents of the world, demonstrating, therefore, its capacity for cultural adaptation to each reality.

Key messages
PCAT's set of instruments remains current for the evaluation of primary health care services from the users' perspective nationwide. The importance of using National Health Surveys in each country, with random household sampling to assess health systems and conditions.