bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perspectives on collaboration in maternity and child health: Patients and caregivers’ views
Authors: Hermans A , Franx A , Van der Kooy J 
Published: October 2024

Abstract

Background
The World Health Organization promotes people-centred organization of maternity care and preventive child healthcare (PCHC). However, globally and in the Netherlands, these services often operate separately, causing care discontinuity. We posit that this disproportionately affects vulnerable patients, hindering tailored-care. Our aim is to explore how collaboration between healthcare providers is perceived by mothers and providers, and understanding challenges and needs for integration.

Methods
We conducted 14 semi-structured interviews with mothers (n = 9) and healthcare providers (midwives, PCHC caregivers, n = 5). Women were categorized as non-vulnerable, potentially vulnerable, or vulnerable based on social situation, enabling comparison of care experiences.

Results
We found that the experienced interprofessional collaboration varied; most non-vulnerable women perceived the interprofessional collaboration as sufficient, whereas women from the potentially vulnerable group were uncertain who to turn to when help was needed. They expressed a need for expectation management to know what to expect from different healthcare providers. Furthermore, they were confused about which healthcare domain (i.e., maternity care or PCHC) ‘was in the lead’ in the postnatal period. Healthcare providers expressed a need for mutual understanding of expertise to foster trust and ease transitions between maternity care and PCHC. Themes emerged: organizational structures, support levels for collaboration, and trust among providers.

Conclusions
Our findings suggest the necessity for governance and shared ownership in healthcare collaboration in the maternity care and PCHC continuum to meet the needs of potentially vulnerable women effectively.

Key messages
• Experienced interprofessional collaboration varies among women based on vulnerability.
• Clear governance and shared ownership are crucial for meeting the needs of potentially vulnerable women in maternity and child health services.
The vital role of stakeholders and National Immunization Technical Advisory Groups (NITAGs)
Authors: Zavadska D , Ozolina K 
Published: October 2024

Abstract
To successfully implement comprehensive, multidisciplinary and interdisciplinary approaches, collaborative, cross-sectoral policy and strategies are essential. This is critical not only for addressing shared challenges but also for developing effective intervention strategies. One of the main hurdles in any collective action initiative is the ability to galvanize diverse stakeholders, each with their unique set of interests and capacity. EUVABECO is dedicated to conducting pilots, and developing implementation plans that are not only effective but also adaptable and sustainable across various healthcare settings in Europe. The healthcare environments across the pilot countries exhibit considerable variability, including differences in epidemiological trends, immunization information systems, vaccine nomenclature, and the dynamics of collaboration with National Immunization Technical Advisory Groups (NITAGs). Throughout implementation, the cooperation between these diverse stakeholders and NITAGs will be crucial, notably to share local vaccination policies for integration into the Clinical Decision Support (CDS) system. EUVABECO’s goal is to craft implementation plans that are flexible enough to be tailored to local needs, ensuring that interventions are both practical and effective in each unique context. This presentation will explore the vital role that stakeholders and NITAGs play in this process, highlighting the importance of their involvement for the success of EUVABECO’s initiatives.
The potential of non-clinical guidance alongside e-mental Health to overcome non adherence
Authors: Van Der Heijde C M , De Bruijn-De Goffau C E , Vonk P 
Published: October 2024

Abstract

Background
Mental health problems account worldwide for over an eighth of the global burden of disease and waiting lists nowadays are commonplace. E-Health has potential to reduce mental illness, whilst waiting for therapy or as a stand alone. A big problem with implementation of E-health in clinical practice is non adherence. Non-clinical guidance could make a difference as compared to the non guidance modus. Our research question is: what factors contribute to the potential of non-clinical guidance in overcoming non adherence for e-mental Health for patients with depressive, anxiety and stress symptoms?

Methods
We did a qualitative study in a Dutch general practice. The treatment consisted of several modules accompanied by non-clinical guidance by a healthcare assistant. Out of 190 invited patients, 31 patients participated. Eight weeks after being invited, 11 semi-structured interviews were conducted until data saturation. Thematic analysis was used with open, axial and selective coding.

Results
Three major themes emerged: 1) The patients were satisfied with the non-clinical guidance in almost all aspects: Negative comments arose from an urge for more contact or tailoring. 2) The form of the guidance (e.g. non-clinical; used interface) was subordinate to the amount and tailoring of it. 3) Adherence could further be improved through a more personal introduction, explaining the benefits of certain exercises and more time management.

Conclusions
The potential of non-clinical guidance in overcoming non adherence for e-mental Health can be improved by further tailoring and increasing the interactivity when needed. Further research is also needed, after the suggested improvements, whether the intervention is effective, compared to a therapist guided and a non guided version. This study needs to be repeated in other clinical settings.

Key messages
• Non-clinical guidance, alongside e-mental health has potential to help with non adherence, thereby decreasing the burden of waiting lists.
• Non-clinical guidance was positively received by patients who received e-mental health, although further tailoring could make online treatment even a larger success.
Referral and disease patterns of patients treated at the Nicosia General Hospital Breast Centre
Authors: Papadopoulos M , Loizidou M , Giannopoulou C , Nikolopoulos G , Yiallourou A 
Published: October 2024

Abstract

Background
Cyprus has one of the lowest mortality rates from breast cancer in Europe. The reasons behind this have not been investigated but it is speculated that the ease of access to Breast Centers in combination with an increased public awareness play a role. The aim of this study was to investigate referral and disease presentation patterns of patients treated at the Nicosia General Hospital (NGH) Breast Centre and define opportunities for effective public health interventions.

Methods
A retrospective study of all patients (585) with in situ or invasive breast cancer treated at the NGH Breast Centre between February 2017 and November 2023 was conducted. Data on referral sources, symptoms, and cancer stage at the time of diagnosis were analyzed using Stata 18.

Results
Most patients were referrals from the national population screening program (42.2%), followed by self-referrals (40.6%), and General Practitioner (GP)/or other specialist referrals (17.2%). Half of the patients (50.3%) were asymptomatic at diagnosis. In addition, 8% of the patients diagnosed with invasive breast cancer were Stage I, 65% Stage II, and 27% Stage III.

Conclusions
Our study provides important insights forming the basis of public health activities for the early detection of breast cancer based on the fact that 20% of newly diagnosed breast cancer cases in Cyprus receive treatment in NGH Breast Center. Although adherence to the national population screening program does not meet desired expectations, a significant proportion of breast cancers were detected via this program highlighting its effectiveness in early detection of asymptomatic cancers. A large proportion of patients were self-referred underlining the high degree of breast cancer awareness in Cyprus but also the media-induced anxiety which leads to early investigations.

Key messages
• Screening program and breast cancer awareness campaigns are effective in detecting breast cancers early.
• These activities should be sustained to further reduce breast cancer mortality rate.
Substitution of care through the eyes of Dutch health insurers: a qualitative study
Authors: Dros J T , Bos I , van Dijk C E , Meijboom B R , Verheij R A 
Published: October 2024

Abstract

Objectives
The objective of health policy measures in the Netherlands is to promote the substitution of care from hospitals to general practitioners (GPs), with reimbursement facilitating this shift. Given that health insurers are tasked with healthcare reimbursement in the Netherlands, understanding their experiences regarding care substitution is crucial.

Methods
First, informal interviews were held with employees from the Dutch Ministry of Health, Welfare and Sports, the National Health Care Institute and the Netherlands Institute of Health Services Research to construct the topic list. Then, we conducted semi-structured interviews with 15 employees from 7 health insurers, including healthcare purchasers, strategists, client relations executives, and business analysts, between February and April 2024. Transcripts were analyzed in MAXQDA by two researchers, after member checking.

Results
Insurers navigating substitution face a complex interplay of competition and collaboration, lacking a comprehensive framework. Long-term agreements with hospitals and GPs are seen as potential solutions, contingent on building trust. Diverse views on insurers’ roles emerge, from passive reimbursement to active infrastructure support. Budgetary constraints vary, with some insurers feeling constrained by national budgets for GPs and hospitals while others perceive more flexibility. Risks equalization and deductibles are identified as hindrances to substitution efforts, necessitating changes in financial incentives.

Conclusions
Overall, addressing these complexities requires aligning incentives and balancing collaboration and competition to optimize resource allocation to effectively meet evolving healthcare needs. A comprehensive framework to balance collaboration and competition might be helpful.

Key messages
• Understanding insurers’ views on care substitution is vital for healthcare policy in the Netherlands.
• A comprehensive framework is needed to balance collaboration and competition, aligning incentives effectively.
The WHO health system performance assessment applied to child healthcare in Luxembourg, 2011-2022
Authors: Ducomble T , Seuring T , Berthet F 
Published: October 2024

Abstract

Background
Health System Performance Assessments (HSPAs) evaluate health systems in terms of their objectives and their overall goals, such as access to quality services and health improvement. Beyond the overall health system assessment, HSPA can evaluate performance in providing care to specific populations. We assessed the response of the Luxembourg health system to children’s particular health needs, by populating the WHO HSPA framework for universal healthcare with child-specific indicators.

Methods
We searched international databases, guidelines, policy documents, and the scientific literature to identify child-specific indicators suitable for assessing the health system objectives as defined by the WHO HSPA framework. To select the most relevant indicators, we conducted expert appraisal regarding feasibility, validity and actionability. Those indicators were calculated based on available national data. To explore inequities within the system, we performed socioeconomic stratifications.

Results
Twenty-nine indicators were used to populate the framework, sourced from social security databases (n = 15), monitoring and surveillance (n = 11), and surveys (n = 2). For effectiveness assessment, we used 11 indicators and found that preventive services performed best for children under two years. Five indicators showed good accessibility to primary and secondary care. Another five indicators assessed safety indicating a recent increase in the relative use of broad-spectrum antimicrobials and an overuse of caesarean sections. Additional disaggregation of three indicators didn’t expose socioeconomic inequities in service delivery. Data gaps exist to assess children’s user-experience and financing of child health services.

Conclusions
The WHO HSPA framework proved valuable for evaluating the Luxembourg health system’s performance for children. We identified good performance in accessibility and effectiveness for young children, alongside data gaps to assess user-experience.

Key messages
• The application of national child-specific indicators to the WHO health system performance assessment, highlighted strengths in accessibility and effectiveness while also pointing to key data gaps.
• We used the WHO health system performance assessment (HSPA) to evaluate the health system for children in Luxembourg. This exercise enhances the development of a tailored national HSPA framework.
The meaning of organizational culture and structure for interprofessional collaboration
Authors: Redzewsky L , Thielhorn U , Wallesch C , Körner M 
Published: October 2024

Abstract

In Germany, early neurological rehabilitation (ENR) acts as a link between acute inpatient care and rehabilitation, aiming to restore patients’ ability to rehabilitate amid their complex clinical conditions. Interprofessional cooperation (IPC) is crucial for harmonized treatment due to patients’ vulnerability. An interprofessional team comprising medical, nursing, and various therapy professionals is essential for this purpose. To explore the meaning of organizational culture and structure to IPC, 15 group discussions in 5 clinics were conducted with n = 76 participants.
1. Weekly team meetings are used to coordinate treatment goals and outcomes, but their implementation varies from clinic to clinic. Two types of meetings were identified: those that focus primarily on billing compliance and others that address patients’ long-term perspectives. However, both require additional social service involvement and are not sufficient to adequately address daily tasks, requiring additional IPC coordination. Some clinics have therefore introduced daily meetings to improve the coordination of IPC tasks. 2. Therapy planning and therapist assignment shape IPC and task fulfillment. Three therapy planning methods were observed: centralized, block-based, and flexible, each with different therapist allocation strategies. Centralized planning with flexible allocation leads to appointment pressure and interprofessional communication challenges. Block therapy reduces therapist turnover and promotes better interprofessional coordination in patient care. Flexible therapy planning is conducted through daily interprofessional meetings with shared task allocation and planning leads to a shared understanding.
Initial analysis underscores the meaning of organizational structure on interprofessional task fulfillment in ENR, emphasizing the importance of enhancing different cooperation formats which can balance stability and flexibility and integrate social services effectively in patientcare.

Key messages
• Morning interprofessional meetings on the ward facilitate flexible responses to daily changes in patients’ health conditions and promote interprofessional collaboration.
• The consideration of occupational group-specific processes in ward organization is a necessary structural prerequisite for successful interprofessional collaboration.
Health care provider payment schemes in Central and Eastern European countries
Authors: Ndayishimiye C , Tambor M , Dubas-Jakóbczyk K 
Published: October 2024

Abstract

Background
Health care provider payment schemes are key elements of the health care system that influence providers behavior, quality of care, and efficient use of resources. In recent decades, Central and Eastern European (CEE) counties have implemented various reforms that have changed payments methods and other elements of the purchasing process. The aim of the study was to provide an overview of the current provider payment schemes within the public health system in selected CEE countries and identify the main directions of their reforming.

Methods
Based on existing literature, a theoretical framework and data collection form were first developed. Next, desk research was conducted to collect data on provider payment methods and other elements of the purchasing process in primary care, outpatient specialized care, hospital care, and long-term care. The collected information was verified and supplemented though consultations with national experts. Nine countries were included: Bulgaria, Croatia, Czechia, Estonia, Latvia, Lithuania, Hungary, Poland, and Romania. The study was conducted in 2023.

Results
Capitation, fee-for-service, and case-based payments are the most commonly used methods in the analyzed countries. The countries are increasingly using blended payment methods. Primary and hospital care have the most diverse payment method mix and have experienced the most substantial changes in their payment schemes since 2010. The most common changes focused on modifying existing methods (detailing payment categories, changing the principles of tariff valuation), and introducing additional methods to pay for specific services or performance (fee-for-service, bonus payments).

Conclusions
CEE countries are following similar directions in reforming provider payment systems, with the goal of strengthening primary health care, shifting emphasis from inpatient to outpatient care and improving cooperation between health care providers.

Key messages
• CEE countries largely use output-based methods to pay for health care services.
• Provider payment systems are becoming more blended as countries look for the most effective payment method mix to meet policy objectives.
Productivity and consultation times in Portuguese primary care: trends and payment model variations
Authors: Madeira F , Pestana J , Perelman J 
Published: October 2024

Abstract

Background
Portugal faces a shortage of primary care workforce resulting in an increase in patients without Family Physician (FP). While expanding the patient list per FP may help, it could also result in excessive workloads, compromising Consultation Times (CT) and quality of care. Furthermore, it is important to study the role of the primary healthcare (PHC) financing model in incentivizing their productivity. This study aims to analyse the productivity and CT in PHC units in Portugal, variation over time, and differences across PHC unit payment models.

Methods
6,563 PHC units with different payment models (salary at UCSP, salary and group pay-for-performance at USF-A, and salary, capitation, and individual pay-for-performance at USF-B) from 2015 to 2022 were analysed, including the annual numbers of medical and nursing consultations and full-time equivalents (FTE) of physicians and nurses. Weekly productivity (WP) was calculated using the consultations per FTE physician and nurse. CT were determined by dividing each FTE’s weekly workload by WP. Multivariate analysis explored differences in CT between PHC units, temporal variations, and the influence of the patient population characteristics.

Results
FTE physicians had a mean WP of 117 consultations (SD 39) lasting 22.4 minutes (SD 7.0). FTE nurses had a mean WP of 56 consultations (SD 18) lasting 41.0 minutes (SD 14.3). Compared to UCSPs, USF-A and USF-B had shorter CT (p &lt; 0.05) by 2.48 to 4.05 minutes for medical consultations and by 5.51 to 8.04 minutes for nursing consultations. CT increased over time, decreased with higher PHC age and favorable socio-demographic context, and increased with higher population density and elderly patients’ proportion (p &lt; 0.05).

Conclusions
USF-B professionals showed higher productivity and shorter CT, suggesting that financial incentives are effective in enhancing productivity but that gains may be obtained with losses in visit duration.

Key messages
• Effective workforce management is crucial given the current primary care professionals shortages.
• Physicians and nurses in PHC units pay-for-performance exhibit higher productivity and shorter consultation time.
Marketing Harm to Children: Children’s exposure to unhealthy commodity marketing using body cameras
Authors: Signal L , Worters T , McKerchar C 
Published: October 2024

Abstract

Background
Sophisticated, persuasive and extensive product marketing is a key driver of unhealthy commodity (UHC) consumption. This study aims to identify the nature and extent of children’s exposure to UHC marketing.

Methods
The study is a secondary analysis of Kids’Cam, a cross-sectional study in which 168 New Zealand 12-year-old children wore body cameras that automatically captured images of their environment every 7 seconds over four days. Images were analysed for exposure to UHC, Healthy and ‘Other’ marketing.

Results
Children were exposed to UHC marketing on average 76.2 times/day, nearly 2.5 times their daily exposure to ‘Healthy’ marketing. Exposure included: unhealthy food marketing (68.4/day), alcohol (5.7/day), gambling (2.1/day) and tobacco marketing (0.1/day). These exposure rates align with the level of statutory regulation each UHC faces in NZ. Food outlets were the most common setting for UHC marketing exposures, while product packaging was the most common medium. Coca-Cola (6.3/day) was the most common UHC exposure, followed by Cadbury, Tip Top, Bluebird and Powerade. Over half of children’s unhealthy food (54.9%) and alcohol (51.9%) marketing exposures were attributed to multinational corporations. In contrast, statutory bodies are responsible for almost all (97.4%) of children’s gambling marketing exposure.

Conclusions
Children currently grow up in an environment in which they are constantly persuaded to consume products that directly harm their health - an environment in which the profits of corporations are favoured over public health. Statutory regulation of UHC marketing is urgently needed to protect children from harm.

Key messages
• Children were exposed to unhealthy commodity marketing on average 76.2 times/day, nearly 2.5 times their daily exposure to ‘healthy’ marketing.
• Statutory regulation of unhealthy commodity marketing is urgently needed to protect children from harm.