scholarly journals Barriers to Accessing Health Care for People with Chronic Conditions: A Qualitative Study

2021 ◽  
Author(s):  
Tanja Schwarz ◽  
Andrea E. Schmidt ◽  
Julia Bobek ◽  
Joy Ladurner
Keyword(s):  
Health Services ◽  
Conceptual Framework ◽  
Healthcare System ◽  
Chronic Conditions ◽  
Chronic Back Pain ◽  
Service Providers ◽  
Healthcare Services ◽  
Coordination Of Care ◽  
Health Administration ◽  
Patient Pathways

Abstract Background: There is a growing interest in redesigning healthcare systems to increase access to and coordination across care settings for people with chronic conditions. We aim to promote patient-centredness by gaining a better understanding of the barriers faced by (1) children with chronic bronchial asthma, (2) adults with non-specific chronic back pain, and (3) older people with pre-existing mental illness/es while addressing the problem of fragmentation in Austria’s healthcare system.Methods: Using a qualitative design, we conducted semi-structured interviews face-to-face and by telephone with health service providers, researchers, experts by experience (e.g., patient advocates, family members/carers), and employees in public health administration between July and October 2019. The analysis and interpretation of data were guided by Levesque’s model of access, a conceptual framework used to evaluate access broadly according to five dimensions of accessibility to care: approachability, acceptability, availability and accommodation, affordability, and appropriateness.Results: The findings from the 25 expert interviews were organised within Levesque’s conceptual framework in four dimensions of barriers. They highlight the lack of coordination and defined patient pathways, particularly at the onset of the condition, when seeking a diagnosis, but also later on. Barriers related to issues such as geography (e.g., longer distances and travel times as well as fewer healthcare services in remote rural regions), coordination of care (e.g., structural barriers and inconsistent care pathways), socioeconomic status (e.g., the ability to pay for healthcare services but also basic health literacy), and comorbidity (e.g., consideration of the patients’ state of mental health and holistic therapy approaches).Conclusions: Barriers to healthcare access are of particular concern for patients with chronic conditions, resulting in an urgent need to improve health services according to patients’ specific needs. For health services to be properly accessible, timely and integrated care independent of social and economic resources, continuity of care, and significant improvements in patient-centred communication and coordination of care are paramount. This study has important implications for policy and practice as it highlights provider, expert, and researcher perspectives on access to the healthcare system in Austria and offers a broader look at the changes required by stakeholders in the future.

IOT-Based Smart Healthcare System: A Review on Constituent Technologies

2021 ◽  
pp. 2130008
Author(s):  
Manju Lata Sahu ◽  
Mithilesh Atulkar ◽  
Mitul Kumar Ahirwal
Keyword(s):  
Healthcare System ◽  
Service Providers ◽  
Data Communication ◽  
Healthcare Services ◽  
Vital Role ◽  
Medical Practitioners ◽  
Smart Healthcare ◽  
Rural And Remote Areas ◽  
Medical Infrastructure ◽  
Physiological Sensing

The revolution in the Internet of Things (IoT) is redesigning and reshaping the healthcare system technologically, economically and socially. The emerging and rapidly growing IoT-based Smart Healthcare System (SHCS) is seen as a sustainable solution to reduce the burden on the existing healthcare system due to increasing diseases and limited medical infrastructure. IoT-based SHCS plays a vital role in delivery of healthcare services in rural and remote areas where the essential medical amenities, necessary infrastructures and qualified medical practitioners are not available. Therefore, in this paper, a comprehensive investigation of futuristic IoT-based SHCS and its constituents is presented. This paper provides exhaustive review on different techniques and technologies dealing with smart healthcare framework, physiological sensing, signal processing, data communication, cloud computing and data analytics used in IoT-based SHCS. A comparative analysis of existing literature has been carried out to identify the recent trends and advancements in this very dynamic field of global importance. In addition to this, it highlights different issues and challenges, along with the recommendation for further research in the field. The prime objective of this paper is to deliver the state-of-the-art understanding and update about IoT-based SHCS and its constituents by providing a good source of information to the researchers, service providers, technologists, medical practitioners and the general population.

scholarly journals Do community scorecards improve utilisation of health services in community clinics: experience from a rural area of Bangladesh

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
S. M. A. Hanifi ◽  
Aazia Hossain ◽  
Asiful Haidar Chowdhury ◽  
Shahidul Hoque ◽  
Mohammad Abdus Selim ◽  
...  
Keyword(s):  
Health Services ◽  
Rural Area ◽  
Service Providers ◽  
Healthcare Providers ◽  
Community Support ◽  
Healthcare Services ◽  
Public Health Services ◽  
Community Clinics ◽  
Community Awareness ◽  
The Government

Abstract Background The government of Bangladesh initiated community clinics (CC) to extend the reach of public health services and these facilities were planned to be run through community participation. However, utilisation of CC services is still very low. Evidence indicates community score card is an effective tool to increase utilisation of services from health facility through regular interface meeting between service providers and beneficiary. We investigated whether community scorecards (CSC) improve utilisation of health services provided by CCs in rural area of Bangladesh. Methods This study was conducted from December 2017 to November 2018. Three intervention and three control CCs were selected from Chakaria, a rural sub-district of Bangladesh. CSC was introduced with the Community Groups and Community Support Groups in intervention CCs between January to October 2018. Data were collected through observation of CCs during operational hours, key informant interviews, focus group discussions, and from DHIS2. Utilisation of CC services was compared between intervention and control areas, pre and post CSC intervention. Results Post CSC intervention, community awareness about CC services, utilisation of clinic operational hours, and accountability of healthcare providers have increased in the intervention CCs. Utilisation of primary healthcare services including family planning services, antenatal care, postnatal care and basic health services have significantly improved in intervention CCs. Conclusion CSC is an effective tool to increase the service utilization provided by CCs by ensuring community awareness and participation, and service providers’ accountability. Policy makers and concerned authorities may take necessary steps to integrate community scorecard in the health system by incorporating it in CCs.

scholarly journals Medical and Social Factors Associated with Referral for Elder Abuse Services in a National Healthcare System

2021 ◽  
Author(s):  
Lena K Makaroun ◽  
Carolyn T Thorpe ◽  
Maria K Mor ◽  
Hongwei Zhang ◽  
Elijah Lovelace ◽  
...  
Keyword(s):  
Healthcare System ◽  
Elder Abuse ◽  
Healthcare Services ◽  
Veterans Health ◽  
Health Administration ◽  
Next Of Kin ◽  
Eligibility Criteria ◽  
Logistic Regression Models ◽  
Neighborhood Socioeconomic Status ◽  
Factors Associated

Abstract Background Elder abuse (EA) is common and has devastating health consequences yet is not systematically assessed or documented in most health systems, limiting efforts to target healthcare-based interventions. Our objective was to examine sociodemographic and medical characteristics associated with documented referrals for EA assessment or services in a national US healthcare system. Methods We conducted a national case-control study in US Veterans Health Administration facilities of primary care (PC)-engaged Veterans age ≥60 years who were evaluated by social work (SW) for EA-related concerns between 2010-18. Cases were matched 1:5 to controls with a PC visit within 60 days of the matched case SW encounter. We examined the association of patient sociodemographic and health factors with receipt of EA services in unadjusted and adjusted models. Results Of 5,567,664 Veterans meeting eligibility criteria during the study period, 15,752 (0.3%) received services for EA (cases). Cases were mean age 74, and 54% unmarried. In adjusted logistic regression models (aOR; 95%CI), age ≥85 (3.56 v. age 60-64; 3.24-3.91), female sex (1.96; 1.76-2.21), child as next-of-kin (1.70 v. spouse; 1.57-1.85), lower neighborhood socioeconomic status (1.18 per higher quartile; 1.15-1.21), dementia diagnosis (3.01; 2.77-3.28) and receiving a VA pension (1.34; 1.23-1.46) were associated with receiving EA services. Conclusion In the largest cohort of patients receiving EA-related healthcare services studied to date, this study identified novel factors associated with clinical suspicion of EA that can be used to inform improvements in healthcare-based EA surveillance and detection.

scholarly journals Antecedents and Contextual Factors Affecting Occupational Turnover among Registered Nurses in Public Hospitals in Hong Kong: A Qualitative Descriptive Study

2020 ◽  
Vol 17 (11) ◽  
pp. 3834
Author(s):  
Maria S. Y. Hung ◽  
Stanley K. K. Lam
Keyword(s):  
Hong Kong ◽  
Registered Nurses ◽  
Healthcare System ◽  
Service Providers ◽  
Contextual Factors ◽  
Healthcare Services ◽  
Public Hospitals ◽  
Healthcare Sector ◽  
Snowball Sampling ◽  
Qualitative Descriptive

Global increases in both population size and ageing have led to a drastic expansion in the demand for healthcare services. The shortage of nursing workforce capacity continues, posing immense challenges for the global healthcare system. We aimed to identify the antecedents and contextual factors that contribute to the decisions of occupational turnover from the clinical duties of registered nurses in public hospitals in Hong Kong. A qualitative descriptive design was used in this study. A total of 18 registered nurses who had resigned from public hospitals in Hong Kong and changed their occupations were recruited via convenience and snowball sampling methods. Data were collected through individual, semi-structured, and face-to-face interviews and were analyzed according to the content analysis approach. The antecedents and contextual factors that contributed to the registered nurses’ decisions regarding occupational turnover were identified from the collected data. These factors were classified into three overarching categories: (1) job dissatisfaction due to a tense work environment, (2) low motivation due to limited career opportunities, and (3) inadequate communication due to ineffective leadership. The identification of these antecedents and contextual factors could help healthcare service providers to develop strategies to enhance nurses’ commitment and engagement in their positions and eventually improve their retention. Based on these factors, healthcare sector policy makers could consider incorporating appropriate strategies into healthcare system policy.

Providing Care for Migrants and Refugees

2017 ◽  
Vol 41 (S1) ◽  
pp. S35-S35
Author(s):  
M. Schouler-Ocak
Keyword(s):  
Mental Health ◽  
Healthcare System ◽  
Mental Health Professionals ◽  
Asylum Seekers ◽  
Mental Health Problems ◽  
Service Providers ◽  
Mental Healthcare ◽  
Healthcare Services ◽  
Common Mental Health Problems ◽  
Refugees And Asylum Seekers

With growing globalisation and an increasing number of people on the move across boundaries, it has become vital that service providers, policy makers and mental health professionals are aware of the different needs of the patients they are responsible. One of the most fundamental barriers for migrants, refugees and asylum seekers in accessing health services are inadequate legal entitlement and, mechanisms for ensuring that they are well known and respected in practice. Access to the healthcare system is impeded by language and cultural communication problems. Qualified language and cultural mediators are not widely available, and moreover, are not regularly asked to attend. This can lead to misunderstandings, misdiagnosis and incorrect treatment, with serious consequences for the afflicted. The language barrier represents one of the main barriers to access to the healthcare system for people who do not speak the local language; indeed, language is the main working tool of psychiatry and psychotherapy, without which successful communication is impossible. Additionally, the lack of health literacy among the staff of institutions, which provide care for refugees and asylum seekers means that there is a lack of knowledge about the main symptoms of common mental health problems among these groups. The healthcare services, which are currently available, are not well prepared for these increasing specific groups. In dealing with ethnic minorities, including asylum seekers and refugees, mental healthcare professionals need to be culturally competent.In this talk, main models for providing mental health care for migrants and refugees will be presented and discussed.Disclosure of interestThe author has not supplied his declaration of competing interest.

Patient Autonomy and Social Fairness

2000 ◽  
Vol 9 (3) ◽  
pp. 391-399 ◽  
Author(s):  
JOSHUA COHEN
Keyword(s):  
Quality Of Life ◽  
Conceptual Framework ◽  
Healthcare System ◽  
Patient Autonomy ◽  
Healthcare Services ◽  
Capabilities Approach ◽  
Adequate Level ◽  
Conceptual Clarity

In this paper, an attempt is made to give patient autonomy added conceptual clarity. A concept of patient autonomy grounded in both negative and positive freedoms is defended. Amartya Sen's capabilities approach is used as a conceptual framework in which patient autonomy and fairness are defined compatibly. It is argued that in a socially fair healthcare system, everyone should have at least the degree of patient autonomy that affords access to those healthcare services necessary for survival and a minimally adequate level of quality of life, consistent with each person's naturally endowed health characteristics.

scholarly journals Healthcare inequities and barriers to access for homeless individuals: a qualitative study in Barcelona (Spain)

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Andrés Cernadas ◽  
Ángela Fernández
Keyword(s):  
Qualitative Study ◽  
Health Services ◽  
Healthcare Workers ◽  
Service Providers ◽  
Universal Access ◽  
Healthcare Services ◽  
Medical Professional ◽  
Homeless Population ◽  
Public Health Services ◽  
Structured Interviews

Abstract Background In Spain, homeless individuals have lower perceived quality of health than the rest of the population and their life expectancy is 30 years lower than the national average. While the Spanish health system provides universal access and coverage, homeless individuals do not access or use public care enough to maintain their health. The objective of this study is to determine if homeless individuals can access public health services in conditions of equality with the rest of the population, as established in healthcare legislation, and to better understand the causes of observed inequalities or inequities of access. Methods A detailed qualitative study was carried out in the city of Barcelona (Spain) from October 2019 to February 2020. A total of nine open and in-depth interviews were done with homeless individuals along with seven semi-structured interviews with key informants and two focus groups. One group was composed of eight individuals who were living on the street at the time and the other consisted of eight individuals working in healthcare and social assistance. Results The participants indicated that homeless individuals tend to only access healthcare services when they are seriously ill or have suffered some kind of injury. Once there, they tend to encounter significant barriers that might be 1) administrative; 2) personal, based on belief that that will be poorly attended, discriminated against, or unable to afford treatment; or 3) medical-professional, when health professionals, who understand the lifestyle of this population and their low follow-through with treatments, tend towards minimalist interventions that lack the dedication they would apply to other groups of patients. Conclusions The conclusions derived from this study convey the infrequent use of health services by homeless individuals for reasons attributable to the population itself, to healthcare workers and to the entire healthcare system. Accordingly, to reduce inequities of access to these services, recommendations to healthcare service providers include adapting facilities to provide more adequate care for this population; increasing sensitivity/awareness among healthcare workers; developing in situ care systems in places where the homeless population is most concentrated; and establishing healthcare collaboration agreements with entities that work with this population.

scholarly journals Organizational Culture in Healthcare Services: Characteristics, Advantages and Disadvantages

2019 ◽  
Vol 12 (1) ◽  
pp. 5-12
Author(s):  
Agoritsa Koulouri
Keyword(s):  
Organizational Culture ◽  
Health Services ◽  
Conceptual Framework ◽  
Healthcare Services ◽  
Health Organizations ◽  
Negative Contribution ◽  
Advantages And Disadvantages ◽  
Key Factor ◽  
Internal Integration

Organizational culture - a system of rules, values and behaviors of an organization's – is a key factor of the functionality, performance and quality of the services it provides. Organizational culture is the personality of the organization. It is a structured set of key assumptions that have been invented, discovered or developed by a team of the organization in order to cope with problems of external adaptation or internal integration. Organizational culture creates a sense of identity for every health formation, while it is serving as a reference frame for decisions and actions. The purpose of this review is to present the conceptual framework of organizational culture in the light of its existence in health organizations. Additionally, the development of its special characteristics as well as its positive and/ or negative contribution (advantages and disadvantages) to the way the health services operate are examined. Organizational culture is characterized by difficulty in identifying its components in regards to every environment, it is facing resistance in change and needs time to be implemented.

scholarly journals What do service providers in Southern Ethiopia say about barriers to using youth-friendly sexual and reproductive health services for adolescents?: Qualitative study

2021 ◽  
Author(s):  
Yitagesu Habtu ◽  
Mirgissa Kaba ◽  
Hussen Mekonnen
Keyword(s):  
Reproductive Health ◽  
Health Services ◽  
Healthcare System ◽  
Sexual And Reproductive Health ◽  
Service Providers ◽  
Healthcare Providers ◽  
System Level ◽  
Southern Ethiopia ◽  
Reproductive Health Services ◽  
Youth Friendly

Abstract Background: In Ethiopia, the utilization coverage of adolescent-friendly health services (AFSRHs) ranged only from 9% to 55% and it was the lowest of all Sub-Saharan African countries in 2016. Little is known why adolescents were not accessing the existing services to the side of healthcare providers. Objective: The aim of this study is to explore contextual perceived and actual barriers to accessing AFSRHs by adolescents in Southern Ethiopia.Methods: Phenomenological study design supplemented with observation was used to explore perceived and actual barriers to accessing AFSRHs in 2020. Criterion sampling was used to select study participants. In-depth interviews with healthcare providers and non-specialist sexual and reproductive healthcare providers were conducted. Transcribed interviews and observations were imported to Open Code 4.02 for coding, categorizing, and creating themes. Finally, barriers to accessing existing services were explained using thematic analysis. Results: The study explores contextual barriers to accessing sexual and reproductive health services in five emergent themes. According to providers’ points of view, the barriers include ranging from providers (e.g poor providers’ competency), health facilities (e.g. supply constraints and unsupportive environment), adolescents (e.g perceived lack of information and attitude towards SRHs), community (e.g. lack of parental and social support), and broader health system (e.g. poor implementation and multi-sectorial engagement). Conclusion: As to providers, adolescents face multiple barriers to accessing youth friendly sexual and reproductive health services. Healthcare facilities and all levels of the healthcare system should implement varieties of approaches to increase access to the services for adolescents. Given the lack of progress in utilization of adolescents- youth friendly sexual and reproductive services, the existing strategy should be re-evaluated and new interventions at all levels of the healthcare system are needed. Moreover, implementation research is required at system level factors.

Public Services and Informal Profits: Governing Township Health Centres in a Context of Misfit Regulatory Institutions

2018 ◽  
Vol 237 ◽  
pp. 108-130
Author(s):  
Armin Müller
Keyword(s):  
Healthcare System ◽  
Local Governments ◽  
Capital Investment ◽  
Service Providers ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Care Services ◽  
Curative Care ◽  
Health Centres ◽  
Informal Practices

AbstractChina's healthcare system is governed by institutions that are mutually incompatible. Although healthcare providers are supposed to offer affordable curative care services and engage in public health and administrative work, they receive insufficient financial support from the state and rely on generating informal profits and grey income. The “institutional misfit” between this public welfare mandate and medical service providers’ market orientation is particularly pronounced in the case of township health centres (THCs), a generalist type of healthcare provider with a key role in China's healthcare system. Based on fieldwork in four county-level jurisdictions, this study explores how local governments and THCs interact to cope with institutional misfit. It sheds light on a large variety of informal practices pertaining to human resources, healthcare services, drug procurement, health insurance and capital investment. Local governments deliberately neglect regulatory enforcement and collude with THCs to generate informal profits, behaviour which undermines service quality and increases healthcare costs. The study also shows that while the New Healthcare Reform altered the informal and collusive practices, it has failed to harmonize the underlying institutional misfit. To date, we see only a reconfiguration rather than an abandoning of informal practices resulting from recent healthcare reforms.

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